Purpose or Case Report: Liver transplantation is a potentially life-saving procedure for children with liver failure. Pediatric liver transplant recipients are at greater risk for complications such as vascular thrombosis than adults. In addition, children more commonly receive reduced size grafts, which alter the normal liver anatomy. While the postoperative assessment of pediatric liver transplants with sonography has been well studied, less exists in the radiology literature regarding intraoperative Doppler sonography of the graft prior to abdominal closure. We illustrate the intra- and post-operative ultrasound findings in pediatric liver transplants, with an emphasis on normal features, common pitfalls, and frequently encountered vascular complications.
Methods & Materials: After obtaining approval from our institution's review board we reviewed the intra- and post-operative Doppler sonogram examinations and operative notes from 203 pediatric patients that underwent liver transplantation between October 2006 and October 2016. Correlation was made between intra-operative Doppler exams, surgical findings, and post-operative Doppler exams.
Results: We illustrate our institution's intra-operative Doppler imaging technique, normal exam findings, common imaging pitfalls, and vascular complications.
Conclusions: We present a pictorial review of intra-operative Doppler sonography of pediatric liver transplants as a useful tool in the assessment of the liver transplant prior to abdominal closure. The viewer's understanding of intra-operative ultrasound is further facilitated by correlation with surgical notes and post-operative imaging. At the end of the exhibit, the reviewer will be familiar with the imaging appearance of normal anatomy, common pitfalls, and a range of potential intraoperative complications.