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Liver Transplant Complications
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Clinical Issues

      TERMINOLOGY

      • Synonyms

        • Segmental liver transplant = partial liver transplant, split liver transplant, reduced-size liver transplant
      • Definitions

        • Segmental liver transplant
          • In children, left hepatic lobe or lateral segment of left lobe usually transplanted
          • Developed to ↑ supply of liver transplants for children
          • Usually adult donor, cadaveric or living
          • Combined with small bowl transplant in select cases
          • Combined with kidney transplant in select cases
        • Vascular complications
          • Hepatic artery (HA) vasospasm (immediately postop)
          • Hepatic arterial thrombosis (HAT) or stenosis
          • HA pseudoaneurysm at infrarenal anastomosis with aorta
          • Portal vein stenosis (PVS) & thrombosis
          • Hepatic vein stenosis (HVS)
          • Anastomotic bleeding
        • Biliary complications
          • Anastomotic: Biliary stenosis or leak
          • Nonanastomotic
            • Intrahepatic biliary stenosis → dilation
            • Biloma
            • Intraductal sludge or stone
        • Extrahepatic fluid collection
          • Hematoma, seroma, bile leak, abscess
          • Usually found soon after surgery
        • Posttransplant lymphoproliferative disease (PTLD)
        • Infection
          • Abscess from hematologic spread
          • Cholangitis via ascending route
        • Organ rejection

