Learning objectives
To review surgical techniques of pediatric liver transplant.
To review normal patterns in the postoperative ultrasound.
To show the most common complications of pediatric liver transplant.
To recognize a few pitfalls.
Background
Liver transplant became the last-resort approach for the treatment of appropriately selected patients with end-stage liver disease. In the past few years, there has been a significant advance in survival rates, due to improvements in surgical techniques, organ availability, selection of appropriate living donors, amelioration in pediatric intensive care, and new immunosuppressive regimens.
The number of patients awaiting liver transplantation increased throughout the years, and although it has augmented deceased donations it is still not as abundant as needed. It was one of the reasons...
Findings and procedure details
A. Surgical Techniques
The most common techniques are living donor (segments 2 and 3 and a portion of segment 4) and deceased donor (whole-liver transplant or split organ grafting). In any form of transplant, there are 4 major anastomoses: biliary, portal vein, hepatic vein, and hepatic artery.
[Fig 1][Fig 2]
B. Normal Postoperative Imaging Features
It is mandatory to evaluate liver parenchyma, biliary tree, perihepatic fluid collections, and patency of the intra and extrahepatic vessels.
A slightly heterogeneous pattern of the liver parenchyma at gray-scale...
Conclusion
Radiologists are a part of the multidisciplinary team caring for transplanted children and play a decisive role in postoperative scenarios by assisting and diagnosing possible complications. Ultrasound is a radiation-free, available, and low-cost tool to assist these children. Therefore knowledge of the surgical techniques and the patterns of the normal gray-scale ultrasound and spectral Doppler waveforms is essential. We compiled and illustrated the most common and important complications and a few pitfalls you should know because early identification is decisive for assistance.
Personal information and conflict of interest
D. d. C. Khalil:
Nothing to disclose
L. L. d. Faria:
Nothing to disclose
S. M. S. d. Rocha:
Nothing to disclose
L. Suzuki:
Nothing to disclose
References
Stevens JP, Xiang Y, Leong T, Naik K, Gupta NA. Portal vein complications and outcomes following pediatric liver transplantation: Data from the Society of Pediatric Liver Transplantation. Liver Transpl. 2022 Jul;28(7):1196-1206. doi: 10.1002/lt.26412. Epub 2022 May 9. PMID: 35092344.
Hou Y, Wang X, Yang H, Zhong S. Survival and Complication of Liver Transplantation in Infants: A Systematic Review and Meta-Analysis. Front Pediatr. 2021 Apr 29;9:628771. doi: 10.3389/fped.2021.628771. PMID: 33996682; PMCID: PMC8116516.
Horvat N, Marcelino ASZ, Horvat JV, Yamanari TR, Batista Araújo-Filho JA, Panizza P, Seda-Neto...