The radiologist’s role in managing paediatric liver transplantation: personal experience with 40 patients
2007
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
retransplantations: 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.
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