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Doppler ultrasound predictors of transplant hepatic venous outflow obstruction in pediatric patients.
- Source :
-
Pediatric transplantation [Pediatr Transplant] 2018 Dec; Vol. 22 (8), pp. e13310. Date of Electronic Publication: 2018 Oct 19. - Publication Year :
- 2018
-
Abstract
- Objective: To investigate Doppler US and catheter venogram correlates to improve detection of transplant HVOO and avoid unnecessary invasive imaging procedures.<br />Materials and Methods: A retrospective review was performed in all pediatric OLT patients undergoing catheter venography of the hepatic veins between 2007 and 2017 at a single large tertiary pediatric liver transplant institution.<br />Results: Forty-four transplant hepatic venograms in 32 OLT patients were included (mean 1.38, range 1-4 venograms per patient). All venograms were preceded by an independent Doppler US examination. Twenty-one (47.7%) venograms were performed for the investigation of suspected HVOO based on Doppler US alone, 19 (43.2%) were performed for TJLB without suspected HVOO, 4 (9.1%) were performed for both. Sixteen (36.3%) instances of >50% anastomotic stenosis were identified. Mean peak anastomotic velocities were 208 cm/s and 116 cm/s in the presence and absence of a >50% venographic stenosis, respectively (P < 0.004). In all cases where there was a monophasic waveform seen on Doppler US, there was a > 50% stenosis seen on hepatic vein venogram. In all cases where a triphasic waveform was seen on Doppler US, there was no stenosis seen on hepatic vein venogram.<br />Conclusion: While a Doppler US velocity threshold providing both high sensitivity and specificity has yet to be identified, increasing peak anastomotic velocity and decreasing intrahepatic venous velocity correlate strongly with venographic outflow stenosis. The presence of a triphasic intrahepatic waveform provides good NPV.<br /> (© 2018 Wiley Periodicals, Inc.)
- Subjects :
- Adolescent
Anastomosis, Surgical
Angiography
Catheters
Child
Child, Preschool
Constriction, Pathologic
Female
Hepatic Veins diagnostic imaging
Humans
Infant
Male
Portal Vein diagnostic imaging
Propionic Acidemia complications
Retrospective Studies
Unnecessary Procedures
Young Adult
Budd-Chiari Syndrome diagnostic imaging
Liver diagnostic imaging
Liver surgery
Phlebography
Ultrasonography, Doppler
Subjects
Details
- Language :
- English
- ISSN :
- 1399-3046
- Volume :
- 22
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Pediatric transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 30338622
- Full Text :
- https://doi.org/10.1111/petr.13310