To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) in hepatic artery complications after liver transplantation.

The clinical data of 858 patients who underwent liver transplantation in the Organ Transplant Center of the Affiliated Hospital of Qingdao University from August 2015 to December 2022 were retrospectively analyzed. Regular ultrasound examination was performed after liver transplantation, and CEUS examination was performed in 29 patients with suspicious hepatic artery lesions indicated by color Doppler flow imaging(CDFI). Digital subtraction angiography (DSA), computerized tomography angiography (CTA) or surgical results were used to determine the accuracy of CEUS in diagnosing hepatic arterial complications. The paired t test was used for comparison between normal distribution data groups, and Fisher exact probability method was used for comparison between data groups. P<0.05 was considered statistically significant.

Further CEUS examination was performed on 29 patients with suspected hepatic artery disease indicated by CDFI examination, and 9 cases were diagnosed as hepatic artery thrombosis (HAT), 1 case as hepatic artery stenosis (HAS), and 9 cases as splenic artery stealing blood syndrome (SASS). According to DSA, CTA or surgical results, a total of 17 cases of hepatic arterial complications were confirmed, including 8 cases of HAT (including 1 case of hepatic artery dissection with HAT), 1 case of HAS and 8 cases of SASS. The accuracy of CDFI and CEUS in detecting hepatic artery complications was 58.6% (17/29) and 89.5% (17/19), respectively, with statistical significance (P=0.026). The sensitivity, specificity and consistency rates of CUES in diagnosing hepatic artery complications were 100% (16/16), 76.9% (10/13) and 89.7% (26/29), respectively. The CEUS of HAT showed that the hepatic artery did not develop around the portal vein in the arterial stage or even in the portal vein stage. The CEUS of SASS showed obvious enhancement signal in portal vein, hepatic artery was developed later than splenic artery and/or portal vein, and intrahepatic artery was dim. The CEUS of HAS showed thin hepatic artery flow and anastomotic stenosis in the hepatic portal area.

CEUS plays an important role in the diagnosis of hepatic arterial complications after liver transplantation. When hepatic artery abnormalities are suspected by routine ultrasound, CEUS examination should be performed immediately, which is conducive to early detection of hepatic artery complications.