Evaluation of the hepatic artery anastomosis by intraoperative sonography with high-frequency transducer in right-lobe graft living donor liver transplantation.

摘要

OBJECTIVE: To describe the usefulness of intraoperative ultrasonography (IOUS) with high-frequency transducer in living donor liver transplantation (LDLT) using right-lobe graft (RLG). METHOD: This retrospective study was approved by our institutional review board. We performed IOUS in 22 patients (17 men and 5 women, aged 51 +/- 9.0 years) during LDLT with RLG using a Sequoia 512 scanner with an 8-12-MHz linear transducer. Hepatic artery (HA) anastomosis was identified on gray-scale US, and the diameter and percentage of stenosis of the anastomosis were measured. The HA was evaluated to detect thrombus or dissection in the region of anastomosis. Doppler study of the graft HA was also performed. Patients were divided into those with and without abnormalities, including thrombosis, dissection, and abnormal Doppler parameters (peak systolic velocity < 30 cm/s or > 2 m/s, resistance index < 0.5, and systolic acceleration time > 80 msec). RESULT: On gray-scale and Doppler IOUS study, abnormalities were found in 10 of 22 patients. Diagnoses were anastomotic stenosis (n = 2), celiac stenosis (n = 1), compromise of HA inflow due to systemic hypotension (n = 1), HA thrombosis (n = 2), and HA dissection (n = 4). Re-anastomoses were done in 3 case (2 stenoses and 1 thrombosis). Uneventful postoperative recovery occurred in the other 7 patients without re-anastomosis. CONCLUSION: IOUS with high-frequency transducer is a useful method to make an early diagnosis of HA complications of LDLT with RLG.