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

Abstract

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.

Doppler Ultrasonography Findings of Splenic Arterial Steal Syndrome After Liver Transplant

“…Doppler ultrasound examination of orthotopic liver transplant patients has been accepted as an effective tool to monitor vascular complications and is regarded as a standard of care. 6,7 For this reason, our Doppler surveillance program in our clinic includes an intraoperative examination to show maintenance of vascular anastomosis. We perform Doppler sonography on a 12-hour basis during the first 7 days after the operation.…”

“…Early postoperative diagnosis and treatment of complications maximize both graft and patient survival. 6 Color and Duplex Doppler ultrasound are the important techniques for preoperative, intra operative, and postoperative evaluation of liver transplant recipients. They assess vascular supply of the graft by various indices including peak systolic velocity (PSV), pulsatility index, resistivity index (RI), and acceleration time of the hepatic artery, portal vein velocity, and resistivity index of the splenic artery.…”

Multimodality postoperative imaging of liver transplantation

“…Different imaging modalities are used to optimize the follow-up of these patients. We propose an algorithm (Table 1) for imaging liver transplant recipients, with the objective of minimizing the impact of complications and maximizing both graft and patient survival [7]. The first step in post-transplantation surveillance should be represented by US and Doppler examination.…”

“…6) [10,12]. Uzochukwu et al have demonstrated that in adult orthotopic liver transplantation recipients low early posttransplant hepatic artery resistive indexes are sensitive (100%) and specific (80%) predictors for vascular complications (involving hepatic artery, portal vein, hepatic veins, and IVC) but not for biliary complications [7].…”

“…Imaging has a fundamental role in all phases of liver transplantation, and different modalities including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US) are used, often in combination, to optimize screening and preoperative and postoperative evaluation of the recipient and the donor in cases of living donor liver transplantation [3][4][5][6]. Postoperative complications contribute significantly to the morbidity and mortality of liver transplant recipients; therefore early postoperative imaging surveillance is important in minimizing the impact of complications and maximizing both graft and patient survival [7]. and can be performed at the patient's bedside and repeatedly.…”