Abstract:
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Purpose: To assess the value of early post-operative hepatic arterial resistive indices (RI) in predicting vascular and biliary complications in adult OLT patients.
Methods and Materials: The study sample consisted of 110 adult OLT patients who had received grafts between 1999 and 2001 at the OCF. Doppler ultrasonographic evaluations of the graft including measurements of main, right and left hepatic arterial RIs were obtained within 48 hours of surgery. Clinical, operative, procedural and radiological reports were reviewed to determine the occurrence vascular and/or biliary complications beyond the immediate post-operative period. Frequency, t-test, logistic and regression statistical analyses were performed.
Results: Seven patients (6.4%) had vascular complications including 2 (1.8%) with hepatic artery stenosis, 2 (1.8%) with hepatic vein stenosis, 1 (0.9%) with hepatic vein thrombosis, 2 (1.8%) with portal vein thrombosis, and 2 (1.8%) with IVC thrombosis. Nineteen patients (17.3%) had biliary complications including anastomotic strictures and leaks. Complication occurred as early as 2 weeks and as late as 18 months. There was a significant difference in the mean hepatic arterial RI between grafts that had vascular complications and those that did not. There was no significant difference in the mean hepatic arterial RI between grafts that had biliary complications and those that did not. The group of patients with vascular complications consistently had low hepatic arterial RIs (< 0.5) compared to the group of patients with other non-vascular complications or those without any complications. The left hepatic artery RI had a greater predictability of complications than the right or main Hepatic arterial RIs.
Conclusion: Low early hepatic arterial RIs, particularly the left hepatic arterial RIs are predictors of early and long-term vascular complications in adult OLT patients. These vascular complications included not only hepatic artery stenosis, but also portal vein, hepatic vein and IVC occlusion and/or stenosis. A low early hepatic arterial RI is not a predictor for biliary complications. All patients with hepatic arterial RIs below 0.5 in the first 48 hours following OLT should be monitored more closely for vascular complications.
Uzochukwu MD, L,
Early Post-Operative Hepatic Ultrasound as a Predictor for Vascular and Biliary Complications in Adult Orthotopic Liver Transplant (OLT) Patients. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3104805.html
