| Objective: Liver transplantation is effective for patients with end-stage liver disease and liver cancer.Some patients are diagnosed with portal hypertension before surgery.Early detection of portal hypertension after surgery can help clinicians adjust their treatment strategies in a timely manner,further improve the prognosis of patients and prolong survival.Currently,non-invasive and accurate diagnostic technologies are needed in diagnosing portal hypertension.This study intended to use point shear wave elastography(PSWE)to monitor the spleen stiffness(SS)of recipient before and after surgery to investigate the application of shear wave elastography of the spleen in monitoring the improvement of portal hypertension in recipients after liver transplantation.Methods: Thirty-three patients with liver cirrhosis and portal hypertension who received liver transplantation from November 2018 to July 2019 in our organ transplant center were classified into the experimental group.According to the average age and gender distribution of the experimental group,30 individuals without hepatitis,portal hypertension,portal vein or spleen vein thrombosis and any spleen disorders were included as the healthy control group.The experimental group underwent ultrasound and shear wave elastography examination of the spleen(S-SWE),CT portal vein angiography or gastroscopy before liver transplantation,and performed ultrasound and S-SWE at the 2nd,4th,6th,and 8th weeks after operation.At the same time,laboratory tests were performed.Examinations mentioned above were performed on the healthy control group upon admission.The specimens of liver grafts were acquired before or in surgery to evaluate the degree of steatosis.The differences in SS values between the experimental group and the control group,between the patients with esophageal varices and without esophageal varices,and among the experimental group at different time periods were analyzed.The value of PSWE in monitoring SS changes after liver transplantation in patients with liver cirrhosis and portal hypertension and the influence factors of SS changes after surgery was discussed.Results: The preoperative SS value of the experimental group was significantly higher than that of the healthy control group(46.38±5.40 k Pa vs.12.81±1.60 k Pa;P=0.003).The preoperative SS value of patients with esophageal varices in the experimental group was higher than patients without(47.44±4.72 k Pa vs.40.45±5.60 k Pa;P=0.006).The SS value of liver transplantation in the experimental group before surgery,2nd,4th,and 6th weeks after operation gradually decreased(P<0.01).The SS value at the 8th week after operation was lower than that before the operation and at 2nd,4th,and 6th weeks after operation(P<0.001),and there was no significant difference with the 6th week SS value(P=1.0).The decrease of SS value after operation was significantly positively correlated with the value of SS before surgery(r=0.948,P<0.01),and was negatively correlated with the degree of liver grafts steatosis(r=-0.438,P=0.011),and has no correlation with the cold ischemic time of donor liver,the transaminase level before and after the recipient operation(P> 0.05).Conclusion: PSWE can indirectly evaluate the therapeutic effect of portal hypertension by monitoring the spleen stiffness before and after liver transplantation.S-SWE provides more valuable information for doctors to improve postoperative prognosis of patients. |
PDF Full Text Request