Life-Saving Precision: Image-Guided Interventions Transforming Outcomes in Living-Donor Liver Transplant Complications

Living-donor liver transplantation (LDLT) is a preferred treatment modality for patients with end-stage liver disease. However, the incidence of postoperative complications, particularly involving the biliary and vascular systems, remains significant. These complications often necessitate urgent interventional management to prevent graft loss. Although surgical revision is an option, it carries increased morbidity and mortality risks. This case series explores the utility of minimally invasive, image-guided techniques for managing complex post-LDLT complications. We present four cases involving distinct image-guided interventions, including percutaneous transhepatic biliary drainage (PTBD) with balloon cholangioplasty for biliary strictures, hepatic venoplasty with intravascular stenting for hepatic venous outflow tract obstruction, and transjugular intrahepatic portosystemic shunt (TIPS) placement for refractory ascites secondary to portal hypertension. Procedural techniques, immediate outcomes, and follow-up results were assessed. All interventions were technically successful, with immediate clinical and biochemical improvement observed in each patient. Follow-up imaging confirmed patency and resolution of the vascular or biliary complications. This series underscores the efficacy of image-guided interventions as a safer alternative to surgical re-exploration in complex post-transplant cases. Image-guided interventions, including PTBD, venoplasty, and TIPS, offer robust management solutions for biliary and vascular complications in LDLT recipients, highlighting the role of interventional radiology in post-transplant care.