Utility of Dynamic 68Ga-DAZA-PET/CT for Bile Leak Localization After Liver Transplantation: First Clinical Experiences

<b>Background/Objectives</b>: Biliary complications are common after liver transplantation (LT), with bile leaks representing a major cause of morbidity. Conventional imaging modalities such as ultrasound, CT, MRCP, and endoscopic techniques may fail to localize peripheral or complex leaks. This study aimed to evaluate the feasibility of [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT for non-invasive localization of bile leaks after LT. <b>Methods</b>: Five male patients (mean age 53.2 years) with suspected bile leakage and inconclusive prior imaging underwent [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT. The tracer was synthesized under GMP conditions and administered at a mean activity of 204 ± 42 MBq. Dynamic PET/CT imaging was performed for 60 min, and findings were classified according to the Nagano classification. <b>Results</b>: Bile leaks were detected and anatomically localized in all five patients. Sites included the liver resection surface, central bile ducts, bilioenteric anastomosis, and biliary drainage exit. PET/CT findings guided revision surgery in one case and endoscopic treatment in three, while one patient improved without intervention. No adverse effects occurred. <b>Conclusions</b>: [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT is a feasible and safe imaging technique for the anatomical localization of bile leaks following LT. Its antegrade visualization of biliary flow, high spatial and temporal resolution, and lack of contraindications make it a promising complementary modality when conventional imaging is inconclusive or not feasible. Larger studies are warranted to validate its diagnostic value and clinical utility in postoperative and post-traumatic biliary injuries.