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Hepatic arterial resistance index--an indicator of diffuse liver disease in children treated with bone marrow
W M Kauffman1, H E Heslop, S A Gronemeyer
1Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Insights
The hepatic arterial resistance index (HARI) can non-invasively detect liver dysfunction in pediatric bone marrow transplant patients. A HARI below 0.55 effectively indicates liver issues, aiding early diagnosis and management.
Area of Science:
- Pediatric Hematology and Oncology
- Hepatology
- Diagnostic Imaging
Background:
- Bone marrow transplantation (BMT) in children can lead to significant liver complications.
- Early detection of liver dysfunction is crucial for improving patient outcomes post-BMT.
- Non-invasive markers are needed to monitor liver health in these vulnerable patients.
Purpose of the Study:
- To investigate the correlation between the common hepatic artery resistance index (HARI) and liver function tests (LFTs) in pediatric BMT recipients.
- To identify HARI thresholds predictive of liver dysfunction.
Main Methods:
- Prospective analysis of 106 Doppler ultrasound examinations of the common hepatic artery in 31 pediatric BMT patients.
- Assessment of HARI in relation to serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase (ALK), lactate dehydrogenase (LDH), and serum albumin (ALB).
Main Results:
- A significant breakpoint for HARI was observed at 0.55 for SGOT, SGPT, and ALK, and 0.53 for LDH (P < 0.05).
- HARI values below these breakpoints predicted liver dysfunction with high specificity (81-93%).
- No significant association was found between LFTs and serum albumin levels.
Conclusions:
- The hepatic arterial resistance index (HARI) serves as a reliable non-invasive indicator of liver dysfunction in pediatric BMT patients.
- A HARI threshold of 0.55 can effectively identify children at risk of hepatic complications post-transplant.
Aim:
To describe the relationship between the resistance index of the common hepatic artery and liver function tests in children undergoing bone marrow transplantation.
Materials And Methods:
We analysed prospectively the results of 106 Doppler ultrasound examinations of the common hepatic artery from 31 bone marrow transplant patients, 16 of whom had normal liver function. The aetiology of the liver dysfunction in the other 15 patients was veno-occlusive disease (n = 7), unknown (n = 3), hepatic graft-versus-host disease (n = 2), hepatitis (n = 2), or cholestasis (n = 1). We assessed the relationships between the hepatic arterial resistance index (HART) and the results of the serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase (ALK), lactate dehydrogenase (LDH) and serum albumin (ALB) assays and calculated HARI break-point values that might distinguish patients with liver disease from patients with the normal liver function.
Results:
The significant break point (P < 0.05) of the HARI was 0.55 for SGOT, SGPT and ALK. LDH was associated with a break point of 0.53. Resistance indices for the common hepatic artery below the break-point values predicted liver dysfunction with specificities of 81%, 80%, 92% and 93%, respectively. There was no significant relationship between liver function tests and ALB levels.
Conclusion:
If below 0.55, the hepatic arterial resistance index is a non-invasive indicator of liver dysfunction in children undergoing bone marrow transplantation.