*Purpose: Vascular complications such as hepatic artery stenosis/thrombosis can occur following liver transplantation. Doppler ultrasound is the primary method of screening for vascular complications in the early post-operative period. We investigated patients with abnormal ultrasound findings who received subsequent vascular intervention.

*Methods: A retrospective chart review (January 2014 to March 2019) was conducted on consecutive adult patients undergoing deceased donor liver transplantation. Primary outcomes included abnormal ultrasound findings and performing an intervention (transplant angiography or surgery). Abnormal ultrasound findings were defined as: (1) resistive index < 0.5 of right, left, or common hepatic artery (CHA), (2) CHA peak systolic velocity > 250 cm/sec, or (3) CHA acceleration time > 0.1 sec.

*Results: Of 391 liver transplants, 388 patients had at least one ultrasound within 45 days post-transplant. Of these, 125 (32%) had abnormal ultrasound findings with 31 (25%) of them undergoing intervention. In addition, 264 patients had at least two ultrasounds. Of these patients, 110 (41.7%) had at least one abnormal ultrasound finding with 36 (33%) undergoing intervention. Lastly, 49 patients had two abnormal ultrasounds within 45 days post-transplant with 23 (47%) requiring evaluation of the hepatic artery by angiogram or surgery. Ultimately 91% of patients with two abnormal ultrasounds and further intervention had clinically significant stenosis or thrombosis.

*Conclusions: Liver transplant patients, with two consecutive abnormal ultrasounds within 45 days post-transplant, should receive a follow-up due to increased likelihood of hepatic artery complication requiring intervention suggesting increased utility of repeat ultrasound to decrease the incidence of graft loss.

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