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No need for fasting prior to doppler ultrasound of pediatric liver transplants: A self-controlled study
Martijn V Verhagen1, Hubert P J van der Doef2, Thomas C Kwee1
1Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Insights
Routine Doppler-ultrasound (DUS) for children post-liver transplant (LT) does not require fasting. This finding can reduce discomfort and improve the DUS experience for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Transplant Surgery
- Diagnostic Imaging
Background:
- Children undergoing liver transplantation (LT) often require routine Doppler-ultrasound (DUS).
- Fasting for DUS can cause significant hunger and discomfort in pediatric patients.
Purpose of the Study:
- To evaluate the impact of prandial changes on DUS measurements, specifically portal vein (PV) parameters.
- To assess if eating affects the distress and feasibility of DUS in children post-LT.
Main Methods:
- Prospective study of children 6 months post-LT undergoing pre- and postprandial DUS.
- Measurements included portal vein peak systolic velocity (PSV), hepatic artery, and hepatic vein velocities.
- Statistical analysis compared pre- and postprandial values and assessed test consistency using intraclass correlation coefficients (ICC).
Main Results:
- No significant differences were found in DUS measurements between pre- and postprandial states (p > .05).
- Test consistency was good to excellent for PV anastomotic PSV and PV velocity ratio (VR).
- Fasting was difficult for 57.2% of children, and 46.4% became upset when fasted.
Conclusions:
- Routine Doppler-ultrasound for children after liver transplantation does not necessitate fasting.
- Eliminating fasting can decrease patient burden and improve the examination experience.
Background:
Children frequently undergo routine Doppler-ultrasound (DUS) after liver transplantation (LT) for which they are fasted, but this may cause hunger and discomfort.
Objective:
To determine if DUS measurements, with focus on the portal vein (PV), are affected by prandial changes, and if this affects distress and feasibility of the DUS.
Materials And Methods:
Children were prospectively included to undergo a pre- and postprandial DUS on the same day at 6 months after LT. Pre- and anastomotic PV peak systolic velocity (PSV), and hepatic artery and hepatic vein DUS measurements were obtained. Pre- and postprandial measurements, and relative postprandial change of PV velocity ratio (VR) compared to PV anastomotic PSV, were compared using paired-sample t-tests and intraclass correlation coefficients (ICC). Obscuration by bowel gas, difficulty of DUS, and impact of fasting were assessed using 5-point rating scales.
Results:
Twenty-eight children (median age 3.5 years, IQR 1.6-10.8) were included; four were subsequently excluded because they were not fasted (N = 2) or withdrew consent for the second DUS (N = 2). Measurements between pre- and postprandial DUS, and relative postprandial change of VR compared to PV anastomotic PSV, were not significantly different (p > .05). Test consistency was good (ICC = 0.69, 95% CI = 0.29-0.67) for PV anastomotic PSV, and excellent (95% CI = 0.61-0.93) for PV VR. Obscuration by bowel gas or ease of DUS did not change after eating (p > .05). The majority (16/28, 57.2%) found fasting difficult, and several (13/28, 46.4%) got upset when fasted.
Conclusion:
Children with an LT do not need to be fasted for routine DUS, which may decrease the burden of the examination.
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