Interventional Procedures in Pediatric Liver Transplantation

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Abdomen and Pelvis: 1.00

Magnetic Resonance Imaging: 1.00
Procedures: 1.00
Body: 1.00

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Abdominal Section: 2.50

Sonography: 1.50
Procedures: 1.50
Abdomen: 1.50

Radiation Therapy: 1.00
Patient Care: 0.50
Patient and Medical Record Management: 0.50
Procedures: 0.50
Treatment Sites and Tumors: 0.50

Vascular-Interventional Radiography: 2.50
Procedures: 2.50
Vascular Interventional Procedures: 1.25
Nonvascular Procedures: 1.25

Vascular Sonography: 1.00
Procedures: 1.00
Abdominal/Pelvic Vasculature: 1.00

Outline

1. Introduction
2. Diagnosis of Graft Disease
   1. Percutaneous Liver Biopsy
   2. Transjugular Liver Biopsy
3. Treatment of Vascular Complications
   1. Hepatic Artery Stenosis
   2. Hepatic Artery Thrombosis
   3. Hepatic Vein Stenosis
   4. Inferior Vena Cava Stenosis
   5. Portal Vein Stenosis
4. Treatment of Biliary Complications
   1. Anastomotic Biliary Strictures
   2. Intrahepatic Biliary Strictures and Bilomas
   3. Isolated Draining Intrahepatic Biliary Ducts
   4. Bile Leakage
5. Summary

Objectives

Upon completion of this course, students will:

1. know the most common type of pediatric liver transplant
2. know the role of radiology in pediatric liver transplantation programs
3. understand the imaging modality most often used for performing percutaneous liver biopsies
4. understand how a percutaneous liver biopsy is performed
5. know proper post liver biopsy procedures
6. know the contraindications of percutaneous liver biopsy
7. understand how a transjugular liver biopsy is performed
8. know which imaging modalities help reduce the risk of capsule perforation
9. know the contraindications of transjugular liver biopsy
10. know when most vascular complications appear following transplantation
11. know the percentage of patients that develop hepatic artery stenosis
12. understand the causes of hepatic artery stenosis
13. appreciate the benefits of early diagnosis of hepatic artery stenosis and early intervention
14. know proper hepatic arteriography procedures
15. comprehend abnormal trans-stenotic pressure gradients
16. know what defines procedural success after hepatic artery stenosis intervention
17. know the imaging modality that is most commonly used for follow up evaluation of flow
18. understand hepatic artery thrombosis
19. know the current treatment options for hepatic artery thrombosis
20. understand hepatic vein stenosis
21. know the treatment options for hepatic vein stenosis
22. recognize abnormal pressure gradients in hepatic vein stenosis
23. know when metallic stents are appropriate for hepatic vein stenosis
24. know where inferior vena cava stenoses usually occur
25. know the treatment for vena cava stenosis
26. understand portal vein stenosis
27. know the treatment for portal vein stenosis
28. comprehend biliary complications in pediatric liver transplants
29. know when biliary complications occur
30. understand MR cholangiography
31. understand hepatobiliary scintigraphy
32. know proper percutaneous transhepatic cholangiography techniques
33. know what causes intrahepatic biliary strictures
34. comprehend how isolated draining biliary ducts are treated
35. be familiar with the usual treatment for bile leaks