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The radiologist's role in managing paediatric liver transplantation: personal experience with 40 patients
P Sacchetto1, A Veltri, V Cena
1Istituto di Radiologia, Università di Torino, Via Genova 3, I-10126 Turin, Italy.
Insights
Radiologists play a key role in managing pediatric liver transplant (OLT) complications. Early ultrasound diagnosis of vascular and biliary issues is crucial for effective treatment and improved patient outcomes.
Area of Science:
- Pediatric Radiology
- Transplant Surgery
- Medical Imaging
Background:
- Orthotopic liver transplantation (OLT) in children presents unique management challenges.
- Post-transplant complications require vigilant monitoring and prompt intervention.
- The radiologist's role in diagnosing and managing these complications is critical.
Purpose of the Study:
- To evaluate the radiologist's contribution to managing pediatric OLT.
- To analyze the diagnostic and interventional radiology experience in post-OLT complications.
- To assess the impact of radiological findings on patient and graft survival.
Main Methods:
- Retrospective review of 44 OLTs in 40 children over 71 months.
- Analysis of radiological examinations, complications, and interventional procedures.
- Categorization of follow-up into hospital stay, early post-discharge, and later periods.
Main Results:
- Ultrasound (US) was the primary imaging modality (92.3%).
- Color-Doppler US detected all vascular complications (22.5% of patients), enabling early treatment.
- US identified biliary complications (27.5% of patients), with 75% successfully managed via interventional radiology.
Conclusions:
- Radiologists are essential for early sonographic diagnosis of pediatric OLT complications.
- Prompt management of vascular complications, often multifocal, improves prognosis.
- Interventional radiology offers safe and effective treatment for biliary complications.
Purpose:
The aim of our study was to evaluate the radiologist's role in managing paediatric orthotopic liver transplantation (OLT) through a retrospective review of our experience in diagnosing and treating post-OLT complications.
Materials And Methods:
Forty children (mean age 4.6 years) underwent 44 OLTs over 71 months. The follow-up period (mean 724 days) was divided into three phases: hospital stay, up to three months after discharge and subsequent period. The number and type of radiological examinations, radiologically detectable complications and interventional procedures were analysed.
Results:
Most examinations were carried out with ultrasound (US) (859/931 of all radiological studies performed during the first two phases, 92.3%). Colour-Doppler US enabled early detection and treatment of all vascular complications (9/40, 22.5% of patients; 13 complications in nine patients, eight arterial and five portal complications; 1.4 for each patient with complications). Computed tomography (CT) or angiography was very rarely employed. US also detected biliary complications (11 patients, 27.5%: three cases of segmental ducts excluded from the anastomosis, four cases of stenosis of the biliodigestive anastomosis, one lithiasis, three stenoses associated with lithiasis), which were successfully managed in 75% of the cases treated with interventional radiology procedures (percutaneous bilioplasty and/or lithotripsy). At the time of writing this paper, the patient survival rate was 100%, and the organ survival rate was 91% (40/44). There were four re-transplantations: three due to hepatic artery thrombosis and one to biliary stenosis with lithiasis.
Conclusions:
The radiologist's role is fundamental for early sonographic diagnosis of post-OLT complications in children. Vascular complications are often associated in a single patient, and early treatment may improve the prognosis. Interventional radiology represents a safe and effective treatment for many biliary complications.
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