Hepatic artery thrombosis after liver transplantation: Radiologic evaluation

Hepatic artery thrombosis after liver transplantation is a devastating event requiring emergency retransplantation in most patients. Early clinical signs are often nonspecific. Before duplex sonography (combined real-time and pulsed Doppler) capability was acquired in October 1984, 76% of all transplants in this institution referred for angiography with a clinical suspicion of hepatic artery thrombosis had patent arteries. In an effort to reduce the number of negative angiograms, CT, real-time sonography, and pulsed Doppler have been evaluated as screening examinations to determine which patients need angiography. Of 14 patients with focal inhomogeneity of the liver architecture detected by CT and/or real-time sonography, 12 (86%) had hepatic artery thrombosis, one had slow arterial flow with hepatic necrosis, and one had a biloma with a patent hepatic artery. In 29 patients undergoing duplex sonography of the hepatic artery, six (21%) had absence of a Doppler arterial pulse. All six had abnormal angiograms: Four had thrombosis, one had a significant stenosis, and one had slow flow with biopsy-proven ischemia. Of 23 patients with a Doppler pulse, two had hepatic artery thrombosis at surgery. However, real-time sonography demonstrated focal inhomogeneity in the liver in both cases. Our data demonstrate that pulsed Doppler of the hepatic artery combined with real-time sonography of the liver parenchyma currently is the optimal screening test for selecting patients who require hepatic angiography after liver transplantation. A diagnostic algorithm is provided

Master\u27s Recital

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Rapid growth of an intact human liver transplanted into a recipient larger than the donor

Two individuals undergoing orthotopic hepatic transplantation received livers from donors who were on average 10 kg smaller than themselves based on recipient ideal body weight. As a result, the donor livers in these 2 cases were 29%-59% smaller than would be expected had the donor liver and recipient been matched ideally. The liver grafts in the recipients steadily increased in size, as determined by serial computed tomography scanning, to achieve new volumes consistent with those that would have been expected in a normal individual of the recipient's size, sex, and age. Fasting plasma levels of amino acids, glucagon, insulin, and standard liver injury tests were monitored to determine which measure best reflected the changes observed in the size of the grafts over time. No relationship between the changes observed in any of these parameters and hepatic growth was apparent. In both cases, the liver increased in volume at a rate of ~70 ml/day. These data demonstrate that a small-for-size liver transplanted into a larger recipient increases in size at a rate of ~70 ml/day until it achieves a liver volume consistent with that expected given the recipient's size, age, and sex. © 1987

Nextet

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NEXTET

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Nextet Spring Concert No. 1

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Nextet Spring Concert No. 2

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Exploring Beethoven: An All Beethoven Gala Concert

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New material of Lophiparamys debequensis from the Willwood Formation (early Eocene) of Wyoming, including the first postcrania of the genus

We report new material of the rare early Eocene rodent Lophiparamys debequensis Wood, 1962 from the Willwood Formation of the southern Bighorn Basin, north-central Wyoming. The new material constitutes the first record of L. debequensis from the Bighorn Basin and documents aspects of the anatomy of Lophiparamys that were previously unknown, including a portion of the maxilla and a portion of the tarsus. The maxillary fragment demonstrates that Lophiparamys has a small P3 and a relatively large infraorbital canal. The tarsus of Lophiparamys is similar to that of other early rodents but differs in a few features that suggest an arboreal locomotor repertoire, including an asymmetric astragalar trochlea, long astragalar neck, transverse astragalar sustentacular facet, short calcaneal tuber, elongate calcaneal ectal facet, and circular calcaneal cuboid facet. The presence of arboreally adapted features in the tarsus of Lophiparamys is consistent with a hypothesized relationship between small-bodied Eocene microparamyine rodents and extant Gliridae. Phylogenetic analysis fails to consistently support this relationship or monophyly of Microparamyinae, but both remain plausible. Comparison of L. debequensis with other species of the genus emphasizes the distinctiveness of L. debequensis and suggests the presence of multiple lineages of Lophiparamys. Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of The Paleontological Society.Open access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]