PURPOSE: The purpose of this study was to investigate the value of UltraFast Doppler ultrasonography (US) for evaluating hepatic vessels in liver recipients. METHODS: Thirty-nine liver Doppler US sessions were conducted in 20 liver recipients. Each session consisted of UltraFast and conventional liver Doppler US in a random order. We compared the velocities and phasicities of the hepatic vessels, duration of each Doppler study, occurrence of technical failures, and differences in clinical decisions. RESULTS: The velocities and resistive index values of hepatic vessels showed a strong positive correlation between the two Doppler studies (mean R=0.806; range, 0.710 to 0.924). The phasicities of the hepatic vessels were the same in both Doppler US exams. With respect to the duration of the Doppler US exam, there was no significant difference between the UltraFast (251+/-99 seconds) and conventional (231+/-117 seconds) Doppler studies (P=0.306). In five poor breath-holders, in whom the duration of conventional Doppler US was longer, UltraFast Doppler US (272+/-157 seconds) required a shorter time than conventional Doppler US (381+/-133 seconds; P=0.005). There was no difference between the two techniques with respect to technical failures and clinical decisions. CONCLUSION: UltraFast Doppler US is clinically equivalent to conventional Doppler US with advantages for poor breath-holders during the post-liver transplantation work-up.
Liver Transplantation ; Liver* ; Ultrasonography, Doppler*

Post-transplantation lymphoproliferative disorder occurs in transplant recipients in whom immunosuppressivetherapy has compromised the immune system. In patients who have undergone transplants, suppressor T lymphocytefunction is suppressed, leading to unbridled B lymphocyte proliferation. We encountered a case withpost-transplantation lymphoproliferative disorder which manifested as a focal hepatic mass in transplanted liver.This mass was isoechoic, with a peripheral hypoechoic halo on ultrasonogram, while on all three phases of helicalCT scan low attenuation without contrast enhancement was seen.
Humans ; Immune System ; Liver* ; Lymphocytes ; Lymphoproliferative Disorders* ; Transplantation ; Ultrasonography

Mesenchymal hamartoma is an uncommon benign tumor usually found in childhood, especially during the first two years of life. The tumor consists of a solid component and multiple cyst. Without treatment, these lesions can grow to an enormous size. We experienced a case of mesenchymal hamartoma which was found incidentally, in a 8 month old girl who had ascending cholangitis after Kasai operation due to biliary atresia. On abdominal ultrasonography and CT, there was a well-defined homogeneous small echogenic mass in the right lobe of the liver with cirrhosis. Five months later, she underwent liver transplantation. Gross picture of the resected liver showed a dark greenish pigmented solid mass in the right lobe of the cirrhotic liver. Microscopic findings showed reactive mesenchyma and epithelial overgrowth.
Biliary Atresia* ; Cholangitis ; Female ; Fibrosis ; Hamartoma* ; Humans ; Infant ; Liver ; Liver Transplantation ; Mesoderm ; Ultrasonography

Portal flow steal occasionally persists even after the liver transplantation, which may reduce the portal flow and thus threaten the patients' outcome. Therefore, pre- and peri-operative detection of portal steal phenomenon requiring radiological or surgical interruption is essential for the liver transplantation candidates as well as for the recipients.
Adult ; Hepatitis B, Chronic/complications ; Humans ; Liver Cirrhosis/etiology/*therapy ; *Liver Transplantation ; Male ; Mesenteric Veins/*ultrasonography

BACKGROUND/AIMS: Clinical validation is required to determine whether Doppler measurements are comparable before and after administering ultrasound contrast agent (USCA). The purpose of this study is to explore whether the use of USCA affects spectral Doppler analysis in recipients of liver transplantation (LT). METHODS: For this study, 36 patients were examined using Doppler ultrasonography (US) along with a contrast-enhanced US for surveillance of vascular complications after LT. The following spectral Doppler US parameters were measured before and after administration of USCA: peak systolic velocity, end-diastolic velocity, resistive index, and systolic acceleration time of the graft hepatic artery; peak flow velocity of the graft portal vein; and peak flow velocity and venous pulsatility index of the graft hepatic vein. RESULTS: The mean peak systolic and end-diastolic velocities of the hepatic artery and the peak flow velocity of the portal and hepatic veins were increased after intravenously administration of the USCA, ranging from 10% to 13%. However, the changes were not statistically significant (P=0.097, 0.103, 0.128, and 0.190, respectively). There were no significant differences in other measured parameters, including the resistive index (P=0.205) and systolic acceleration time (P=0.489) of the hepatic artery and venous pulsatility index (P=0.494) of the hepatic vein. CONCLUSIONS: The measured velocities of graft hepatic vessels tended to increase after administration of USCA, but without statistical significance. The comparison of serial Doppler parameters with or without injection of USCA is valid during Doppler surveillance in recipients of LT.
Acceleration ; Contrast Media* ; Doppler Effect ; Hepatic Artery ; Hepatic Veins ; Humans ; Liver Transplantation* ; Liver* ; Microbubbles ; Portal Vein ; Transplants ; Ultrasonography* ; Ultrasonography, Doppler

Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.
Diagnosis ; Fibrosis* ; Hepatic Artery ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Transplantation ; Portal Vein ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color

