Pediatric liver transplantation. Part I. Standardization of preoperative diagnostic imaging

The preoperative radiologic imaging workups of 44 pediatric liver transplantation patients were reviewed. Biliary atresia (43%) and metabolic disorders (33%) with end-stage liver disease were the leading indications for pediatric liver transplantation at our institution. The radiologic imaging examinations included chest and skeletal radiography, upper gastrointestinal tract series, abdominal ultrasonography (US), computed tomography, angiography, and contrast echocardiography. Abdominal US (performed in 38 of 44 patients) was the pivotal screening imaging examination; it was invaluable in determining the patency and size of the extrahepatic portal vein and inferior vena cava. Angiography is mandatory if this vascular anatomy is not established with certainty on sonograms or if malrotation is seen on the upper gastrointestinal tract series. Congenital malrotation should be differentiated from small bowel malposition caused by portoenterostomy in patients with biliary atresia. Vascular anomalies, especially absent portal vein and/or inferior vena cava, in patients with biliary atresia and polysplenia syndrome may preclude liver transplantation.