1) Review the indications for multivisceral transplantation (MVTx) in pediatric patients. 2) Understand the surgical anatomy following transplantation. 3) Review the complications that can arise after MVTx as seen on magnetic resonance (MR) with advanced imaging correlates as needed.

Intestinal failure is a rare but devastating condition in pediatric patients that is often caused by short bowel syndrome (SBS) secondary to necrotizing enterocolitis, volvulus, atresia, or other etiology. With recent advances in intestinal rehabilitation (IR) related to dietary and surgical lengthening innovations, the need for transplantation has decreased. Nevertheless, some patients who develop cholestasis and end stage liver disease (ESLD) from parenternal nutrition (PN) will require transplantation. Even as intestinal rehabilitation methods have improved and reduced the need for transplants, multivisceral (MVTx) transplantation has...

Indications for Bowel Transplantation(Fig. 2, Fig. 3) 1) Intestinal failure due to short bowel syndrome (SBS) complicated by loss of vascular access or catheter sepsis - SBS causes: Gastroschisis, necrotizing enterocolitis (NEC), volvulus, intestinal atresia 2) Total parenteral nutrition (TPN) induced end stage liver disease (ESLD) 3) Locally invasive malignancies such as desmoid tumors within the abdomen 4) Premalignant conditions (e.g., Gardner syndrome) Anatomy: Multivisceral Transplant (Fig. 4) MVTx is an effective way to treat children with SBS and irreversible liver failure from long-standing TPN....

As one of the final options should intestinal rehabilitation fail or prove inadequate, MVTx remains an important lifeline for patients who have developed liver and intestinal failure. MR imaging can aid in the identification of infectious, immunological, vascular, anastomotic, and motility-related complications associated with these complex procedures without the use of radiation. The delicate clinical state of these patients necessitates familiarity with the complications associated with transplantation by pediatric radiologists to ensure graft survival and the best possible outcome for the patient.

Jerry T. Loo, MD Assistant Clinical Professor of Radiology David Geffen School of Medicine University of California, Los Angeles (UCLA) Mailing Address: 757 Westwood Blvd, Suite 1621 Los Angeles, CA 90095 Email: jtloo at mednet dot ucla dot edu J. Loo; Los Angeles/US - nothing to disclose T. Hall; Los Angeles/US - nothing to disclose S. Ghahremani; Los Angeles/US - nothing to disclose P. Iskander; Los Angeles/US - nothing to disclose J. Chen; Los Angeles/US - nothing to disclose

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