To describe imaging protocol and interventional radiology management in patients with suspected complications after liver transplantation (LT) in a high-flow LT centre, >160/year (the first center in Italy in 2018 for LT).

EASL 2018 guidelines confirm LT as a first line treatment in patients with early HCC unsuitable for surgery and life-saving treatment in patients with end-stage liver disease [Fig.1]. Even though patient selection, surgical technique, organ preservation and immunosuppressive agents advancement significantly improved with 5-year graft and patient survival rates of 67% and 74%, respectively, radiologists’ role remains of the utmost importance to early detect and treat transplant complications avoiding graft loss. After discharge, one month after transplant, ultrasound (US) is performed as a first line...

Radiologist should be aware of normal post-LT appearance [Fig.2] and of clinically non-significant abnormal findings such as pleural effusion, mild ascites, small perihepatic fluid collections, subtle perihepatic hematoma and periportal edema [Fig.3]. These findings must be evaluated during follow-up but should not cause concern,as they resolve themselveswithin few weeks. Most frequent complicationsare usuallyclassified in vascular (arterial/venous) and biliary. Hepatic artery (HA) complications include thrombosis, stenosis and pseudoaneurysm. HA trombosis occurs in 8% of transplant, classified in early (within 15 days of LT) and delayed thrombosis....

Radiologists have a pivotal role in the diagnostic and therapeutic management of LT complications, mandatory to avoid any life-threatening risk or retransplantation.

All authorsare affiliated to theUniversity Hospital of Pisa: Francesco Paolo Tarantino is residentof Radiology Piercarlo Rossi is researchcontractor in Vascular Imaging Roberto Cioni is the chairman of the Interventional Radiology Unit Davide Caramella is full professorof Radiology Laura Crocetti is associate professorof Radiology

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