ABSTRACT
BACKGROUND: Venous complications after pediatric liver transplantation seriously affect the survival rate of patients and grafts. At present, the diagnostic indicators have not been unified. Venous complications may cause portal hypertension, which may lead to splenomegaly and splenic vein dilatation. Therefore, the changes in spleen may be closely related to the venous complications. The purpose of this study was to explore the relationship between ultrasonic splenic parameters and venous complications and to study whether these splenic parameters can be used for the diagnosis of venous complications. METHODS: We retrospectively included pediatric patients who underwent liver transplantation and collected ultrasonic spleen parameters before, and then 1-3 days, 1-3 weeks, 1-3 months, and 4-12 months after liver transplantation. We observed whether there were portal vein or hepatic vein complications within 1 year after liver transplantation. RESULTS: Among 109 pediatric patients after liver transplantation included in our study, 11 of them suffered from portal vein complications and nine hepatic vein complications. Spleen transverse diameter, spleen longitudinal diameter, spleen portal vein diameter, spleen index, spleen transverse diameter ratio, spleen longitudinal diameter ratio, and spleen index ratio were independent risk factors of venous complications. The accuracy of spleen transverse diameter (AUROC: 0.73), spleen index (AUROC: 0.70), spleen transverse diameter ratio (AUROC: 0.71), and spleen index ratio (AUROC: 0.72) in predicting venous complications were higher than other ones. CONCLUSIONS: Ultrasonic examination is a common follow-up method for pediatric patients after liver transplantation and the application of ultrasonic spleen parameters may be helpful to monitor venous complications.
Subject(s)
Liver Transplantation , Spleen , Humans , Child , Spleen/diagnostic imaging , Liver Transplantation/adverse effects , Liver Transplantation/methods , Retrospective Studies , Portal Vein/diagnostic imaging , Ultrasonography , Splenic Vein/diagnostic imagingABSTRACT
At present, a large quantity of patients with end-stage liver diseases are still waiting for liver transplantation. Evaluation of donor liver quality with rapid, convenient, non-invasive and accurate methods plays a pivotal role in improving the prognosis and quality of life of liver transplant recipients. No standard evaluation criteria of donor liver quality have been established in clinical practice. Comprehensive evaluation methods have been primarily adopted, including clinical parameters of donors, laboratory examination, imaging examination and pathological examination, etc. Conventional ultrasound and contrast-enhanced ultrasound may evaluate the quality of donor liver before liver transplantation and predict the incidence of complications after liver transplantation, which are of significant application prospect in liver transplantation. In this article, the basic methods and research progress on conventional ultrasound and contrast-enhanced ultrasound in evaluating the vascular variation of donor liver, micro-circulatory perfusion of liver parenchyma, degree of steatosis of donor liver, degree of fibrosis of donor liver, volume and quality of donor liver were reviewed, aiming to provide more methods and ideas for clinical evaluation of donor liver quality.
ABSTRACT
To evaluate the impact of intrahepatic cholestasis on liver stiffness measurement ( LSM ) of two‐dimensional shear wave elastography ( 2D‐SWE ) in patients with chronic hepatitis B . Methods Between June 2011 and December 2016 , total of 1 188 patients with chronic hepatitis B infection were enrolled to collect clinical ,2D‐SWE ,biochemical variables and histological ( M ET AVIR scoring system ) datas . LSM was compared between normal total bilirubin group ( TB ＜ 23 .9 μmol/L ) versus abnormal TB group( ≥23 .9 μmol/L ) . Correlation of TB with LSM s was assessed . Results Nine hundred and seventy‐three patients with effective LSM in the study were analyzed . Within the same fibrosis stage ( F1‐F4) ,LSM showed significantly higher value in abnormal TB group than those of normal TB group ( r＝0 .328 ,0 .247 ,0 .495 ,0 .435 ,all P ＜ 0 .001 ) . Increased LSM for abnormal TB group was generally found within different subset of patients [ fibrosis stage ≤ F2 ,AL T ≥ 2 × upper limit of normal ( ULN ) ;fibrosis stage≤ F2 ,M ET AVIR activity grade ≤ A1 or ≥ A2 ] ,with r ＝ 0 .266 ,0 .210 ,0 .243 ( all P ＜0 .001) ,respectively .Increased LSM for abnormal TB group was also found within different subset of patients [ fibrosis stage≥F3 ,AL T＜2× ULN ,≥2×ULN ; fibrosis stage≥F3 ,M ET AVIR activity grade≥A2 ,with r ＝ 0 .671 ,0 .200 ,0 .468 ( all P ＜ 0 .05 ) ] . Conclusions Hepatogenous jaundice induced to intrahepatic cholestasis shows slight positive correlation with LSM s in patients with chronic hepatitis B .
ABSTRACT
[Objective]To evaluate the two-dimensional shear wave elastography(2D SWE)in predicting the prognosis of the patients with acute-on-chronic hepatitis B liver failure(ACLF-HBV).[Methods]312 patients diagnosed with ACLF-HBV at the De-partment of Infectious Diseases in the Third Affiliated Hospital of Sun Yat-sen University from October 1st 2013 to December 31th 2015 were recruited. The baseline data of all patients,including 2D SWE,laboratory data,ultrasonographic data,Model for End-stage Liver Disease score(MELD),Child-Turcotte-Pugh score(CTP),and King′s College Hospital score(KCH),were collected when enrolled. All patients were followed up for at least 90 days and their clinical outcomes(recovering or worsening)were recorded. 2D SWE values of all patients were dynamically collected every 2~4 weeks during the follow-up until death,liver transplantation, or discharging from hospital.[Results]The worsening patients showed higher 2D SWE values than the recovering ones[(44.0 ± 7.5) kPa vs(36.8 ± 10.3)kPa,t=-6.5,P=0.000],2D SWE value less than 39.2 kPa could be a prediction of the patient′s recovery in 90 days.The predictive value of 2D SWE(AUROC=0.73)was higher than that of KCH(AUROC:0.65,z=2.1,P=0.033). Among all the dynamically measured patients,2D SWE rose from(42.1 ± 8.0)kPa to(47.5 ± 9.3)kPa in the worsening group during the 90-day follow-up,while nearly stable in the recovery group.[Conclusion]Noninvasive liver stiffness measurement by 2D SWE is a use-ful method in evaluating the prognosis of ACLF-HBV patients. Taking a cutoff of 39.2 kPa,patients with higher 2D SWE values could have worse clinical outcomes ,otherwise better. It seems that dynamically measuring 2D SWE values could also be helpful ,but more research in the future should be needed.
