Real-time and Doppler US after pediatric segmental liver transplantation : II. Hepatic vein stenosis.

Background: Accurate diagnosis of hepatic vein (HV) stenosis by real-time and color Doppler US (CD-US) after segmental liver transplantation in children can decrease morbidity because it allows unnecessary biopsy, obstruction or thrombosis and loss of the graft to be avoided.

Objective: To evaluate CD-US parameters to predict HV stenosis after segmental liver transplantation in children.

Materials And Methods: Retrospective review of 79 CD-US examinations measuring velocity at the HV anastomosis (HV1) and the main trunk 1-2 cm proximal to the HV/IVC anastomosis (HV2), the HV1/HV2 ratio and the spectral waveform of HV2. The study group comprised patients with stenosis confirmed by angiography. The control group comprised patients with a good clinical outcome.

Results: HV stenosis was seen in 12 CD-US examinations. The mean HV1/HV2 ratio was higher in the study group (6.0 versus 4.0). An HV1/HV2 ratio of >4.1 was predictive of HV stenosis (sensitivity 83%, specificity 76%).

Conclusion: An HV1/HV2 ratio of >4.1 is a highly predictive CD-US parameter for the detection of hemodynamically significant HV stenosis on angiography.