ROUTINE DOPPLER ULTRASOUND FOR THE DETECTION OF CLINICALLY UNSUSPECTED VASCULAR COMPLICATIONS IN THE EARLY POSTOPERATIVE PHASE AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

To assess the role of routine Doppler ultrasound in the detection of c linically unsuspected vascular complications in the early postoperativ e phase after orthotopic liver transplantation (OLT), the findings of 858 routinely performed Doppler ultrasound examinations were analyzed in 268 transplants. At various time intervals after OLT, we encountere d 46 abnormal Doppler findings: hepatic artery (thrombosis), portal ve in [anastomotic stenosis, (non)occlusive thrombosis or reversed flow], inferior vena cava [anastomotic stenosis with reversed flow, no flow or (non)occlusive thrombosis], and hepatic veins (to-and-fro flow or s tenosis with reversed flow) in 14, 20, 9, and 2 transplants, respectiv ely. Most of these abnormal Doppler findings were confirmed by angiogr aphy, cavography, or surgery. The positive predictive value for hepati c artery thrombosis (HAT) was 12 out of 14, or 86 %. In the first 2 we eks after OLT, routine Doppler ultrasound revealed 20 of the 46 abnorm al findings (43 %). Clinically unsuspected complications of the hepati c artery, portal vein, inferior vena cava, and hepatic veins were foun d in 9 of the 14 (64 %), 6 of the 20 (30 %), 3 of the 9 (33 %), and 2 of the 2 (100 %) transplants, respectively. The highest incidence nine vascular complications - was found on the 1st day. On each of the rem aining days (except for the 2nd and 9th days), one or two vascular com plications were detected. HAT was found mainly in the Ist week. Vascul ar complications developed independently or concomitantly. We conclude that routine Doppler ultrasound is very important for the detection o f clinically unsuspected vascular complications, particularly HAT, in the first 2 weeks after OLT. We recommend routine Doppler ultrasound o f all hepatic vessels every 3 days in the early postoperative phase af ter OLT Special attention should be paid to the Ist day.