[Complications and liver transplantation: diagnostic strategy].

Liver transplantation is currently the treatment of choice for end-stage liver failure in children and adults. 670 liver transplantations were performed in France in 1990. The 2-year survival rate in adults is 65%. Significant progress in terms of survival has been achieved as a result of improvement of surgical techniques and postoperative surveillance, the development of effective immunosuppressant therapy and a better organization of donor organs. Surgical techniques depend on the recipient and the transplant available. Imaging is useful in pretransplantation assessment, but especially during the immediate and long-term follow-up to assess transplant vitality and to detect any complications, which are of four types: vascular, biliary, or related to rejection or infection. Postoperative surveillance of the transplant must be based on a diagnostic approach conducted according to the following optimal sequence: laboratory parameters, histological examination and imaging, performed systematically from the 1st day onwards, including examination of the hepatic parenchyma, bile ducts, hepatic vessels and search for effusions and collections. The role of imaging in the context of rejection is not so much to visualize of rejection, as to eliminate a vascular, biliary or even infectious cause for the altered laboratory parameters. In the context of surgical vascular, biliary, infectious or complex complications, the examination sequence always includes clinical and laboratory findings, histology, angiography in the context of vascular complications and CT scan to assess the vitality of the hepatic parenchyma and to identify any intrahepatic or perihepatic collections. Interventional radiology plays an important role in the treatment of these vascular, biliary and infectious complications and should be considered prior to any surgical revision.