Hepatic vein stenosis after living donor liver transplantation: evaluation with Doppler US

PURPOSE: To determine the spectral Doppler ultrasonographic (US) findings that would indicate hepatic vein stenosis after living donor liver transplantation (LDLT). MATERIALS AND METHODS: The authors retrospectively reviewed postoperative Doppler US images of the hepatic veins in 113 consecutive patients who underwent LDLT. Doppler US was performed 1-25 times (mean, 5.2 times) during 1-433 days after LDLT. Nineteen patients who were inadequate for analysis were excluded; thus, 94 patients (72 male patients and 22 female patients; mean age, 40 years) were included in the study. Patients with more than 10 mm Hg of pressure gradient between the hepatic vein and the inferior vena cava were considered to have substantial hepatic vein stenosis (stenosis group). Those without substantial stenosis (control group) included patients with no clinical or radiologic evidence of hepatic vein stenosis for at least 3 months after LDLT. The wave pattern and peak flow velocity of the hepatic veins were compared between the groups. RESULTS: Five patients (5%) had substantial hepatic vein stenosis: three had persistent monophasic wave patterns at all US examinations, and two had monophasic wave patterns at most US examinations and biphasic or triphasic wave patterns at 6- and 9-day follow-up examinations. In the control group, 52 (58%) of 89 patients had a persistent triphasic or biphasic wave pattern and 37 (42%) had a monophasic wave pattern at one or more US examinations; this included two patients with persistent monophasic wave patterns. A monophasic wave pattern was more frequent in the stenosis group than in the control group (P =.015). There was no significant difference between the velocities of the hepatic veins in the stenosis group (22.3 cm/sec +/- 9.6 [SD]) and those in the control group (37.5 cm/sec +/- 20.3) (P =.14). CONCLUSION: A persistent monophasic wave pattern on Doppler US images of the hepatic veins is suggestive of, but not specific for, substantial hepatic vein stenosis after LDLT. A persistent triphasic wave pattern on Doppler US images can exclude the possibility of substantial stenosis.