Can Doppler Sonography Discern Between Hemodynamically Significant and Insignificant Portal Vein Stenosis After Adult Liver Transplantation?

Abstract

The purpose of our study was to determine whether Doppler sonography, using a strict reference standard, can specifically identify hemodynamically significant portal vein anastomotic stenosis after liver transplantation in adults. The duplex and color Doppler examinations of 13 consecutive adult patients who underwent portal venography for suspected portal vein stenosis after liver transplantation were retrospectively examined. Peak systolic velocity (PSV) and change in PSV (ΔPSV) along the portal vein were correlated with portal venography. Stenoses above 50% on the basis of strict venographic criteria were considered hemodynamically significant. The Doppler studies before and after intervention were also assessed. Fourteen randomly chosen subjects with transplants without suspicion of portal anastomotic stenosis acted as controls. Six patients had significant portal vein stenosis (> 50%) and seven had stenosis below 50%. PSV and ΔPSV were significantly greater for patients with > 50% stenosis in comparison with those with ≤ 50% stenosis and control subjects. Optimal threshold values for PSV and ΔPSV were 80 and 60 cm/s, respectively, with either value alone yielding sensitivity of 100% and specificity of 84% for significant stenosis. Threshold values also included cases of stenosis below 50%. Five of six patients with > 50% stenosis underwent stenting, with poststent PSV and ΔPSV significantly declining to match that of control subjects. Three of seven with stenosis below 50% had stents placed but no significant change in the Doppler examination. Doppler threshold criteria reliably exclude those without posttransplantation portal vein stenosis and have high sensitivity for detecting portal stenosis. However, these criteria cannot discern the extent of stenosis.