Doppler ultrasonography in liver transplant recipients with hepatic artery dissection: Association of Doppler abnormalities with disease severity

Objectives: Role of Doppler ultrasonography in determining radiologic and clinical significance of hepatic artery dissection (HAD) is not known. To determine the frequency of abnormalities on Doppler ultrasonography in liver transplant recipients with HAD and to evaluate association between Doppler abnormalities and disease severity. Methods: 107 liver transplant (LT) recipients with HAD between January 2008 and December 2016 were included, in whom Doppler ultrasonography was performed within the week of diagnosis. Patients with HAD were subdivided into with/without Doppler abnormality groups, and intergroup differences in frequency of graft ischemia/infarction, laboratory values, and frequency of progressive interval change on follow up were evaluated. Results: 18 (16.8%) of 107 LT recipients with HAD had Doppler abnormalities [tardus-parvus waveform (n = 8, 7.5%), no flow (n = 10, 9.3%)]. HAD with Doppler abnormality group more commonly showed graft ischemia/infarction (p < 0.0001), had significantly higher mean peak laboratory values, including for aspartate aminotransferase, alanine aminotransferase, total bilirubin, and direct bilirubin (all p < 0.05), and were more likely to show progressive interval change (p < 0.001). All eight (7.5%) HAD patients requiring revascularization or retransplantation were in Doppler abnormality group. Conclusion: Doppler abnormalities are occasionally found in LT recipients with HAD and indicate disease severity. Patients with HAD and Doppler abnormalities are more likely to show graft ischemia/infarction, laboratory abnormalities, and progressive changes on follow up that often require revascularization or retransplantation. Advances in knowledge: Doppler ultrasonography abnormalities are frequently found in liver transplant recipients with HAD, and are a strong indicator of disease severity, such as graft ischemia/infarction, laboratory abnormalities, and progressive changes on follow up that often necessitate revascularization or retransplantation.