Value Of Color Doppler Ultrasonography In Monitoring Normal Haemodynamics Change Postoperative Orthotopic Liver Transplantation

Objectives: To study normal haemodynamics change postoperative orthotopic liver transplantation (OLT) by color Doppler Ultrasonography (CDUS). And to evaluate the value of color Doppler Ultrasonography in the blood vessel complications postoperative orthotopic liver transplantation. And to investigate the relationship between the DPI index of the hepatic artery and biliary tract complications postoperative orthotopic liver transplantation .Methods: We retrospectively analyzed the sonographic features in 75 patients postoperative orthotopic liver transplantation, including 64 male and 11 female, years of age from 22 to 55. Using color Doppler Ultrasonography monitored 30 patients without blood vessel complications and biliary tract complications whithen 30 days after operation. At the same time, We also retrospectively analyzed the sonographic features in 7 patients suffered from hepatic artery complications and 10 patients with biliary tract complications .There were 31 patients with primary hepatic carcinoma, 31 patients with HBV hepatic cirrhosis, 7 patients with serious hepatitis, 3 patients with HCV hepatic cirrhosis, 1 patient with alcoholic cirrhosis, 1 patient with mammary cancer hepatic metastasis and 1 patient with Kinnier-Wilson syndrome in 75 researched patients. The 75 patients postoperative orthotopic liver transplantation were examined by CDUS and gotten the results including peak systolic velocity (Pv), resistance index (RI), end-diastole velocity (Ed), average flow (Vmean), inner diameter (D),volume of blood flow per minute(HAF) and Doppler perfusion index (DPI) of the hepatic artery (HA), inner diameter (D)and time average velocity (TAV) of portal vein (PV), as well as velocity of hepatic vein (HV) within different stages after operation .Results: In the early stage postoperative OLT, peak systolic velocity (Pv) and volume of blood flow per minute of the hepatic artery (HAF)were lower within the first 7days than after the 7days for the 30 patients without complications(Ps=57.07±20.82cm/s, P=0.04, P<0.05; HAF=152.1±50.1ml/min, P=0.04, P<0.05); but higher resistance index (RI) were seen in the same patients within the first 7days than after the 7days (RI=0.690±0.09, P=0.01, P<0.05). In the same time, time average velocity (TAV) of portal vein were higher within the first 7days than after the 7days for the same patients(TAV=32.47±14.35cm/s, P=0.03, P<0.05); but inner diameter (D) of portal vein were smaller within the first 7days than after the 7days(D=1.08±0.16cm, P=0.04, P<0.05).And other blood flow parameters, for example inner diameter (D) of the hepatic artery and volume of blood flow per minute of portal vein, did not show statistical significance(P>0.05)in thedifferent stages postoperative orthotopic liver transplantation.CDUS hinted 7 patients(7/75,9%)suffered from the hepatic artery vessel complications. Five patients(7%)showed no hepatic arterial flow signals around portal vein and were dignosed hepatic artery thrombosis (HAT) by CDUS. One patient(1%) happened hepatic artery stenosis (HAS) and one patient(1%)had arterio-venous fistula (AVF). There were 6 patients confirmed by angiography and the accurate rate of Ultrasonography is 85.7%.There were 10 patients(10/75,13.3%)suffered from biliary tract complications postoperative orthotopic liver transplantation. In them there were 4 bile duct stoma stenosis; there were 2 patients with Calculus of bile duct; one patient with mud intrahepatic bile duct and 3 patients with biliary fistula. The complications happened from 7days to more than one year postoperative orthotopic liver transplantation .And all the patients were conformed by ERCP, other imageology and operations.Conclusion: In the early stage(withen the first 7days)postoperative orthotopic liver transplantation, peak systolic velocity (Pv) and volume of blood flow per minute(HAF) of the hepatic artery were lower, and time average velocity (TAV) of portal vein were higher. This phenomenon was concerned with narrow inner diameter and stoma dropsy of the hepatic artery. And peak systolic velocity of the hepatic artery and time average velocity of portal vein would return normal range after 1 week. The hemodynamics changes of PV and HA in liver transplantation are valuable for assessing the liver of transplantation and early diagnose its complication by CDUS.CDUS is a sensitive and specific way for the blood vessel complications after OLT, and has becomed the first detection instrument, monitoring all kinds of complications.One primary cause of biliary tract complications postoperative liver transplantation was insufficiency of blood supply. That using CDUS and computing Doppler perfusion index (DPI) of the hepatic artery diagnosed the liver whether or not to be in a insufficiency of blood state is very clinical valuable.