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Doppler ultrasonography and contrast-enhanced ultrasonography to evaluate liver allograft discard: A pilot
Hong-Jun Zhang1, Bo-Wen Zheng1, Shi-Jie Gu2
1Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, Guangdong, People's Republic of China.
Insights
Doppler ultrasonography (DUS) and contrast-enhanced ultrasonography (CEUS) can predict the discard risk of brain death (DBD) or cardiac death (DCD) donor livers. Prolonged hepatic artery systolic acceleration time (SAT) and decreased enhancement indicate higher discard probability.
Area of Science:
- Transplant surgery
- Medical imaging
- Hepatology
Background:
- Hemodynamic changes significantly impact donor liver viability after brain death (DBD) or cardiac death (DCD).
- The utility of Doppler ultrasonography (DUS) and contrast-enhanced ultrasonography (CEUS) in assessing perfusion and predicting discard risk for these livers remains under investigation.
Purpose of the Study:
- To evaluate the predictive capability of DUS and CEUS for the discard risk of DBD or DCD donor livers.
Main Methods:
- Consecutive DBD or DCD donors underwent DUS/CEUS before organ procurement.
- Analysis of DUS and CEUS images focused on recording specific perfusion parameters.
Main Results:
- Fifteen out of 67 (22.4%) donor livers were discarded.
- Discarded livers exhibited prolonged hepatic artery SAT on DUS (0.08s vs 0.06s) and reduced homogeneous enhancement on CEUS (40.0% vs 73.1%).
- Multivariable analysis identified prolonged hepatic artery SAT and decreased enhancement as independent risk factors for liver discard.
Conclusions:
- DUS and CEUS serve as promising tools for screening high-risk liver donors.
- Prolonged hepatic artery SAT (DUS) and decreased liver enhancement (CEUS) reflect hemodynamic changes and are significant risk factors for discarding DBD/DCD donor livers.
Background:
Broad hemodynamic changes, is believed to have a profoundly damaging effect on donor livers after brain death (DBD) or cardiac death (DCD). It remains unclear whether Doppler ultrasonography (DUS) and contrast-enhanced ultrasonography (CEUS), the imaging modalities to evaluate perfusion, could provide more information of liver discarded.
Objective:
To evaluate the ability of DUS and CEUS to predict the risk of DBD or DCD liver discarded.
Methods:
The consecutive DBD or DCD donors with DUS/CEUS examinations before surgical procurement from February 2016 to June 2018 at our institution were included. The US and CEUS images of each donor liver were analyzed and the parameters were recorded.
Results:
Among the 67 eligible donor livers, 15 (22.4%) were discarded and 52 (77.6%) were used. The discarded livers showed prolonged SAT of hepatic artery (0.08s vs 0.06s, OR = 2.169, P = 0.008) on DUS, less cases with homogeneous enhancement (40.0% vs 73.1%, OR = 0.243, P = 0.028) on CEUS, more cases with decreased enhancement (53.3% vs 19.2%, OR = 4.800, P = 0.009), and less difference of the peak time between portal vein and liver parenchymal (0.5s vs 6.7s, OR = 0.917, P = 0.034). The multivariable analysis showed that donor liver with prolonged SAT of hepatic artery (OR = 7.304, 95% CI: 1.195-44.655, P = 0.031) and decreased enhancement (OR = 2.588, 95% CI: 1.234-5.426, P = 0.012) were independent factors of liver discarded.
Conclusions:
DUS/CEUS could be applied as a promising predictive tool to screen high-risk liver donors. The prolonged SAT of hepatic artery on DUS and the decrease of liver donor in enhancement on CEUS, indicating hemodynamic changes in DBD and DCD donor livers, were risk factors of liver discarded.
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