S. Fu1, R. Maqsood1, K. Andreoni1, M. Johnson1, N. Battula1, A. Zarrinpar1, E. Thomas2 1University Of Florida,Surgery,Gainesville, FL, USA 2University Of Texas Health Science Center At San Antonio,Surgery,San Antonio, TX, USA
Introduction:
Hepatic artery complications after liver transplantation (LT) can lead to graft loss and are related to high morbidity rates and even recipient mortality. Early recognition and intervention are key components of mitigating the risks and improving patient outcomes.
Methods:
In a retrospective cohort study of patients at a single transplant center, 170 subjects who underwent primary liver transplant from May 2012 to November 2017 were analyzed. Doppler ultrasonography was routinely performed on these patients immediately after the LT operation per protocol. Parameters measured on these studies include resistive indices (RIs) within right, left, and main hepatic arteries, parvus tardus waveforms, and keywords such as “blunting,” “occlusion,” and “delayed upstroke.” RI < 0.5 was considered abnormal. These parameters were used to identify ultrasounds as “Normal” or “Abnormal.” The primary outcomes were hepatic artery stenosis (HAS) and hepatic artery thrombosis (HAT) categorized as early (< 30 days) and late (³30 days) and confirmed by operative exploration, angiogram, and/or CT Angiogram (CTA). We correlated the prognostic utility of the specific parameters of immediate post-transplant Duplex ultrasonography with subsequent HAS and HAT.
Results:
Of the 170 patients in the cohort, 27% (45/170) developed confirmed HAS and/or HAT. 17.8% (30/170) of all patients had abnormal HA ultrasound findings immediately after the transplant operation. 27% (40/148) of patients with normal initial RIs had early or late HAS/HAT, while 23% (5/22) of patients with abnormal initial RIs had HAS/HAT. From patients who developed early HAS/HAT, 69% (11/16) had normal ultrasound directly after transplant. Of patients with late HAS/HAT, 93% (27/29) had normal initial ultrasounds.
Conclusion:
Hepatic Artery duplex ultrasound results obtained immediately post-LT do not correlate with either early or late HAS/HAT. While this study may be underpowered to find a statistical difference, there does not appear to be a correlation between finding an abnormal immediate post-transplant ultrasound and HAS and/or HAT, nor does a normal ultrasound finding predict the absences of HAS/HAT development in the future. A broad designation of “abnormal” ultrasound or measurement of resistive indices of the hepatic arteries do not predict poor outcomes. More sensitive and specific tests will need to be used to predict HAS or HAT in this setting.
