Purpose or Case Report: Intestinal failure is a rare but devastating condition in pediatric patients that is often caused by short bowel syndrome (SBS) secondary to necrotizing enterocolitis, volvulus, or intestinal atresia. Patients require the use of total parenteral nutrition (TPN) to survive, which can lead to cholestasis and end stage liver disease (ESLD). Treatment of intestinal failure in pediatric patients who have developed subsequent liver failure from TPN with multivisceral (MVTx) transplantation has progressed dramatically in the past two decades as a result of improvements in immunosuppression, surgical technique, and post-transplant care. The number of transplantations has always been relatively low due to a lack of appropriate donors and the rarity of intestinal failure. However, given the high acuity of patients that do ultimately undergo these procedures, recognition of post-operative complications is critical for graft survival and improved outcomes. This educational exhibit will review the indications and relevant anatomy for these types of transplantations. Magnetic resonance (MR) findings related to post-transplantation complications will be presented with imaging correlates from other modalities (CT, PET/CT, US) as needed.
Methods & Materials: Using a case list from our experience within a tertiary pediatric care and transplantation center in addition to other published sources as needed, we will provide a pictorial review emphasizing the MR appearance of acute and long-term complications of multivisceral transplantation.
Results: Content Organization:
1) Indications for transplantation
2) Descriptions and anatomy of the procedure
3) Complications
- vascular (bleeding, thrombosis)
- leaks (biliary, intestinal)
- infection
- acute and chronic rejection
- malignancy
Conclusions: With continuing improvement in patient and graft survival following recent advances in immunology, surgical technique and post-transplant care, multivisceral transplantation has become an important lifeline for patients who have developed liver and intestinal failure. Magnetic resonance imaging can aid in the identification of vascular, anastomotic, infectious, and immunological complications associated with these complex procedures. The delicate clinical state of these patients necessitates familiarity with the common complications associated with transplantation by pediatric radiologists to ensure the best possible outcome and graft survival for the patient.