Early postoperative US predicts liver transplant complications

(Radiology Review) The hepatic artery resistive index can predict vascular and nonvascular complications in adult liver transplant patients, according to radiologists at Ochsner Clinic Foundation in New Orleans. In the December issue of American Journal of Roentgenology, the authors highlight the importance of early detection of hepatic artery stenosis or thrombosis with ultrasound to enable timely revascularization.

During a two-year period, hepatic artery resistive indexes were measured in the main, right, and left hepatic arteries one to two days following liver transplant surgery in 100 patients. Dr. Lawrence Uzochukwu and colleagues reviewed the clinical, operative, procedural, and radiologic reports for vascular and biliary complications.

Because ultrasound imaging is noninvasive, portable, and inexpensive, all Ochsner Clinic Foundation liver transplant patients undergo postoperative monitoring using color Doppler sonography, the authors stated. They described vascular complications as "stenosis or thrombosis of the hepatic artery, hepatic vein, portal vein, and vena cava," and nonvascular complications as "biliary anastomotic leaks and strictures, fluid collections, abscesses, and large hematomas."

Results demonstrated that "seven 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 IVC." Biliary complications (anastomotic strictures and leaks) occurred in 19 patients (17.3%) from one week to 18 months following transplantation. Ultrasound imaging demonstrated large hematomas in 11 patients (10%).

"In grafts with vascular complications or large hematomas, the mean early post-transplant main, right, and left indexes were significantly lower than without these complications." However, liver transplant patients with biliary complications showed no early change in resistive indexes in the main, right, or left hepatic artery. "Low early post-transplant 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," the authors concluded.

"Early Postoperative Hepatic Sonography as a Predictor of Vascular and Biliary Complications in Adult Orthotopic Liver Transplant Patients"
Lawrence N. Uzochukwu et al
Edward I. Bluth, Department of Radiology, Ochsner Clinic Foundation
1514 Jefferson Hwy, New Orleans, LA 70121, USA
AJR 2005 (December); 185:1558-1570

By Radiology Review
January 6, 2006

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