Spleen stiffness measurements by acoustic radiation force impulse imaging after living donor liver transplantation in children: a potential quantitative index for venous complications
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Living donor liver transplantation in children often results in venous complications, leading to portal hypertension. Spleen stiffness measurements have been recently proposed as a new, noninvasive parameter for portal hypertension in cirrhotic patients.
To evaluate the diagnostic value of spleen stiffness measurements by acoustic radiation force impulse (ARFI) imaging in diagnosing venous complications after pediatric living donor liver transplantation.
Materials and methods
We prospectively enrolled 69 patients after pediatric living donor liver transplantation using a left-side liver allograft. Around the time of the protocol liver biopsy examination, spleen stiffness measurements by ARFI imaging were performed via the left intercostal space at the center of the spleen parenchyma and repeated five times. Imaging examinations around the time of the spleen stiffness measurements were retrospectively reviewed. Regarding venous complications, significant portal and hepatic venous stenosis was defined as >50% stenosis on multiphasic computed tomography.
After post hoc exclusion, 62 patients were studied. Portal and hepatic venous stenosis was identified in three and two patients, respectively. The median spleen stiffness values were 2.70 and 4.00 m/s in patients without and with venous complications, respectively (P < 0.001). Spleen stiffness measurements showed good diagnostic power for venous complications, and the cutoff value was determined as 2.93 m/s, with 100% sensitivity and 78.9% specificity. Spleen stiffness measurements decreased with the relief of venous stenosis resulting from an interventional radiology procedure.
Spleen stiffness measurements by ARFI imaging might provide a useful quantitative index for venous complications after pediatric living donor liver transplantation.
KeywordsAcoustic radiation force impulse imaging Living donor liver transplantation Child Portal hypertension Spleen stiffness measurement Complications
The research presented in this manuscript was supported by the Japan Society for the Promotion of Science (JSPS KAKENHI, Grant-in-Aid for Young Scientists [B], Grant Number 26870570), and the authors have no conflicts of interest to disclose. The authors thank Mieko Tsuchida, Yuko Shirahata, Yoshiko Shiomi, Chigusa Mochizuki, Dr. Akihisa Ueno and Yuji Masuda for performing the measurements of spleen and liver stiffness by ARFI imaging.
Conflicts of interest
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