Hepatic arterial waveforms on early posttransplant Doppler ultrasound.

OBJECTIVES

To determine the significance of spectral Doppler hepatic artery waveforms obtained in the first 10 days after primary liver transplantation and to determine the best early predictor of hepatic arterial thrombosis (HAT).

SUBJECTS AND METHODS

A total of 645 patients were retrospectively followed up to 1 year after liver transplantation. Doppler waveforms of the hepatic arteries were categorized as normal, abnormally elevated, not visualized, or with resistive index (RI) <0.5 on all examinations performed within the first 10 days. Waveforms were then correlated with patient outcomes within 1 year.

RESULTS

Of the 645 patients, 83 (12.8%) had nonvisualization of at least one hepatic artery on Doppler evaluation and 56 (8.7%) developed HAT or stenosis within the first year after transplantation. Odds ratios (ORs) demonstrate that a single nonvisualized hepatic artery (OR, 9.66; 95% confidence interval [CI], 4.51-20.70) has a much higher incidence of HAT in the first 10 days after transplantation compared to low RI (OR, 1.93; 95% CI, 0.77-4.79)] or high RI (OR, 1.06; 95% CI, 0.44-2.55]. The loss or reversal of diastolic flow on Doppler ultrasound performed in the first 10 days after transplantation does not seem to correlate with active or impending HAT.

CONCLUSION

Absence of hepatic arterial flow Doppler signal in the first 10 days after liver transplantation is associated with higher incidence of thrombosis than previously demonstrated, whereas persistently high diastolic flow early on seems to be more significant and leads to further hepatic arterial complications than decreased diastolic flow.