title: Use of Systemic Vasodilators for the Management of Doppler Ultrasound Arterial Abnormalities After Orthotopic Liver Transplantation.
abstract: BACKGROUND
  Doppler ultrasound (DUS) arterial abnormalities (DAA) after orthotopic liver transplantation (OLT) often represent a sign of hepatic artery (HA) complication (HAC). The standard management of DAA involves computed tomographic angiography (CTA) followed by invasive vascular intervention (IVI) or observation. We evaluated the contribution of systemic vasodilators (SVD) to the management of DAA after OLT.
  
  
  METHODS
  Between 2005 and 2015, 91 of 514 OLT recipients developed DAA (defined by HA resistive index [HARI] <0.5) and received oral SVDs. Doppler ultrasound was performed 2 days later, and patients were assigned to 3 groups accordingly: the normalization group (HARI >0.5), improvement group (HARI increase of >0.1 but value <0.5), or nonresponse group. We analyzed the contribution of this strategy to predict clinically significant HAC, defined as thrombosis or HAC requiring IVI.
  
  
  RESULTS
  A clinically significant HAC (4 thromboses, 35 HACs requiring IVI) was found in 2.9% (n = 1/34), 32.1% (n = 9/28), and 100% (n = 29/29) of patients in the normalization, improvement, and nonresponse groups, respectively (P < 0.001). On multivariate analysis, absence of HARI normalization after SVD and time to DAA longer than 30 days were associated with clinically significant HAC. Specificity and accuracy of DUS after SVD increased from 88.1% to 95.1% and from 88.9% to 95.1% (P < 0.001), without altering its sensitivity (97.7% vs 95.5%, P = 1.000).
  
  
  CONCLUSIONS
  The use of SVD improves the diagnostic performance of DUS for clinically significant HAC after OLT. It allows identifying patients at low risk for HAC, for whom CTA could be avoided, and helps choosing between observation and IVI in patients with inconclusive CTA.
authors.affiliation: 1 Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.2 Ecole Doctorale EDISS ED205, EMR3738, Université Lyon 1, Lyon France.3 Department of Cardiology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.4 Department of Radiology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.5 Department of Clinical Pharmacy, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Mohkam
authors.forename: Florian
authors.initials: F
authors.lastname: Fanget
authors.forename: Benjamin
authors.initials: B
authors.lastname: Darnis
authors.forename: Brahim
authors.initials: B
authors.lastname: Harbaoui
authors.forename: Agnès
authors.initials: A
authors.lastname: Rode
authors.forename: Bruno
authors.initials: B
authors.lastname: Charpiat
authors.forename: Christian
authors.initials: C
authors.lastname: Ducerf
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D000792:Angiography; D001158:Arteries / Q000473:pathology; D000072226:Computed Tomography Angiography; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D017093:Liver Failure / Q000000981:diagnostic imaging* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014652:Vascular Diseases / Q000000981:diagnostic imaging; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents