Postoperative Elevated Resistive Indices Do Not Predict Hepatic Artery Thrombosis in Extended Criteria Donor Livers

Duplex Doppler evidence of high hepatic artery resistive index after liver transplantation: Role of portal hypertension and clinical impact

BACKGROUND

Early increase of hepatic artery resistive index (HARI) is frequently observed after liver transplant (LTx).

AIM

We aimed to investigate contributing factors and prognostic relevance of high HARI after LTx from deceased donor.

METHODS

We conducted a retrospective analysis of prospectively collected data from January 2017 and February 2019. According to the Duplex Doppler HARI values (3^d post-operative day), patients were grouped in normal (0.55-0.80) and high (>0.80-1) HARI groups.

RESULTS

Among 81 LTx, 36 had a high HARI and 45 a normal HARI. Patients developing high HARI were older, exhibited lower platelet, hemoglobin, platelet count/spleen diameter ratio, higher serum creatinine, and a more pronounced spleen enlargement (median values 170 versus 120 mm). At multivariate analysis, PLT/spleen diameter ratio (OR 0.994, p < 0.001) creatinine levels (OR 2.418, p = 0.029), and recipient age (OR 1.157, p = 0.004) significantly predicted the occurrence of high HARI. Patients with high or normal HARI had similar vascular complications, rejection rate and 90-day mortality. In most cases, HARI recovered to normal without any clinical effect.

CONCLUSIONS

HARI rises in presence of several surrogate markers of portal hypertension. The increase is mostly transitory, and it may result from the hepatic artery spasm due to the high portal blood flow.

Clinical value of digital subtraction angiography and contrast-enhanced ultrasound in evaluating early hepatic artery thrombosis after liver transplantation

BACKGROUND

Hepatic artery embolism is a serious vascular complication after liver transplantation. If not detected and handled promptly, it will lead to insufficient perfusion of liver parenchyma, ischemia of the biliary tract, failure of liver transplantation, and even death. Contrast-enhanced ultrasound (CEUS) can effectively display the perfusion status of micro-vessels and accurately evaluate whether the micro-vessels are patent or not.

AIM

To evaluate the clinical value of digital subtraction angiography (DSA) and CEUS in evaluating early hepatic artery thrombosis (HAT) after liver transplantation.

METHODS

Twenty-one patients who were suspected of having HAT after liver transplantation were selected as study subjects. CEUS was performed to observe whether there was HAT after liver transplantation and the whole hepatic perfusion. The result of DSA was used as the "gold standard" for comparative analysis.

RESULTS

DSA showed that 16 patients developed HAT. CEUS showed that hepatic arteries were not displayed in the arterial phase, hepatic arteries were unobstructed in five patients, and hepatic arteries were clearly displayed in the arterial phase. The sensitivity, specificity, and accuracy of CEUS in evaluating early HAT after liver transplantation were all 100%.

CONCLUSION

CEUS can effectively monitor hepatic artery blood flow and hepatic perfusion after liver transplantation, thus providing a reliable imaging method for early detection of HAT.

RNA Sequencing Reveals the Suitability of Cardiac Death Livers for Transplantation

Background

Organ transplantation is considered the best treatment for end-stage organ failure. However, the lack of available organs for transplantation and the increasing number of patients waiting for transplants are primary issues facing the transplant community. Thus, developing strategies to increase the number of donors, especially for liver transplantation, has become a priority. The use of organs acquired from donors who suffered cardiac related deaths has increased the pool of potential liver donors. However, donation after cardiac death (DCD) livers increases the risk of primary graft dysfunction.

Methods

In the current study, we conducted transcriptome sequencing using livers from a DCD rat to assess the short-term feasibility and functional efficacy of DCD livers. RNA sequencing (RNAseq) data showed that the liver transcriptome varied greatly in rat livers subjected to 15 minutes of cardiac arrest.

Results

The livers used in the current study had a significant loss of normal function before transplantation. Functional and network analyses consistently indicated that transcription and translation processes were inhibited after approximately 15 minutes of cardiac arrest. Moreover, the transcriptomic sequencing data provides significant insight for identifying functional genes and testing additional biological questions in DCD liver transplantation in future studies.