Scientific Session 28 — SS28: Gastrointestinal Imaging - Advanced Abdomen TechniquesFriday, May 10, 2019
3050. Utility of Nifedipine Use for Doppler US Early After Liver Transplantation To Predict Short Term Complications and Long Term Outcomes
Kadaba P*, Lewis S, Beitia L, Rosen A, Simpson W. The Mount Sinai Hospital, New York , NY
Address correspondence to P. Kadaba (email@example.com)
Objective: To evaluate the ability of response to nifedipine administration as measured by changes in hepatic arterial flow on Doppler ultrasound (US) to predict short-term complications and long-term outcomes in liver transplant patients.
Materials and Methods: In this IRB-approved retrospective study, we included patients in whom liver Doppler US was performed within 3 days of liver transplant from 1/1/2005 to 12/31/2015. The study group consisted of patients who received nifedipine during the Doppler US examination. A positive response to nifedipine was defined as either detection of hepatic arterial flow when none was seen initially or a reduction in hepatic arterial resistive index (RI) after nifedipine administration (reduction of RI = 0.1). A control group consisted of liver transplant patients who underwent Doppler US examination without nifedipine. Outcomes assessed included overall patient survival, the need for retransplantation or reoperation (such as intraabdominal bleeding, bile leak, and hepatic artery thrombosis), nontransient biliary dilatation (indicating biliary ischemia), or intrahepatic collections. Student t-test was used to compare the complication rates and outcomes between the study and control groups.
Results: Preliminary results from 237 patients (179M/58F, mean age 49 years) are presented. The study group comprised 150 patients, and the control group comprised 87 patients. The average time interval between liver transplant and US was 1.7 days. In the study group, 110 of 150 (73.3%) of patients showed positive hepatic arterial response to nifedipine. There was no difference between the nifedipine study group and the control group for retransplantation rates (4.7% vs 7.2%, p=0.32), need for reoperation (16.9% vs 24.4%, p=0.18) or percutaneous intervention (13.4% vs 20.4%, p=0.18), or mortality at 1 year (7.4% vs 11.6%, p=0.27). There was no difference in outcomes for patients who responded to nifedipine compared to nonresponders for retransplantation (2.8% vs 10%, p=0.16), percutaneous intervention (11.9% vs 17.9%, p=0.42), or mortality at 1 year (7.3% vs 12.8%, p=0.38). There was a significant difference in reoperation rates for patients in the nifedipine responder group compared to nonresponders (13.8% vs 30%, p= 0.04).
Conclusion: Preliminary results show that a positive response to nifedipine administration on hepatic arterial flow at Doppler US was associated with a lower reoperation rate. There was no significant difference in short-term complication rate or mortality between the study group versus control group and nifedipine responders versus nonresponders. Further investigation with a larger sample size is in process to determine the value of response to nifedipine at Doppler US as a predictor of short-term complications and long-term outcomes in patients who underwent liver transplant.