Postoperative liver allograft dysfunction: the use of quantitative duplex Doppler signal analysis in adult liver transplant patients.
40 patients after orthotopic liver transplantation were prospectively analysed by serial quantitative duplex Doppler signal analysis (DDSA) to quantify the abnormalities of Doppler waveform of the hepatic artery (HA), the portal vein (PV) and the hepatic vein (HV) under various conditions of graft dysfunction. Quantitative analysis of the HA, PV and HV was obtained before, during and after allograft dysfunction by different Doppler angle independent parameters. The results obtained later on were correlated with clinical and laboratory data, cytological and histological findings of liver core biopsy and quantitative DDSA data of healthy transplanted volunteers. The increase of the resistive index of Pourcelot calculated for the hepatic artery (HA-RI) was found to be significant in early graft reperfusion reaction (p < 0.01). No correlation was found between the HA-RI and acute allograft rejection. Different patterns of damping quantified by the damping index (DI = minimum velocity shift/maximum velocity shift) for the portal vein (PV-DI) and the hepatic vein (HV-DI) Doppler signal were observed under various conditions of allograft dysfunction. Acute rejection was identified by premature decrease of PV-DI and increase of HV-DI (p < 0.01) with a sensitivity of 75%, a specificity of 91%, a positive predictive value (ppv) of 75% and a negative predictive value (npv) of 91%. Chronic allograft rejection was not associated with an increase of HV-DI but only with a significant decrease of PV-DI (p < 0.01), with a sensitivity of 80%, a specificity of 95%, ppv of 95%, npv of 98%.(ABSTRACT TRUNCATED AT 250 WORDS)
Harms
J
J
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule, Hannover.
Ringe
B
B
Pichlmayr
R
R
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000503:physiopathology; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D008099:Liver / Q000098:blood supply*; D017093:Liver Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000000981:diagnostic imaging* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000000981:diagnostic imaging / Q000503:physiopathology; D018615:Ultrasonography, Doppler, Color; D014655:Vascular Resistance / Q000502:physiology