SpringerLink
Log in

Indirect Doppler ultrasound abnormalities of significant portal vein stenosis after liver transplantation

  • Original Article
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Purpose

To determine indirect Doppler ultrasound (DUS) abnormalities associated with significant portal vein (PV) stenosis (PVS) in recipients of liver transplantation (LT).

Methods

This retrospective study was approved by our institutional review board. Between February 2006 and May 2017, 41 LT recipients were diagnosed with significant PVS, defined as having more than 50% narrowing of PV diameter for any reason, including thrombosis or flow disturbance associated with prominent collateral vessels on portal venography. We reviewed the DUS findings of hepatic arteries (HAs) as well as PVs of them, before and after treatment of PVS, and in comparison, with a one-to-one case-matched control. Inter-group comparison of frequency in DUS abnormalities was performed using Chi square (χ2) with Fisher’s exact test and McNemar’s test. Diagnostic values of each abnormal DUS finding and combinations were also evaluated.

Results

DUS of significant PVS showed “no demonstrable color flow,” either at recipient PVs or anastomoses (26.7%), and showed turbulence (66.7%) and hepatofugal portal flow (HFPF; 20.0%) at the graft PVs. HFPF was more frequently observed in those with “no demonstrable color flow” at recipient PVs or anastomoses (p = 0.006). DUS of graft HAs revealed tardus–parvus waveforms (20.9%) and prolonged systolic acceleration times (16.3%), more commonly in the “no demonstrable color flow” group (p = 0.012). These indirect DUS abnormalities disappeared and resolved on follow-up DUS after treatment. In the control group, such Doppler abnormalities were less frequently shown than in the PVS group (p ≤ 0.01, respectively). When one of the portal-blood flow velocity (PFV)-related index abnormalities (such as increased time average velocity [TAV] at anastomosis and TAV ratio between recipient PV and anastomosis) or “no demonstrable color flow” were shown in DUS as well as one of the indirect DUS abnormalities, sensitivity, and specificity was 71.11 and 97.78%, respectively.

Conclusion

In addition to PFV-related abnormalities, DUS occasionally shows “no demonstrable color flow” either at recipient PVs or anastomoses, and indirect Doppler abnormalities such as turbulence, HFPF at graft PVs, and abnormal waveforms at graft HAs in LT recipients with significant PVS. The combination of PFV-related abnormalities and indirect DUS abnormalities would be helpful for diagnosis of PVS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Meirelles Junior RF, Salvalaggio P, Rezende MB, et al. Liver transplantation: history, outcomes and perspectives. Einstein. 2015;13:149–52 (Sao Paulo, Brazil).

    Article  PubMed  Google Scholar 

  2. Farkas S, Hackl C, Schlitt HJ. Overview of the indications and contraindications for liver transplantation. Cold Spring Harb Perspect Med. 2014;4:a015602.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Crossin JD, Muradali D, Wilson SR. US of liver transplants: normal and abnormal. Radiographics. 2003;23:1093–114.

    Article  PubMed  Google Scholar 

  4. Jiang SM, Zhou GW, Zhang R, et al. Role of splanchnic hemodynamics in liver regeneration after living donor liver transplantation. Liver Transpl. 2009;15:1043–9.

    Article  PubMed  Google Scholar 

  5. Broniszczak D, Szymczak M, Kamiński A, et al. Vascular complications after pediatric liver transplantation from the living donors. Transpl Proc. 2006;38:1456–8.

    Article  CAS  Google Scholar 

  6. Chong WK, Beland JC, Weeks SM. Sonographic evaluation of venous obstruction in liver transplants. AJR. 2007;188:W515–21.

    Article  PubMed  Google Scholar 

  7. Huang TL, Cheng YF, Chen TY, et al. Portal hemodynamics in living-related liver transplantation: quantitative measurement by Doppler ultrasound. Transpl Proc. 1998;30:3186–7.

    Article  CAS  Google Scholar 

  8. Glockner JF, Forauer AR. Vascular or ischemic complications after liver transplantation. AJR. 1999;173:1055–9.

    Article  CAS  PubMed  Google Scholar 

  9. Sanyal R, Zarzour JG, Ganeshan DM, et al. Postoperative Doppler evaluation of liver transplants. Indian J Radiol Imaging. 2014;24:360–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Singh AK, Nachiappan AC, Verma HA, et al. Postoperative imaging in liver transplantation: what radiologists should know. Radiographics. 2010;30:339–51.

    Article  PubMed  Google Scholar 

  11. Woo DH, Laberge JM, Gordon RL, et al. Management of portal venous complications after liver transplantation. Tech Vasc Interv Radiol. 2007;10:233–9.

    Article  PubMed  Google Scholar 

  12. Nghiem HV, Tran K, Winter TC 3rd, et al. Imaging of complications in liver transplantation. Radiographics. 1996;16:825–40.

    Article  CAS  PubMed  Google Scholar 

  13. Jang YJ, Kim KW, Jeong WK, et al. Influence of preoperative portal hypertension and graft size on portal blood flow velocity in recipient after living donor liver transplantation with right-lobe graft. AJR. 2010;194:W165–70.

