Contrast-Enhanced Ultrasonography Findings Within 3 Days Postoperatively Are Associated With 1-Month Graft Failure After Split Liver Transplantation.

Rationale and objectives: This study aimed to evaluate whether Doppler ultrasonography (DUS) and contrast-enhanced ultrasonography (CEUS) within 3 days postoperative can identify 1-month graft failure after split liver transplantation (SLT).

Materials and methods: A total of 58 consecutive patients who underwent SLT between February 2022 and September 2023 were included. The DUS and CEUS images and parameters within 3 days postoperatively were analyzed and recorded. The DUS parameters included peak systolic velocity (PSV), resistive index, and systolic acceleration time for the hepatic artery and PSV for the portal vein and hepatic vein. The CEUS qualitative analysis variables included the liver parenchyma enhancement pattern and the posterior enhancement attenuation. Logistic regression and Cox proportional hazard regression were used to evaluate the relationship between DUS/CEUS findings and 1-month graft failure.

Results: Seven of the 58 liver grafts failed within 1 month. Poor CEUS enhancement (pattern Ⅱ/Ⅲ) was observed in five of seven patients (71.4%) of graft failure, whereas good contrast enhancement (pattern Ⅰ) was found in 47 of the 51 patients (92.1%) in the successful group on postoperative day 3. Multivariate logistic regression analysis revealed that 1-month graft failure was independently predicted by operative time (odds ratio [OR] = 3.79, 95% confidence interval [CI]: 1.27-11.29, p = .017) and CEUS enhancement pattern on postoperative day 3 (OR = 90.88, 95% CI: 2.77-2979.56, p = .011). Cox proportional hazard regression showed that operative time (hazard ratio [HR] = 1.6, 95% CI: 1.15-2.22, p = .005) and CEUS enhancement pattern on postoperative day 3 (HR = 11.947, 95% CI: 2.04-69.98, p = .006) were independent predictors for graft failure.

Conclusion: Poor CEUS enhancement (pattern Ⅱ/Ⅲ) was associated with 1-month graft failure in SLT recipients. CEUS may serve as a noninvasive, valuable prognostic tool to predict clinical outcomes early after SLT.