Early Postoperative Hepatic Sonography as a Predictor of Vascular and Biliary Complications in Adult Orthotopic Liver Transplant Patients

• Published in: American journal of roentgenology (1976) Vol. 185; no. 6; pp. 1558 - 1570
• Main Authors: Uzochukwu, Lawrence N, Bluth, Edward I, Smetherman, Dana H, Troxclair, Laurie A, Loss, George E., Jr, Cohen, Ari, Eason, James D
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.12.2005; American Roentgen Ray Society
• Subjects: Adolescent; Adult; Aged; Biliary Tract Diseases - diagnostic imaging; Biological and medical sciences; Cardiovascular system; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver - blood supply; Liver Transplantation; Logistic Models; Male; Medical sciences; Middle Aged; Postoperative Complications - diagnostic imaging; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Vascular Diseases - diagnostic imaging; Vascular Resistance; Doppler ultrasound study; Biliary tract; Nuclear medicine; Liver; Stenosis; Transplantation; Surgery; Blood vessel; Adult; Complication; Graft; Venous thrombosis; Inferior vena cava; Hepatic artery; Sonography; Human; Postoperative; Statistical analysis; Method; Student; Treatment; Hematoma; Radiology; Portal vein; Predictive factor; Bibliographic review
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.04.1258

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. 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. 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. 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.