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Liver transplant rejection: value of hepatic vein Doppler waveform analysis
S Zalasin1, R S Shapiro, N Glajchen
1Department of Radiology, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Background:
To determine whether abnormal hepatic vein Doppler tracings can be used to predict liver transplantation rejection.
Methods:
A total of 158 hepatic vein Doppler tracings were obtained on 93 postliver transplant patients (63 patients without rejection and 30 patients with biopsy-proven rejection). Hepatic vein Doppler tracings were scored according to an established grading system (0 = normal triphasic waveform, 1 = dampened waveform, with loss of flow reversal, 2 = completely flat waveform). The hepatic vein Doppler tracings were then correlated with biopsy findings.
Results:
In the group of 63 patients without rejection, 124 Doppler examinations were performed and graded as follows: 0 = 87 (70%), 1 = 31 (25%), and 2 = 6 (5%). In the group of 30 patients with biopsy-proven rejection, 34 Doppler examinations were performed and graded as follows: 0 = 16 (47%), 1 = 14 (41%), and 2 = 4 (12%). The sensitivity of abnormal hepatic vein Doppler tracings for detection of rejection was 53% and the specificity was 70%. The positive predictive value of an abnormal hepatic vein Doppler tracing was 33% and the negative predictive value of a normal Doppler tracing was 84%.
Conclusions:
Abnormal hepatic vein Doppler tracings are observed in patients with and without liver transplant rejection. Abnormal tracings cannot be used to predict liver transplant rejection.