Gray-scale ultrasonography shows serial changes of the congestive area after living donor liver transplantation using right lobe graft.
Objective: Hepatic venous congestion after living donor liver transplantation using right lobe graft produces various abnormalities on ultrasonography. Doppler sonography can reveal reversal of the portal flow direction in patients with acute and severe venous congestion and can show the presence of a functional intrahepatic anastomosis between the hepatic vein tributaries during the follow-up period in those people with improved congestion. However, few abnormal findings have so far been observed using gray-scale ultrasonography.
Methods: Thirteen patients who underwent living-donor liver transplantation using right lobe graft enrolled in this study. Postoperative ultrasonography was performed during the first 14 days after surgery. The serial changes of the congestive area indicated by gray-scale ultrasonography were quantitatively and qualitatively analyzed.
Results: Gray-scale ultrasonography showed the congestive areas as hyperechoic lesion in comparison to normal hepatic parenchyma. Congestive areas were seen in 4 patients in the early postoperative period (1-3 postoperative days). The acoustic intensity was higher in the congestive areas than in non-congestive areas (19.7 +/- 1.6 vs. 9.7 +/- 1.8 dB, respectively) in the early postoperative period. However, there was no difference between the congestive and non-congestive areas (21.3 +/- 5.0 vs. 19.8 +/- 2.6 dB, respectively) in the late postoperative period (8-14 postoperative days). Interestingly, the acoustic intensity in the congestive area in the early postoperative period was similar to that in the non-congestive area in the late postoperative period (19.7 +/- 1.6 vs. 19.8 +/- 2.6 dB, respectively). In nine patients who had no congestive area, acoustic intensity was similar throughout the postoperative period.
Conclusions: Congestive areas can be seen in gray-scale ultrasonography. A congestive area may spread to a non-congestive area in patients whose congestive area can be seen on gray-scale ultrasonography in the early postoperative period.