Advertisement

Radiological Investigation and Intervention in Pediatric Solid Organ Transplantation

  • Aki Tanimoto
  • Shankar Rajeswaran
  • Stanley Kim
  • Jared R. Green
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

Interventional radiologists offer minimally invasive alternative treatments for many complications of liver and renal transplantation. Complications that are amenable to interventional radiologic treatments include vascular complications, biliary complications, and ureteral complications. Studies in adult and pediatric transplant recipients have demonstrated successful outcomes of minimally invasive treatments of posttransplant complications, some of which are now considered first-line treatments.

Keywords

Angiography Angioplasty Endovascular intervention Intra-arterial thrombolysis Thrombectomy Selective embolization Portal venoplasty Cavogram Cholangiography Cholangioplasty Percutaneous biopsy Transjugular biopy Stent grafts Percutaneous drainage Double J stent Sclerotherapy Ureteroplasty 

References

  1. Ackermann O, Branchereau S, Franchi-Abella S et al (2012) The long-term outcome of hepatic artery thrombosis after liver transplantation in children: role of urgent revascularization. Am J Transplant 12: 1496–1503.  https://doi.org/10.1111/j.1600-6143.2011.03984.x CrossRefPubMedGoogle Scholar
  2. Akbar SA, Jafri SZH, Amendola MA et al (2005) Complications of renal transplantation. Radiographics 25: 1335–1356.  https://doi.org/10.1148/rg.255045133 CrossRefPubMedGoogle Scholar
  3. Aytekin C, Boyvat F, Harman A et al (2007) Percutaneous therapy of ureteral obstructions and leak after renal transplantation: long-term results. Cardiovasc Intervent Radiol 30:1178–1184.  https://doi.org/10.1007/s00270-007-9031-8 CrossRefPubMedGoogle Scholar
  4. Benfield MR, Herrin J, Feld L et al (1999) Safety of kidney biopsy in pediatric transplantation: a report of the controlled clinical trials in pediatric transplantation trial of induction therapy study group. Transplantation 67: 544–547CrossRefPubMedGoogle Scholar
  5. Berrocal T, Parrón M, Álvarez-Luque A et al (2006) Pediatric liver transplantation: a pictorial essay of early and late complications. Radiographics 26: 1187–1209.  https://doi.org/10.1148/rg.264055081 CrossRefPubMedGoogle Scholar
  6. Bhagat VJ, Gordon RL, Osorio RW et al (1998) Ureteral obstructions and leaks after renal transplantation: outcome of percutaneous antegrade ureteral stent placement in 44 patients. Radiology 209:159–167.  https://doi.org/10.1148/radiology.209.1.9769827 CrossRefPubMedGoogle Scholar
  7. Bilge I, Rozanes I, Acunas B et al (1999) Endovascular treatment of arteriovenous fistulas complicating percutaneous renal biopsy in three paediatric cases. Nephrol Dial Transplant 14:2726–2730.  https://doi.org/10.1093/ndt/14.11.2726 CrossRefPubMedGoogle Scholar
  8. Booth C, Preston R, Clark G, Reidy J (2002) Management of renal vascular disease in neurofibromatosis type 1 and the role of percutaneous transluminal angioplasty. Nephrol Dial Transplant 17:1235–1240.  https://doi.org/10.1093/ndt/17.7.1235 CrossRefPubMedGoogle Scholar
  9. Boraschi P, Donati F (2004) Complications of orthotopic liver transplantation: imaging findings. Abdom Imaging 29:189–202.  https://doi.org/10.1007/s00261-003-0109-8 CrossRefPubMedGoogle Scholar
