Abstract
Early detection of hepatic allograft injury is essential to ensure graft viability and to minimize patient morbidity. The hepatic microvasculature is adversely affected in ischemic preservation injury and rejection, resulting in diminished sinusoidal blood flow. We investigated whether portal vein volume flow as determined by Doppler ultrasound could provide an index of graft function. In an animal model for ischemic preservation injury we found significantly reduced portal flow in animals with allograft injury. No significant difference in flow volume was demonstrated between normally functioning allografts and non-operated controls. We have evaluated 42 human patients with hepatic allografts. In patients with normally functioning livers (n = 17), mean portal vein flow (Q) was 1659 ± 524 ml/min. Patients with chronic rejection (n = 3) demonstrated markedly reduced flow (Q = 788 ± 109 ml/min; p < 0.001), similar to that seen in cirrhotic patients undergoing preoperative evaluation for liver transplantation (Q = 668 ± 256 ml/min). Patients with acute rejection demonstrated a wide variance in flow rates. Portal flow volumes < 1050 ml/min were associated with greater long term morbidity than those with greater flow volume. Quantitative doppler flowmetry of the portal vein is a promising new non-invasive technique which may provide a unique physiologic indicator of allograft perfusion.
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Foster, G.S., Rapoport, M.I., Sankary, H.N. et al. Quantitative Doppler flowmetry of the portal vein in hepatic allografts: initial results in animal and human subjects. Eur. Radiol. 2, 346–349 (1992). https://doi.org/10.1007/BF00175440
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DOI: https://doi.org/10.1007/BF00175440