Hepatic Outflow Obstruction at Middle Hepatic Vein Tributaries or Inferior Right Hepatic Veins after Living Donor Liver Transplantation with Modified Right-lobe Graft: Comparison of CT and Doppler Sonography

  • Dr Hye Jeon Hwang, Asan Medical Center, University of Ulsan College of Medicine, Korea
  • Dr Kyoung Won Kim, Asan Medical Center, University of Ulsan College of Medicine, Korea, Democratic People's Rep
  • Dr Woo Kyoung Jeong, Hanyang University Guri Hospital, Korea
  • Dr So Yeon Kim, Seoul National University Bundang Hospital, Korea
  • Dr Gi-Won Song, Asan Medical Center, University of Ulsan College of Medicine, Korea
  • Dr Shin Hwang, Asan Medical Center, University of Ulsan College of Medicine, Korea
  • Dr Sung-Gyu Lee, Asan Medical Center, University of Ulsan College of Medicine, Korea

    • Objective: To compare CT and Doppler ultrasound (DUS) in diagnosis of hepatic outflow obstruction at middle hepatic vein tributaries (MHVTs) and inferior right hepatic veins (IRHVs) after living donor liver transplantation (LDLT) with modified right-lobe grafts.
    Materials and Methods: The study was approved by our institutional review board. Thirty-seven venographies were performed in 36 patients after LDLT with modified right-lobe grafts, evaluating 51 MHVTs and 25 IRHVs. They were classified as obstructed or non-obstructed. On DUS or CT, flow patterns of MHVTs and IRHVs or relative parenchymal attenuation, enhancement, and opacification of these veins were evaluated for diagnosis of hepatic outflow obstructions. McNemar tests were performed to compare diagnostic values of DUS and CT.
    Results: Based on hepatic venography, 33 MHVTs were categorized as obstructed and 18 as non-obstructed; 16 IRHVs were categorized as obstructed and 9 as non-obstructed. For diagnosis of MHVT obstruction, DUS was more sensitive and accurate, although less specific, than CT (97% vs. 39%, P<.001; 86% vs. 61%, P=.0209; 67% vs. 100%, P=.0412). Similarly, DUS was more sensitive (94% vs. 31%) and accurate (84% vs. 56%) than CT, although less specific (67% vs. 100%), for diagnosis of IRHV obstruction, with a statistical significance only for sensitivity (P=.002, =.248, and =.092, respectively).
    Conclusion: DUS is more sensitive and accurate than CT for obstruction at MHVTs and IRHVs in patients after LDLT using modified right-lobe grafts. Although current CT criteria produces high specificity and may reduce unnecessary invasive venographies, optimal CT criteria with acceptable sensitivity should be re-established.