Pediatric Liver Transplant: Anatomic, Imaging, and Surgical Considerations-A Report of the Pediatric LI-RADS Working Group, From the AJR Special Series on Critical Anatomy.

Abstract

Liver transplant is the definitive treatment for children with end-stage liver disease, select metabolic disorders, and unresectable hepatic malignancies. Radiologists play a central role in the multidisciplinary transplant team, contributing to preoperative assessment, surgical planning, and postoperative surveillance. This article, a report from the Pediatric LI-RADS working group in collaboration with pediatric liver transplant surgeons, highlights the unique aspects of pediatric liver transplantation, focusing on critical anatomic, imaging, and surgical considerations specific to children. Use of the PRE-Treatment EXTent of tumor (PRETEXT) system for tumor staging is described, along with anatomic factors relevant to resectability and transplant eligibility. Particular attention is given to technical aspects of transplantation, including the frequent use of living donor and segmental grafts in pediatric recipients. Imaging protocols for both donor and recipient evaluation are reviewed, with emphasis on volumetric analysis, vascular and biliary anatomy, and identification of anatomic variants that may influence surgical decision-making. Postoperative imaging findings, including common vascular and biliary complications, are also discussed. By understanding the unique anatomic and surgical considerations in pediatric liver transplantation, radiologists can enhance diagnostic accuracy, facilitate interdisciplinary communication, and support optimal outcomes for pediatric transplant recipients.