Lee Sunyoung, Kim Kyoung Won, Jeong So Yeong, Lee Kyung Jin, Kim So Yeon, Song Gi Won, Lee Sung Gyu
1 Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
2 Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine , Seoul , South Korea.
Br J Radiol. 2018 Sep;91(1089):20180066. doi: 10.1259/bjr.20180066. Epub 2018 Jun 14.
To investigate the value of Doppler ultrasound (US) in recipients of living donor liver transplantation (LDLT) using modified right-lobe grafts (mRLGs) with obstruction of the middle hepatic vein tributaries (MHVTs)-interposition vessel graft (IVG).
This study included 240 consecutive LDLT recipients in whom 564 MHVTs (>5 mm) were reconstructed using IVG. Regular follow-up Doppler US was performed to assess the patency of the MHVTs-IVG and, if there was an obstruction, to evaluate for the establishment of collateral drainage. MHVTs with obstruction were subdivided into those with and without intrahepatic veno-venous collaterals on Doppler US and were correlated with CT scans.
MHVTs-IVG obstruction was identified in 137 patients with 227 MHVTs on follow-up Doppler US (6.2 ± 4.7 months). 90 patients with 149 MHVTs in whom the time interval between Doppler US and contrast-enhanced dynamic CT scans was <1 week were classified into either collateral (68 patients with 121 MHVTs) or non-collateral (22 patients with 28 MHVTs) groups. The presence of intrahepatic veno-venous collaterals on Doppler US were significantly related to no remarkable hepatic venous congestion on CT by both per-patient and per-vein analyses (66 of 68 patients (97.1%) and 118 of 121 MHVTs (97.5%), p < 0.001 and p < 0.001, respectively).
On Doppler US follow-up of LDLT recipients using mRLGs, identification of intrahepatic veno-venous collaterals associated with obstruction of MHVTs-IVG suggests no remarkable hepatic venous congestion. Advances in knowledge: When an obstruction of a MHVTs-IVG is encountered on Doppler US follow-up of LDLT recipients using mRLGs, no further evaluation with CT is warranted if intrahepatic veno-venous collaterals are observed on Doppler US, as this finding suggests no remarkable hepatic congestion.
探讨多普勒超声（US）在使用改良右叶移植物（mRLG）且肝中静脉属支（MHVT）-间置血管移植物（IVG）阻塞的活体肝移植（LDLT）受者中的应用价值。
本研究纳入240例连续的LDLT受者，其中564条直径>5 mm的MHVT采用IVG重建。定期进行多普勒超声随访，以评估MHVT-IVG的通畅情况，若存在阻塞，则评估侧支引流的建立情况。将多普勒超声显示有阻塞的MHVT分为有和无肝内静脉-静脉侧支两组，并与CT扫描结果进行关联分析。
在随访的多普勒超声检查中，137例患者的227条MHVT出现了MHVT-IVG阻塞（6.2±4.7个月）。90例患者的149条MHVT在多普勒超声检查与对比增强动态CT扫描之间的时间间隔<1周，根据有无侧支分为侧支组（68例患者，121条MHVT）和无侧支组（22例患者，28条MHVT）。通过患者和静脉分析，多普勒超声显示的肝内静脉-静脉侧支的存在与CT上无明显肝静脉淤血显著相关（68例患者中的66例（97.1%）和121条MHVT中的118条（97.5%），p均<0.001）。
在使用mRLG的LDLT受者的多普勒超声随访中，识别与MHVT-IVG阻塞相关的肝内静脉-静脉侧支提示无明显肝静脉淤血。知识进展：在使用mRLG的LDLT受者的多普勒超声随访中，若遇到MHVT-IVG阻塞，且多普勒超声观察到肝内静脉-静脉侧支，则无需进一步进行CT评估，因为这一发现提示无明显肝淤血。
