2415: Role of Doppler US for the diagnosis of hepatic venous congestion in the anterior segment of the modified right lobe graft after living donor liver transplantation: A prospective study of 40 patients

Abstract

Objectives: To assess the value of Doppler US for the diagnosis of hepatic venous congestion (HVC) in anterior segment of the modified right-lobe graft (MRLG) after living donor liver transplantation (LDLT).Methods: Doppler US in 40 patients following LDLT with MRLG, in which middle hepatic vein tributaries(MHVT) larger than 5 mm were reconstituted with interposition vein graft, were prospectively evaluated. On color Doppler US, the number of MHVT of anterior segment of MRLG, their flow velocity and direction and reversal of segmental portal vein were evaluated. In addition, parenchymal echogenecity on grayscale US was recorded. HVC was diagnosed when there is dampened flow of MHVT in anterior segment of MRLG. Doppler US results were correlated to CT and angiographic findings.Results: Doppler US identified 100 of 103 MHVT larger than 5 mm (sensitivity 97%). The sensitivity and specificity of Doppler US for diagnosis of HVC was 89% (8/9) and 93% (85/91). Among 10 territories with HVC, increase of parenchymal echogenecity, reversed flow of MHVT and reversal of segmental portal vein was found in 7, 5 and 1, respectively.Conclusions: Doppler US provide excellent noninvasive screening for HVC in anterior segment of MRLG after LDLT. Dampened flow of MHVT larger than 5 mm may indicate HVC. Objectives: To assess the value of Doppler US for the diagnosis of hepatic venous congestion (HVC) in anterior segment of the modified right-lobe graft (MRLG) after living donor liver transplantation (LDLT). Methods: Doppler US in 40 patients following LDLT with MRLG, in which middle hepatic vein tributaries(MHVT) larger than 5 mm were reconstituted with interposition vein graft, were prospectively evaluated. On color Doppler US, the number of MHVT of anterior segment of MRLG, their flow velocity and direction and reversal of segmental portal vein were evaluated. In addition, parenchymal echogenecity on grayscale US was recorded. HVC was diagnosed when there is dampened flow of MHVT in anterior segment of MRLG. Doppler US results were correlated to CT and angiographic findings. Results: Doppler US identified 100 of 103 MHVT larger than 5 mm (sensitivity 97%). The sensitivity and specificity of Doppler US for diagnosis of HVC was 89% (8/9) and 93% (85/91). Among 10 territories with HVC, increase of parenchymal echogenecity, reversed flow of MHVT and reversal of segmental portal vein was found in 7, 5 and 1, respectively. Conclusions: Doppler US provide excellent noninvasive screening for HVC in anterior segment of MRLG after LDLT. Dampened flow of MHVT larger than 5 mm may indicate HVC.