      IMAGING

      • Ultrasonographic Findings

        • CT Findings

          • MR Findings

            • Angiographic Findings

              • Nonvascular Interventions

                • Imaging Recommendations

                  PATHOLOGY

                  • General Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Treatment

                          Selected References

                          1. De Luca M et al: Invasive candidiasis in liver transplant patients: Incidence and risk factors in a pediatric cohort. Pediatr Transplant. 20(2):235-40, 2016
                          2. Foster BJ et al: High risk of liver allograft failure during late adolescence and young adulthood. Transplantation. 100(3):577-84, 2016
                          3. Kerkar N et al: Pediatric liver transplantation: a North American perspective. Expert Rev Gastroenterol Hepatol. 1-11, 2016
                          4. Lee KW et al: Outcome of partial reconstruction of multiple hepatic arteries in pediatric living donor liver transplantation using left liver grafts. Transpl Int. ePub, 2016
                          5. Neto JS et al: Alternatives for vascular reconstruction in pediatric living donor liver transplantation. Pediatr Transplant. 20(5):717-722, 2016
                          6. Ranawaka R et al: Combined liver and kidney transplantation in children: analysis of renal graft outcome. Pediatr Nephrol. 31(9):1539-43, 2016
                          7. Sang AX et al: EBV-associated lymphoepithelial carcinoma after pediatric liver transplant. Liver Transpl. 22(6):849-53, 2016
                          8. Seda-Neto J et al: Twenty years of experience in pediatric living donor liver transplantation: focus on hepatic artery reconstruction, complications, and outcomes. Transplantation. 100(5):1066-72, 2016
                          9. Stanescu AL et al: Pediatric abdominal organ transplantation: current indications, techniques, and imaging findings. Radiol Clin North Am. 54(2):281-302, 2016
                          10. Stine JG et al: Pre-transplant portal vein thrombosis is an independent risk factor for graft loss due to hepatic artery thrombosis in liver transplant recipients. HPB (Oxford). 18(3):279-86, 2016
                          11. Choi JW et al: Long-term outcome of endovascular intervention in hepatic venous outflow obstruction following pediatric liver transplantation. Liver Transpl. 21(9):1219-26, 2015
                          12. Crowley JJ et al: Retained surgical stents as a cause of biliary obstruction in pediatric liver transplants. Pediatr Radiol. 45(3):430-4, 2015
                          13. Feier FH et al: Biliary complications after pediatric liver transplantation: risk factors, diagnosis and management. World J Hepatol. 7(18):2162-70, 2015
                          14. Kamran Hejazi Kenari S et al: Current state of the art in management of vascular complications after pediatric liver transplantation. Pediatr Transplant. 19(1):18-26, 2015
                          15. Laurence JM et al: Biliary complications in pediatric liver transplantation: incidence and management over a decade. Liver Transpl. 21(8):1082-90, 2015
                          16. Tannuri U et al: Technique advance to avoid hepatic venous outflow obstruction in pediatric living-donor liver transplantation. Pediatr Transplant. 19(3):261-6, 2015
                          17. Teplisky D et al: Ultrasonography, laboratory, and cholangiography correlation of biliary complications in pediatric liver transplantation. Pediatr Transplant. 19(2):170-4, 2015
                          18. Jamieson LH et al: Doppler ultrasound velocities and resistive indexes immediately after pediatric liver transplantation: normal ranges and predictors of failure. AJR Am J Roentgenol. 203(1):W110-6, 2014
                          19. Lüthold SC et al: Risk factors for early and late biliary complications in pediatric liver transplantation. Pediatr Transplant. 18(8):822-30, 2014
                          20. Shaheen MF et al: Outcome of duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses in below 15-kg pediatric liver transplant recipients. Pediatr Transplant. 18(8):831-8, 2014
                          21. Tannuri AC et al: A new simplified technique of arterial reconstruction in pediatric living-donor liver transplantation: a comparison with the classical technique. J Pediatr Surg. 49(10):1518-21, 2014
                          22. Uchida H et al: Hepatic artery reconstruction preserving the pancreaticoduodenal arcade in pediatric liver transplantation with celiac axis compression syndrome: report of a case. Pediatr Transplant. 18(7):E232-5, 2014
                          23. Yabuta M et al: Long-term outcome of percutaneous transhepatic balloon angioplasty for portal vein stenosis after pediatric living donor liver transplantation: a single institute's experience. J Vasc Interv Radiol. 25(9):1406-12, 2014
                          24. Moon SB et al: Graft rotation and late portal vein complications in pediatric living donor liver transplantation using left-sided grafts: Long-term computed tomography observations. Liver Transpl. 17(6):717-22, 2011
                          25. Babyn PS: Imaging of the transplant liver. Pediatr Radiol. 40(4):442-6, 2010
                          26. Kamath BM et al: Liver transplantation in children: update 2010. Pediatr Clin North Am. 57(2):401-14, table of contents, 2010
                          27. Khalaf H: Vascular complications after deceased and living donor liver transplantation: a single-center experience. Transplant Proc. 42(3):865-70, 2010
                          28. Venick RS et al: Predictors of survival following liver transplantation in infants: a single-center analysis of more than 200 cases. Transplantation. 89(5):600-5, 2010
                          29. Wiederkehr JC et al: Prevalence of posttransplantation lymphoproliferative disease in pediatric liver transplant recipients. Transplant Proc. 42(2):521-2, 2010
                          30. Bucuvalas J: Long-term outcomes in pediatric liver transplantation. Liver Transpl. 15 Suppl 2:S6-11, 2009
                          31. Takahashi Y et al: Surgical complications after living donor liver transplantation in patients with biliary atresia: a relatively high incidence of portal vein complications. Pediatr Surg Int. 25(9):745-51, 2009
                          32. Unsinn KM et al: Spectrum of imaging findings after pediatric liver transplantation: part 1, posttransplantation anatomy. AJR Am J Roentgenol. 181(4):1133-8, 2003
                          33. Unsinn KM et al: Spectrum of imaging findings after pediatric liver transplantation: part 2, posttransplantation complications. AJR Am J Roentgenol. 181(4):1139-44, 2003
                          34. Buell JF et al: Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg. 236(5):658-66, 2002
                          35. Donnelly LF et al: Unique imaging issues in pediatric liver disease. Clin Liver Dis. 6(1):227-46, viii, 2002
                          36. Jain A et al: Pediatric liver transplantation. A single center experience spanning 20 years. Transplantation. 73(6):941-7, 2002
                          37. Ametani F et al: Spectrum of CT findings in pediatric patients after partial liver transplantation. Radiographics. 21(1):53-63, 2001
                          Related Anatomy
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Clinical Issues

                              TERMINOLOGY

                              • Synonyms

                                • Segmental liver transplant = partial liver transplant, split liver transplant, reduced-size liver transplant
                              • Definitions

