Hepatofugal portal venous flow on Doppler sonography after liver transplantation. Analysis of presumed causes based on radiologic and pathologic features.
OBJECTIVE
The purpose of this study was to categorize hepatofugal portal venous flow on Doppler sonography after liver transplantation and to investigate its clinical importance and presumed causes based on radiologic and pathologic findings.


METHODS
This retrospective study was approved by our Institutional Review Board, and the requirement for informed consent was waived. Examination of our database over 4 years revealed 30 patients in whom Doppler sonography showed hepatofugal portal venous flow during follow-up periods. We investigated its occurrence and clinical features, including radiologic and pathologic findings, and classified the possible causes into 5 types: A, systemic problems; B, gross vascular abnormalities correctable by intervention; C, specific cardiac problems; D, microscopic abnormalities of the graft; and E, miscellaneous. We classified the patterns of hepatofugal portal venous flow into continuous hepatofugal or hepatofugal-dominant to-and-fro flow and hepatopetal-dominant to-and-fro flow, and we investigated the relationship of the presumed causes and flow patterns with the clinical course.


RESULTS
The incidence of hepatofugal portal venous flow was 2.38%. The overall mortality rate was 26.67% (95% confidence interval, 11.1%-42.9%): all patients (n = 5) in group A, 1 in group C, and 2 in group D, died. Possible cause type B and a mainly hepatopetal flow pattern were good prognostic factors (P = .031 and .018, respectively).


CONCLUSIONS
Hepatofugal portal venous flow reflects diverse pathologic conditions after liver transplantation, and its clinical importance also differs depending on the cause.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2 Dong, Songpa-ku, Seoul 138-736, Korea. kimkw@amc.seoul.kr
Woo Kyoung
WK
Jeong
Kyoung Won
KW
Kim
So Jung
SJ
Lee
Yong Moon
YM
Shin
Jinoo
J
Kim
Gi Won
GW
Song
Shin
S
Hwang
Sung-Gyu
SG
Lee
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018615:Ultrasonography, Doppler, Color; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology