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Imaging in pediatric liver transplantation.

In liver transplantation, the role of the imaging study in the evaluation of transplant candidacy is to define the conditions in which transplantation is contraindicated and to identify anatomic variations that may alter the surgical approach. Among pediatric recipients, the largest numbers of patients were suffering from biliary atresia, and metabolic diseases. Acquired and congenital vascular anomalies are usually associated with biliary atresia which may be hazardous to liver transplantation requiring a modification of standard surgical procedure. Therefore, confirmation of the patency of the vascular structure is the most essential prerequisite especially in living related liver transplantation. From June 17, 1994 to November 30, 1996, eleven living related liver transplantations were performed at Chang Gung Memorial Hospital, Kaohsiung Medical Center. The left liver or the left lateral segment of the liver was used as the graft. It is necessary to keep patency of the inflow and outflow of hepatic vessels and biliary trees of both donor and recipient. Both resected and remnant livers have to function well postoperatively. In order to achieve parenchyma dissection with minimal hepatic damage, various anatomical variations of the liver size, portal vein, hepatic veins and bile duct of the donor cannot be ignored. Therefore, the precise preoperative anatomical evaluation of the donor using various imaging modalities is mandatory for the safe partial liver transplantation. Ultrasound, computed tomography, magnetic resonance image and three dimensional computed tomographic cholangiography are the method of choice in demonstrating the anatomical structures. After the complex anatomical factors can be well evaluated we can assess the appropriateness and feasibility of the procedure that may correct problems during or after transplantation. Finally, noninvasive and safe examination procedures are our outmost concern and policy in doing this survey.