Purpose: To categorize hepatofugal portal flow (HFPF) on Doppler US in patients following liver transplantation (LT) according to presumed causes based on radiologic and pathologic findings, and to investigate clinical significance.
Materials and Methods: We searched database of LT recipients in our institution. After review of radiological and pathological reports, we found 30 patients in whom Doppler US revealed HFPF, and classified into three groups: A, hepatic inflow; B, hepatic outflow; C, parenchymal abnormalities. We also categorized Doppler pattern into 1) continuously HFPF (pattern 1), 2) to-and-fro pattern of which overall amount of hepatofugal larger than hepatopetal (pattern 2), 3) to-and-fro pattern of which hepatofugal smaller than hepatopetal (pattern 3). We investigated clinical features and Doppler pattern in each group,
Results: In patients classified as group A, presumed cause was portal insufficiency (n=8). In group B, it was hepatic outflow obstruction at anastomosis (n=4) and post-anastomotic problems such as tricuspid regurgitation or high central venous pressure (n=4). In group C, it was acute rejection (n=6), hepatocytic necrosis (n=5), and liver cirrhosis (n=1). Two patients without obvious cause who improved spontaneously classified to miscellaneous. Sixteen (53%) of the patients with HFPF improved with medical treatment, 7 (23%) improved after intervention or surgery, and other 7 were dead. Mortality of group C was 33.3%, which was the highest value among three groups. About Doppler pattern, four patients who showed pattern 1 were dead.
Conclusion: HFPF reflects various pathologic conditions after LT, and its clinical significance is also diverse depending on the causes.