Ahmad Tahani, Chavhan Govind B, Avitzur Yaron, Moineddin Rahim, Oudjhane Kamaldine
1 Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
2 Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
AJR Am J Roentgenol. 2017 Sep;209(3):671-675. doi: 10.2214/AJR.17.17902. Epub 2017 Jun 28.
The purpose of this article is to determine whether hepatic artery (HA) Doppler parameters can be used to predict pediatric liver graft status in the immediate postoperative (< 10 days) period and in the first year after transplant.
A retrospective review of the liver transplant database was performed to review operative, clinical, laboratory, histopathologic, and ultrasound findings at three time points after surgery: 3 days, 3 months, and 1 year. The association between HA velocity and resistive index (RI) with graft status was assessed.
Of 120 children (54 girls and 66 boys; mean age, 3 years 2 months) enrolled, 70 had satisfactory graft status at the 1-year follow-up examination. HA velocity of 50-200 cm/s at 3 days was associated with normal graft status during the immediate postoperative period (p = 0.003), at 3 months (p = 0.0653), and at the 1-year follow-up examination (p = 0.0268). Vascular and biliary complications in the immediate postoperative period were more frequent at an HA velocity of 201-300 cm/s (p = 0.0024). There was a significant association between RI at 3 days and graft status in the immediate postoperative period (p = 0.0308), with an RI less than 0.5 associated with vascular complications (p = 0.0116).
An RI less than 0.5 is associated with vascular complications. An HA velocity of 50-200 cm/s and an RI of 0.5-0.8 are associated with normal graft status in children within the first year after transplant. Values outside this range, or in this range along with a constellation of other ultrasound findings and clinical status, support the initiation of additional more-specific investigations that may help in early treatment to prevent complications.
本文旨在确定肝动脉（HA）多普勒参数是否可用于预测小儿肝移植术后即刻（<10天）及移植后第一年的肝移植状态。
对肝移植数据库进行回顾性分析，以查看术后三个时间点（3天、3个月和1年）的手术、临床、实验室、组织病理学和超声检查结果。评估HA速度和阻力指数（RI）与移植状态之间的关联。
纳入的120名儿童（54名女孩和66名男孩；平均年龄3岁2个月）中，70名在1年随访检查时移植状态良好。术后3天HA速度为50 - 200 cm/s与术后即刻（p = 0.003）、3个月时（p = 0.0653）及1年随访检查时（p = 0.0268）的移植状态正常相关。术后即刻HA速度为201 - 300 cm/s时血管和胆道并发症更常见（p = 0.0024）。术后3天的RI与术后即刻的移植状态之间存在显著关联（p = 0.0308），RI小于0.5与血管并发症相关（p = 0.0116）。
RI小于0.5与血管并发症相关。移植后第一年内，HA速度为50 - 200 cm/s且RI为0.5 - 0.8与儿童移植状态正常相关。超出此范围的值，或在此范围内同时伴有一系列其他超声检查结果和临床状态，支持开展更多特异性检查，这可能有助于早期治疗以预防并发症。
