The radiologist's role in managing paediatric liver transplantation: personal experience with 40 patients

The radiologist's role in managing paediatric liver transplantation: personal experience with 40 patients

The aim of our study was to evaluate the radiologist's role in managing paediatric orthotopic liver transplantation (OLT) through a retrospective review of our experience in diagnosing and treating post-OLT complications. Forty children (mean age 4.6 years) underwent 44 OLTs over 71 months. The...

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Bibliographic Details
Published in:Radiologia medica Vol. 112; no. 3; pp. 456 - 471
Main Authors: Sacchetto, P, Veltri, A, Cena, V, Gisolo, F, Gennari, F, Salizzoni, M, Righi, D, Gandini, G
Format: Journal Article
Language:English
Published: Italy 01-04-2007
Subjects:
Adolescent
Age Factors
Angiography
Child
Child, Preschool
Female
Follow-Up Studies
Graft Survival
Humans
Infant
Liver Transplantation - adverse effects
Liver Transplantation - diagnostic imaging
Liver Transplantation - mortality
Male
Postoperative Complications - diagnostic imaging
Postoperative Complications - therapy
Reoperation
Retrospective Studies
Survival Analysis
Time Factors
Tomography, X-Ray Computed
Ultrasonography, Doppler
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Summary:The aim of our study was to evaluate the radiologist's role in managing paediatric orthotopic liver transplantation (OLT) through a retrospective review of our experience in diagnosing and treating post-OLT complications. Forty children (mean age 4.6 years) underwent 44 OLTs over 71 months. The follow-up period (mean 724 days) was divided into three phases: hospital stay, up to three months after discharge and subsequent period. The number and type of radiological examinations, radiologically detectable complications and interventional procedures were analysed. Most examinations were carried out with ultrasound (US) (859/931 of all radiological studies performed during the first two phases, 92.3%). Colour-Doppler US enabled early detection and treatment of all vascular complications (9/40, 22.5% of patients; 13 complications in nine patients, eight arterial and five portal complications; 1.4 for each patient with complications). Computed tomography (CT) or angiography was very rarely employed. US also detected biliary complications (11 patients, 27.5%: three cases of segmental ducts excluded from the anastomosis, four cases of stenosis of the biliodigestive anastomosis, one lithiasis, three stenoses associated with lithiasis), which were successfully managed in 75% of the cases treated with interventional radiology procedures (percutaneous bilioplasty and/or lithotripsy). At the time of writing this paper, the patient survival rate was 100%, and the organ survival rate was 91% (40/44). There were four re-transplantations: three due to hepatic artery thrombosis and one to biliary stenosis with lithiasis. The radiologist's role is fundamental for early sonographic diagnosis of post-OLT complications in children. Vascular complications are often associated in a single patient, and early treatment may improve the prognosis. Interventional radiology represents a safe and effective treatment for many biliary complications.
ISSN:0033-8362
1826-6983
DOI:10.1007/s11547-007-0128-6