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[Imaging of complications of liver transplantation in children]
D Pariente1, E Urvoas, J Y Riou
1Service de Radiopédiatrie, Hôpital Bicêtre, Kremlin Bicêtre.
Insights
Imaging plays a crucial role in diagnosing complications after pediatric liver transplantation (LT). Doppler ultrasonography is key for identifying hepatic artery thrombosis and portal vein thrombosis, guiding timely interventions.
Area of Science:
- Radiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Liver transplantation (LT) in children is complex, with potential vascular and biliary complications.
- Early detection of post-transplant complications is vital for patient outcomes.
Purpose of the Study:
- To review the imaging experience in 286 pediatric liver transplantations.
- To highlight the role of various imaging modalities in diagnosing and managing complications.
Main Methods:
- Retrospective analysis of imaging findings in 286 pediatric liver transplantations.
- Utilized Doppler ultrasonography, computed tomography, angiography, and cholangiography.
Main Results:
- Hepatic artery thrombosis (9%) is the most serious complication, diagnosed by Doppler ultrasonography.
- Portal thrombosis (4.5%) and biliary complications (20%) were also observed.
- Interventional Radiology procedures were essential in managing complications.
Conclusions:
- Doppler ultrasonography is the primary imaging tool for early detection of vascular complications post-LT.
- A structured imaging protocol, including frequent Doppler assessments, is recommended.
- Prompt diagnosis and intervention, often guided by imaging, improve outcomes in pediatric liver transplant recipients.
Abstract:
The authors report their experience of imaging of 286 liver transplantations (LT) in children. Hepatic artery thrombosis is the most serious complication (9%), with a maximum risk during the first two weeks. Its clinical presentation is very variable and its diagnosis is based on Doppler ultrasonography. Emergency surgical disobstruction prevented the development of biliary or ischaemic complications in one half of cases. Portal thrombosis (4.5%) is due, in the majority of cases, to hypoplasia of the recipient's portal vein. Patency of intrahepatic portal branches with inversion of flow can delay the ultrasonographic diagnosis. Biliary complications are frequent (20%) and occur after a very variable interval. Their diagnosis is ultrasonographic, but sometimes delayed compared to the histological signs. Transhepatic cholangiography visualises the lesions and allows external drainage or even percutaneous dilatation. In 1 out of 4 cases, the aetiology was hepatic artery thrombosis. The imaging protocol after LT consists of ultrasonography with daily Doppler (or even twice-daily) in the patient's bed for the first two weeks and then as required. Computed tomography is useful to demonstrate parenchymal ischaemia and intraperitoneal abscess in multi-operated children. Angiography and cholangiography confirm the ultrasonographic signs. Interventional Radiology plays an increasingly important role.