Interventional radiology procedures after pediatric liver transplantation

Abstract

Interventional radiology procedures after pediatric liver transplantation include diagnostic liver biopsy (percutaneous transhepatic and percutaneous transjugular approaches), treatments for vascular and biliary complications, and percutaneous fluid drainage. Of these, Department of Radiology at National Center for Child Health and Development is deeply involved in treatments for vascular and biliary complications. Once interventional procedures are indicated, all patients are treated in collaborative work between transplant surgeons and radiologists. All procedures are managed under general anesthesia. The majority of interventional procedures are started with fluoroscopy-assisted ultrasound-guided percutaneous transhepatic puncture. Once percutaneous transhepatic access is accomplished, both vascular and biliary complications are managed with biplane fluoroscopic angiography equipment. We strongly recommend the use of lateral projection fluoroscopy, considering the anatomy of the transplanted liver. During the procedures, transhepatic puncture followed by sheath placement is performed by an experienced transplant surgeon. Subsequent interventional procedures are mainly performed by radiologists. This review demonstrates both typical and atypical cases necessitating technical modifications based on the clinician’s experience with interventional radiology procedures after liver transplantation.