In 2020, 1,700 pediatric patients received solid organ transplants in the United States.1 Pediatric transplants include heart, lung, liver, kidney, intestines (small bowel), as well as combined multi-organ transplants such as heart-lung, heart-kidney, heart-liver, liver-lung, liver-intestines, and liver-intestine-pancreas. The transplanted organs that are most commonly treated by interventional radiologists include the transplanted livers and kidneys.

The indications for solid organ transplant are different between the pediatric and adult populations. For example, the most common etiologies for liver failure in the pediatric population are biliary atresia and hepatoblastoma2,3 compared to chronic hepatitis C, alcohol abuse, and non-alcoholic fatty liver disease in the adult population.4 Similarly, the most common etiologies for end stage renal disease (ESRD) in the pediatric population are obstructive uropathy, dysplastic kidneys, and focal segmental glomerulosclerosis compared to chronic conditions like diabetes and hypertension in the adult population.5,6

Pediatric organ transplantation can have unique challenges as compared to adults. Pediatric transplant patients are at higher risk of donor-recipient size mismatch, complications of a growing child, and nonadherence to therapy.7 Liver and kidney transplants are particularly challenging in children given higher rates of hepatic and renal vascular complications in children.8,9 Interventional radiology (IR) plays an integral role in diagnosing, managing, and treating post-procedural complications in pediatric patients with transplants.8 IR offers minimally invasive benefits for patients that are often at high risk for surgical morbidity and mortality. Additionally, the decreased recovery times allows patients decreased hospital stays and improved quality of life. This paper will focus on the common interventions that pediatric interventional radiologists may encounter as part of a multi-disciplinary transplant team.