| Background:Various complications after liver transplantation are important risk factors that affect recipients’ quality of life and the long-term survival of transplanted liver.Abnormal liver function is the most common clinical manifestation after liver transplantation.The causes of abnormal liver function in different stages after liver transplantation are also different.The main factors include ischemia-reperfusion injury,acute rejection,liver factors,vascular factors,biliary factors and drug factors.Compared with non-transplanted patients,ischemia-reperfusion injury and acute rejection are two specific pathogenic factors of abnormal liver function after liver transplantation.According to the diagnosis and treatment standard of Clinical Technical Operation Standard of Organ Transplant Pathology(2019 Edition)-Liver Transplantation,abnormal liver function caused by ischemia-reperfusion injury and acute rejection mainly occur within one month after liver transplantation,and some studies have shown that abnormal liver function repeatedly occurs in some patients from1 to 12 months after liver transplantation.Imaging methods are of great significance in the diagnosis and differential diagnosis of complications after liver transplantation.Among them,two-dimensional ultrasound and color Doppler ultrasound are the first choices for imaging examination after liver transplantation because of their simple diagnostic methods and advantages in vascular and hemodynamic detection.Studies have confirmed that ultrasound can make an accurate clinical diagnosis by observing the biliary diameter changes for biliary complications caused by abnormal liver function after liver transplantation.Vascular complications can not only cause liver function damage but also cause changes in hemodynamic parameters in liver ultrasound.Antirejection drugs need to be taken orally for a long time after liver transplantation and need to adjust the dosage repeatedly.Otherwise,it will cause liver damage.However,there are few clinical research reports about the changes of ultrasonic parameters of liver hemodynamics after drug-induced liver injury.Objective:To explore the correlation between drug-related liver injury after liver transplantation and changes in liver hemodynamic ultrasound parameters,so as to further improve the pathological mechanism of drug-related liver injury after liver transplantation and provide imaging basis for treatment decision-making and efficacy evaluation.Methods:1.A retrospective analysis method was used to collect the medical records,imaging,pathological and biochemical data of 206 patients who underwent liver transplantation in the Second Affiliated Hospital of Da-Lian Medical University from January 14,2016 to February 20,2020.Included in the standard:(1)Abnormal liver function occurred 1 to 12 months after liver transplantation,underwent two-dimensional and color Doppler ultrasound examination,and liver hemodynamic ultrasound parameters were recorded;(2)Tacrolimus + mycophenolate mofetil triple immunosuppressive regimen was used for treatment after liver transplantation,and the changes of liver biochemical and ultrasound parameters were monitored.Exclusion criteria:(1)The cause of liver function injury is clearly liver tumor recurrence,vascular and biliary tract related diseases,such as hepatic artery/portal vein stenosis or thrombosis,biliary tract stenosis,etc;(2)Patients with preoperative splenectomy;(3)Irregular follow-up and incomplete data.Ultimately,21 patients were included in the study.According to abnormal liver function and return to normal after treatment of two time points,the data is divided into A,B two groups of data: will the data of 21 cases of abnormal liver function is defined as A set of data,monitoring blood drug concentration and liver function index changes,adjust drug doses,repeatedly to 21 cases of patients with liver function returned to normal when the data is defined as A group B.The two groups of data were compared and analyzed to observe the changes of liver ultrasonic hemodynamics before and after the adjustment of anti-immune rejection drugs and liver-protecting treatment,so as to clarify the influence of drug-related liver injury on the ultrasonic hemodynamics of the transplanted liver.2.The data were statistically analyzed by using IBM SPSS statistic 17.0,and the measurement data were expressed by mean ± standard deviation.T-test was used for the difference of mean between groups.Spearman correlation coefficient was used for correlation test for bi-directional ordered continuous variables,and P< 0.05 was statistically significant.Results:Patients with drug-related liver injury occur 1～12 months after liver transplantation:1.Compared with the normal liver function group,patients with abnormal liver function after liver transplantation:(1)The diameter of portal vein in the abnormal liver function group was significantly higher(t test,P< 0.05).(2)The correlation test showed that the diameter of portal vein was positively correlated with AST(Spearman correlation coefficient,P<0.01).(3)The diameter of portal vein was positively correlated with ALT(Spearman correlation coefficient,P< 0.01).2.Compared with the normal liver function group,patients with abnormal liver function after liver transplantation:(1)The portal vein blood flow velocity in the abnormal liver function group was significantly lower(t test,P< 0.01).(2)The correlation test showed that the portal vein blood flow velocity was negatively correlated with AST(Spearman correlation coefficient,P< 0.01).(3)The portal vein blood flow velocity was negatively correlated with ALT(Spearman correlation coefficient,P< 0.01).3.Compared with the normal liver function group,the mean value of portal vein blood flow in the abnormal liver function group had no significant difference(t-test,P>0.05).4.Compared with the normal liver function group,patients with abnormal liver function after liver transplantation:(1)Higher blood flow(t-test,P< 0.05).(2)Hepatic arterial blood flow was positively correlated with the severity of abnormal liver function(Spearman correlation coefficient,P< 0.01).Hepatic artery blood flow may be a key indicator for predicting drug-related liver injury.Conclusion:1.There is a correlation between drug-related liver injury after liver transplantation and ultrasonic parameters of liver hemodynamics.2.Two-dimensional and color Doppler ultrasound can provide imaging basisfor treatment decision-making and efficacy evaluation. |
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