Helena Gabriel MD, Abstract Co-Author: Nothing to Disclose

Michael Luo, Presenter: Nothing to Disclose

Alexander James Kieger MD, Abstract Co-Author: Nothing to Disclose

Robert McCarthy MD, Abstract Co-Author: Nothing to Disclose

David Donald Casalino MD, Abstract Co-Author: Nothing to Disclose

Nancy A. Hammond MD, Abstract Co-Author: Nothing to Disclose

Paul Nikolaidis MD, Abstract Co-Author: Nothing to Disclose

Jeanne Miriam Horowitz MD, Abstract Co-Author: Nothing to Disclose

Juan Caicedo, Abstract Co-Author: Nothing to Disclose

To compare and contrast complications and sonographic findings between partial and whole liver transplants to determine if previously held interpretation guidelines should be altered for partial transplants.

In this retrospective, IRB-approved study, we evaluated partial liver transplants and chose a MELD score-matched cohort of whole liver transplants to compare.  Each patient had a baseline ultrasound at 24 hours and most had addditional exams at 1, 2, and 4 weeks, as well as preceding a complication.  Numerous sonographic parameters were noted and statistically compared between the two groups.

104 partial transplants were compared to 104 whole transplants resulting in a review of 577 ultrasound exams.  Partial liver transplants experienced a significantly higher overall number of complications than whole (66 vs. 44, p<0.02) with biliary complications predominating (39% vs. 23%, p<0.05).  Vascular complication rates were similar between the two groups.  Of ultrasound parameters, partial transplants demonstrated significantly increased portal vein velocities throughout the portal venous system (avg 91 cm/s vs 65 cm/s, p<0.05) and significantly lower hepatic arterial RIs at the anastomosis and distally (.66 vs .77, p<0.05). Partial transplants were slightly more likely to have monophasic hepatic venous flow than whole.  When following these patients over time, these differences in parameters normalized at the one month period.   Of patients with biliary complications, vascular RI differences on the US preceding detection of the complication approached significance.

Partial liver transplants experience higher rates of overall complications dominated by biliary complications.  Also, differences in sonographic parameters occur in partial liver transplants relative to whole early on but tend to normalize on follow up at one month.  These differences can be erroneously misinterpreted as representing vascular emergencies necessitating further work up.  An awareness these these sonographic parameter variations in partial liver transplants may be in the realm of normal may avoid unnecessary procedures.

An awareness that sonographic parameter variations can occur early on with partial liver transplants but tend to normalize at one month may suggest follow up rather than more aggressive procedures in these patients.

Gabriel, H, Luo, M, Kieger, A, McCarthy, R, Casalino, D, Hammond, N, Nikolaidis, P, Horowitz, J, Caicedo, J, Comparison of Partial and Whole Adult Liver Transplants: A Need for New Interpretive Guidelines?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011322.html