SONOGRAPHIC EVALUATION OF OUTFLOW VEINS IN SUDANESE LIVER TRANSPLANTS

Ashraf Mustafa Mohammed Osman,Babiker Abd Elwahab Awad Alla,Asma Ibrahim Ahmed,Mohammed Al Fadil Gar Al Naby

doi:10.29121/granthaalayah.v6.i12.2018.1079

Ashraf Mustafa Mohammed Osman, Babiker Abd Elwahab Awad Alla + Show 2 more

Open Access

https://doi.org/10.29121/granthaalayah.v6.i12.2018.1079

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Abstract

The purpose of this study was to identify the specific Doppler criteria for the outflow vein (hepatic veins and inferior vena cava) obstruction in liver transplants. A case control study was done after performing venous Doppler sonographic studies in 300 normal (control) and 45 liver transplant cases (4 whole liver, 41 lobar) with no vascular obstruction. The ultrasonic Doppler study were classified as normal, occluded, or stenosed on the basis of gray scale and color flow mapping appearances as well as elevated or absent waves. The following Doppler parameters were evaluated: the outflow veins on color Doppler interrogation, venous pulsatility index on spectral trace. Receiver operating characteristic curves were constructed. There were no cases of outflow vein obstruction found in our sample (neither stenosis, nor occlusion). Mean venous pulsatility index for normal outflow veins was 0.75 and is found ranging between (0.55-0.75). A venous pulsatility index of < 0.45 is specific for stenosis (5). The venous pulsatility index is a useful parameter for diagnosing venous stenosis in liver transplants.

Highlights

Doppler ultrasound plays an important role in the postoperative management of hepatic transplantation, by enabling early detection and treatment of various vascular complications
This paper describes the normal Doppler findings in the outflow veins following liver transplantation
The incidence of hepatic venous outflow stenosis is higher in living donors and split graft liver pediatric grafts than in whole liver grafts, likely due to the size mismatch and small anastomosis. [Wang SL, et al 2005]

Summary

Introduction

Doppler ultrasound plays an important role in the postoperative management of hepatic transplantation, by enabling early detection and treatment of various vascular complications. It discusses transient waveform abnormalities, often seen on a post-transplant Doppler examination, and the importance of differentiating them from findings suggestive of ominous vascular complications of the hepatic veins and IVC. Thrombosis and stenosis are two rare complications of the IVC and hepatic veins, after hepatic transplantation. The incidence of hepatic venous outflow stenosis is higher in living donors and split graft liver pediatric grafts than in whole liver grafts, likely due to the size mismatch and small anastomosis. Most hepatic venous stenosis present late, many months to years after transplantation. [Buell JF, et al 2002]

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