Herrmann Jochen, Tozakidou Magdalini, Busch Jasmin, Herden Uta, Fischer Lutz, Groth Michael, Petersen Kay U, Helmke Knut
Department of Pediatric Radiology, Diagnostic and Interventional Radiology and Nuclear Medicine, University Clinic Hamburg-Eppendorf, Hamburg, Germany.
Department of Hepatobiliary Surgery, University Clinic Hamburg-Eppendorf, Hamburg, Germany.
Pediatr Transplant. 2019 Dec;23(8):e13593. doi: 10.1111/petr.13593. Epub 2019 Oct 6.
Color Doppler US is a readily available imaging modality for the evaluation of liver transplants. The aim of our study was to evaluate the temporal course of color Doppler US findings in children after LTX and to investigate the effect of resolving and persisting abnormalities during follow-up on long-term outcome. All children who underwent LTX during January 2000 until December 2003 (155 LTX in 137 patients, 75 male and 62 female; mean age at LTX 4.1 ± 4.8 years; range, 0.1-16.3 years) were retrospectively evaluated. Following a predefined ultrasound protocol with prospective documentation, intraoperative, post-operative, and follow-up examinations were evaluated for color Doppler abnormalities. The time of occurrence and temporal course of the findings were recorded. Graft survival rates and graft survival times were compared. Abnormal color Doppler US examinations were noted in 98 of 155 grafts during the entire observational period (63.2%). In 57 of 98 grafts (58.2%), abnormalities were limited to the perioperative period (<30 days after LTX). Survival of grafts with transient perioperative abnormalities was similar to transplantations with regular color Doppler US examinations (graft survival rates, 80.7% vs 84.2%, P = .622; mean graft survival time, 2596.92 vs 2511.40 days, P = .67). Grafts with persisting color Doppler US abnormalities in the follow-up period (>30 days after LTX; 37/98 LTX, 37.8%) showed reduced survival compared with regular courses (graft survival rate 62.2% vs 80.7%, P = .047), indicating underlying organ-specific alterations. Standardized longitudinal evaluation during the perioperative and the follow-up period can enhance the prognostic capabilities of color Doppler US in children following LTX.
彩色多普勒超声是一种易于获得的用于评估肝移植的成像方式。我们研究的目的是评估儿童肝移植术后彩色多普勒超声检查结果随时间的变化过程，并探讨随访期间异常情况的缓解和持续对长期预后的影响。对2000年1月至2003年12月期间接受肝移植的所有儿童（137例患者行155次肝移植，75例男性，62例女性；肝移植时平均年龄4.1±4.8岁；范围0.1 - 16.3岁）进行回顾性评估。按照预先定义的超声检查方案并进行前瞻性记录，对术中、术后及随访检查的彩色多普勒异常情况进行评估。记录检查结果出现的时间和随时间的变化过程。比较移植物存活率和移植物存活时间。在整个观察期内，155例移植物中有98例（63.2%）彩色多普勒超声检查异常。98例异常移植物中有57例（58.2%）的异常仅限于围手术期（肝移植术后<30天）。围手术期短暂异常的移植物存活率与彩色多普勒超声检查正常的移植相似（移植物存活率，80.7%对84.2%，P = 0.622；平均移植物存活时间，2596.92天对2511.40天，P = 0.67）。随访期（肝移植术后>30天）彩色多普勒超声持续异常的移植物（37/98例肝移植，37.8%）与正常病程相比存活率降低（移植物存活率62.2%对80.7%，P = 0.047），提示存在潜在的器官特异性改变。围手术期和随访期的标准化纵向评估可提高彩色多普勒超声对儿童肝移植术后的预后评估能力。