                                • Segmental liver transplant
                                  • In children, left hepatic lobe or lateral segment of left lobe usually transplanted
                                  • Developed to ↑ supply of liver transplants for children
                                  • Usually adult donor, cadaveric or living
                                  • Combined with small bowl transplant in select cases
                                  • Combined with kidney transplant in select cases
                                • Vascular complications
                                  • Hepatic artery (HA) vasospasm (immediately postop)
                                  • Hepatic arterial thrombosis (HAT) or stenosis
                                  • HA pseudoaneurysm at infrarenal anastomosis with aorta
                                  • Portal vein stenosis (PVS) & thrombosis
                                  • Hepatic vein stenosis (HVS)
                                  • Anastomotic bleeding
                                • Biliary complications
                                  • Anastomotic: Biliary stenosis or leak
                                  • Nonanastomotic
                                    • Intrahepatic biliary stenosis → dilation
                                    • Biloma
                                    • Intraductal sludge or stone
                                • Extrahepatic fluid collection
                                  • Hematoma, seroma, bile leak, abscess
                                  • Usually found soon after surgery
                                • Posttransplant lymphoproliferative disease (PTLD)
                                • Infection
                                  • Abscess from hematologic spread
                                  • Cholangitis via ascending route
                                • Organ rejection

                              IMAGING

                              • Ultrasonographic Findings

                                • CT Findings

                                  • MR Findings

                                    • Angiographic Findings

                                      • Nonvascular Interventions

                                        • Imaging Recommendations

                                          PATHOLOGY

                                          • General Features

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Demographics

                                                • Treatment

                                                  Selected References

                                                  1. De Luca M et al: Invasive candidiasis in liver transplant patients: Incidence and risk factors in a pediatric cohort. Pediatr Transplant. 20(2):235-40, 2016
                                                  2. Foster BJ et al: High risk of liver allograft failure during late adolescence and young adulthood. Transplantation. 100(3):577-84, 2016
                                                  3. Kerkar N et al: Pediatric liver transplantation: a North American perspective. Expert Rev Gastroenterol Hepatol. 1-11, 2016
                                                  4. Lee KW et al: Outcome of partial reconstruction of multiple hepatic arteries in pediatric living donor liver transplantation using left liver grafts. Transpl Int. ePub, 2016
                                                  5. Neto JS et al: Alternatives for vascular reconstruction in pediatric living donor liver transplantation. Pediatr Transplant. 20(5):717-722, 2016
                                                  6. Ranawaka R et al: Combined liver and kidney transplantation in children: analysis of renal graft outcome. Pediatr Nephrol. 31(9):1539-43, 2016
                                                  7. Sang AX et al: EBV-associated lymphoepithelial carcinoma after pediatric liver transplant. Liver Transpl. 22(6):849-53, 2016
                                                  8. Seda-Neto J et al: Twenty years of experience in pediatric living donor liver transplantation: focus on hepatic artery reconstruction, complications, and outcomes. Transplantation. 100(5):1066-72, 2016
                                                  9. Stanescu AL et al: Pediatric abdominal organ transplantation: current indications, techniques, and imaging findings. Radiol Clin North Am. 54(2):281-302, 2016
                                                  10. Stine JG et al: Pre-transplant portal vein thrombosis is an independent risk factor for graft loss due to hepatic artery thrombosis in liver transplant recipients. HPB (Oxford). 18(3):279-86, 2016
                                                  11. Choi JW et al: Long-term outcome of endovascular intervention in hepatic venous outflow obstruction following pediatric liver transplantation. Liver Transpl. 21(9):1219-26, 2015
                                                  12. Crowley JJ et al: Retained surgical stents as a cause of biliary obstruction in pediatric liver transplants. Pediatr Radiol. 45(3):430-4, 2015
                                                  13. Feier FH et al: Biliary complications after pediatric liver transplantation: risk factors, diagnosis and management. World J Hepatol. 7(18):2162-70, 2015
