Doppler Parameters of the Hepatic Artery as Predictors of Graft Status in Pediatric Liver Transplantation

Ahmad, Tahani; Chavhan, Govind; Avitzur, Yaron; Moineddin, Rahim; Oudjhane, Kamaldine

doi:10.2214/ajr.17.17902

Cited by 14 publications

(22 citation statements)

References 16 publications

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“…Doppler ultrasound was performed routinely in the intensive care unit after pediatric liver transplantation to confirm the patency of graft blood flow 17 . Compared with adult liver transplantation, pediatric recipients are at higher risk of developing HAT due to the technical challenges presented by smaller blood vessels and size mismatch between graft and recipient vessels 18‐21 . The absence of detectable intrahepatic arterial flow by pulse Doppler was regarded as the diagnostic criterion for HAT.…”

Section: Discussionmentioning

confidence: 99%

“…The measure of kappa agreement for CDI, PDI, cSMI, and mSMI was 0.902, 0.889, 0.882, and 0.882, respectively pediatric recipients are at higher risk of developing HAT due to the technical challenges presented by smaller blood vessels and size mismatch between graft and recipient vessels. [18][19][20][21] The absence of detectable intrahepatic arterial flow by pulse Doppler was regarded as the diagnostic criterion for HAT. The judgment of thrombosis can be difficult using conventional ultrasound, especially when the hepatic artery is thin or has low-velocity flow, and intrahepatic arteries are sometimes obscured by portal venous flow.…”

Section: F I G U R Ementioning

confidence: 99%

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Additional value of superb microvascular imaging for assessing hepatic arterial blood flow after pediatric liver transplantation

Fang

Liu

et al. 2020

Pediatric Transplantation

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Background: The aim of this study was to explore the value of SMI compared with conventional ultrasonography for assessing hepatic arterial blood flow after pediatric liver transplantation. Methods: From March 2018 to November 2018, a total of 105 pediatric recipients with biliary atresia underwent liver transplantation in our hospital. Ultrasound examinations were performed at the bedside in the intensive care unit to check the patency of the blood flow in the hepatic allograft. CDI, PDI, cSMI, and mSMI were performed to assess the display, orientation, and distribution of the graft hepatic artery. Ultrasound examinations were performed by one radiologist, and the images were judged by two observers. Results: The median age, weight, and height of the recipients were 6.97 (5.92, 9.58) months, 6.50 (6.00, 7.80) kg, and 64.00 (62.00, 68.00) cm, respectively. The measure of kappa agreement was 0.902, 0.889, 0.882, and 0.882 for CDI, PDI, cSMI, and mSMI, respectively. HAT occurred in 7 pediatric recipients and was confirmed by CTA (computed tomography angiography) and surgery. The diagnostic performance of sensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value), and accuracy were 100%, 92.86%, 50%, 100%, and 93.33% for CDI and 100%, 98.98%, 87.50%, 100%, and 99.05% for SMI. Conclusions: As an additional method to CDI, SMI can clearly show the distribution of hepatic arterial blood flow and provide more details, thereby markedly improving the diagnostic performance of postoperative HAT.

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Section: Discussionmentioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 99%

Additional value of superb microvascular imaging for assessing hepatic arterial blood flow after pediatric liver transplantation

Fang

Liu

et al. 2020

Pediatric Transplantation

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“…3). 10 If thrombus is present, it is visible on grayscale imaging as an echogenic focus within the artery. Anastomotic stenosis will cause visible luminal narrowing with turbulent, high-velocity flow at the site and low resistive index within the hepatic parenchyma.…”

Section: Specific Clinical Scenarios Ideally Imaged With Ultrasound Amentioning

confidence: 99%

Pediatric Mesenteric Vasculature: Noninvasive Imaging and Catheter Arteriography

Braswell

2019

Dig Dis Interv

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The imaging of the mesenteric vasculature of infants and children can be effectively accomplished using a variety of noninvasive and invasive techniques. As with adult imaging, the choice of modality will depend on the specific clinical scenario. Unique considerations and challenges are related to pediatric body size, pathology, the patient's developmental ability to tolerate the exam, and practical radiation concerns. Pediatric angiography can provide both diagnostic information and a pathway to definitive treatment of vascular abnormalities. Utilizing the right modality in the appropriate situation allows for accurate and timely diagnosis so that treatment is most effective.

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“…The most commonly accepted normal values and thresholds are extracted either from studies in the adult population or from studies with mixed populations that did not clearly describe the values obtained from children 12–15. Although some authors have proposed normal ranges for Doppler values of graft vasculature in children,16 17 these values vary depending on demographic or graft-related characteristics and their relationship with graft complications is unclear.…”

Section: Introductionmentioning

confidence: 99%

Doppler ultrasound values after liver transplantation in children and their association with graft outcomes: a protocol for a systematic review and meta-analysis

et al. 2019

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IntroductionLiver graft and patient survival in children have improved substantially over the years; nevertheless, graft-related complications persist as the most important risk factor for mortality and graft loss. Doppler ultrasound evaluation is routinely used after liver transplantation; however, there is no consensus defining normal values, timing or frequency of Doppler ultrasound postoperative evaluation. Identification of patients who require an intervention or change in postoperative management is therefore challenging.Methods and analysisWe will conduct a systematic review and meta-analysis to appraise and synthesise evidence describing Doppler ultrasound measurements and their association with graft complications in children who have received a liver transplant. We will search multiple databases: Ovid Medline, Embase, Wiley Cochrane Library, Web of Science—Science Citation Index Expanded, trial registry records and meeting abstracts using a combination of subject headings and keywords for liver transplantation, Doppler ultrasound and paediatric patients. All identified titles and abstracts of studies will be assessed for potential relevance. Selected studies will be retrieved and subjected to a second phase of screening, both selection phases will be done in duplicate by two independent reviewers, and discrepancies will be documented and resolved by a third reviewer. Data extraction will be done independently by two reviewers using a standardised data extraction form. Quality of evidence and risk of bias will be assessed, synthesised and pooled for meta-analysis if possible. We will perform a subgroup analysis if enough data are available.Ethics and disseminationStrategies to disseminate our review include presenting in liver transplant review sessions, publishing in high-impact peer-reviewed medical journals, and presenting at national and international paediatric radiology and liver transplant meetings, conference presentations, events, courses and plain-language summaries. This knowledge will allow easier identification of patients with a higher risk of developing graft-related complications and could potentially improve patient and graft outcomes. We wish to disseminate our results to discover potential areas for future research and drive improved future practices and policies. Our target audience includes researchers, institutions, healthcare professionals, health system decision-makers, policy-makers and research funders community.Trial registration numberCRD42019119986.

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Doppler Parameters of the Hepatic Artery as Predictors of Graft Status in Pediatric Liver Transplantation

Cited by 14 publications

References 16 publications

Additional value of superb microvascular imaging for assessing hepatic arterial blood flow after pediatric liver transplantation

Additional value of superb microvascular imaging for assessing hepatic arterial blood flow after pediatric liver transplantation

Pediatric Mesenteric Vasculature: Noninvasive Imaging and Catheter Arteriography

Doppler ultrasound values after liver transplantation in children and their association with graft outcomes: a protocol for a systematic review and meta-analysis

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