Sunyoung Lee1,2, Kyoung Won Kim1, So Yeong Jeong1, Kyung Jin Lee1, So Yeon Kim1, Gi Won Song3, Sung Gyu Lee3. 1. 1 Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea. 2. 2 Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine , Seoul , South Korea. 3. 3 Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
Abstract
OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSION: 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.
OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Authors: Michel Claudon; Christoph F Dietrich; Byung Ihn Choi; David O Cosgrove; Masatoshi Kudo; Christian P Nolsøe; Fabio Piscaglia; Stephanie R Wilson; Richard G Barr; Maria C Chammas; Nitin G Chaubal; Min-Hua Chen; Dirk Andre Clevert; Jean Michel Correas; Hong Ding; Flemming Forsberg; J Brian Fowlkes; Robert N Gibson; Barry B Goldberg; Nathalie Lassau; Edward L S Leen; Robert F Mattrey; Fuminori Moriyasu; Luigi Solbiati; Hans-Peter Weskott; Hui-Xiong Xu Journal: Ultrasound Med Biol Date: 2012-11-05 Impact factor: 2.998
Authors: S Lee; K Park; S Hwang; Y Lee; D Choi; K Kim; K Koh; S Han; K Choi; K Hwang; M Makuuchi; Y Sugawara; P Min Journal: Transplantation Date: 2001-03-27 Impact factor: 4.939