Abstract
Postoperative transplant liver ultrasounds were analyzed in standard criteria donor
(SCD), extended criteria donor (ECD), and donation after cardiac death (DCD) liver
allografts to determine if elevated resistive indices (RIs) are consistently present
and if they are pathological. Postoperative transplant liver ultrasounds were reviewed
from 115 consecutive patients. Hepatic arterial RIs were stratified based on the type
of donor: DCD, macrosteatosis (>30%), or standard criteria. In all patients with elevated
RI, subsequent ultrasounds were reviewed to demonstrate RI normalization. The mean
RI for all 115 patients was 0.64, DCD was 0.67, macrosteatosis was 0.81, and SCD was
0.61 (p = 0.033). The RI on subsequent liver ultrasounds for DCD and macrosteatosis normalized
without any intervention. There were no incidences of early hepatic artery thrombosis
(HAT) observed in the cohort. Hepatic arterial RI in ECDs and DCDs are elevated in
the immediate postoperative period but are not predictive of HAT. It represents interparenchymal
graft stiffness and overall graft edema rather than an impending technical complication.
The results of our study do not support the routine use of anticoagulation or routine
investigation with computed tomography angiography for elevated RIs as these findings
are self-limiting and normalize over a short period of time. We hope that this information
helps guide the clinical management of liver transplant patients from expanded criteria
donors.
Keywords
liver transplantation - liver transplant ultrasound - donation after cardiac death
- hepatic macrosteatosis - hepatic artery thrombosis - extended criteria donors