  10. Boyvat F, Aytekin C, Karakayalı H et al (2006) Stent placement in pediatric patients with hepatic artery stenosis or thrombosis after liver transplantation. Transplant Proc 38:3656–3660.  https://doi.org/10.1016/j.transproceed.2006.10.169 CrossRefPubMedGoogle Scholar
  11. Buell JF, Funaki B, Cronin DC et al (2002) Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg 236: 658–666.  https://doi.org/10.1097/01.SLA.0000032944.15795.B8 CrossRefPubMedPubMedCentralGoogle Scholar
  12. Cheng YF, Chen CL, Huang TL et al (2005) Angioplasty treatment of hepatic vein stenosis in pediatric liver transplants: long-term results. Transpl Int 18:556–561.  https://doi.org/10.1111/j.1432-2277.2005.00088.x CrossRefPubMedGoogle Scholar
  13. Corbetta JP, Durán V, Burek C et al (2011) Renal autotransplantation for the treatment of renovascular hypertension in the pediatric population. J Pediatr Urol 7:378–382.  https://doi.org/10.1016/j.jpurol.2011.02.017 CrossRefPubMedGoogle Scholar
  14. Cronin DC II, Alonso EM, Piper JB et al (1997) Biliary complications in living Donor liver transplantation. Transplant Proc 29:419CrossRefPubMedGoogle Scholar
  15. Dagli M, Ramchandani P (2011) Percutaneous nephrostomy: technical aspects and indications. Semin Interv Radiol 28:424–437.  https://doi.org/10.1055/s-0031-1296085 CrossRefGoogle Scholar
  16. Davari HR, Yarmohammadi H, Malekhosseini SA et al (2006) Urological complications in 980 consecutive patients with renal transplantation. Int J Urol 13: 1271–1275.  https://doi.org/10.1111/j.1442-2042.2006.01539.x CrossRefPubMedGoogle Scholar
  17. Dimitroulis D, Bokos J, Zavos G et al (2009) Vascular complications in renal transplantation: a single-center experience in 1367 renal transplantations and review of the literature. Transplant Proc 41:1609–1614.  https://doi.org/10.1016/j.transproceed.2009.02.077 CrossRefPubMedGoogle Scholar
  18. Donaldson JS (2014) Renal arteriography and interventions. In: Pediatric interventional radiology. Springer, New York, pp 53–70CrossRefGoogle Scholar
  19. Drudi FM, Pagliara E, Cantisani V et al (2007) Post-transplant hepatic complications: imaging findings. J Ultrasound 10:53–58.  https://doi.org/10.1016/j.jus.2007.02.004 CrossRefPubMedPubMedCentralGoogle Scholar
  20. Egawa H, Uemoto S, Inomata Y et al (1998) Biliary complications in pediatric living related liver transplantation. Surgery 124:901–910.  https://doi.org/10.1016/S0039-6060(98)70015-7 CrossRefPubMedGoogle Scholar
  21. Eklöf H, Ahlström H, Magnusson A et al (2006) A prospective comparison of duplex ultrasonography, captopril Renography, MRA, and CTA in assessing renal artery stenosis. Acta Radiol 47:764–774.  https://doi.org/10.1080/02841850600849092 CrossRefPubMedGoogle Scholar
  22. Fontaine AB, Nijjar A, Rangaraj R (1997) Update on the use of percutaneous nephrostomy/balloon dilation for the treatment of renal transplant leak/obstruction. J Vasc Interv Radiol 8:649–653CrossRefPubMedGoogle Scholar
  23. Fukker TF, Kang S-M, Hirose R et al (2003) Management of Lymphoceles after renal transplantation: laparoscopic versus open drainage. J Urol 169:2022–2025.  https://doi.org/10.1097/01.ju.0000063800.44792.61 CrossRefGoogle Scholar
  24. Funaki B, Rosenblum JD, Leef JA et al (1995) Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty. AJR Am J Roentgenol 165:161–165.  https://doi.org/10.2214/ajr.165.1.7785578 CrossRefPubMedGoogle Scholar
