Semin intervent Radiol 2004; 21(4): 321-333
DOI: 10.1055/s-2004-861566
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Interventional Radiology in the Treatment of the Complications of Organ Transplant in the Pediatric Population-Part 2: The Liver

Alexander J. Towbin1 , Richard B. Towbin
  • 1Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Further Information

Publication History

Publication Date:
07 January 2005 (online)

ABSTRACT

Organ transplantation continues to grow in demand in the pediatric population. The liver is the second most common organ that is transplanted in the pediatric population, but it results in the greatest number of interventional procedures. Transplant continues to be the preferred treatment for end-stage liver failure in children and has been shown to prolong life. There are several significant differences in liver transplantation between adults and children. They include different indications and diseases leading to transplant, the smaller body size of children, and differences in the surgical techniques used to implant the liver. These differences have led to a set of complications that is unique to or is more frequently seen in the transplanted child. The complications require interventional solutions tailored to the special needs of children. This paper will examine the complications that are encountered and the technical challenges that the interventionalist must address to successfully treat this subgroup of children. The purpose of this paper is to present the techniques and “pearls” that we have found to be helpful in treating this group of patients that in many ways is the most challenging in all of pediatric intervention.

REFERENCES

  • 1 Current data based on statistics from www.optn.org. Accessed February 21 2004
  • 2 Bergey E A, Sane S S, Kaye R D et al.. Pediatric transvenous liver biopsy.  J Vasc Interv Radiol. 1998;  9 829-832
  • 3 Hanafee W, Weiner M. Transjugular percutaneous cholangiography.  Radiology. 1967;  88 35-39
  • 4 Lebrec D, Goldfarb G, Degott C et al.. Transvenous liver biopsy: an experience based on 1000 hepatic tissue samplings with this procedure.  Gastroenterology. 1982;  83 338-340
  • 5 Colapinto R F. Transjugular biopsy of the liver.  Clin Gastroenterol. 1985;  14 451-467
  • 6 Gamble P, Colapinto R F, Stronell R D et al.. Transjugular liver biopsy: a review of 461 biopsies.  Radiology. 1985;  157 589-593
  • 7 Bull H J, Gilmore I T, Bradley R D et al.. Experience with transjugular liver biopsy.  Gut. 1983;  24 1057-1060
  • 8 Furuya K N, Burrows P E, Phillips M J, Roberts E A. Transjugular liver biopsy in children.  Hepatology. 1992;  15 1036-1042
  • 9 Johnston T D, Gates R, Reddy K S et al.. Nonoperative management of bile leaks following liver transplantation.  Clin Transplant. 2000;  14 365-369
  • 10 Egawa H, Uemoto S, Inomata Y et al.. Biliary complications in pediatric living related transplantation.  Surgery. 1998;  124 901-910
  • 11 Lorenz J M, Funaki B, Leef J A et al.. Percutaneous transhepatic cholangiography and biliary drainage in pediatric liver transplant patients.  AJR Am J Roentgenol. 2001;  176 761-765
  • 12 Esquivel C O, Koneru B, Karrer F et al.. Liver transplantation before 1 year of age.  J Pediatr. 1987;  110 545-548
  • 13 Heffron T G, Pillen T, Welch D et al.. Biliary complications after pediatric liver transplantation revisited.  Transplant Proc. 2003;  35 1461-1462
  • 14 Burkhardt H, Muller W. Versuche uber die Punktion der Gallenblase und ihre rontgendarstellung.  Deutsch Chirug. 1921;  161 168
  • 15 Okuda K, Tanikawa K, Emura T et al.. Nonsurgical, percutaneous transhepatic cholangiography-diagnostic significance in medical problems of the liver.  Dig Dis. 1974;  19 21-36
  • 16 Harbin W P, Mueller P R, Ferrucci Jr J T. Transhepatic cholangiography: complications and use patterns of the fine-needle technique: a multi-institutional survey.  Radiology. 1980;  135 15-22
