The postoperative hepatic artery resistance index after living donor liver transplantation can predict early allograft dysfunction

Lv, Tao; Kong, Lingxiang; Yang, Jiayin; Wu, Hong; Wen, Tianfu; Jiang, Li; Yang, Jian

doi:10.1097/md.0000000000018677

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…The ability to measure both arterial and venous flow from a single study has practical clinical implications. The importance of arterial or venous flow may vary over time for a given patient, and there are clinical scenarios where evaluation of both systems is of interest, for example following liver transplant 32 . Prior studies have concurrently assessed hepatic arteries and portal veins 13,21,31 .…”

Section: Discussionmentioning

confidence: 99%

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Brunsing

Brown

Almahoud

et al. 2021

Magnetic Resonance Imaging

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Background Non‐invasive assessment of the hemodynamic changes of cirrhosis might help guide management of patients with liver disease but are currently limited. Purpose To determine whether free‐breathing 4D flow MRI can be used to quantify the hemodynamic effects of cirrhosis and introduce hydraulic circuit indexes of severity. Study Type Retrospective. Population Forty‐seven patients including 26 with cirrhosis. Field Strength/Sequence 3 T/free‐breathing 4D flow MRI with soft gating and golden‐angle view ordering. Assessment Measurements of the supra‐celiac abdominal aorta, supra‐renal abdominal aorta (SRA), celiac trunk (CeT), superior mesenteric artery (SMA), splenic artery (SpA), common hepatic artery (CHA), portal vein (PV), and supra‐renal inferior vena cava (IVC) were made by two radiologists. Measures of hepatic vascular resistance (hepatic arterial relative resistance [HARR]; portal resistive index [PRI]) were proposed and calculated. Statistical Analysis Bland–Altman, Pearson's correlation, Tukey's multiple comparison, and Cohen's kappa. P < 0.05 was considered significant. Results Forty‐four of 47 studies yielded adequate image quality for flow quantification (94%). Arterial structures showed high inter‐reader concordance (range; ρ = 0.948–0.987) and the IVC (ρ = 0.972), with moderate concordance in the PV (ρ = 0.866). Conservation of mass analysis showed concordance between large vessels (SRA vs. IVC; ρ = 0.806), small vessels (celiac vs. CHA + SpA; ρ = 0.939), and across capillary beds (CeT + SMA vs. PV; ρ = 0.862). Splanchnic flow was increased in patients with portosystemic shunting (PSS) relative to control patients and patients with cirrhosis without PSS (P < 0.05, difference range 0.11–0.68 liter/m). HARR was elevated and PRI was decreased in patients with PSS (3.55 and 1.49, respectively) compared to both the control (2.11/3.18) and non‐PSS (2.11/2.35) cohorts. Data Conclusion 4D flow MRI with self‐navigation was technically feasible, showing promise in quantifying the hemodynamic effects of cirrhosis. Proposed quantitative metrics of hepatic vascular resistance correlated with PSS. Level of Evidence 3 Technical Efficacy Stage 2

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Section: Discussionmentioning

confidence: 99%

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Brunsing

Brown

Almahoud

et al. 2021

Magnetic Resonance Imaging

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“…Serum bilirubin ≥10 mg/dL on postoperative day 7 or international normalized ratio ≥1.6 on postoperative day 7 or serum alanine aminotransferase or aspartate aminotransferase >2000 IU/mL within the first 7 postoperative days. [12][13][14][15]31…”

Section: Early Allograft Dysfunctionmentioning

confidence: 99%

“…10,11 It manifests as early allograft dysfunction (EAD) with a reported incidence of 11%-31%. [12][13][14][15] Although shear stress resulting from high portal vein flow (PVF) and portal venous pressure (PVP) may serve as a promoter of liver regeneration, 16 PVF of >250 mL/min/100 g and a PVP of >15 mm Hg are shown to be associated with graft injury and thus, the development of EAD. [17][18][19][20][21] Large spleen contributes to a high PVF and PVP with splenic vein flow contributing up to 52% of the portal inflow in patients with portal hypertension.…”

Section: Introductionmentioning

confidence: 99%

HPi: A Novel Parameter to Predict Graft-related Outcome in Adult Living Donor Liver Transplant

et al. 2021

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“…In recent decades LT has been used as a curative option for patients with end-stage liver disease. 15 Survival of LT recipients has been extended by advances in surgical techniques and patient management after the surgical procedure, but strict follow-up must be maintained for early detection of any complications. 8 Liver biopsy is traditionally considered the gold standard for assessing the degree of fibrosis and steatosis in patients with chronic liver disease, but it has limitations.…”

Section: Discussionmentioning

confidence: 99%

Transient Hepatic Elastography in the Assessment of Liver Fibrosis in Patients After Liver Transplantation

Longo¹,

Matheus²,

Santos³

et al. 2021

Acta gastroenterol. latinoam.

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Introduction and Objectives. Liver biopsy is the gold standard for assessing fibrosis and inflammation in liver transplant recipients. As this study has risks, the use of noninvasive tools has been proposed, including transient elastography, a method that needs further study in this population, which is the purpose of this research. Material and methods. Demographic and clinical data were collected retrospectively in patients who received a liver transplant, underwent liver biopsy and transient elastography less than 1 year apart. Sensitivity, specificity, diagnostic accuracy and Kappa concordance test between the two methods were determined. Results. Of 356 patients evaluated after transplantation, 45 underwent liver biopsy and transient elastography within 1 year; 60.0% were male and 75.6% had hepatitis C virus infection. At the time of transient elastography, laboratory values were: mean total bilirubin 1.5 mg/dL, alanine aminotransferase 108.1 U/L, aspartate aminotransferase, 101.6 U/L, alkaline phosphatase, 96.0 U/L and gamma-glutamyl transferase 9.0 U/L. The main indications for liver biopsy were assessment for rejection, hepatitis C virus infection or both. According to liver biopsy, 82.2% presented absent or minimal fibrosis and 75.6% had no inflammation. Acute cellular rejection was present in 20.0% of cases. A cut-off point of > 9.5 kPa was used to define advanced fibrosis, while a value < 7.5 kPa was set to indicate absent or mild fibrosis. Poor agreement was found between transient elastography and liver biopsy for these categories (Kappa 0.125, sensitivity 69.5%, specificity 66.7%) and for specific stages of fibrosis (Kappa 0.095). Conclusions. Accuracy, sensitivity and specificity were low for fibrosis staging when comparing transient elastography with liver biopsy. In liver transplant recipients, transient elastography would overestimate fibrosis, probably due to inflammation secondary to other causes.

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The postoperative hepatic artery resistance index after living donor liver transplantation can predict early allograft dysfunction

Cited by 9 publications

References 24 publications

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

HPi: A Novel Parameter to Predict Graft-related Outcome in Adult Living Donor Liver Transplant

Transient Hepatic Elastography in the Assessment of Liver Fibrosis in Patients After Liver Transplantation

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