    Article  PubMed  Google Scholar 

  14. Park YS, Kim KW, Kim SY, et al. Obstruction at middle hepatic venous tributaries in modified right lobe grafts after living-donor liver transplantation: diagnosis with contrast-enhanced US. Radiology. 2012;265:617–26.

    Article  PubMed  Google Scholar 

  15. García-Criado A, Gilabert R, Berzigotti A, et al. Doppler ultrasound findings in the hepatic artery shortly after liver transplantation. AJR. 2009;193:128–35.

    Article  PubMed  Google Scholar 

  16. Sureka B, Bansal K, Rajesh S, et al. Imaging panorama in postoperative complications after liver transplantation. Gastroenterol Rep. 2015;4:96–106.

    Article  Google Scholar 

  17. Caiado AH, Blasbalg R, Marcelino AS, et al. Complications of liver transplantation: multimodality imaging approach. Radiographics. 2007;27:1401–17.

    Article  PubMed  Google Scholar 

  18. Mullan CP, Siewert B, Kane RA, et al. Can Doppler sonography discern between hemodynamically significant and insignificant portal vein stenosis after adult liver transplantation? AJR. 2010;195:1438–43.

    Article  PubMed  Google Scholar 

  19. Huang TL, Cheng YF, Chen TY, et al. Doppler ultrasound evaluation of postoperative portal vein stenosis in adult living donor liver transplantation. Transpl Proc. 2010;42:879–81.

    Article  CAS  Google Scholar 

  20. Huang TL, Chen TY, Tsang LL, et al. Hemodynamics of portal venous stenosis before and after treatment in pediatric liver transplantation: evaluation with Doppler ultrasound. Transpl Proc. 2012;44:481–3.

    Article  CAS  Google Scholar 

  21. Hawkins CM, Shaw DW, Healey PJ, et al. Pediatric liver transplant portal vein anastomotic stenosis: correlation between ultrasound and transhepatic portal venography. Liver Transpl. 2015;21:547–53.

    Article  PubMed  Google Scholar 

  22. Hsu HW, Huang TL, Cheng YF, et al. Sonographic evaluation of post-transplantation portal vein stenosis in pediatric living-donor liver transplant recipients with left-liver grafts. Transpl Proc. 2016;48:1162–5.

    Article  Google Scholar 

  23. García-Criado A, Gilabert R, Bargalló X, et al. Radiology in liver transplantation. Semin Ultrasound CT MR. 2002;23:114–29.

    Article  PubMed  Google Scholar 

  24. Spencer MP, Reid JM. Quantitation of carotid stenosis with continuous-wave (C-W) Doppler ultrasound. Stroke. 1979;10:326–30.

    Article  CAS  PubMed  Google Scholar 

  25. Eipel C, Abshagen K, Vollmar B. Regulation of hepatic blood flow: the hepatic arterial buffer response revisited. World J Gastroenterol. 2010;16:6046–57.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Park YS, Kim KW, Lee SJ, et al. Hepatic arterial stenosis assessed with Doppler US after liver transplantation: frequent false-positive diagnoses with tardus parvus waveform and value of adding optimal peak systolic velocity cutoff. Radiology. 2011;260:884–91.

    Article  PubMed  Google Scholar 

  27. Platt JF, Rubin JM, Ellis JH. Hepatic artery resistance changes in portal vein thrombosis. Radiology. 1995;196:95–8.

    Article  CAS  PubMed  Google Scholar 

  28. Henderson JM, Gilmore GT, Mackay GJ, et al. Hemodynamics during liver transplantation: the interactions between cardiac output and portal venous and hepatic arterial flows. Hepatology. 1992;16:715–8.

    Article  CAS  PubMed  Google Scholar 

  29. Payen DM, Fratacci MD, Dupuy P, et al. Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: interest for early complications and nutrition. Surgery. 1990;107:417–27.

    CAS  PubMed  Google Scholar 

  30. Lafortune M, Dauzat M, Pomier-Layrargues G, et al. Hepatic artery: effect of a meal in healthy persons and transplant recipients. Radiology. 1993;187:391–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by the Basic Science Research Program through the National Research Foundation (NRF) of South Korea, funded by the Ministry of Science, ICT, and Future Planning (No. 2017R1E1A1A03070961).

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea

    Jieun Byun, Kyoung Won Kim, Sang Hyun Choi & Sunyoung Lee

  2. School of Computer Science and Engineering, Soongsil University, Seoul, South Korea

    Jeong** Lee

  3. Division of Liver Transplantation and Hepatobiliary Surgery, Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Gi Won Song & Sung Gyu Lee

Authors
  1. Jieun Byun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyoung Won Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang Hyun Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sunyoung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeong** Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gi Won Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sung Gyu Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyoung Won Kim.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Byun, J., Kim, K.W., Choi, S.H. et al. Indirect Doppler ultrasound abnormalities of significant portal vein stenosis after liver transplantation. J Med Ultrasonics 46, 89–98 (2019). https://doi.org/10.1007/s10396-018-0894-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-018-0894-x

Keywords

Search

Navigation