Sonographic evaluation of vessel grafts in living donor liver transplantation recipients of the right lobe

Abstract

Aim: To evaluate the vessel grafts (VG) used to reconstruct the middle hepatic vein (MHV) tributaries with ultrasonography.

Methods: Twenty-four patients undergone living donor liver transplantation were enrolled in our study. MHV tributaries larger than 5 mm in diameter were reconstructed with interposition VG. Blood flow of the graft and interposition VG was checked by Doppler ultrasonography daily in the first 2 postoperative weeks and monthly followed up after discharge. The sensitivity of VG detected by ultrasonography was assessed using surgical records as references. Student's t test was used to compare the velocity of VG and occluded VG in chronic patents (> 3 mo).

Results: Thirty-one VG were used to reconstruct the MHV tributaries. Ultrasonography identified 96.7% (30/31) of large MHV tributaries and 90.3% (28/31) of VG. The diameter of VG was 5.6 +/- 0.8 mm and the velocity of VG was 19.7 +/- 8.1 cm/s. Two VG (2/31, 6.5%) were occluded on the first postoperative day in one patient who suffered from persistent ascites and had a prolonged recovery of liver function. Twenty-six VG (26/31, 83.9%) were patent 2 wk after operation. Six (6/31, 19.4%) VG were patent over 3 mo after operation. Intrahepatic venous collaterals were detected in 29.2% (7/24) patients. The velocity of VG and occluded VG was 30.1 +/- 5.6 cm/s, 16.5 +/- 5.8 cm/s, respectively, in chronic patents. The difference between two groups was statistically significant (P < 0.001).

Conclusion: Our results indicate that most VG are patent in the first postoperative week while only a small portion with a higher velocity remains patent after 3 mo. Intrahepatic venous collaterals can be observed in some patients after occlusion of VG.

Figure 1

Intraoperative photograph showing an interposition vessel graft (white arrow) draining venous flow from MHV tributaries in segments V-IVC (black arrow) (A) and interposition vessel grafts V5 (white arrow) and V8 (black arrow) (B) used to reconstruct MHV tributaries in segments V and VIII. MHV: Middle hepatic vein, IVC: Inferior vena cava.

Figure 2

Color Doppler ultrasonography showing large MHV tributaries (arrow) in segment V containing hepatofugal venous flow (A), vessel grafts (arrow) draining the IVC along the surgical margin of liver graft (B), and vessel graft (arrow) filled with contrast agent on contrast enhanced ultrasound indicating the vessel graft patency (C).

Figure 3

Color Doppler sonography showing MHV tributaries filled with hypoechoic substances representing thrombus (arrow) with no color signal in vessel grafts (A), contrast enhanced sonography showing no contrast agent in vessel grafts (arrow) and MHV tributaries (red arrow) indicating vessel occlusion (B), and contrast enhanced CT scan on postoperative day 2 showing an area of low attenuation in segment V corresponding to the draining territory of MHV (arrow) (C) in a 42-years old male who received a modified right lobe graft from his brother.

Figure 4

Color Doppler ultrasonography (A) and its sketch (B) showing MHV tributaries draining into the RHV via collaterals after thrombosis of vessel grafts on postoperative day 7 in a 32 years old male who received a right lobe graft from his wife.