Endovascular treatment of vascular complications following liver transplantation: A retrospective single-center study

Vascular complications after liver transplantation (LT) are associated with graft loss, while selected patients treated showed promising results. This study assessed early and late endovascular interventions and their biochemical impact on liver enzymes post-LT. This single-center, retrospective study (July 2014–December 2024) included 51 of 484 LT-recipients who underwent endovascular procedures early (≤30 days) or late (>30 days), categorized as arterial or venous. Fisher's exact test compared early and late complications. Biochemical changes in liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are reported as median (interquartile range) and analyzed using Wilcoxon signed-rank test. Group comparisons between hepatocellular carcinoma (HCC) and non-HCC recipients were performed using Fisher's exact and Mann–Whitney U tests. A multivariable logistic regression model evaluated predictors of re-LT, including age, sex, body-mass index, HCC etiology, and hepatic artery reconstruction type. Technical success was 99 %, with no major intervention-related complications. Sixteen patients (31 %) required re-LT, one (2 %) re-re-LT. Arterial complications (83 %) occurred predominantly early (p = 0.004), whereas venous complications were more frequent late (p = 0.005). HCC recipients developed complications significantly later than non-HCC recipients (p < 0.001). Arterial interventions showed significant biochemical improvement post-intervention (AST 61 (33–130) U/l vs. 160 (35–654) U/l; p = 0.005; ALT 50 (34–214) vs. 149 (39–446) U/l; p = 0.002). Multivariable analysis identified no independent predictors of re-LT. Endovascular management represents a safe approach for post-transplant complications. Arterial complications occurred early and late, venous complications predominantly late, while arterial interventions were associated with biochemical improvement in liver function tests.