Ch 28 Liver transplants

_____ anastomosis is commonly made between donor CHD or celiac trunk & recipient CHA common hepatic artery

Arterial

Donor hepatic veins & IVC are connected together to the recipient _____.

IVC

Hepatic veins are connected to the ___.

IVC

A liver transplant patient presents to the vascular lab for follow up. Upon questioning, the patient indicates he has been experiencing lower extremity swelling. Which of the following would be of concern to the vascular tech?

IVC thrombosis

_____ transplants are usually performed with a whole liver from a DD.

Orthotropic

_____ liver transplant is the most commonly performed.

Orthotropic (when it is placed in the normal position in the body of the recipient)

A hepatic artery stenosis spectral Doppler waveform demonstrates an increased _____ & turblulent flow.

PSV

Daily Doppler exams should reveal an improvement in the _____. If it doesn't improve, arterial thrombosis should be suspected

RI

The donor CBD is typically anastomosed end-to-end with the recipient _____.

CHD (common hepatic duct)

Criteria for ranking patients to receive a liver transplant include _____ & MELD (model for end-stage liver disease) scores.

Child-Pugh

Within _____ hours postop, a lack of end diastolic flow in the main HA is not indicative of impending hepatic artery thrombosis.

48

_____ sites should be carefully evaluated.

Anastomotic

What is the preferred anastomosis of donor CBD?

common hepatic duct

Single-lobe LRD transplants are becoming more _____. The _____ lobe is used in adults & the _____ lobe is used in children.

common, right, left

A Doppler study of the main hepatic artery immediately posttransplantation demonstrates a complete absence of _____ flow. The high resistance waveform pattern is likely secondary to increased peripheral vascular resistance, which is secondary to edema of the hepatic parenchyma.

diastolic

A choledochojejunostomy (biliary system drains directly into the jejunum) may be needed if the recipient duct is _____

diseased

In a single-lobe LRD transplant, the donor hepatic artery, bile duct, portal vein, & hepatic vein are anastomosed _____ or end -to-side with the native structure.

end-to-end

Portal vein thrombosis (PVT) is a rare finding that usually involves the _____ portion, intraluminal echoes, & may involve the patient having early liver failure & signs of portal _____.

extrahepatic, hypertension

Hepatic artery pseudoaneurysm (PSA) is an abnormal dilation or ballooning of the hepatic artery either _____ (usually due to disruption of intimal lining), or _____ (thought to be caused by fore needle biopsy or infection) with a high risk of hemorrhage & organ failure.

extrahepatic, intrahepatic

The _____ technique is typically used for arterial anastomosis, where the smaller vessel walls are split & sewn over the larger vessel.

fish mouth

The _____ technique prevents development of postsurgical stenosis.

fish mouth

Which type of anastomosis is performed for the arterial anastomosis of hepatic artery in liver transplants?

fish mouth

Ultrasound is the procedure of choice for initial evaluation of potential _____ collections, abnormalities of the _____ tree, & vascular complications.

fluid, biliary

The most common cause of transplant loss is _____ followed by biliary complications.

graft failure/rejection

Which of the following is NOT a contraindication for liver transplantation?

hemochromatosis

Upon duplex evaluation of a recent liver transplant, tardus parvus waveforms are noted in the inter-parenchymal hepatic arteries. Which of the following wuld be a concern in this patient?

hepatic artery stenosis

What is the most common vascular complication of liver transplantation?

hepatic artery thrombosis

The most common vascular complication of liver transplants is _____

hepatic artery thrombosis (HAT)

A normal right hepatic vein Doppler waveform in a patient with a right lobe transplant shows _____ flow with pulsatility reflecting the _____ pressure. The transient reversal of flow, the "A" wave, is produced by the contraction of the right atrium.

hepatofugal, right heart

What is the best patient "window" for sonographich duplex assessments of hepatic transplant?

