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Updated: Feb 18, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Postoperative Elevated Resistive Indices Do Not Predict Hepatic Artery Thrombosis in Extended Criteria Donor Livers
Eric J Siskind1, Fauzia Vandermeer1, Tamar R Siskind1
1Division of Transplantation, University of Maryland Medical Center, Baltimore, Maryland.
Insights
Elevated hepatic arterial resistive indices (RIs) in liver transplant recipients using expanded criteria donors are common post-surgery but self-limiting. These findings indicate graft edema, not impending complications, and do not require intervention.
Area of Science:
- Transplant Surgery
- Vascular Imaging
- Hepatology
Background:
- Postoperative ultrasound assessment of liver allografts is crucial for monitoring graft health.
- Elevated resistive indices (RIs) in hepatic arteries can be a concern in liver transplantation.
- The significance of elevated RIs in grafts from expanded criteria donors (ECDs) requires clarification.
Purpose of the Study:
- To determine if elevated hepatic arterial resistive indices (RIs) are consistently present in liver allografts from standard criteria donors (SCD), extended criteria donors (ECD), and donation after cardiac death (DCD) donors.
- To ascertain if these elevated RIs are pathological or indicative of impending complications like hepatic artery thrombosis (HAT).
- To evaluate the natural course of elevated RIs and guide clinical management strategies.
Main Methods:
- Retrospective analysis of postoperative liver transplant ultrasounds from 115 consecutive patients.
- Stratification of hepatic arterial RIs based on donor type: DCD, macrosteatosis (>30%), or SCD.
- Review of subsequent ultrasounds to assess RI normalization in patients with initially elevated RIs.
Main Results:
- The mean RI was 0.64 overall, with DCD at 0.67, macrosteatosis at 0.81, and SCD at 0.61 (p=0.033).
- Elevated RIs in DCD and macrosteatosis groups normalized spontaneously without intervention.
- No early hepatic artery thrombosis (HAT) was observed; elevated RIs in ECDs and DCDs were not predictive of HAT.
Conclusions:
- Elevated hepatic arterial RIs in ECD and DCD liver allografts are common postoperatively but represent graft edema and stiffness, not technical complications.
- These elevated RIs are self-limiting and normalize over time, suggesting that routine anticoagulation or CT angiography is not warranted.
- Findings support a conservative approach to managing elevated RIs in liver transplant recipients from expanded criteria donors.
Abstract:
Postoperative transplant liver ultrasounds were analyzed in standard criteria donor (SCD), extended criteria donor (ECD), and donation after cardiac death (DCD) liver allografts to determine if elevated resistive indices (RIs) are consistently present and if they are pathological. Postoperative transplant liver ultrasounds were reviewed from 115 consecutive patients. Hepatic arterial RIs were stratified based on the type of donor: DCD, macrosteatosis (>30%), or standard criteria. In all patients with elevated RI, subsequent ultrasounds were reviewed to demonstrate RI normalization. The mean RI for all 115 patients was 0.64, DCD was 0.67, macrosteatosis was 0.81, and SCD was 0.61 ( p = 0.033). The RI on subsequent liver ultrasounds for DCD and macrosteatosis normalized without any intervention. There were no incidences of early hepatic artery thrombosis (HAT) observed in the cohort. Hepatic arterial RI in ECDs and DCDs are elevated in the immediate postoperative period but are not predictive of HAT. It represents interparenchymal graft stiffness and overall graft edema rather than an impending technical complication. The results of our study do not support the routine use of anticoagulation or routine investigation with computed tomography angiography for elevated RIs as these findings are self-limiting and normalize over a short period of time. We hope that this information helps guide the clinical management of liver transplant patients from expanded criteria donors.
