Tablet-sonography is a useful bedside tool during the first week after liver transplantation

Introduction: Detection of vascular complications in the first post-operative week after liver transplantation are very important. In particular an early diagnosis of hepatic artery thrombosis is essential in decision-making to go for early re-intervention or re-liver transplantation. Therefore abdominal sonography is performed several times in the first post-operative week, to look for patency of the hepatic artery, portal vein and liver veins. Hand-held devices might be expected to facilitate bedside abdominal sonography. In this study we compared sonography with regular machines, with tablet-sonography.

Methods: In the first week after liver transplantation, sonography of the liver vessels was performed at day 0 (immediately after transplantation and arrival at the ICU), day 1 and day 7. Sonography was performed with Hitachi Avius or Hitachi Preirus systems; when the authors were on duty, Philips Visiq system (tablet) was also being used. Good patency was considered when: the Doppler signal of the proper hepatic artery was quantifiable, the maximal velocity in the portal vein was above 15 cm/s, and the qualitative Doppler signal in the liver veins was obvious.

Results: In the study-period January-February-March 2016, 21 liver transplants were performed in 21 patients. Hepatic artery thrombosis was detected in one patient immediately after transplantation, for which successful thrombectomy was performed. There were 63 sonography moments, whether day 0, day 1 or day 7. During 31 moments the authors were able to perform sonography: at all 31 moments good patency of all liver vessels could be demonstrated, outcomes with tablet-sonography were completely in accordance with ‘regular’ sonography: 7 moments were at day 0, 13 at day 1, and 11 at day 7.

Conclusion: First impression of tablet sonography suggests good applicability for the investigation of liver vasculature, which is comparable to regular sonography in the setting of ‘first week after liver transplantation’.