Hepatic Artery Doppler Flow Changes During Cholangitis in Liver Transplantation Patients

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Abstract

Introduction

Biliary tract complications after orthotopic liver transplantation are seen in 10% to 35% of patients which are still frequent reasons of morbidity and mortality. These complications may be functional or structural leading to hepatic dysfunction. Cholangitis after transplantation is thought to be originated from whether microorganisms in the bile leading to ascending infection or an obstruction in biliary branches increasing the luminal pressure. Biliary complications may arise without any clinical symptoms or elevated laboratory results. Since cholangitis may lead to bile duct necrosis and eventually graft loss, early diagnosis and the prompt treatment is important. Postoperative Doppler imaging after liver transplantation for precise and early determination of vascular complications is vital. This is a prospective study investigating whether there is an association between cholangitis and hepatic arterial doppler US findings after liver transplantation.

Materials and Methods

Liver transplant patients were prospectively scanned from March 2017 to October 2017. Among these follow-up patients, the ones which were diagnosed with cholangitis were detected. The laboratory data of 11 patients who were complicated with cholangitis were reviewed. Patients with hepatic arterial thrombosis or stenosis were excluded. All patients were examined with doppler US at the time of cholangitis and after cholangitis was treated. One patient who had hepatic artery occlusion in the recovery period was excluded. Hepatic arterial flow, arterial resistive index values and other Doppler findings were noted.

Results

The mean hepatic arterial volume flow of 10 patients at the time of cholangitis was found 0.287 L/min. We observed an increase of volume flow in hepatic artery and confirmed this increase when compared to the control values in recovery period. The mean hepatic arterial volume flow in the recovery period was decreased to 0.203 L/min (p= .03). Only one patient hepatic arterial flow remained the same (0.176 L/min). We observed a decrease in hepatic arterial diameter and hepatic arterial resistive index (RI) after cholangitis. The mean RI of hepatic artery was observed to regress from 0.64 to 0.58 and hepatic arterial diameter from 4,5 mm to 4 mm. None of these patients were deceased nor went to re-transplantation for biliary complications.

Conclusion

When cholangitis arise after liver transplantation with or without any clinical and/or laboratory findings, doppler US follow-up’s give us the clue of cholangitis by an increased volume flow in the hepatic artery of the transplanted liver. This is a non-specific finding that can be observed in other vascular complications as well, however it should be considered as an early sign of important ischaemic incidents, including biliary-associated ones, which may lead to graft loss.

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