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Doppler ultrasound follow-up of middle hepatic vein tributaries-interposition vessel graft in recipients of living donor liver transplantation using modified right lobe grafts

 Sunyoung Lee  ;  Kyoung Won Kim  ;  So Yeong Jeong  ;  Kyung Jin Lee  ;  So Yeon Kim  ;  Gi Won Song  ;  Sung Gyu Lee 
 BRITISH JOURNAL OF RADIOLOGY, Vol.91 : 20180066, 2018 
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Female ; Follow-Up Studies ; Hepatic Veins/diagnostic imaging* ; Hepatic Veins/transplantation ; Humans ; Liver/blood supply ; Liver/diagnostic imaging* ; Liver Transplantation*/methods ; Living Donors* ; Male ; Middle Aged ; Ultrasonography, Doppler* ; Vascular Patency
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.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Sunyoung(이선영) ORCID logo https://orcid.org/0000-0002-6893-3136
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