title: Transcapsular arterial neovascularization after liver transplantation in pediatric patients indicates transplant failure.
abstract: OBJECTIVE
  To identify transcapsular arterial neovascularization with Doppler ultrasonography (US) in pediatric patients after liver transplantation and to assess the frequency of the finding, its underlying causes, and its relevance in terms of clinical outcome.
  
  
  METHODS
  The study was approved by the local ethics committee, with waived informed consent. All pediatric patients who underwent liver transplantation between January 2000 and December 2003 were retrospectively evaluated. Patients were followed up until June 2008, by using a predefined US protocol with prospective documentation. Of 182 consecutive liver transplantations performed in 162 patients (mean age, 4.5 years; range, 0.1-18.4 years) in this period, 25 patients with a total of 27 liver transplantations underwent US examinations conducted by multiple investigators and were primarily excluded. Student t tests and χ(2) tests were performed where appropriate. The Tarone-Ware test was used to compare transplant survival times.
  
  
  RESULTS
  Transcapsular arterial neovascularization was noticed in 13 of 137 patients (9.5%) and in 13 of 155 liver transplants (8.4%). The mean time until arterial neovessels appeared was 157 days after liver transplantation (median, 97 days; range, 19-477 days). Arterial neovascularization was associated with pronounced transplant malperfusion and inflammatory changes (P < .001). Patients with transcapsular arterial neovascularization had a significantly shorter mean transplant survival time (1426.4 days ± 244.5 [standard error], with 95% confidence interval: 947.23, 1905.23, vs 2526.4 days ± 92.1, with 95% confidence interval: 2345.84, 2706.97; P = .008) and a higher retransplantation rate (53.8% vs 19.7%, P = .009).
  
  
  CONCLUSIONS
  Transcapsular arterial neovascularization, detected with color Doppler US, occurred in 9.5% (13 of 137) of pediatric patients and 8.4% (13 of 155) of liver transplants and was associated with underlying malperfusion and inflammation. The diagnosis of transcapsular arterial neovascularization was associated with reduced graft survival times and a high retransplantation rate. The negative prognostic value of the sign may assist in a strategy of organ allocation.
authors.affiliation: Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. j.herrmann@uke.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Herrmann
authors.forename: Carl M
authors.initials: CM
authors.lastname: Junge
authors.forename: Martin
authors.initials: M
authors.lastname: Burdelski
authors.forename: Rainer
authors.initials: R
authors.lastname: Ganschow
authors.forename: Siegbert
authors.initials: S
authors.lastname: Scheibner
authors.forename: Kay U
authors.initials: KU
authors.lastname: Petersen
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Broering
authors.forename: Gerhard
authors.initials: G
authors.lastname: Adam
authors.forename: Knut
authors.initials: K
authors.lastname: Helmke
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007223:Infant; D008102:Liver Circulation; D016031:Liver Transplantation; D008297:Male; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011379:Prognosis; D012189:Retrospective Studies; D014463:Ultrasonography