ARTERIAL ABNORMALITIES FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION - ARTERIOGRAPHIC FINDINGS AND CORRELATION WITH DOPPLER SONOGRAPHIC FINDINGS

OBJECTIVE. We studied the findings on conventional arteriography in pa tients who had suspected graft ischemia after orthotopic liver transpl antation to determine the value of a single Doppler signal in predicti ng these lesions. MATERIALS AND METHODS. We retrospectively reviewed s elective visceral arteriograms with abnormal findings from 20 adults w ho had suspected graft ischemia after orthotopic liver transplantation and a single Doppler signal from the hepatic artery at the porta hepa tis on sonograms obtained before arteriography. Arteriographic abnorma lities were categorized according to morphology and location as follow s: stenosis of recipient's hepatic artery, occlusion or stenosis of th e transplanted extrahepatic artery, and occlusion or stenosis of the t ransplanted intrahepatic artery. RESULTS. Twenty-three arteriographic abnormalities were detected: four recipient celiac axis stenoses, seve n extrahepatic occlusions, nine extrahepatic stenoses, and two occlusi ons and one stenosis of the transplanted intrahepatic artery. Six of t he extrahepatic occlusions, two of the extrahepatic stenoses, and none of the recipient artery stenoses or the intrahepatic occlusions or st enoses were correctly diagnosed on the basis of Doppler findings. One patient with both an extrahepatic stenosis and and extrahepatic occlus ion was thought to have an intrahepatic occlusion, and two patients wi th mild (<50%) extrahepatic stenoses and one with an intrahepatic occl usion were thought to have an extrahepatic occlusion. CONCLUSION. A wi de spectrum of abnormalities in the recipient's celiac axis or the tra nsplanted arteries that may be associated with graft ischemia after or thotopic liver transplantation are often not detected or findings are misinterpreted on routine Doppler examination. In patients with suspec ted graft ischemia, visceral arteriography should be performed promptl y to confirm the diagnosis and to allow early intervention.