Routine intraoperative Doppler sonography in the evaluation of complications after living-related donor liver transplantation.
OBJECTIVE
To determine whether quantitative and qualitative analysis of intraoperative Doppler sonography data are predictive of vascular complications after living-related donor liver transplantation.


METHODS
Intraoperative sonograms of 81 transplanted livers (right lobe in 61 patients, left lobe in 20 patients) were analyzed for the presence of blood flow, resistance index, systolic acceleration time (SAT), peak systolic velocity, and morphologic characteristics of spectral waveform of the hepatic artery. Peak velocity and spectral waveforms of portal and hepatic veins were also analyzed. Intraoperative sonography results were compared with information obtained with multidetector-row CT (MDCT) angiography or conventional angiography. The time interval between operation and angiography ranged from 1 to 23 days (mean, 8.5 days).


RESULTS
Hepatic artery stenosis (HAS) was identified in 20 patients via MDCT angiography, conventional angiography, or both. The Doppler parameters found helpful for predicting HAS were tardus-parvus pattern and delayed SAT. The sensitivity, specificity, and negative predictive value (NPV) were 60.0%, 73.7%, and 84.9%, respectively, for tardus-parvus pattern and 40.0%, 83.6%, and 80.9%, respectively, for delayed SAT. Peak velocities of the portal and hepatic veins were not reliable indicators of vascular complication. Loss of triphasity of the hepatic vein had a 98.4% NPV for venous obstruction.


CONCLUSIONS
Delayed SAT of the hepatic artery and loss of triphasity of the hepatic vein had a >80% for specificity for predicting vascular complications. Tardus-parvus pattern, delayed SAT of the hepatic artery, and loss of triphasity of the hepatic vein showed an acceptable NPV for identifying vascular complications.
Choi
Jin-Young
JY
Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Gu, Seoul, Korea.
Lee
Jae Young
JY
Lee
Jeong Min
JM
Kim
Se Hyung
SH
Lee
Min Woo
MW
Han
Joon Koo
JK
Choi
Byung Ihn
BI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D001783:Blood Flow Velocity / Q000502:physiology; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D008102:Liver Circulation / Q000502:physiology; D016031:Liver Transplantation / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance / Q000502:physiology