Early postoperative hepatic sonography as a predictor of vascular and biliary complications in adult orthotopic liver transplant patients.
OBJECTIVE
Our objective was to quantitatively assess the value of early posttransplantation hepatic artery resistive indexes in predicting vascular and nonvascular complications in adult orthotopic liver transplant (OLT) patients.


METHODS
Between 1999 and 2001, 110 consecutive adults received grafts. Doppler sonographic graft evaluations measured main, right, and left resistive indexes within 24 to 48 hr after surgery (normal resistive index cutoff, 0.6). Clinical, operative, procedural, and radiologic reports were reviewed for vascular and biliary complications. Frequency, Student's t test, logistic, and regression statistical analyses were performed.


RESULTS
even patients (6.4%) had vascular complications, including two (1.8%) hepatic artery and two (1.8%) hepatic vein stenoses, one (0.9%) hepatic vein thrombosis, two (1.8%) portal vein thromboses, and one (0.9%) thrombosis and two (1.8%) stenoses of the inferior vena cava (IVC). In 19 patients (17.3%), biliary complications included anastomotic strictures and leaks 1 week to 18 months after transplantation. In 11 patients (10%), sonographically large hematomas required surgical evacuation. In grafts with vascular complications or large hematomas, the mean early posttransplant main, right, and left indexes were significantly lower (< or = 0.6) than without these complications (p < 0.01). In grafts with and without biliary complications, mean early posttransplant main, right, and left indexes did not differ significantly.


CONCLUSIONS
In adult OLT patients, low early posttransplant hepatic artery resistive indexes were sensitive (100%) and specific (80%) predictors for vascular complications (e.g., hepatic artery, portal vein, hepatic vein, and IVC) but not for biliary complications. All patients with indexes less than 0.6 within 24-48 hr after surgery should be monitored closely for vascular complications.
Uzochukwu
Lawrence N
LN
Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
Bluth
Edward I
EI
Smetherman
Dana H
DH
Troxclair
Laurie A
LA
Loss
George E
GE
Cohen
Ari
A
Eason
James D
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D014652:Vascular Diseases / Q000000981:diagnostic imaging*; D014655:Vascular Resistance