Woo Kyoung Jeong MD, Presenter: Nothing to Disclose

Kyoung Won Kim MD, Abstract Co-Author: Nothing to Disclose

Pyo Nyun Kim MD, Abstract Co-Author: Nothing to Disclose

Gi Won Song, Abstract Co-Author: Nothing to Disclose

Shin Hwang MD, Abstract Co-Author: Nothing to Disclose

Sung Gyu Lee MD, Abstract Co-Author: Nothing to Disclose

To classify the diseases causing hepatofugal portal flow (HFPF) on Doppler US in patients following liver transplantation (LT), to categorize HFPF according to the wave pattern, and to investigate the clinical significance of HFPF in each class and category.

We searched database of LT recipients in our institution, and found 29 patients in whom Doppler US revealed HFPF during the follow-up. After review of their radiological and pathological reports, patients were classified them into three groups according to the presumed cause of HFPF: A, hepatic inflow; B, hepatic outflow; and C, parenchymal abnormalities. We also categorized the Doppler patterns into 1) continuously HFPF, 2) to-and-fro pattern of which overall amount of HFPF larger than hepatopetal portal flow (HPPF), and 2) to-and-fro pattern of which HFPF smaller than HPPF. Medical records were reviewed to investigate clinical outcome.

HFPF developed on postoperative day 1 to 3350 days (mean, 363.1 days). Ten, eight and eleven patients with HFPF were classified into group A, B and C, respectively. In group A, the presumed cause was portal insufficiency (n=6) and portal vein thrombosis (n=4). In group B, it was the hepatic outflow obstruction at anastomosis (n=4) and post-anastomotic problems such as tricuspid regurgitation (TR) or high central venous pressure (n=4). In group C, it was acute rejection (n=5), ischemic necrosis (n=3), liver cirrhosis (n=1), and venoocclusive disease (VOD) (n=2). In group A, two (20%) of ten patients died of portal insufficiency; in group B, one (12.5%) of eight died of severe TR; in group C, five (45.5%) of eleven died of ischemic necrosis (n=3), VOD (n=1) and acute rejection (n=1). Based on Doppler waveform, twelve patients had pattern 1 HFPF, seven had pattern 2, and the other ten had pattern 3. The mortality in patients with pattern 1 HFPF was 33.3%, pattern 2 was 28.6%, and pattern 3 was 20%.

HFPF reflects various pathologic conditions after LT, and the prognosis is also diverse depending on the causes.

Hepatofugal portal flow reflects various pathologic conditions after liver transplantation, and the prognosis is also diverse depending on the causes.

Jeong, W, Kim, K, Kim, P, Song, G, Hwang, S, Lee, S, Hepatofugal Portal Venous Flow on Doppler US in Patients Following Liver Transplantation: Is it Always a Sign of the Life-threatening Complication?.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6016985.html