The Clinical And Experimental Studies On The Evaluation Of Ischemic-type Biliary Lesions After Orthrotopic Liver Transplantation Using Ultrasound Elastography

Objective:1.To study the clinical value of acoustic radiation force impulse imaging(ARFI) inpatients with ischemic-type biliary lesion (ITBL) after orthotopic liver transplantation.2.There is no non-invasive method on assessing biliary duct regeneration. Our study aimsto evaluate biliary duct regeneration by supersonic shear wave elastography(SSI)after liver transplantation with cold preservation.Methods:1. Between July2012and January2013, fourty-one patients in General Hospital ofthe People’s Liberation Army were enrolled in this study who were admitted forpost-orthotopic liver transplantation follow-up. Among them,15patients werediagnosed as ITBL by ultrasonography. Besides conventional ultrasonography, ARFIwas used to detect the shear wave velocity (SWV) of liver tissue at depth of4cm and5cm respectively. Simultaneously liver function test was performed.Independent-samples t test was performed to compare the difference of SWV betweenITBL and non-ITBL group at the same depth. Paired-Sample T test was performed tocompare the difference of SWV for the same ITBL patient. Pearson correlation analysiswas used in analysing the relation between SWV and liver function.2. Completely randomized design was applied. Ninety six SD rats were dividedinto2groups, forty eight rats were control group, including24donors and24receipts,and forty eight rats were experimental group including24donors and24receipts. Thedonor livers of experimental group were stored at4℃for12hours. Liver specimenswere obtained at1w、2w、4w before performing SSI after operations, and the numberof bile ductules of portal area were observed. Results:1.The average SWV in depth of4cm was (1.561±0.425) m/s and (1.121±0.160)m/sin ITBL and non-ITBL group, respectively. Significant differences were found amongthe ITBL and Non-ITBL groups(t＝-3.173, P＝0.01). The average SWV in depth of5cm was (1.608±0.545)m/s，(1.175±0.173)m/s in ITBL and Non-ITBL group,respectively. Significant differences were found among the ITBL and Non-ITBLgroups(t＝-2.454, P＝0.034). There was not significant difference between SWVmesurements at different depth for the same ITBL patient(P＞0.05). For all patients,SWV at different depths were both strongly correlated with alkaline phosphatase（r=0.656、0.667, respectively; both P=0.000） and γ-glutamyl transpeptidase(r=0.482，P=0.007；r=0.508，P=0.004).2.①At1w,2w,4w after operation,the valueof liver stiffness were significantly higher (P<0.01) than the control group`s. For theexperimental group, there are significantly difference among different groups(P<0.05).②For experimental group, at2w,4w after operation, the correlation analysis showedthat the liver stiffness was closely correlated with the number of biliary duct（r=0.898，P <0.01）.Conclusion:1.The liver stiffness measurement is valuable for the clinical evaluation of post-transplantation ITBL.2. The shear wave elastography is a valuable method forevaluating biliary duct regeneration.