Advances in pediatric liver transplant imaging

Liver transplantation is the only curative treatment for children with end-stage liver disease. This thesis investigated the role of radiological imaging such as Doppler ultrasound (DUS), computed tomography (CT), and magnetic resonance imaging (MRI) from preoperative workup, to perioperative imaging, and short and long-term postoperative follow-up. The aims were to critically assess the already established diagnostic pathway of children that undergo transplantation, to identify and subsequently correct gaps in the current understanding of the usefulness of radiological imaging, and provide clinically useful tools where possible. Advances were made into establishing DUS reference values in both children with and without a liver transplant, the occurrence and incidence of vessel and bile duct complications, the lack of necessity for fasting prior to a liver transplant DUS, justification of CT angiography compared to MR angiography for hepatic artery assessment, the usefulness of CT-based body metrics during the pre-operative work-up, and the yield and usefulness of MRI of the bile ducts for symptomatic bile duct disease after transplantation. In conclusion, this thesis contributes to evidence-based pediatric liver transplant imaging by addressing gaps in understanding and offering solutions. It may also serve as a foundation for future research, with the ultimate aim to improve outcomes for children undergoing liver transplantation