AJR:181, September 2003 831 Significance of and Contributing Factors for a High Resistive Index on Doppler Sonography of the Hepatic Artery Immediately After Surgery: Prognostic Implications for Liver Transplant Recipients OBJECTIVE. The goal of our study was to investigate the contributing factors, clinical reper- cussions, and implications for prognosis of high-resistance flow at the hepatic artery detected on Doppler sonography during the period immediately after orthotopic liver transplantation. MATERIALS AND METHODS. We retrospectively studied the transplanted livers of 90 patients who had been examined on Doppler sonography within the first 3 days after graft- ing. Seventeen variables from organ donors, transplant recipients, graft characteristics, and surgical procedures were investigated. Early clinical evolution was also analyzed. Follow-up was performed for 5 years. RESULTS. Forty-one (45.6%) of the 90 patients showed a high resistive index at the he- patic artery during the first 72 hr after transplantation. Two factors showed a statistically sig- nificant effect on the occurrence of a high resistive index at the hepatic artery immediately after transplantation: an older liver donor (p = 0.008) and extended preservation time (p = 0.005). No relation with early graft function was detected. The incidence of bile duct compli- cations, retransplantation, or death was not higher at follow-up in patients with high-resis- tance flow than in those with normal flow. CONCLUSION. High-resistance flow at the hepatic artery detected on Doppler sonogra- phy during the period immediately after transplantation is a frequent finding and is related to older donor age and prolonged period of ischemia. This finding has neither significant clinical repercussions nor prognosis implications for early and long-term follow-up. oppler sonography has been proven valuable as the initial im- aging modality in the evaluation of hepatic artery patency during the early postoperative period after orthotopic liver transplantation [1–7]. On the study performed immediately after transplantation, a low dias- tolic velocity or an absence of diastolic signal at the hepatic artery that returns to normal in a few days is frequently found. The cause of these findings is unknown, and several studies have tried without success to correlate this in- crease in arterial resistance with the presence of acute rejection [8–10] or as a predictive sign of hepatic artery thrombosis [11]. An- other aspect that has not been analyzed is the long-term prognostic implications of these findings for graft and patient survival. The aim of this study was to investigate the contributing factors and the clinical repercus- sions of high-resistance flow at the hepatic ar- tery immediately after transplantation. For this reason, we analyzed donor and recipient characteristics, preservation, and surgery-re- lated factors that were correlated with early and late graft function in a series of consecu- tive liver transplant recipients. Materials and Methods A retrospective study was carried out to assess liver transplantations consecutively performed at our institution for a period of 30 months. Only pa- tients who were examined on Doppler sonography within the first 72 hr after transplantation were evaluated. During the study period, 98 liver trans- plantations fulfilled this criterion. All Doppler sonography studies were performed by staff radiologists working in the sonography sec- tion. The studies were performed on sonography equipment with color Doppler capability (SSH 140 A, Toshiba, Nasu, Japan) and a 3.75-MHz transducer. Real-time imaging was used to assess the echogenic- ity of graft parenchyma, focal liver lesions, intra- and extrahepatic bile ducts, and the presence of intraab- dominal fluid collections. Doppler examinations were used to study blood flow patency in the portal vein, the hepatic veins, the vena cava, and the hepatic artery. Angeles García-Criado 1 Rosa Gilabert 1 J. Manuel Salmerón 2 Carlos Nicolau 1 Ramón Vilana 1 Luis Bianchi 1 Laura Buñesch 1 J. Carlos García-Valdecasas 2 Antoni Rimola 2 Concepción Brú 1 Received December 19, 2002; accepted after revision March 31, 2003. 1 Imaging Diagnosis Center, Clinic Hospital, Villarroel 170, 08036 Barcelona, Spain. Address correspondence to A. García-Criado (magarcia@clinic.ub.es). 2 Gastrointestinal Diseases Unit, Clinic Hospital, 08036 Barcelona, Spain. AJR 2003;181:831–838 0361–803X/03/1813–831 © American Roentgen Ray Society D Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved