Duplex doppler ultrasound for the detection of vascular occlusion following liver transplantation in children

doi:10.1016/S0009-9260(05)80032-7

Clinical Radiology

Volume 46, Issue 1, July 1992, Pages 38-42

https://doi.org/10.1016/S0009-9260(05)80032-7 Get rights and content

Sixty-three children and adolescent patients who received 78 consecutive orthotopic liver transplants and had serial duplex ultrasound monitoring were retrospectively reviewed for episodes of occlusion of the hepatic artery or portal vein. There were 13 documented episodes of complete occlusion of the main hepatic artery or a major branch, of which nine were diagnosed by the absence of flow during duplex ultrasound examination. Four occlusions were not detected, two affected hepatic artery branches, one an accessory hepatic artery, and one the main hepatic artery. The overall sensitivity of the method was 69% and specificity 100%. Six portal vein occlusions were documented in five patients and all six were successfully diagnosed on ultrasound examination, giving a sensitivity and specificity of 100%. Three of the patients had simultaneous occlusions of both vessels. In the early post-operative period duplex Doppler ultrasound examination has proved an effective non-invasive method for the detection of vascular occlusion, but is not yet sensitive enough to replace angiography fully for the detection of hepatic artery occlusion, particularly when this occurs distal to the main hepatic artery.

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Cited by (38)