  25. García-Criado Á, Gilabert R, Berzigotti A, Brú C (2009) Doppler ultrasound findings in the hepatic artery shortly after liver transplantation. Am J Roentgenol 193:128–135.  https://doi.org/10.2214/AJR.07.3919 CrossRefGoogle Scholar
  26. Garcia-gallont R, Bar-nathan N, Shaharabani E et al (1999) Hepatic artery thrombosis in pediatric liver transplantation: graft salvage after thrombectomy. Pediatr Transplant 3:74–78.  https://doi.org/10.1034/j.1399-3046.1999.00012.x CrossRefPubMedGoogle Scholar
  27. Ghirardo G, De Franceschi M, Vidal E et al (2014) Transplant renal artery stenosis in children: risk factors and outcome after endovascular treatment. Pediatr Nephrol 29:461–467.  https://doi.org/10.1007/s00467-013-2681-7 CrossRefPubMedGoogle Scholar
  28. Govender P, Jonas MM, Alomari AI et al (2013) Sonography-guided percutaneous liver biopsies in children. Am J Roentgenol 201:645–650.  https://doi.org/10.2214/AJR.12.9802 CrossRefGoogle Scholar
  29. Greif F, Bronsther OL, Van Thiel DH et al (1994) The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg 219:40–45CrossRefPubMedPubMedCentralGoogle Scholar
  30. Hamby BA, Ramirez DE, Loss GE et al (2013) Endovascular treatment of hepatic artery stenosis after liver transplantation. J Vasc Surg 57:1067–1072.  https://doi.org/10.1016/j.jvs.2012.10.086 CrossRefPubMedGoogle Scholar
  31. Heffron TG, Emond JC, Whitington PF et al (1992) Biliary complications in pediatric liver transplantation. A comparison of reduced-size and whole grafts. Transplantation 53:391–395CrossRefPubMedGoogle Scholar
  32. Heffron TG, Pillen T, Welch D et al (2003a) Biliary complications after pediatric liver transplantation revisited. Transplant Proc 35:1461–1462.  https://doi.org/10.1016/S0041-1345(03)00463-9 CrossRefPubMedGoogle Scholar
  33. Heffron TG, Pillen T, Welch D et al (2003b) Hepatic artery thrombosis in pediatric liver transplantation. Transplant Proc 35:1447–1448.  https://doi.org/10.1016/S0041-1345(03)00459-7 CrossRefPubMedGoogle Scholar
  34. Jindal RM, Wilkin T, Rose S et al (2001) Renal arterial stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology 219:663–667CrossRefPubMedGoogle Scholar
  35. Johnson SP, Berry RS (2001) Interventional radiological management of the complications of renal transplantation. Semin Intervent Radiol 18:047–058.  https://doi.org/10.1055/s-2001-12838 CrossRefGoogle Scholar
  36. Karatzas T, Lykaki-Karatzas E, Webb M et al (1997) Vascular complications, treatment, and outcome following orthotopic liver transplantation. Transplant Proc 29:2853–2855CrossRefPubMedGoogle Scholar
  37. Kling K, Lau H, Colombani P (2004) Biliary complications of living related pediatric liver transplant patients. Pediatr Transplant 8:178–184.  https://doi.org/10.1046/j.1399-3046.2003.00127.x CrossRefPubMedGoogle Scholar
  38. Kobayashi K, Censullo ML, Rossman LL et al (2007) Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics 27:1109–1130.  https://doi.org/10.1148/rg.274065135 CrossRefPubMedGoogle Scholar
  39. Kodama Y, Sakuhara Y, Abo D et al (2006) Percutaneous transluminal angioplasty for hepatic artery stenosis after living donor liver transplantation. Liver Transpl 12:465–469.  https://doi.org/10.1002/lt.20724 CrossRefPubMedGoogle Scholar
  40. Kubo T, Shibata T, Itoh K et al (2006) Outcome of percutaneous Transhepatic Venoplasty for hepatic venous outflow obstruction after living donor liver transplantation. Radiology 239:285–290.  https://doi.org/10.1148/radiol.2391050387 CrossRefPubMedGoogle Scholar
