Role of Interventional Radiology in the Management of Liver Transplant Complications in Children

Ritu Shah, Pareena Sharma, Darshan Variyam, Michael Leshen, Fredric J. Bertino, Vaz Zavaletta, Jay Shah
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Abstract

Liver transplantation (LT) is a common solid organ transplant in the pediatric population. The common indications for LT, as well as its complications, differ between adults and children. This difference necessitates unique pediatric interventional radiology (IR) interventions. This article focuses on unique vascular complications occurring post-pediatric LT and highlights the importance of IR in their management. It explores IR's involvement in the workup of patients' pre-LT and management of complications following portosystemic shunts. We discuss advantages and disadvantages of different access routes as well as the prevalence, clinical picture, diagnosis, and management of complications after pediatric LT. These complications encompass portal vein stenosis, portal vein thrombosis, hepatic artery stenosis, hepatic artery thrombosis, hepatic artery pseudoaneurysm, arterioportal fistula, hepatic vein stenosis, and inferior vena cava stenosis. The choice of endovascular technique for a clinical indication depends on vascular anatomy, time since LT, and patient-specific factors. Transsplenic access is a useful alternative to transhepatic or transjugular access. The decision to place a stent in a child is influenced by the expected growth of the child and risk of focal narrowing at stent edge (because of recipient growth). Technical challenges in pediatric patient management, including uncooperative patients and sedation issues, must be considered. Pediatric LT complications can present with significant challenges in the posttransplant care of recipients and may lead to serious morbidity and graft failure if not managed effectively. IR techniques like balloon angioplasty, stent placement, thrombolysis, and embolization have demonstrated success in treating these complications, improving patient outcomes, and reducing long-term morbidity and mortality. By enhancing the understanding of medical practitioners and interventional radiologists about complex vascular complications, this article aims to contribute to better posttransplant care and improved outcomes for LT in pediatric populations. Continued collaboration between specialties and research will advance the field of pediatric LT and IR, to create even more effective treatment strategies.
介入放射学在治疗儿童肝移植并发症中的作用
肝移植(LT)是儿科常见的实体器官移植手术。成人和儿童肝移植的常见适应症及其并发症有所不同。这种差异需要独特的儿科介入放射学(IR)干预。本文重点介绍了小儿LT术后出现的独特血管并发症,并强调了IR在这些并发症治疗中的重要性。文章探讨了IR在LT术前检查和门静脉分流术后并发症治疗中的参与情况。我们讨论了不同入路的优缺点,以及小儿LT术后并发症的发病率、临床表现、诊断和处理。这些并发症包括门静脉狭窄、门静脉血栓形成、肝动脉狭窄、肝动脉血栓形成、肝动脉假性动脉瘤、动静脉瘘、肝静脉狭窄和下腔静脉狭窄。临床适应症中血管内技术的选择取决于血管解剖、LT 后的时间和患者的具体因素。经脾入路是经肝或经颈静脉入路的有效替代方案。为儿童放置支架的决定受到儿童预期生长和支架边缘局灶性狭窄风险(因受体生长)的影响。必须考虑到儿科患者管理中的技术挑战,包括不合作的患者和镇静问题。小儿 LT 并发症会给受体移植后的护理带来巨大挑战,如果处理不当,可能会导致严重的发病率和移植失败。气囊血管成形术、支架置入术、溶栓和栓塞等红外技术在治疗这些并发症、改善患者预后以及降低长期发病率和死亡率方面已取得了成功。本文旨在通过加深医疗从业人员和介入放射科医生对复杂血管并发症的了解,为改善移植后护理和儿童 LT 的预后做出贡献。各专科之间的持续合作和研究将推动儿科LT和IR领域的发展,创造出更有效的治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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