Contrast‐Enhanced Ultrasound for identifying circulatory complications after liver transplants in children

Abstract

Our main goal with this study was to share our off-label experience with CEUS for identifying circulatory complications after liver transplantation in children. A total of 74 CEUS examinations performed on 34 pediatric patients who underwent a liver transplant were retrospectively included. About 53% of the examinations were performed on children 2 years old or younger. About 82% of the examinations were performed within 30 days from the transplant. About 62% of patients were transplanted due to a cholestatic disease, 11% due to a metabolic disease, 8% were retransplanted due to graft failure, and 19% was due to other conditions. BA was the most common reason for transplantation and represented 38% of patients. About 38% of the transplantations were performed with whole grafts from DD, 40% with split liver grafts, and 22% with left lateral segments from LD. For diagnosing arterial circulatory complications, the PPV was 80%. For diagnosing portal vein circulatory complications, the PPV was 66.7%. NPV was 100%. In 28% of the examinations, the examiner could not visualize the normal arterial blood flow without CEUS. CEUS is a non-invasive and safe imaging technique that seems valuable in these patients and further efforts are needed to license its use in the post-transplant setting. K E Y W O R D Scirculatory complications, contrast-enhanced ultrasound, liver transplant, off-label, pediatric

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020 – WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS

“…More extensive experience has been documented with blunt abdominal trauma of the liver, and in the follow-up of focal areas of injury in the liver [267][268][269]. Experience using CEUS in the assessment of the liver transplant recipients is limited, with studies reporting success mainly with areas of infarction and abscess formation, with vascular "Doppler rescue" useful [270][271][272]. For details we refer to the EFSUMB position paper "Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement" [19].…”

Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver–Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS

“…More extensive experience has been documented with blunt abdominal trauma of the liver and in the follow-up of focal areas of injury in the liver (Valentino et al 2008;Menichini et al 2015;Durkin et al 2016). Experience using CEUS in the assessment of liver transplant recipients is limited, with studies reporting success mainly with areas of infarction and abscess formation, with vascular "Doppler rescue" useful (Bonini et al 2007;Rennert et al 2012;Torres et al 2019). For details we refer to the EFSUMB position paper Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement ).…”

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB): An Update on the Pediatric CEUS Registry on Behalf of the “EFSUMB Pediatric CEUS Registry Working Group”

“…The application of CEUS in children following transplantation is likely to be of equal value compared with the adult population [35][36][37][38]. Issues addressed included vascular patency, areas of organ necrosis, assessment of new focal liver or renal lesions and the assessment of post-operative complications (e. g., fluid collections).…”