Kumar Tushar,  Noda Sakura,  Kim Helen Hr

Final Pr. ID: Poster #: EDU-048

Pediatric liver transplantation has evolved into a life-saving procedure since the first successful transplant, for biliary atresia, in 1967. In the United States, biliary atresia remains the leading indication, accounting for nearly half of all pediatric liver transplants, with most recipients aged five years or younger. Advances in surgical techniques, particularly the development of split-liver and living-donor transplantation, have significantly improved graft availability and patient survival, achieving one-year survival rates as high as 94%. Despite these advances, post-transplant complications remain common and are broadly categorized as vascular, biliary, infectious, and parenchymal or neoplastic. Vascular complications pose the greatest threat to graft viability. Early postoperative imaging surveillance with grayscale and Doppler ultrasound is vital for timely detection. Normal early postoperative findings include mild perihepatic fluid, subtle vascular narrowing, and heterogeneous parenchymal echotexture. Typical Doppler characteristics include brisk systolic upstroke with continuous diastolic flow in the hepatic artery, monophasic flow in portal vein, and multiphasic or dampened venous waveforms. Hepatic artery thrombosis is the most critical vascular complication, often manifested as tardus-parvus arterial waveforms, and can lead to graft ischemia or failure. Hepatic artery stenosis, occurring most often within the first 100 days, may require prompt endovascular intervention. Portal vein thrombosis or stenosis, though less frequent, can cause portal hypertension with splenomegaly and ascites. Biliary complications, including anastomotic strictures and leaks, affect approximately 12–40% of pediatric recipients, usually within the first three months post-transplant. In the longer term, neoplastic complications such as post-transplant lymphoproliferative disorder occur in up to 2-8%of pediatric liver transplant patients, necessitating vigilant radiologic and clinical follow-up. Ultrasound remains the cornerstone of early and serial postoperative evaluation, given its safety, accessibility, and high sensitivity for vascular and biliary pathology. Rapid identification of complications enables timely intervention, optimizing graft function and long-term survival in pediatric liver transplant recipients. Read More

Authors:  Kumar Tushar , Noda Sakura , Kim Helen Hr

Keywords:  Hepatic Transplant, Transplant Interventions, Ultrasonography

Juang Eric,  Collard Michael,  Katz Danielle,  Adams Megan,  Wachs Michael,  Annam Aparna,  Zavaletta Vaz

Final Pr. ID: Poster #: EDU-048

Through a series of cases, this poster demonstrates how to diagnose and treat biliary anastomotic complications with image-guided techniques in infants after liver transplant.

We present several cases to illustrate the variability of biliary anastomoses including location, type, and number of anastomoses. Pediatric interventional radiologists and image-guided procedures are critical in the successful management of post-transplant biliary anastomotic strictures and leaks and minimize the need for invasive reoperation.

The selected cases illustrate complex image-guided percutaneous management of multiple duct anastomotic strictures, anastomotic dehiscence, cut surface leaks, and removal of surgically placed stents that may be malpositioned and/or causing obstruction. The interventional methods used to percutaneously manage these cases include complex biliary access utilizing snares, multiple drain placement, stent placement, and rendezvous procedures with endoscopic retrograde cholangiopancreatography.

The use of image-guided techniques by the pediatric interventional radiologist are invaluable in the management of biliary complications post-liver transplant in infants. Read More

Authors:  Juang Eric , Collard Michael , Katz Danielle , Adams Megan , Wachs Michael , Annam Aparna , Zavaletta Vaz

Keywords:  Transplant Interventions, Biliary, Image-Guided