Peak systolic velocity at arterial Doppler ultrasound in pediatric liver transplantation: A predictor of acute severe complications

The diagnosis of arterial complications in children after Liver Transplantation (LT) urges prompt diagnosis and treatment. This study aims to determine whether hepatic artery Doppler Ultrasound (DUS) parameters can predict arterial complications in the immediate period after LT in children. A retrospective review of the pediatric liver database at our tertiary-care pediatric hospital was performed. The study included 70 pediatric patients who underwent a liver transplantation from 2016 to 2021. Clinical, laboratory and Doppler findings were recorded daily the first 5 days after transplantation, with special attention given to post-anastomotic Peak Systolic Velocity (PSV) and Resistive Index (RI). Patients with hepatic artery complications, including acute thrombosis and stenosis, had lower PSV values after surgery compared to the group with non-complications, with a statistical significance (< 0.001). Receiver operating characteristic (ROC) curve analysis determined an optimal cut-off value of PSV less than 29 cm/s the 2nd day after LT, 25.2 cm/s the 3rd day, 28.5 cm/s the 4th day and 29.4 cm/s the 5th day, to discriminate children with and without hepatic arterial complications. Notably, these cut-off values are lower than those proposed in adults. Optimal PSV cutt-off values in children in the immediate period after LT are presented. Knowledge of these cutt-off values improves the interpretation of DUS measurements and thereby, may help to accurately guide the clinical management.