  41. Lallier M, St-Vil D, Dubois J et al (1995) Vascular complications after pediatric liver transplantation. J Pediatr Surg 30:1122–1126.  https://doi.org/10.1016/j.transproceed.2004.03.104 CrossRefPubMedGoogle Scholar
  42. Le L, Terral W, Zea N et al (2015) Primary stent placement for hepatic artery stenosis after liver transplantation. J Vasc Surg 62:704–709.  https://doi.org/10.1016/j.jvs.2015.04.400 CrossRefPubMedGoogle Scholar
  43. López-Benítez R, Schlieter M, Hallscheidt PJ et al (2008) Successful arterial thrombolysis and percutaneous transluminal angioplasty for early hepatic artery thrombosis after split liver transplantation in a four-month-old baby. Pediatr Transplant 12:606–610.  https://doi.org/10.1111/j.1399-3046.2008.00925.x CrossRefPubMedGoogle Scholar
  44. López-Santamaria M, Martinez L, Hierro L et al (1999) Late biliary complications in pediatric liver transplantation. J Pediatr Surg 34:316–320.  https://doi.org/10.1016/S0022-3468(99)90199-9 CrossRefPubMedGoogle Scholar
  45. Lorenz JM, Funaki B, Leef JA et al (2001) Percutaneous transhepatic cholangiography and biliary drainage in pediatric liver transplant patients. Am J Roentgenol 176:761–765.  https://doi.org/10.2214/ajr.176.3.1760761 CrossRefGoogle Scholar
  46. Lorenz JM, Van Ha T, Funaki B et al (2006) Percutaneous treatment of venous outflow obstruction in pediatric liver transplants. J Vasc Interv Radiol 17:1753–1761.  https://doi.org/10.1097/01.RVI.0000241540.31081.52 CrossRefPubMedGoogle Scholar
  47. Mali VP, Aw M, Quak SH et al (2012) Vascular complications in pediatric liver transplantation; single-center experience from Singapore. Transplant Proc 44:1373–1378.  https://doi.org/10.1016/j.transproceed.2012.01.129 CrossRefPubMedGoogle Scholar
  48. Maruzzelli L, Miraglia R, Caruso S et al (2010) Percutaneous endovascular treatment of hepatic artery stenosis in adult and pediatric patients after liver transplantation. Cardiovasc Intervent Radiol 33:1111–1119.  https://doi.org/10.1007/s00270-010-9848-4 CrossRefPubMedGoogle Scholar
  49. Maya ID, Maddela P, Barker J, Allon M (2007) Percutaneous renal biopsy: comparison of blind and real-time ultrasound-guided technique. Semin Dial 20:355–358.  https://doi.org/10.1111/j.1525-139X.2007.00295.x CrossRefPubMedGoogle Scholar
  50. McMullin ND, Reidy JF, Koffman CG et al (1992) The management of renal transplant artery stenosis in children by percutaneous transluminal angioplasty. Transplantation 53:559–563CrossRefPubMedGoogle Scholar
  51. McTaggart SJ, Gulati S, Walker RG et al (2000) Evaluation and long-term outcome of pediatric renovascular hypertension. Pediatr Nephrol 14:1022–1029CrossRefPubMedGoogle Scholar
  52. Miraglia R, Maruzzelli L, Caruso S et al (2009) Interventional radiology procedures in pediatric patients with complications after liver transplantation. Radiographics 29:567–584.  https://doi.org/10.1148/rg.292085037 CrossRefPubMedGoogle Scholar
  53. Moray G, Boyvat F, Sevmiş Ş et al (2005) Vascular complications after liver transplantation in pediatric patients. Transplant Proc 37:3200–3202.  https://doi.org/10.1016/j.transproceed.2005.08.045 CrossRefPubMedGoogle Scholar
  54. Murata Y, Mizuno S, Kato H et al (2016) Technical feasibility and clinical outcomes of interventional endovascular treatment for hepatic artery thrombosis after living-donor liver transplantation. Transplant Proc 48:1142–1148.  https://doi.org/10.1016/j.transproceed.2015.12.092 CrossRefPubMedGoogle Scholar
