Validity and feasibility of transient elastography for the transplanted liver in the peritransplantation period.
BACKGROUND
Transient elastography has recently been suggested to be capable of detecting dynamic changes in stiffness that accompanies acute liver damage. Its feasibility and usefulness in the perioperative period in living donor liver transplantation (LDLT) have not been studied.


METHODS
We evaluated 678 liver stiffness measurements (LSMs) obtained in the peritransplantation period from 24 LDLT recipients, 24 corresponding donors (preoperatively only), another five donors with a remnant right liver, and three deceased donor liver transplantation recipients. The LSM was performed once preoperatively, every morning postoperatively until postoperative day 14, and three times a week after that until the patient was discharged from the hospital.


RESULTS
Overall LSM success rate (valid shots/total shots) was 0.929+/-0.119. There was a significant negative relationship between the LSM success rate and thoracic belt thickness (P<0.0021). The interquartile range to median value rate of LSMs remained high (21.1%+/-11.2%) compared with the preoperative values (15.6%+/-8.5%), even 1 month after the transplantation. Among LDLT recipients (n=24), the LSM value was highest in the first postoperative week and declined thereafter. Recipients with complications had significantly higher LSM values than those without complications in the fourth postoperative week (POW4; P=0.0066) and POW5 or later (P=0.0028). All cases of acute cellular rejection had a concomitant sharp rise in liver stiffness and a rapidly depleted portal flow.


CONCLUSIONS
Despite the high variability of the results, transient elastography may be an efficient method for monitoring changes in dynamic liver stiffness in the early posttransplant period.
Inoue
Yosuke
Y
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Sugawara
Yasuhiko
Y
Tamura
Sumihito
S
Ohtsu
Hiroshi
H
Taguri
Masataka
M
Makuuchi
Masatoshi
M
Kokudo
Norihiro
N
D000328:Adult; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005240:Feasibility Studies; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008099:Liver / Q000648:ultrastructure*; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013997:Time Factors; D055815:Young Adult