Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Radiology. 2011 Nov;261(2):566-72. doi: 10.1148/radiol.11110138. Epub 2011 Aug 24.
To identify transcapsular arterial neovascularization with Doppler ultrasonography (US) in pediatric patients after liver transplantation and to assess the frequency of the finding, its underlying causes, and its relevance in terms of clinical outcome.
The study was approved by the local ethics committee, with waived informed consent. All pediatric patients who underwent liver transplantation between January 2000 and December 2003 were retrospectively evaluated. Patients were followed up until June 2008, by using a predefined US protocol with prospective documentation. Of 182 consecutive liver transplantations performed in 162 patients (mean age, 4.5 years; range, 0.1-18.4 years) in this period, 25 patients with a total of 27 liver transplantations underwent US examinations conducted by multiple investigators and were primarily excluded. Student t tests and χ(2) tests were performed where appropriate. The Tarone-Ware test was used to compare transplant survival times.
Transcapsular arterial neovascularization was noticed in 13 of 137 patients (9.5%) and in 13 of 155 liver transplants (8.4%). The mean time until arterial neovessels appeared was 157 days after liver transplantation (median, 97 days; range, 19-477 days). Arterial neovascularization was associated with pronounced transplant malperfusion and inflammatory changes (P < .001). Patients with transcapsular arterial neovascularization had a significantly shorter mean transplant survival time (1426.4 days ± 244.5 [standard error], with 95% confidence interval: 947.23, 1905.23, vs 2526.4 days ± 92.1, with 95% confidence interval: 2345.84, 2706.97; P = .008) and a higher retransplantation rate (53.8% vs 19.7%, P = .009).
Transcapsular arterial neovascularization, detected with color Doppler US, occurred in 9.5% (13 of 137) of pediatric patients and 8.4% (13 of 155) of liver transplants and was associated with underlying malperfusion and inflammation. The diagnosis of transcapsular arterial neovascularization was associated with reduced graft survival times and a high retransplantation rate. The negative prognostic value of the sign may assist in a strategy of organ allocation.
利用多普勒超声（US）识别小儿肝移植术后包膜下动脉新生血管，并评估其检出率、潜在原因及其与临床结果的相关性。
本研究经当地伦理委员会批准，患者无需知情同意。回顾性评估 2000 年 1 月至 2003 年 12 月期间接受肝移植的所有小儿患者。采用预设的 US 方案进行前瞻性记录，对患者进行随访至 2008 年 6 月。在此期间，162 例患者（平均年龄 4.5 岁；范围，0.1-18.4 岁）共进行了 182 例连续肝移植，其中 25 例患者（共 27 例肝移植）接受了多位研究者进行的 US 检查，主要被排除在外。适当情况下采用 Student t 检验和 χ(2)检验。Tarone-Ware 检验用于比较移植生存时间。
137 例患者中有 13 例（9.5%）和 155 例肝移植中有 13 例（8.4%）发现包膜下动脉新生血管。肝移植后出现动脉新生血管的平均时间为 157 天（中位数为 97 天；范围，19-477 天）。动脉新生血管与明显的移植灌注不良和炎症改变相关（P <.001）。有包膜下动脉新生血管的患者移植生存时间明显缩短（平均 1426.4 天±244.5[标准误差]，95%置信区间：947.23，1905.23，vs 2526.4 天±92.1，95%置信区间：2345.84，2706.97；P =.008），再次移植率较高（53.8% vs 19.7%，P =.009）。
彩色多普勒 US 检测到小儿患者（13/137，9.5%）和肝移植患者（13/155，8.4%）中存在包膜下动脉新生血管，与潜在的灌注不良和炎症有关。包膜下动脉新生血管的诊断与移植物生存时间缩短和高再次移植率相关。该征象的负预后价值可能有助于器官分配策略。
