Doppler Ultrasound Findings in the Hepatic Artery Shortly After Liver Transplantation

Purpose: To present the successful endovascular treatment of a severe recipient celiac trunk stenosis that led to allograft ischemia following liver transplantation. Case Report: A 56-year-old woman underwent orthotopic liver transplantation because of hepatitis C—induced cirrhosis. After the operation, routine hepatic Doppler ultrasonography showed a tardus parvus flow pattern in the hepatic artery, suggesting an impending hepatic artery thrombosis. Digital subtraction angiography (DSA), however, showed severe stenosis of the recipient celiac trunk and moderate splenic artery steal. The stenosis was dilated and stented in the same session. The postprocedural DSA showed good dilation of the lesion with immediate improvement of hepatic opacification. Follow-up Doppler ultrasound scans showed normal flow patterns in the hepatic artery at 3 and 6 months. Conclusions: In the presence of a tardus parvus flow pattern on Doppler ultrasound after liver transplantation, the possibility of an undetected recipient celiac stenosis should be considered in the differential diagnosis. Such lesions can successfully be treated with angioplasty and stenting.

Abstract The objective of this study is to determine whether hepatic artery Doppler ultrasound parameters can predict arterial complications in the immediate period after a liver transplantation in children.A retrospective review of the pediatric liver database at our tertiary-care pediatric hospital was performed. The study included 57 pediatric patients who underwent liver transplantation from 2016 to 2020. Clinical, laboratory and Doppler findings were recorded daily the first 5 days after transplantation. Especial attention was focused on extrahepatic post-anastomotic Peak Systolic Velocity (PSV) and intrahepatic Resistive Index (RI). Forty-nine liver transplant recipients were analyzed. Patients with acute hepatic artery complications, including acute thrombosis and stenosis, had lower PSV values at 3 and 4 days after surgery compared to the group with non-complications, with a statistical significance (p=.015). Receiver operating characteristic (ROC) curve analysis determined an optimal cut-off value of PSV less than 30 cm/s to discriminate children with and without acute hepatic arterial complications, which is lower than that proposed in adults. It correlates with acute arterial stenosis and thrombosis in children even before RI, clinical symptoms or laboratory anomalies appear.