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Doppler Sonography to Diagnose Venous Congestion in a Modified Right Lobe Graft After Living Donor Liver Transplantation

¹ Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2 dong, Songpa-ku, Seoul 138-736, Korea.
² Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

OBJECTIVE. The objective of our study was to assess the value of Doppler sonography for the diagnosis of hepatic venous congestion in a modified right lobe graft during the early postoperative period after living donor liver transplantation.

SUBJECTS AND METHODS. Doppler sonography examinations were prospectively performed in 54 patients within 24 hours after living donor liver transplantation with a modified right lobe graft in which large (> 5 mm) middle hepatic vein (MHV) tributaries were reconstructed. The number, flow direction, and waveform of the MHV tributaries; the echogenicity of the surrounding parenchyma; and the flow direction of the corresponding portal branch were evaluated. Hepatic venous congestion was diagnosed when there was no color flow or a monophasic waveform of an MHV tributary. The sensitivity of Doppler sonography for the detection of MHV tributaries was assessed using donors' preoperative CT scans and surgical records as references. The diagnostic values of Doppler sonography for hepatic venous congestion were assessed using recipients' postoperative CT scans as references. Differences in prevalence of Doppler sonography findings between the group with hepatic venous congestion and the non–hepatic venous congestion group were assessed.

RESULTS. Doppler sonography enabled us to identify 90% (155/173) of all and 98% (129/131) of the large MHV tributaries. The sensitivity and specificity of Doppler sonography for hepatic venous congestion were 90% (28/31) and 77% (96/124), respectively, for all and 88% (15/17) and 85% (95/112), respectively, for large MHV tributaries. Parenchymal hyperechogenicity was more commonly seen in the hepatic venous congestion group (65%, 20/31) than in non–hepatic venous congestion group (6%, 7/124) (p < 0.01). All five MHV tributaries with reversed flow were seen in the non–hepatic venous congestion group. All five portal branches with hepatofugal flow were seen in the hepatic venous congestion group.

CONCLUSION. Doppler sonography provides a reliable noninvasive surveillance tool for hepatic venous congestion in a modified right lobe graft during the early postoperative period after living donor liver transplantation.

Keywords: Doppler sonography • hepatic venous congestion • hepatocellular carcinoma • living donor liver transplantation • modified right lobe graft

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