Pre- and Intraoperative Ultrasound Support of Orthotopic Liver Transplantation from a Deceased Donor: Diagnostic and Prognostic Possibilities

Background. Pre- and intraoperative ultrasound is a key tool for preoperative assessment of anatomy and hemodynamics and for immediate verification of vascular anastomosis patency during orthotopic liver transplantation. Adding ultrasound elastography expands opportunities for quantitative risk stratification and prediction of adverse outcomes.

Objective. To evaluate the diagnostic and prognostic value of pre- and intraoperative ultrasound in recipients undergoing orthotopic liver transplantation from deceased donors.

Materials and Methods. A retrospective analysis included 99 adult patients (>18 years) who underwent primary orthotopic liver transplantation for decompensated cirrhosis. Preoperatively, liver and spleen size, signs of portal hypertension, and portal and arterial flow parameters were assessed; shear-wave elastography was performed (2D‑SWE ElastQ and pSWE ElastPQ) with 10 measurements and quality control (IQR/median ≤ 30 %). Intraoperatively, after anastomosis construction, patency and Doppler parameters of the hepatic artery, portal, and caval anastomoses were assessed; complications were verified by reference imaging (CT/MRI/angiography). Statistical processing was performed using IBM Statistics 25.0.

Results. Arterial complications, represented by hepatic artery stenosis, occurred in 7.1 % of patients. Biliary complications included anastomotic stricture in 18.2 % and biloma in 6.1 %; 12-month mortality was 9.1 %. In the study cohort, an intraoperative caval anastomosis flow velocity ≤ 76.5 cm/s was associated with subsequent hepatic artery stenosis (AUC = 0.875; p = 0.002; sensitivity 85.0 %; specificity 97.6 %). Preoperative liver stiffness ≥18.9 kPa was associated with an increased risk of death (AUC = 0.799; p = 0.006; sensitivity 77.8 %; specificity 66.7 %). Markers of portal hypertension, including splenomegaly, portal vein dilatation, and reduced portal flow velocity, were more frequent in patients who subsequently developed vascular complications.

Conclusions. Comprehensive pre- and intraoperative ultrasound assessment in orthotopic liver transplantation provides clinically relevant information on recipient anatomy and hemodynamics and may help identify patients at increased risk of early postoperative complications. The threshold values obtained in this retrospective single-center cohort, including caval anastomosis flow velocity ≤ 76.5 cm/s and preoperative liver stiffness ≥18.9 kPa, should be regarded as preliminary prognostic findings requiring prospective validation before implementation as routine clinical criteria.

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