  55. Nadalin S, Bockhorn M, Malagó M et al (2006) Living donor liver transplantation. HPB (Oxford) 8:10–21.  https://doi.org/10.1080/13651820500465626 CrossRefGoogle Scholar
  56. Nghiem HV, Tran K, Winter TC et al (1996) Imaging of complications in liver transplantation. Radiographics 16:825–840.  https://doi.org/10.1148/radiographics.16.4.8835974 CrossRefPubMedGoogle Scholar
  57. Nixon JN, Biyyam DR, Stanescu L et al (2013) Imaging of pediatric renal transplants and their complications: a pictorial review. Radiographics 33:1227–1251.  https://doi.org/10.1148/rg.335125150 CrossRefPubMedGoogle Scholar
  58. Orons PD, Sheng R, Zajko AB (1995a) Hepatic artery stenosis in liver transplant recipients: prevalence and cholangiographic appearance of associated biliary complications. AJR Am J Roentgenol 165: 1145–1149.  https://doi.org/10.2214/ajr.165.5.7572493 CrossRefPubMedGoogle Scholar
  59. Orons PD, Zajko AB, Bron KM et al (1995b) Hepatic artery angioplasty after liver transplantation: experience in 21 allografts. J Vasc Interv Radiol 6:523–529.  https://doi.org/10.1016/S1051-0443(95)71128-9 CrossRefPubMedGoogle Scholar
  60. Pawlak J, Wróblewski T, Małkowski P et al (2000) Vascular complications related to liver transplantation. Transplant Proc 32:1426–1428.  https://doi.org/10.1016/S0041-1345(00)01281-1 CrossRefPubMedGoogle Scholar
  61. Raynaud A, Bedrossian J, Remy P et al (1986) Percutaneous transluminal angioplasty of renal transplant arterial stenoses. AJR Am J Roentgenol 146:853CrossRefPubMedGoogle Scholar
  62. Repetto HA, Rodriguez-Rilo L, Mendaro E et al (2004) Percutaneous treatment of transplant renal artery stenosis in children. Pediatr Nephrol 19:1400–1403.  https://doi.org/10.1007/s00467-004-1656-0 CrossRefPubMedGoogle Scholar
  63. Richard HM (2004) Perirenal transplant fluid collections. Semin Interv Radiol 21:235–237.  https://doi.org/10.1055/s-2004-861557 CrossRefGoogle Scholar
  64. Rose SC, Andre MP, Roberts AC et al (2001) Integral role of interventional radiology in the development of a pediatric liver transplantation program. Pediatr Transplant 5:331–338.  https://doi.org/10.1034/j.1399-3046.2001.00013.x CrossRefPubMedGoogle Scholar
  65. Saad WEA (2012) Arterioportal fistulas in liver transplant recipients. Semin Interv Radiol 29:105–110.  https://doi.org/10.1055/s-0032-1312571 CrossRefGoogle Scholar
  66. Saad NEA, Saad WEA, Davies MG et al (2005a) Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics 25:S173–S189.  https://doi.org/10.1148/rg.25si055503 CrossRefPubMedGoogle Scholar
  67. Saad WEA, Davies MG, Sahler L et al (2005b) Hepatic artery stenosis in liver transplant recipients: primary treatment with percutaneous transluminal angioplasty. J Vasc Interv Radiol 16:795–805.  https://doi.org/10.1097/01.RVI.0000156441.12230.13 CrossRefPubMedGoogle Scholar
  68. Sabri SS, Saad WEA, Schmitt TM et al (2011) Endovascular therapy for hepatic artery stenosis and thrombosis following liver transplantation. Vasc Endovasc Surg 45:447.  https://doi.org/10.1177/1538574411407088 CrossRefGoogle Scholar
  69. Sankari BR, Geisinger M, Zelch M et al (1996) Post-transplant renal artery stenosis: impact of therapy on long-term kidney function and blood pressure control. J Urol 155:1860–1864.  https://doi.org/10.1016/S0022-5347(01)66030-0 CrossRefPubMedGoogle Scholar
