Angiographic and interventional radiologic considerations in liver transplantation

Of 46 liver transplantations performed, 15 patients are alive at follow-up intervals from 2 to 50 months. The most common indications for liver transplantation were biliary atresia, cirrhosis, and neoplasia. About 50% of the patients had pre- and/or postoperative angiograms. Additional material was available from pretransplant workups in patients subsequently shown to be unsuitable for transplantation. Of 13 preoperative angiographic studies, portal vein patency was confirmed in two, inferior vena caval (IVC) patency was confirmed in two, and diffuse neoplasm was identified in three. These patients subsequently had transplants. Conditions precluding liver transplantation in six patients were inadequate portal vein size (less than 5 mm) in two, occluded IVC or portal vein in one each, nonvisualized portal vein in one, and neoplasm localized to one lobe in one. Postoperatively 18 vascular studies identified hepatic arterial compromise in nine, postbiopsy arteriovenous fistula in two, and bleeding from a right adrenal artery in one. Postoperative venography showed thrombosis or occlusion of the IVC in five, portal vein thrombosis in one, and splenic vein thrombosis in one. Of the 18 postoperative angiograms, 12 demonstrated findings considered threatening to the transplants' survival. Six of 18 studies demonstrated findings considered compromising to the transplant. Of the nine postoperative cholangiographic studies, six diagnoses were considered threatening to transplant survival: obstruction of the biliary-enteric anastomosis in four, leakage from the biliary-enteric anastomosis in one, and an abscess from biliary leakage in one.