Doppler ultrasonography is a useful tool for the diagnosis of hemodynamics in congestive graft injury due to heart failure after liver transplantation: A case report
2021, International Journal of Surgery Case Reports
Citation Excerpt :
Our patient's LVEF and LV dilation gradually improved post-transplantation. Abdominal Doppler US is the primary method of detecting complications after liver transplantation [16–18]. The normal hepatic vein Doppler US waveform is triphasic and represents physiological changes in blood flow during the cardiac cycle.
Patients with end-stage liver disease often have cardiac dysfunction, which can be worsened by hemodynamic instability in liver transplantation, causing congestive graft injury.
A 28-year-old male with Wilson's disease underwent liver transplantation. The patient's history included cirrhotic cardiomyopathy and a preoperative ejection fraction of 37% on echocardiography. After liver transplantation, massive transfusion and acute renal failure led to increased central venous pressure. Doppler ultrasonography (US) showed an increase in positive components of the hepatic vein triphasic wave, followed by pulsatile changes in the portal vein waveforms and an eventual to-and-fro pattern. Laboratory data showed severe elevations of hepatocellular transaminase levels. Based on Doppler US findings, we determined liver damage was due to passive congestion caused by heart failure. Immediate initiation of continuous hemodiafiltration (CHDF) and intra-aortic balloon pumping (IABP) led to the patient's recovery from severe heart failure and graft injury.
In our case, changes in the hepatic and portal vein waveforms and marked elevation of hepatocellular transaminases implied exacerbation of heart failure caused by hepatic congestion and injury. Worsening heart failure, in turn, led to progressive liver damage as the result of hepatic passive congestion. The patient's condition was successfully managed with early initiation of CHDF and IABP.
Doppler US can help diagnose congestive graft injury due to heart failure in liver transplant patients and should be performed during post-transplant management of patients with cardiac dysfunction.
Early hepatic artery thrombosis after liver transplantation: A systematic review of the incidence, outcome and risk factors
2009, American Journal of Transplantation
To clarify inconsistencies in the literature we performed a systematic review to identify the incidence, risk factors and outcome of early hepatic artery thrombosis (eHAT) after liver transplantation. We searched studies identified from databases (MEDLINE, EMBASE, Science Citation Index) and references of identified studies. Seventy-one studies out of 999 screened abstracts were eligible for this systematic review. The incidence of eHAT was 4.4% (843/21, 822); in children 8.3% and 2.9% in adults (p < 0.001). Doppler ultrasound screening (DUS) protocols varied from ‘no routine’ to ‘three times a day.’ The median time to detection was at day seven. The overall retransplantation rate was 53.1% and was higher in children (61.9%) than in adults (50%, p < 0.03). The overall mortality rate of patients with eHAT was 33.3% (range: 0–80%). Mortality in adults (34.3%) was higher than in children (25%, p < 0.03). The reported risk factors for eHAT were, cytomegalovirus mismatch (seropositive donor liver in seronegative recipient), retransplantation, arterial conduits, prolonged operation time, low recipient weight, variant arterial anatomy, and low volume transplantation centers. eHAT is associated with significant graft loss and mortality. Uniform definitions of eHAT and uniform treatment modalities are obligatory to confirm these results and to obtain a better understanding of this disastrous complication.
Prevalence, Treatment, and Outcomes of the Hepatic Artery Stenosis After Liver Transplantation
2008, Transplantation Proceedings
Citation Excerpt :
Doppler US is a noninvasive method to show hepatic artery patency; however, in a series described by Albvasoglu et al,19 its sensitivity was only 85%. Lomas et al have suggested that the Doppler US is not sufficiently sensitive to replace angiography to detect HAS.20 HAS treatment is possible with surgical reanastomosis or more recently, the use of interventional vascular procedures such as stent placement and angioplasty.
Hepatic artery stenosis (HAS) after liver transplantation can lead to altered hepatic function and/or thrombosis, there by increasing morbidity and mortality. The prevalence of HAS in the literatures varies from 4% to 11%.
We sought to describe the prevalence and treatment of hepatic artery stenosis.
We performed a descriptive retrospective analysis of 253 liver transplantations from March 1998 to May 2007, including patients with suspected HAS owing to increased hepatic enzymes, altered Doppler ultrasound (us) and hepatic biopsy. The confirmation of HAS was achieved through areriography.
Nine patients were identified to have HAS, a 3.5% prevalence. Among the HAS patients, seven were male and two female. Their average age was 35.5 years (range, 65 to 53). The average time between the diagnosis and transplantation was 14.2 months (range, 9 to 68). The increase in hepatic enzymes among this group averaged: aspartate aminotransferase 131 U/L (range, 26 to 412) and alanine aminotransferase 192 U/L (range, 35 to 511). Doppler US showed alteration in the resistance level index. All patients underwent areriography; only one could not be treated owing to severe hepatic artery spasm, which also occurred during another attempt weeks after the first one. Among the eight patients, six were treated with stents and two with angioplastis. All treated patients displayed improvements in parameters. Four patients treated with stents required retreatment: two underwent angioplasty and two, a thrombolytic. One graft rethrombosed but evolved in compensated fashion with recanalization by collaterals. There has been no graft loss or mortality in this population. The average time of posttreatment follow-up was 31.28 (range, 9 to 68) months.
The prevalence of HAS in our unit was within that reported in the literature. Treatment with a stent or angioplasty proved to be efficient to control this complication, considering that hepatic function recovered and that there was neither graft nor patient loss.
Split-Liver Transplantation for Two Adults
2005, Transplantation of the Liver
A pictorial review of conventional and new applications of duplex Doppler sonography in the pediatric abdomen
2003, Current Problems in Diagnostic Radiology
Citation Excerpt :
Color-flow Doppler scan at the hepatic hilum shows flow in the hepatic artery and absence of flow in the portal vein (arrow) in a 12-year-old boy with entire liver transplantation. Color-flow and pulsed-wave Doppler scanning show total absence of flow within the portal lumen.41,42 On occasion, there might be total absence of flow in the hepatic hilum and inversion of the portal flow in peripheral intrahepatic branches, caused by spontaneous arterioportal shunts that rapidly open in the presence of portal vein thrombosis.
Sonographic measurements of the portal vein and its intrahepatic branches in children
1998, European Journal of Ultrasound
Dilatation of the portal vein is a leading sonographic sign in portal hypertension. Enlargement of its intrahepatic branches is found in various liver diseases such as cystic fibrosis and hepatic schistosomiasis. However, body height dependent values for pathological portal vein diameters on ultrasound have been published for adults only and reference values for intrahepatic portal vein branches have to be established. Diameters of the portal vein and of peripheral portal vein branches were investigated in 130 healthy European children and adolescents by ultrasound. The findings correlated significantly with age and body height. Thus, height related diameter values should be used to define pathological enlargement of the portal vein and its intrahepatic branches in children. Our reference data may contribute to improve sonographical investigation of portal hypertension and periportal fibrosis.

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Original PaperDuplex doppler ultrasound for the detection of vascular occlusion following liver transplantation in children

Journal of Paediatrics

Liver transplantation: the recent Cambridge/King's College Hospital experience

Surgical complications in the post-operative period of liver transplantation in children

Hepatic retransplantation

Variability of clinical presentation of hepatic artery thrombosis in paediatric liver transplantation: role of imaging modalities

Paediatric Radiology

Clinical presentation of hepatic artery thrombosis after liver transplantation in the cyclosporine era

Transplantation

Vascular complication after liver transplantation: a 5 year experience

American Journal of Roentgenology

Failure of duplex sonography to diagnose hepatic artery thrombosis in a high risk group of paediatric liver transplant recipients

Original Paper
Duplex doppler ultrasound for the detection of vascular occlusion following liver transplantation in children