PURPOSE: The hepatic arteries of transplant recipients are sometimes in too poor a condition to make a good anastomosis in living donor liver transplantation. The aim of this study was to evaluate the outcome of hepatic artery reconstruction using the recipient's right gastroepiploic artery. METHODS: A total of 153 LDLTs were performed at Seoul National University Hospital from January 1999 to December 2003. In 10 cases, arterial reconstruction was performed by anastomosis of the donor's hepatic artery to the recipient's right gastroepiploic artery. Hepatic artery reconstruction was carried out with the aid of an operating microscope and with using the interrupted Carrel's technique. The adequate blood flow was verified during the operation by the Doppler ultrasonography and also daily for seven days after transplantation by means of Doppler ultrasonography. The median length of the follow-up was 40 months (range: 20~60 months). RESULTS: In seven cases out of ten, the recipient's right gastroepiploic artery was initially used due to arterial thrombosis or because of severe endothelial damage of the recipient's hepatic artery. In the remaining three cases, the graft was revascularized using the recipient's right gastroepiploic artery. In all cases, excellent hepatic arterial flow was confirmed by the Doppler ultrasonography during the operation. Complications related to the hepatic artery were not detected during the follow-up period. CONCLUSION: The recipient's right gastroepiploic artery is a suitable alternative for hepatic artery reconstruction in LDLT.
Follow-Up Studies ; Gastroepiploic Artery* ; Hepatic Artery* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Seoul ; Thrombosis ; Transplantation ; Transplants ; Ultrasonography, Doppler

The value of color Doppler flow imaging (CDFI) and intravenous contrast-enhanced ultrasound (CEUS) for assessing the transplanted liver and early diagnosing complications by examining hemodynamic changes was discussed. Seventy-five patients with orthotopic liver transplantation (OLT) underwent CDFI. The following parameters were measured: peak systolic velocity (PS), resistance index (RI) and Doppler perfusion index (DPI) of the hepatic artery (HA), time average velocity (TAV) of portal vein (PV) and velocity of hepatic vein (HV) in different stages postoperation. And 11 patients of them received CEUS. Thirty healthy subjects were enrolled as controls. The results showed that: (1) In 23 patients without obvious complications, TAV of PV within 15 days post-operation was significantly higher than in controls (P<0.05), PS and DPI of HA within 7 days postoperation were lower, but RI was higher than in controls (P<0.05); (2) When the hepatic artery thrombosis (HAT) occurred, PS and DPI of HA were obviously decreased, but TAV of PV significantly increased like a high saw-tooth wave; (3) While rejection occurred, both TAV of PV and PS of HA were decreased with the increase in RI of HA, and the triphasic wave of HV disappeared and displayed as saw-tooth wave; (4) The incidence of biliary complications in liver transplantation was increased when DPI was reduced; (5) Seven cases of hepatic carcinoma relapse after OLT demonstrated hyperecho in the arterial phase and hypoecho in the portal and later phase on CEUS; (6) In 2 cases of HA thrombus, there was no visualized enhancement in arterial phase of CEUS, but enhancement during the portal vein and parenchymal phase. It was concluded that the hemodynamic changes of PV, HA and HV in the transplanted liver are valuable for assessing the transplanted liver and early diagnosing complications on CDFI and CEUS.
Bile Ducts/pathology ; Contrast Media/*administration & dosage ; Hemodynamics ; Hepatic Artery/pathology ; Infusions, Intravenous/*methods ; Liver Transplantation/*adverse effects ; Liver Transplantation/*methods ; Liver Transplantation/ultrasonography ; Perfusion ; Postoperative Complications ; Ultrasonography/*methods ; Ultrasonography, Doppler/*methods

Securing the source of hepatic artery inflow is essential for living donor liver transplantation. However, sometimes, the hepatic arteries of the recipients are in poor condition for a good anastomosis in living donor liver transplantation; problems include severe arteriosclerosis, intimal dissection, and significant intimal injuries caused by previous transarterial procedures. In these conditions, the right gastroepiploic artery has generally been the preferred artery because of its anatomical location, size and length. Here, a case of successful hepatic artery reconstruction is reported using the right gastroepiploic artery in living donor liver transplantation. The recipient's hepatic arterial intima was severely injured by multiple transarterial chemoembolization and unsuitable for reconstruction. Instead, the right gastroepiploic artery was anastomosed to the hepatic artery of the graft. Arterial blood flow was satisfactory on Doppler ultrasonography during the operation, and complications related to the hepatic artery were not detected during the follow-up period. Therefore, the right gastroepiploic artery may be considered as a suitable alternative for hepatic artery reconstruction in living donor liver transplantation.
Arteries ; Arteriosclerosis ; Follow-Up Studies ; Gastroepiploic Artery ; Hepatic Artery ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Transplants ; Tunica Intima ; Ultrasonography, Doppler

PURPOSE: The anastomosis of hepatic artery to recipient vessel has a major role in a liver transplantation, so its occlusion is the most important cause of failure of liver transplantations. We made the study to reveal the peculiarities in pediatric liver transplantations compared with adult cases. METHODS: From January 1999 to September 2005, we performed 99 cases of pediatric liver transplantation. The mean age at operation was 4.17 years of age. The hepatic vein and portal vein are anastomosed by the general surgeons and then the hepatic artery is anastomosed by the plastic surgeons. The Doppler ultrasonography and computed tomography were used for postoperative checkup for hepatic artery patency. RESULTS: There were no immediate complications, but hepatic arterial occlusion was developed in 3 cases (2.8%). In pediatric patients, the anastomosis of hepatic artery is more difficult than adults because of the rapid respiratory and pulse rate, the small vascular diameter, and the large gap of diameter difference between the recipient and the donor vessels. CONCLUSION: We could confirm that pediatric liver transplantations are relatively safe but long learning curve was needed.
Adult ; Child* ; Heart Rate ; Hepatic Artery* ; Hepatic Veins ; Humans ; Learning Curve ; Liver Transplantation* ; Liver* ; Portal Vein ; Tissue Donors ; Ultrasonography, Doppler