  • 17 Andrews R C, Hawkins I F. The Hawkins needle-guide system for percutaneous catheterization: 1. Instrumentation and procedure.  AJR Am J Roentgenol. 1984;  142 1191-1195
  • 18 Burhenne H J. Dilatation of biliary tract strictures: a new roentgenologic technique.  Radiol Clin (Basel). 1975;  44 153-159
  • 19 Williams Jr H J, Bender C E, May G R. Benign postoperative biliary strictures: dilation with fluoroscopic guidance.  Radiology. 1987;  163 629-634
  • 20 Garcia-Gallont R, Bar-Nathan N, Shaharabani E et al.. Hepatic artery thrombosis in pediatric liver transplantation: graft salvage after thrombectomy.  Pediatr Transplant. 1999;  3 74-78
  • 21 Blumhardt G, Ringe B, Lauchart W et al.. Vascular problems in liver transplantation.  Transplant Proc. 1987;  19 2412
  • 22 Langnas A N, Marujo W, Stratta R J et al.. Vascular complications after orthotopic liver transplantation.  Am J Surg. 1991;  161 76-82
  • 23 Marujo W C, Langnas A N, Wood R P et al.. Vascular complications following orthotopic liver transplantation: outcome and the role of urgent revascularization.  Transplant Proc. 1991;  23 1484-1486
  • 24 Wozney P, Zajko A B, Bron K M et al.. Vascular complications after liver transplantation: a 5-year experience.  AJR Am J Roentgenol. 1986;  147 657-663
  • 25 White R M, Zajko A B, Demetris A J et al.. Liver transplant rejection: angiographic findings in 35 patients.  AJR Am J Roentgenol. 1987;  148 1095-1098
  • 26 Cardella J F, Amplatz K. Postoperative angiographic and interventional radiologic evaluation of liver recipients.  Radiol Clin North Am. 1987;  25 309-321
  • 27 Hasegawa T, Sasaki T, Kimura T et al.. Successful percutaneous transluminal angioplasty for hepatic artery stenosis in an infant undergoing living-related liver transplantation.  Pediatr Transplant. 2002;  6 244-248
  • 28 Orons P D, Zajko A B, Bron K M et al.. Hepatic artery angioplasty after liver transplantation: experience in 21 allografts.  J Vasc Interv Radiol. 1995;  6 523-529
  • 29 Ko G, Sung K, Yoon H et al.. Endovascular treatment of hepatic venous outflow obstruction after living-donor liver transplantation.  J Vasc Interv Radiol. 2002;  13 591-599
  • 30 Freedman A M, Sanyal A J, Tisnado J et al.. Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review.  Radiographics. 1993;  13 1185-1210
  • 31 Zakim D, Boyer TD Hepatology: A Textbook of Liver Disease. Philadelphia; Saunders 1990
  • 32 Heyman M B, LaBerge J M. Role of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension in pediatric patients.  J Pediatr Gastroenterol Nutr. 1999;  29 240-249
  • 33 Rollins N K, Sheffield E G, Andrews W S. Portal vein stenosis complicating liver transplant in children: percutaneous transhepatic angioplasty.  Radiology. 1992;  182 731-734
  • 34 Funaki B, Rosenblum J D, Leef J A et al.. Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty.  AJR Am J Roentgenol. 1995;  165 161-165
  • 35 Buell J F, Funaki B, Cronin D C et al.. Long-term venous complications after full-size and segmental pediatric liver transplantation.  Ann Surg. 2002;  236 658-666
  • 36 Cherukuri R, Haskal Z J, Naji A, Shaked A. Percutaneous thrombolysis and stent placement for the treatment of portal vein thrombosis after liver transplantation: long term follow-up.  Transplantation. 1998;  65 1124-1126
  • 37 Funaki B, Rosenblum J D, Leef J A et al.. Angioplasty treatment of portal vein stenosis in children with segmental liver transplants: mid-term results.  AJR Am J Roentgenol. 1997;  169 551-554
  • 38 Funaki B, Rosenblum J D, Leef J A et al.. Percutaneous treatment of portal vein stenosis in children and adolescents with segmental hepatic transplants: long-term results.  Radiology. 2000;  215 147-151

Alexander J TowbinM.D. 

University of Pittsburgh Medical Center, Department of Radiology

200 Lothrop Street

Pittsburgh, PA 15213