intercostal

Many times, Doppler measurements are taken from a _____ approach. due to the better angle to the flow of the _____ system. This enhances the Doppler shift & color fill-in.

intercostal, portal

A liver transplant patient presents to the vascular lab for evaluation after core needle biopsy. Which of the following would be a concern in this patient?

intrahepatic artery pseudoaneurysm

Color & spectral Doppler assessment should include the intrahepatic, main, right, & _____ hepatic arteries as well as the main, right, & left _____. Also include the IVC & hepatic veins. Be sure to obtain _____ velocities.

left, portal veins, angle-corrected

Children often receive a partial or split liver transplant using the _____ lobe due to the _____.

left, smaller size

Vascular causes are the _____ most common

next

A transplant where the organ is placed into the normal anatomic position is called a _____ transplant.

orthotropic

Due to organ shortages, _____ liver transplants from LRDs are becoming more common.

partial

A liver transplant patient presents to the vascular lab with worsening liver function. Upon duplex evaluation, velocities in the main portal vein reach 200 cm/s. What do these findings suggest?

portal vein stenois

What would be suspected in a liver transplant patient with signs of early liver failure and portal hypertension?

portal vein thrombosis

Ultrasound does not play a role in the diagnosis of _____.

rejection

Which of the following is the most common cause of liver transplant loss?

rejection

Normal spectral Doppler for the main portal vein shows hepatopetal flow with a slight _____ variation & is above the baseline.

respiratory

With a LD transplant, usually the _____ lobe is used.

right

Liver is the _____ commonly transplanted organ after the _____.

second most, kidney

Anastomoses are often reinforced with a _____.

stent

Hepatic artery complications are cause for immediate _____.

surgical intervention

Presence of a high-resistance signal immediately postop is thought to be caused by liver _____ or increase in intrahepatic pressure & vascular resistance.

swelling

Normal hepatic artery spectral Doppler shows a sharp _____ upstroke & _____ forward diastolic flow.

systolic, continuous

Sonographically, PVT presents with complete or partial flow voids with color, echogenic _____ inside the lumen, _____-velocity scale settings must be used to detect any flow that may be present. Power Doppler should be used to verify absence of flow.

thrombus, low

With hepatic artery stenosis (HAS), increased velocities are noted with poststenotic _____ & tardus parvus waveforms distally.

turbulence

Ultrasound is important in evaluating liver transplants because it is a sensitive test for detection of _____ complications, postop _____ collections, & biliary complications

vascular, fluid

IVC thrombosis/stenosis is a rare finding that presents sonographically where the thrombus seen in the lumen is shows changes in color & spectral Doppler (signs of narrowing & _____ changes).

velocity

It is important to consult the surgical report to determine if it was a full liver or single lobe transplant & to determine the vascular _____ used or if there were any anomalies.

anastomoses

Vascular & biliary _____ vary widely due to the wide variety in anatomy & anomalies.

anastomoses

Hepatic artery stenosis (HAS) is usually seen at the _____ site due to surgical techniques, clamp injuries, perfusion catheter injuries, & interruption of vasa vasorum.

anastomotic

PVS is most common at the _____ site, and is indicated by a PSV >_____ cm/s with an anastomotic to preanastomotic velocity ratio of 3:1.

anastomotic, 125

Signs of rejection include abnormal LFT, _____, pleural effusions, varices, sepsis, fever, biliary obstruction, leakage, infection, & splenomegaly.

ascites

Hepatic artery is the sole source of blood supply to the _____. Lack of blood will lead to _____ necrosis & loss of transplant

bile ducts, biliary

Normal transplant findings include a homogenous appearance, appropriately sized (for the type of transplant), normal appearing _____ system without dilation (it may appear thickened if a stent is in place), perihepatic fluid if early post op that clears up in a few _____.

biliary, days

Extra biliary collection of bile (fluid) is called _____.

biloma

Transplantation is the only treatment option for many patients with _____ end-stage liver failure.

chronic