This study investigates the correlation between early B-type natriuretic peptide (BNP) levels and ultrasound hemodynamics following liver transplantation, with the aim of evaluating short-term prognosis.

We analyzed data from 924 patients who underwent liver transplantation between December 2012 and October 2022. Ustilizing the clinical liver transplantation ultrasound imaging database software V1.0 developed by Tianjin First Central Hospital, we recorded various ultrasonic dynamic parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), peak systolic/diastolic flow velocity (S/D), resistance index (RI), pulsatility index (PI), and portal vein velocity (PVV). Additionally, BNP values were recorded within 24 hours post-surgery. We analyzed the correlation between ultrasound blood flow parameters and BNP levels. Patients were categorized into death and survival groups based on their prognosis at 3 months, and differences in blood flow parameters were compared between these groups. Furthermore, short-term prognosis was assessed based on blood flow parameters associated with diastolic blood flow.

Negative correlations were observed between BNP and the resistance index (RI) and pulsatility index (PI) on the first day after surgery (r = -0.473, r = -0.602, both P < 0.05). Similar correlations were found on the fifth day post-surgery (r = -0.406, r = -0.518, both P < 0.05). Additionally, peak systolic velocity (PSV), end diastolic velocity (EDV), and BNP levels were significantly higher in the death group compared to the survival group on both the first and fifth days after surgery (all P < 0.05), while RI and PI were lower in the death group (both P < 0.05). The systolic/diastolic (S/D) ratio in the death group was also lower than that in the survival group on the first and fifth days post-surgery (both P = 0.001). Furthermore, the presence of early diastolic blood flow after surgery was not associated with short-term prognosis in either group (both P > 0.05).

Early BNP levels correlate with ultrasound blood flow parameters following liver transplantation, providing a foundation for evaluating cirrhotic cardiomyopathy. Patients with a poor short-term prognosis exhibit elevated BNP levels, altered dynamic circulation, and low-resistance blood flow

Using brain-dead donors to obtain organs for transplant is an effective way to overcome the shortage of organ donors. The purpose of this study is to investigate ultrasound flow imaging and elastography as a simple, feasible, accurate and effective method for evaluation of liver damage after brain death using an animal model.

We established a brain-death model using 15 pigs. Brain death was induced by progressively increasing the intracranial pressure, and the brain-death state was maintained for 9 hours. Spectral Doppler imaging and elastography was used to evaluate hepatic hemodynamic parameters and tissue stiffness over the period of brain death.

Electron microscopy of the liver over the progress of brain death revealed gradual mitochondrial swelling (with rupture), expansion of the endoplasmic reticulum, and increased collagen in the extracellular matrix. Spectral Doppler imagin demonstrated that the HA-RI increased over time, which had statistically significant difference between the Bef-BD measurement and measurements at 3, 6, and 9 hours after brain death. Real time elastography of the liver revealed a gradual decrease of the mean relative strain value (MEAN) over the time, and a gradual increase in standard deviation of the relative strain value, complexity of low strain area, and skewness, suggesting that brain-death induced liver damage increases with time. The ROC curves showed that MEAN had the highest sensitivity, specificity, and accuracy for assessing liver injury.

Hepatic tissue damage induced by brain death increased over time. The HA-RI and liver stiffness index changes can be assessed by Doppler ultrasound and elastographic imaging. Our results showed that elastography is a useful method to evaluate liver damage after brain death.