                                                  14. Kamran Hejazi Kenari S et al: Current state of the art in management of vascular complications after pediatric liver transplantation. Pediatr Transplant. 19(1):18-26, 2015
                                                  15. Laurence JM et al: Biliary complications in pediatric liver transplantation: incidence and management over a decade. Liver Transpl. 21(8):1082-90, 2015
                                                  16. Tannuri U et al: Technique advance to avoid hepatic venous outflow obstruction in pediatric living-donor liver transplantation. Pediatr Transplant. 19(3):261-6, 2015
                                                  17. Teplisky D et al: Ultrasonography, laboratory, and cholangiography correlation of biliary complications in pediatric liver transplantation. Pediatr Transplant. 19(2):170-4, 2015
                                                  18. Jamieson LH et al: Doppler ultrasound velocities and resistive indexes immediately after pediatric liver transplantation: normal ranges and predictors of failure. AJR Am J Roentgenol. 203(1):W110-6, 2014
                                                  19. Lüthold SC et al: Risk factors for early and late biliary complications in pediatric liver transplantation. Pediatr Transplant. 18(8):822-30, 2014
                                                  20. Shaheen MF et al: Outcome of duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses in below 15-kg pediatric liver transplant recipients. Pediatr Transplant. 18(8):831-8, 2014
                                                  21. Tannuri AC et al: A new simplified technique of arterial reconstruction in pediatric living-donor liver transplantation: a comparison with the classical technique. J Pediatr Surg. 49(10):1518-21, 2014
                                                  22. Uchida H et al: Hepatic artery reconstruction preserving the pancreaticoduodenal arcade in pediatric liver transplantation with celiac axis compression syndrome: report of a case. Pediatr Transplant. 18(7):E232-5, 2014
                                                  23. Yabuta M et al: Long-term outcome of percutaneous transhepatic balloon angioplasty for portal vein stenosis after pediatric living donor liver transplantation: a single institute's experience. J Vasc Interv Radiol. 25(9):1406-12, 2014
                                                  24. Moon SB et al: Graft rotation and late portal vein complications in pediatric living donor liver transplantation using left-sided grafts: Long-term computed tomography observations. Liver Transpl. 17(6):717-22, 2011
                                                  25. Babyn PS: Imaging of the transplant liver. Pediatr Radiol. 40(4):442-6, 2010
                                                  26. Kamath BM et al: Liver transplantation in children: update 2010. Pediatr Clin North Am. 57(2):401-14, table of contents, 2010
                                                  27. Khalaf H: Vascular complications after deceased and living donor liver transplantation: a single-center experience. Transplant Proc. 42(3):865-70, 2010
                                                  28. Venick RS et al: Predictors of survival following liver transplantation in infants: a single-center analysis of more than 200 cases. Transplantation. 89(5):600-5, 2010
                                                  29. Wiederkehr JC et al: Prevalence of posttransplantation lymphoproliferative disease in pediatric liver transplant recipients. Transplant Proc. 42(2):521-2, 2010
                                                  30. Bucuvalas J: Long-term outcomes in pediatric liver transplantation. Liver Transpl. 15 Suppl 2:S6-11, 2009
                                                  31. Takahashi Y et al: Surgical complications after living donor liver transplantation in patients with biliary atresia: a relatively high incidence of portal vein complications. Pediatr Surg Int. 25(9):745-51, 2009
                                                  32. Unsinn KM et al: Spectrum of imaging findings after pediatric liver transplantation: part 1, posttransplantation anatomy. AJR Am J Roentgenol. 181(4):1133-8, 2003
                                                  33. Unsinn KM et al: Spectrum of imaging findings after pediatric liver transplantation: part 2, posttransplantation complications. AJR Am J Roentgenol. 181(4):1139-44, 2003
                                                  34. Buell JF et al: Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg. 236(5):658-66, 2002
                                                  35. Donnelly LF et al: Unique imaging issues in pediatric liver disease. Clin Liver Dis. 6(1):227-46, viii, 2002
                                                  36. Jain A et al: Pediatric liver transplantation. A single center experience spanning 20 years. Transplantation. 73(6):941-7, 2002
                                                  37. Ametani F et al: Spectrum of CT findings in pediatric patients after partial liver transplantation. Radiographics. 21(1):53-63, 2001