Acute allograft rejection in liver transplant recipients: lack of correlation with loss of hepatic artery diastolic flow.

Abstract

Eighty hepatic artery Doppler ultrasound (US) examinations performed in 49 patients after liver transplantation were retrospectively analyzed to determine if loss of diastolic flow correlated with pathologic evidence of acute allograft rejection. All 80 Doppler examinations were performed within 7 days of hepatic needle biopsy. Forty-three Doppler waveforms from 27 patients showed normal diastolic flow. Seventeen Doppler studies in 17 patients showed complete absence of diastolic flow. Review of biopsy results for each group showed no significant difference in the proportion of acute allograft rejection present (42% for the normal group and 46% for the group lacking diastolic flow). The data from 53 US and biopsy examinations performed 2 days apart in 37 patients confirmed the lack of correlation between absent hepatic artery diastolic blood flow and rejection. The authors conclude that the loss of hepatic artery diastolic flow has no apparent clinical application for the diagnosis of acute hepatic allograft rejection.

W‐shaped diastolic Doppler waveform in the hepatic artery of a patient with acute rejection after living donor liver transplantation

“…Unfortunately, no study has proved their utility in this field. 3,4 Acute rejection increases portal circulatory resistance. The resultant decrease in portal flow 5 may activate the hepatic arterial buffer response (HABR), thereby decreasing hepatic artery resistance.…”

Hepatic arterial resistive indices: Correlation with the severity of cirrhosis

“…Even the weight of the transducer can affect the RI [14]. In liver transplants, attempts have also been made to correlate hepatic arterial RI with rejection, although both prospective and retrospective studies have shown no such correlation [6,7]. One explanation is that hepatic transplant rejection is primarily a cell-mediated event as opposed to the acute vascular rejection often documented in renal allografts.…”

Liver transplant rejection: value of hepatic vein Doppler waveform analysis

“…Longley et al retrospectively analyzed the tracings of the hepatic arteries to determine whether there was loss of hepatic artery diastolic flow in patients with rejection of liver allografts [3]. No correlation was found.…”

“…Early diagnosis and treatment of rejection are important, offering the potential to improve hepatic function and survival [2]. Attempts to use noninvasive techniques, such as Doppler evaluation of the hepatic artery waveform, to predict transplant rejection have been largely unsuccessful [3,4]. At the present time, definitive diagnosis of rejection can only be established by biopsy.…”