OBJECTIVE.The purpose of this study was to determine if duplex sonography of the hepatic vasculature can be used to detect venoocclusive disease in patients who have had bone marrow transplantation.SUBJECTS AND METHODS. Twenty-seven bone marrow transplant recipients were serially studied with hepatic duplex sonography before (n = 27) and biweekly after (n = 136) transplantation.Duplex waveforms were obtained from the hepatic artery and the portal and hepatic venous systems. Clinical records were reviewed to confirm the dinical diagnosis of venoocclusive disease (n = 5), including its time of onset and duration. Patients with venoocclusive disease were further split into two groups: those with clinically active disease and those with clinically inactive disease. The resistive index in the hepatic artery, the velocity in the portal vein, and the differences among bone marrow transplant values before and after transplantation were compared among the groups.RESULTS. On the basis of data obtained before transplantation, a resistive index greater than 0.76 and a change in resistive index greater than 0.10 after transplantation were considered abnormal. Similarly, velocity in the portal vein after transplantation was considered abnormal when the value was less than 4.3 cm/sec or more than 50.3 cm/sec.

Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days. 164 recipients were examined: 41 (25.0%) experienced PRF and 74 (45.1%) prolonged ICU LOS. Significant predictors of PRF with univariate analysis: BMI > 30, pretransplant MELD, preoperative respiratory failure, LVEF < 50%, FVC < 80%, intraoperative transfusion > 6 units, warm ischemic time > 4 minutes, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted PRF (OR 1.14, p = 0.01). Significant predictors of prolonged ICU LOS with univariate analysis are as follows: pretransplant MELD, FVC < 80%, FEV1 < 80%, deceased donor, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted prolonged ICU LOS (OR 1.28, p < 0.001). One-year survival among cohorts with PRF and increased ICU LOS was similar to subjects without. Pretransplant MELD is a robust predictor of PRF and ICU LOS. Higher MELDs at LT are expected to increase need for ICU utilization and modify expectations for recovery in the immediate postoperative period.

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The development of aortic aneurysms in posttransplant patients is a rare but potentially lethal problem. De novo aortic aneurysm formation and rapid growth are postulated to result from an imbalance between pro-and anti-inflammatory vascular endothelial factors after transplant. Here, we present a case of de novo thoracic aneurysm formation within 2 months of orthotopic liver transplant. Prompt clinical recognition allowed for successful endovascular repair. Transplant clinicians should be aware of this potentially life-threatening complication and monitor at-risk recipients accordingly.