  70. Sanyal R, Zarzour JG, Ganeshan DM et al (2014) Postoperative doppler evaluation of liver transplants. Indian J Radiol Imaging 24:360–366.  https://doi.org/10.4103/0971-3026.143898 CrossRefPubMedPubMedCentralGoogle Scholar
  71. Singhal A, Stokes K, Sebastian A et al (2010) Endovascular treatment of hepatic artery thrombosis following liver transplantation. Transpl Int 23:245–256.  https://doi.org/10.1111/j.1432-2277.2009.01037.x CrossRefPubMedGoogle Scholar
  72. Stanley JC, Criado E, Upchurch GR et al (2006) Pediatric renovascular hypertension: 132 primary and 30 secondary operations in 97 children. J Vasc Surg 44: 1219–1228.  https://doi.org/10.1016/j.jvs.2006.08.009 CrossRefPubMedGoogle Scholar
  73. Streeter EH, Little DM, Cranston DW, Morris PJ (2002) The urological complications of renal transplantation: a series of 1535 patients. BJU Int 90:627–634.  https://doi.org/10.1046/j.1464-410X.2002.03004.x CrossRefPubMedGoogle Scholar
  74. Stringer MD, Marshall MM, Muiesan P et al (2001) Survival and outcome after hepatic artery thrombosis complicating pediatric liver transplantation. J Pediatr Surg 36:888–891.  https://doi.org/10.1053/jpsu.2001.23963 CrossRefPubMedGoogle Scholar
  75. Sze DY, Esquivel CO (2002) The role of interventional radiology in a pediatric liver transplant program. Pediatr Transplant 6:1–4.  https://doi.org/10.1034/j.1399-3046.2002.1e066.x CrossRefPubMedGoogle Scholar
  76. Titton RL, Gervais DA, Hahn PF et al (2003) Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics 23:1133–1147.  https://doi.org/10.1148/rg.235035029 CrossRefPubMedGoogle Scholar
  77. Towbin RB, Pelchovitz DJ, Baskin KM et al (2007) Cutting balloon angioplasty in children with resistant renal artery stenosis. J Vasc Interv Radiol 18:663–669.  https://doi.org/10.1016/j.jvir.2007.02.014 CrossRefPubMedGoogle Scholar
  78. Tullus K, Brennan E, Hamilton G et al (2008) Renovascular hypertension in children. Lancet 371:1453–1463.  https://doi.org/10.1016/S0140-6736(08)60626-1 CrossRefPubMedGoogle Scholar
  79. Ueno T, Jones G, Martin A et al (2006) Clinical outcomes from hepatic artery stenting in liver transplantation. Liver Transpl 12:422–427.  https://doi.org/10.1002/lt.20628 CrossRefPubMedGoogle Scholar
  80. Warnaar N, Polak WG, de Jong KP et al (2010) Long-term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation. Liver Transpl 16:847–855.  https://doi.org/10.1002/lt.22063 CrossRefPubMedGoogle Scholar
  81. Wong W, Fynn SP, Higgins RM et al (1996) Transplant renal artery stenosis in 77 patients – does it have an immunological cause? Transplantation 61:215–219CrossRefPubMedGoogle Scholar
  82. Yilmaz A, Arikan C, Tumgor G et al (2007) Vascular complications in living-related and deceased donation pediatric liver transplantation: single center’s experience from Turkey. Pediatr Transplant 11:160–164.  https://doi.org/10.1111/J.1399-3046.2006.00601.X CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Aki Tanimoto
    • 1
  • Shankar Rajeswaran
    • 2
  • Stanley Kim
    • 2
  • Jared R. Green
    • 2
  1. 1.Diagnostic Radiology Northwestern Memorial HospitalChicagoUSA
  2. 2.Pediatric Vascular and Interventional RadiologyAnn & Robert H. Lurie Children’s Hospital of ChicagoChicagoUSA

Section editors and affiliations

  • Tetsu Uejima
    • 1
  1. 1.Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations