Vascular complications in adult patients after orthotopic liver transplantation: role of color duplex sonography in the diagnosis and management of vascular complications.
Vascular complications after orthotopic liver transplantation are one of the most serious problems in liver-grafted patients, and if undetected they may result in graft failure and death unless prompt revascularization or retransplantation is performed. As the outcome of treatment of vascular complications depends on an early diagnosis, the role of color-coded duplex sonography (CCD) for diagnosis and treatment was analyzed during a 17-month observation period. Altogether, 88 consecutive liver allografts in 77 adult patients were studied by serial CCD. Vascular complications occurred with an incidence of 12.9%. Hepatic artery complications represented the most frequent event with an incidence of 11.6%. CCD showed a sensitivity of 100%, a specificity of 97% and a positive predictive value of 0.84. With the use of CCD, vasculature and localization of the site of arterial complications can be directly visualized and the various types of complications can be differentiated, thus reducing the time needed for diagnosis. Early hepatic artery complications, occurring during the first 3 days after transplantation, which were immediately diagnosed by CCD examination and rapidly treated by revascularization had a good clinical outcome. In contrast, the outcome of vascular complications requiring retransplantation was found to be poor. As radiologic intervention offers an alternative to the treatment strategy of vascular complications in liver-grafted patients, CCD is the method of choice to noninvasively monitor the initial and follow-up examinations after intervention.
Harms
J
J
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule, Hannover, FRG.
Chavan
A
A
Ringe
B
B
Galanski
M
M
Pichlmayr
R
R
D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012086:Reoperation; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography