The utility of Doppler sonography for assessing the severity and treatment response of acute rejection in adult to adult living donor liver transplantation

Aim: We explored whether monitoring of graft hemodynamic changes by Doppler sonography can be useful for the treatment of acute rejection in adult to adult living donor liver transplantation (LDLT). Materials/Methods: 29 acute rejection episodes were confirmed by liver biopsy in 21 of 51 adult patients who underwent LDLT. We classified 29 acute rejection episodes into two groups based on the presence (n=8) or absence (n=21) of graft hemodynamic changes detected by Doppler sonography. The postoperative onset time of acute rejection episodes, the peak level of alanine aminotransferase (ALT), and Rejection Activity Index (RAI) were compared between two groups. The pattern of graft hemodynamic changes and response to treatment were analyzed. Results: Acute rejection episodes with graft hemodynamic changes (n=8) were characterized by earlier postoperative onset, higher levels of serum ALT and more severe RAI compared with acute rejection episodes without graft hemodynamic changes (n=21). The graft hemodynamic changes recorded in the former group included reduced mean portal venous flow velocity, pulsatile wave pattern of graft portal vein and increased peak systolic velocity of graft hepatic arterial flow. These graft hemodynamic changes could be reversed by effective antirejection therapy. Acute rejection episodes with graft hemodynamic changes are less likely to respond to steroid pulse therapy. Conclusions: These results suggested that monitoring of graft hemodynamic changes by Doppler sonography could assess the severity and treatment response of acute rejection, contributing to the precise selection of antirejection therapy after adult to adult LDLT.