Learning objectives
To review imaging evaluation in immediate post-operative liver transplantation.
To identify transitory changes at Doppler US in orthotopic liver transplantation.
Show our experience of the transitory changes on US Doppler in patients at Carlos Andrade Marín Hospital (Quito-Ecuador)
Background
Orthotopic liver transplantation is now considered the definitive treatment for a variety of conditions,
including end stage cirrhosis,
malignant and benign liver tumours,
metabolic disorders and other pathological conditions.
(1)
In March 1st 1963,
Starzl et al.
performed the first liver transplantation in the world.
The patient was a 3-year-old boy with biliary atresia who underwent to liver transplantation,
however,
he died during the surgery because of coagulation disorder and uncontrolled bleeding.
No patient have survived more than 23 days in the first 5 liver...
Findings and procedure details
Expected post-operative changes at grayscale US
The ultrasound study is preferred for early evaluation of patients with orthotopic liver transplantation due to its availability,
low cost and security.
Doppler ultrasound of the liver post-surgical varies within the first days,
the findings can be alarming but should not be misinterpreted.
(7)
The normal liver transplant has a homogeneous or slightly heterogeneous pattern at gray scale imaging.(5) Fig 4. The starry sky appearance may result from reperfusion edema in the early postoperative period.
(7) Fig 5.
Transient...
Conclusion
Doppler ultrasound evaluation show transitory findings in early post operative period that we should know to avoid misinterpretation and differentiate pathological changes that need urgent intervention.
Tab 1,
Tab 2.
Dynamic changes in the immediately postoperative period that tend to normalize are:
Increase speed and resistance index hepatic artery.
Monophasic flow and Increased velocity in portal vein.
In the vena cava and hepatic veins show turbulent flow and alteration of their phasicity.
References
1.
Camacho,
J.
C.
et al.
Nonvascular post-liver transplantation complications: from US screening to cross-sectional and interventional imaging.
Radiographics 35,
87–104 (2015).
2. Meirelles Júnior,
R.
F.
et al.
Liver transplantation: history,
outcomes and perspectives.
Einstein (Sao Paulo).
13,
149–52 (2015).
3. Ming,
Y.
Z.,
Niu,
Y.,
Shao,
M.
J.,
She,
X.
G.
& Ye,
Q.
F.
Hepatic veins anatomy and piggy-back liver transplantation.
Hepatobiliary Pancreat.
Dis.
Int.
11,
429–433 (2012).
4. INDOIT.
Instituto Nacional de Donación y Trasplante de Órganos,
Tejidos y Células (2016)....