E1829. Complications of Pediatric Liver Transplants: the Role of the Pediatric Radiologist and Pediatric Interventional Radiologist
  1. Sreeja Sanampudi; UT Southwestern Medical Center
  2. Kristen Crumley; UT Southwestern Medical Center
  3. Elliot Rinzler; UT Southwestern Medical Center
  4. Gary Schooler; UT Southwestern Medical Center
  5. Elizabeth Lagomarsino; UT Southwestern Medical Center
  6. Cory Pfeifer; UT Southwestern Medical Center
Liver transplants in children may offer challenges in evaluation. The reasons for transplant differ from adult patients, and the radiation sensitivity of the pediatric population may confer greater reliance on ultrasound. This image-rich educational exhibit describes the pediatric radiologist's approach to evaluating the transplanted liver while describing the pediatric interventionalist's role in treating complications related to hepatic transplant.

Educational Goals / Teaching Points
Imaging is used to highlight reasons for hepatic transplant common in the pediatric population. Surgical techniques for pediatric liver transplant are described. Using a multimodality approach, complications of liver transplant are depicted. Interventional radiology techniques utilized in the treatment of transplant-related complications are outlined.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Common reasons for pediatric hepatic transplant include an array of congenital and acquired diseases, such as biliary atresia and hepatoblastoma. Several post-operative complications can be encountered, including many that are vascular in origin. Stenosis or thrombosis of the celiac or hepatic artery may occur. Arterial resistance indices may be elevated immediately after transplant, but an early post-transplant resistive index less than 0.6 can be an indicator of hepatic artery vasculopathy. Hepatic artery thrombosis can be treated via catheter-directed thrombolysis. The portal vein may exhibit similar narrowing following transplant, and biliary strictures may also manifest. These stenoses can be treated via the deployment of a balloon once access is established and confirmed. These pathologies and their treatments are depicted using multiple imaging modalities. Cholangiography is useful in confirming establishment of biliary patency and appropriate biliary transit. Biliary leaks and abscesses may also require treatment via pediatric interventional radiology techniques. In rejection, the hepatic echotexture becomes more heterogeneous without corroborating Doppler evaluation to suggest ischemia.

Pediatric liver transplant evaluation requires a multi-modality skillset. As children's hospitals continue to develop independent pediatric interventional radiology services, the need to understand hepatic transplant-related complications has become more prescient. Pediatric radiologists and children's hospital sonographers must likewise be able to recognize radiographic features of this pathology.