الفهرس 
Liver TransplantationOnly 14 pages are availabe for public view
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Abstract
Introduction: Living-Related Liver Transplantation (LRLT) was developed in 1989 to overcome the high mortality on the waiting list for patients with end stage liver disease. Since then, liver transplantation programs around the world have begun to employ this method with encouraging results. Vascular complications, especially hepatic artery thrombosis, are the second leading cause of graft failure in the immediate post-operative period and remain an important cause of morbidity and mortality for transplant recipients.
Aim of the study: To correlate the clinical, laboratory, sonographic and non-contrast Doppler findings in the hepatic graft vasculature in LRLT recipients, in the post transplantation period, firstly in the detection of post transplantation hepatic and portal vascular complications; their incidence and severity, their impact on graft function and patient survival and their impact on the various medical parameters that influence the outcome of the transplant procedure and secondarily in relating the various post transplant complications with the Doppler changes of the hepatic and portal vessels.
Patients and methods: The study enrolled hundred adult recipients of living related liver transplantation who underwent their surgery in Dar AL-Fouad Hospital over the period of four years. All recipients received a right hepatic lobe. The number of transplant surgeries were 102, because two out of those hundred had a re-transplant. The study was carried out after the approval of the Medical and Ethical committees of the Tropical Medicine Department, Cairo University, and of Dar Al- Fouad Hospital.
Results: Hepatic vascular problems were diagnosed in 15 recipients (15 %). Their total number was 17 (9 hepatic artery problems, 6 portal vein problems and 2 hepatic venous outflow problems). Twelve (70.6 %) of the reported vascular complications occurred within the first 4 weeks post transplantation (early complication), and the remaining 5 (29.4 %) occurred beyond 4 weeks post transplantation (delayed complication). There was no statistical significance between the group who developed vascular complications and the group who did not in the overall mortality rate, rate of acute cellular rejection (ACR), number of biliary problems, recurrence of HCV hepatitis, incidence of systemic or graft sepsis, number of chronic cellular rejection episodes (CCR), Child-Turcotte-Pugh (CTP) class and pre-operative model for end stage liver disease (MELD) score, presence of pre-transplant hepatocellular carcinoma (HCC), recipient or donor age, recipient sex, or the immune suppression regimen used. The Doppler ultrasound (DUS) findings obtained from the hepatic artery (HA), portal vein (PV), hepatic veins (HV) and inferior vena cava (IVC) were also non diagnostic nor specific in the patients who developed ACR, biliary problems, recurrent HCV hepatitis, systemic or graft sepsis or CCR.
On the other hand, there was a statistically significant difference between the two groups in the incidence of graft failure (33.3 % for those who developed a vascular problem versus 4.7 % for those who did not) and in the duration of hospital stay post transplant (39.9 +- 30 days versus 28.5 +- 15 days) respectively. The Doppler findings obtained from the HA, PV, HV and IVC were reliable to diagnose the various post transplantation problems affecting these vessels.
Conclusion: Hepatic vascular complications following living related liver transplantation are still considered to be an important issue with a considerable incidence rate and an important cause for graft related problems. They also do prolong the period of hospital stay post transplantation. DUS is a reliable method in the diagnosis of hepatic and portal vascular problems occurring in the post transplantation setting but is less sensitive in the diagnosis and follow up of other medical or surgical complications.