The value of serial Doppler ultrasound as a predictor of clinical outcome and the need for transplantation in fulminant and severe acute liver failure

The aim of this study was to document the changes in Doppler ultrasound var iables of the hepatic artery and portal vein in fulminant and severe acute liver failure, and to assess their prognostic significance. 18 adult patien ts with fulminant and severe acute liver failure underwent serial Doppler s onography, in the early stages after presentation. 12 hourly measurements o f hepatic artery resistance index (HARI), spleen length, portal vein cross- sectional area, time average velocity (TAV) and flow volume were performed. Mean HARI (p=0.03) and mean maximum HARI (p=0.03) were significantly highe r in those who fulfilled criteria for liver transplantation. Increased port al vein flow was demonstrated, although the difference between the groups w as not significant. A significant increase in portal vein cross-sectional a rea (p<0.02) and spleen length (p<0.02) was demonstrated. In summary, an in crease in portal blood flow to the damaged liver has been demonstrated. The mean HARI is significantly higher in patients who fulfil transplant criter ia and may possibly be used as an indicator of poorer prognosis and the nee d for liver transplantation in acute severe and fulminant liver failure.