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Pediatric Liver Transplantation: A Pictorial Essay of Early and Late Complications¹

¹ From the Department of Radiology, Division of Pediatric Radiology (T.B., M.P., A.A.L., C.P.) and the Department of Pediatric Surgery (M.L.S.), University Hospital La Paz, Paseo de la Castellana 263, 28046 Madrid, Spain. Recipient of a Magna Cum Laude award for an education exhibit at the 2004 RSNA annual meeting. Received April 6, 2005; revision requested June 29 and received August 22; accepted September 6. All authors have no financial relationships to disclose. Address correspondence to C.P. (e-mail: cprieto.hulp{at}salud.madrid.org).

Orthotopic liver transplantation is currently the treatment of choice in patients with end-stage liver disease for which no other therapy is available. In children, segmental liver transplantation with living donor, reduced-size cadaveric, and split cadaveric allografts has become an important therapeutic option. However, the resulting expansion of the donor pool has increased the risk for postoperative vascular and biliary complications, which affect children more frequently than adults. Early recognition of these complications requires radiologic evaluation because their clinical manifestations are frequently nonspecific and vary widely. Doppler ultrasonography (US) plays the leading role in the postoperative evaluation of pediatric patients. Current magnetic resonance (MR) imaging techniques, including MR angiography and MR cholangiography, may provide a wealth of pertinent information and should be used when findings at US are inconclusive. Computed tomography is a valuable complement to US in the evaluation of complications involving the hepatic parenchyma as well as extrahepatic sites and is commonly used to guide percutaneous aspiration and fluid collection drainage. Familiarity with and early recognition of the imaging appearances of the various postoperative complications of pediatric liver transplantation are crucial for graft and patient survival.

© RSNA, 2006

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