O'Leary Catherine, Spence Samantha, Wells Reeder M, Sculley Daniel, Bettag Jefferey, Okeke Raymond I, Shoela Ramy, Nazzal Mustafa
Department of Surgery, Saint Louis University School of Medicine, St. Louis, USA.
Department of Surgery, Sisters of St. Mary (SSM) Health Saint Louis University Hospital, St. Louis, USA.
Cureus. 2024 Nov 13;16(11):e73588. doi: 10.7759/cureus.73588. eCollection 2024 Nov.
Aim This study aims to determine if routine use of intraoperative Doppler ultrasonography is preventative of life-threatening vascular complications (VCs) after orthotopic liver transplantation. Methods This single-center, retrospective study reviewed all adult orthotopic liver transplants at Saint Louis University Hospital from 2015 to 2020 (N = 188). The sample population consists of men and women in the age range of 18 to 75. Operative reports were reviewed for the use of intraoperative ultrasound (IOUS) and the associated resistive indices, peak systolic velocities, and qualitative assessments of flow. Postoperative VCs were identified as complications requiring intervention between the time of transplant and December 31, 2020. Life-threatening VCs were defined by the presence of vascular thrombosis. The primary outcome was the incidence of postoperative life-threatening VCs between those in which intraoperative DUS was performed and those in which it was not. Results IOUS was documented in 35 (18.6%) cases. All cases using IOUS demonstrated good flow and no abnormalities, as reported by the operating surgeon. There was no difference in patient population between those who received IOUS and those who did not. Postoperative life-threatening VCs were identified in five cases. Of the cases in which no IOUS was performed, five (3.3%) had life-threatening VCs. Of the patients with documented IOUS, 0 (0%) had life-threatening VCs. Conclusions The IOUS group showed a lower incidence of life-threatening VCs (0%) compared to the no IOUS group, which had a 3.3% life-threatening complication rate. However, this was not statistically significant due to the small number of VCs, as VCs following liver transplants are inherently rare. With these results in combination with current literature, there is support for the use of IOUS in preventing and predicting VCs.
目的 本研究旨在确定术中常规使用多普勒超声检查能否预防原位肝移植术后危及生命的血管并发症（VCs）。方法 这项单中心回顾性研究对2015年至2020年圣路易斯大学医院所有成人原位肝移植病例（N = 188）进行了分析。样本人群包括年龄在18至75岁之间的男性和女性。查阅手术报告，了解术中超声（IOUS）的使用情况以及相关的阻力指数、收缩期峰值流速和血流定性评估。术后VCs被定义为移植后至2020年12月31日期间需要干预的并发症。危及生命的VCs由血管血栓形成来定义。主要结局是术中进行DUS和未进行DUS的患者术后危及生命的VCs发生率。结果 35例（18.6%）有IOUS记录。据主刀医生报告，所有使用IOUS的病例血流均良好且无异常。接受IOUS和未接受IOUS的患者在人群特征上无差异。术后发现5例危及生命的VCs。在未进行IOUS的病例中，5例（3.3%）出现危及生命的VCs。在有IOUS记录的患者中，0例（0%）出现危及生命的VCs。结论 与未使用IOUS组相比，IOUS组危及生命VCs的发生率较低（0%），未使用IOUS组的危及生命并发症发生率为3.3%。然而，由于VCs数量较少，这一差异无统计学意义，因为肝移植后发生VCs本身就很罕见。结合这些结果和现有文献，支持使用IOUS预防和预测VCs。
