Resistance index of hepatic artery can predict anastomotic biliary complications after liver transplantation in children

Background/Purpose: Biliary complications remain a major morbidity after liver transplantation in children. Inadequate arterial supply to the bile duct after transplantation plays an important role in developing anastomotic biliary complications. We aimed to elucidate the relationship between the resistance index (RI) of hepatic artery and the anastomotic biliary complications after liver transplantation in children. Methods: This is a retrospective, case–control design study. We enrolled 11 pediatric patients under 18 years of age with anastomotic biliary complication after liver transplantation and another 26 matched pediatric transplanted patients without biliary complication as the control group. All patients received liver Doppler ultrasonography within 15 months after liver transplantation. We focused on the ultrasound parameters including waveforms, RI and acceleration time (AT) of hepatic artery. Results: We used the receiver operating characteristic curve to analyze the RI in these 37 patients and yielded a cutoff of RI ≦ 0.57 (63.6% sensitivity and 92.3% specificity) for the best prediction of anastomotic biliary complications. Patients with RI ≦ 0.57 have a higher chance of having biliary complications, with an Odds ratio of 21 (95% CI = 3.16–139.66). The Cox's proportional hazard analysis also confirmed the significance of RI ≦ 0.57 in predicting biliary complications (Hazard ratio = 8.11, 95% CI = 2.35–28.01, P = 0.001) after liver transplantation in children. Three (27.3%) patients with biliary complications received hepatojejunostomy reconstruction, and another 8 patients (72.7%) were successfully managed by percutaneous biliary intervention alone. Conclusion: The RI of hepatic artery ≦0.57 may serve as an important non-invasive predictor for anastomotic biliary complications after liver transplantation in children. Keywords: Biliary complication, Children, Doppler ultrasonography, Resistance inde