Duplex Ultrasound Criteria for the Postoperative Liver Transplant Patient

Abstract

Complications following liver transplantation can be lethal. The utility of liver duplex imaging in predicting the need for re-exploration are unclear. We sought to better define the duplex values of the hepatic arterial and venous system in acute liver transplant patients and to assess whether there was a relationship between velocity measurements and need to return to the operating room. A retrospective record query of liver transplants during the period between September 2009 and May 2014 was performed. A total of 591 liver transplants were performed, of which 127 (21%) underwent hepatic duplex. Demographic and laboratory data, as well as return trips to the operating room, were also collected. Univariate analysis on duplex variables was used to determine if any values were associated with a return trip to the operating room. A total of 127 patients underwent 155 hepatic duplex studies during the period studied, most of which were prompted by abnormal bilirubin and liver function tests. Men made up 74% of the cohort, the mean age was 55 years, and the most common indication for transplantation was hepatitis C cirrhosis in (53% [n = 65]). Return to the operating room occurred in 46 patients (36%), but only 12 (10%) were taken back for suspicion of hepatic artery thrombosis. Of the patients, who required a return to the operating room, those taken back for suspected hepatic artery thrombosis, had a higher resistive index (0.82 vs 0.66; P < .01), had a trend towards a lower EDV (25.0 vs 12 cm/s, P = .08) but did not differ significantly in terms of peak systolic velocity of the hepatic or portal veins. These data suggest that high resistive index and low EDV of the hepatic artery may be associated with the need for re-exploration following liver transplantation, and the findings merit further study.