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Acute liver rejection: accuracy and predictive values of doppler US measurements--initial experience.

Abstract：

PURPOSE:To prospectively evaluate accuracy and predictive values of Doppler ultrasonographic (US) measurement of portal blood velocity (PBV) and splenic pulsatility index (SPI) in diagnosis of clinically relevant acute rejection in patients with clinicobiochemical hepatic dysfunction after orthotopic liver transplantation (OLT). MATERIALS AND METHODS:Study was approved by the institutional review board, and protocol conformed to ethical guidelines of Declaration of Helsinki. Patient informed consent was obtained. In 27 patients with OLT (23 men, four women; mean age, 48 years; range, 27-64 years), PBV and SPI were measured at Doppler US within 48 hours before or after liver biopsy for clinically suspected acute rejection. Biopsy specimens were assigned scores according to Banff method, and rejection activity index (RAI) was calculated. RAI score of 4 or greater was considered clinically relevant acute rejection. Doppler US parameters were analyzed as absolute values and as percentage point changes with respect to values obtained at last examination before rejection was suspected. Information from two Doppler US parameters was combined; Doppler US composite index was calculated. Statistical tests were conducted to assess accuracy, sensitivity, specificity, and predictive values of Doppler US parameters in diagnosis of graft rejection. RESULTS:Clinically relevant acute rejection was diagnosed in nine patients. Median time from OLT until histologic diagnosis of acute rejection was 8 days (range, 5-20 days). Rejection was associated with a marked reduction in mean PBV (-43% +/- 5 [standard error of the mean]) and a slight increase in SPI (+12% +/- 16). The calculated Doppler US composite index was strictly related to severity of rejection (P < .001). When applied retrospectively, this index had good accuracy (88%) for prediction of rejection (specificity, 89%; sensitivity, 86%; negative predictive value, 94%). CONCLUSION:During the first weeks after OLT, a marked decrease in PBV associated with increased SPI supports suspicion of clinically relevant acute rejection.

journal_name

Radiology

journal_title

Radiology

authors

Bolognesi M,Sacerdoti D,Mescoli C,Nava V,Bombonato G,Merkel C,Merenda R,Angeli P,Rugge M,Gatta A

doi

10.1148/radiol.2352040506

subject

Has Abstract

pub_date

2005-05-01 00:00:00

pages

651-8

issue

eissn

0033-8419

issn

1527-1315

pii

2352040506

journal_volume

235

pub_type

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Acute liver rejection: accuracy and predictive values of doppler US measurements--initial experience.