Introduction: Prompt radiographic evaluation is essential for early recognition of vascular complications following pediatric liver transplant (LT). Bedside contrast enhanced ultrasound (CE-US) is a non-invasive modality that avoids radiation exposure, the need for sedation and transport, and has potential to detect early post-LT vascular complications.We describe our initial experiences with its use as a screening and for-cause (FC) modality.

Methods: Retrospective analysis was performed on 20 CE-US in 14 pediatric patients undergoing partial (n=5) or whole graft (n=9) LT, between October 2024 and January 2026 at our institution. Intravenous LUMASON® (sulfur hexafluoride lipid-type A microspheres) was administered per protocol. Demographic, clinical, and radiographic data were analyzed. CE-US findings were correlated with standard of care imaging.  

Results: Mean patient age was 7 years old and 57% were females. Indications for transplant included 5 Primary Cholestatic Conditions, 1 Glycogen Storage Disorder, 1 Giant Cell Hepatitis, 2 Autoimmune Hepatitis, 2 Unresectable Hepatic tumors, 2 Acute on Chronic Liver Failure, and 1 Cystic Fibrosis. Compared to standard of care imaging, 6 FC CE-US accurately identified 7 of 8 abnormalities (decreased arterial flow (n=1), asymptomatic arterial anomaly (n=1), IVC stenosis/thrombosis (n=4), parenchymal hypoperfusion (n=1) with 87% sensitivity and 100% specificity. 1 arterial stenosis diagnosed on CTA was not identified on FC CE-US. 4 findings on FC CE-US helped change management. 3 of 14 screening CE-US demonstrated one previously known asymptomatic arterial anomaly and 2 cases of initial poor parenchymal perfusion. The timing of post-operative CE-US varied (mean day post-LT 2.2). There was no standardized reporting of CE-US findings. Contrast enhancement added $90 per study. 

Conclusions: Bedside CE-US was safe and affordable with high sensitivity and specificity in pediatric LT recipients. It provided effective and timely diagnosis avoiding the need for anesthesia and transport. Further efforts necessitate prospective study with correlation to standard of care imaging and clinical outcomes, as well as need for the standardized reporting of CE-US findings.