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Asmundo L, Rizzetto F, Sgrazzutti C, Carbonaro LA, Mazzarelli C, Centonze L, Rutanni D, De Carlis L, Vanzulli A. Computed Tomography and Magnetic Resonance Imaging Signs of Chronic Liver Rejection: A Case-Control Study. J Comput Assist Tomogr 2024; 48:26-34. [PMID: 37422693 DOI: 10.1097/rct.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
OBJECTIVE In liver transplantation, chronic rejection is still poorly studied. This study aimed to investigate the role of imaging in its recognition. METHODS This study is a retrospective observational case-control series. Patients with histologic diagnosis of chronic liver transplant rejection were selected; the last imaging examination (computed tomography or magnetic resonance imaging) before the diagnosis was evaluated. At least 3 controls were selected for each case; radiological signs indicative of altered liver function were analyzed. χ 2 Test with Yates correction was used to compare the rates of radiologic signs in the case and control groups, also considering whether patients suffered chronic rejection within or after 12 months. Statistical significance was set at P < 0.050. RESULTS A total of 118 patients were included in the study (27 in the case group and 91 in the control group). Periportal edema was appreciable in 19 of 27 cases (70%) and in 6 of 91 controls (4%) ( P < 0.001); ascites and hepatomegaly were present in 14 of 27 cases (52%) and 12 of 27 cases (44%), respectively, and in 1 of 91 controls (1%) ( P < 0.001); splenomegaly was present in 13 of 27 cases (48%) and in 8 of 91 controls (10%) ( P < 0.001); and biliary tract dilatation was present in 13 of 27 cases (48%) and in 11 of 91 patients controls (5%) ( P < 0.001). In the controls, periportal edema was significantly less frequent beyond 12 months after transplant (1% vs 11%; P = 0.020); the other signs after 12 months were not significant. CONCLUSIONS The identification of periportal edema, biliary dilatation, ascites, and hepatosplenomegaly can serve as potential warning signs of ongoing chronic liver rejection. It is especially important to investigate periportal edema if it is present 1 year or more after orthotopic liver transplantation.
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Affiliation(s)
- Luigi Asmundo
- From the Postgraduate School in Radiodiagnostic, University of Milan
| | | | | | | | - Chiara Mazzarelli
- Department of Hepatology and Gastroenterology Unit, ASST Grande Ospedale
| | | | - Davide Rutanni
- From the Postgraduate School in Radiodiagnostic, University of Milan
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Truong R, Moore HB, Sauaia A, Kam I, Pshak T, Adams M, Conzen K, Zimmerman MA, Wachs M, Bak T, Pomposelli J, Pomfret E, Nydam TL. Choledochoduodenostomy continues to be a safe alternative for biliary reconstruction in deceased-donor liver transplantation. Am J Surg 2022; 224:1398-1402. [PMID: 36400602 DOI: 10.1016/j.amjsurg.2022.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/25/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
Debate continues as to whether choledochoduodenostomy (CDD) can be used instead of Roux-en-Y choledochojejunostomy (CDJ) when duct-to-duct (DTD) is not an option. We hypothesized that CDD and CDJ had similar rates of complications. All deceased-donor liver transplantations from September 2011 to March 2020 were categorized by biliary reconstruction. Primary outcomes were bleeding, bile leak, anastomotic stricture, and cholangitis. Of the 1,086 patients, 812 (74.8%) received a DTD; 225 (20.7%) received a CDD; and 49 (4.5%) received a CDJ. Cholangitis was significantly higher in CDJ compared to DTD and CDD (26.5% vs 6% vs 13.8%, p < 0.0001). When controlling for significant confounders, CDJ had 10.2 higher odds of cholangitis (95% CI 4.4-23.2) compared to DTD, and 3.3 higher odds compared to CDD (95% CI 1.4-7.8). When compared to DTD, CDJ and CDD had significantly lower odds of stricture. CDD continues to be a safe alternative for biliary reconstruction in deceased-donor liver transplantation.
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Affiliation(s)
- Ronald Truong
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Hunter B Moore
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Angela Sauaia
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA; University of Colorado Denver School of Public Health, Department of Health Systems, Management and Policy, 13011 E. 17th Place, Room E-3309, Aurora, CO, 80045, USA
| | - Igal Kam
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Thomas Pshak
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Megan Adams
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Kendra Conzen
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Michael A Zimmerman
- Medical College of Wisconsin, Division of Transplant Surgery, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Michael Wachs
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Thomas Bak
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - James Pomposelli
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Elizabeth Pomfret
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
| | - Trevor L Nydam
- University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA.
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Decker SO, Krüger A, Wilk H, Uhle F, Bruckner T, Hofer S, Weigand MA, Brenner T, Zivkovic AR. Concurrent Change in Serum Cholinesterase Activity and Midregional-Proadrennomedullin Level Could Predict Patient Outcome following Liver Transplantation. Biomolecules 2022; 12:biom12070989. [PMID: 35883545 PMCID: PMC9312899 DOI: 10.3390/biom12070989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/17/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Background: After liver transplantation (LTX), patients are susceptible to opportunistic infections resulting in reduced outcomes within the early post-transplantation period. The postoperative monitoring of LTX patients has gained much importance in recent years. However, reliable plasmatic markers predicting 90-day outcomes are still lacking. Methods: In the post hoc analysis of a prospective, observational study, butyrylcholinesterase (BChE), mid-regional proadrenomedullin (MR-proADM), as well as conventional inflammatory markers (procalcitonin, C-reactive protein) were evaluated in 93 patients at seven consecutive timepoints within the first 28 days following LTX. Results: Persistently reduced activity of BChE and elevated MR-proADM levels indicated reduced 90-day survival following LTX. Furthermore, reduced BChE and increased MR-proADM activity could indicate early post-transplantation bacterial infections, whereas conventional inflammatory biomarkers showed no diagnostic efficacy within the observation period. Conclusion: Concurrent assessment of BChE and MR-proADM activity might serve as a bedside diagnostic tool for early bacterial infections following liver transplantation. Thus, a combined utilization of the two biomarkers may be a useful tool in the risk evaluation of patients following liver transplantation.
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Affiliation(s)
- Sebastian O. Decker
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
- Correspondence: (S.O.D.); (A.R.Z.); Tel.: +49-(0)62-215636380 (S.O.D.); +49-(0)62-215636843 (A.R.Z.); Fax: +49-(0)62-21565345 (S.O.D. & A.R.Z.)
| | - Albert Krüger
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
| | - Henryk Wilk
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
| | - Florian Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, Heidelberg University, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany;
| | - Stefan Hofer
- Department of Anesthesiology, Westpfalzklinikum, Kaiserslautern, Hellmut-Hartert-Straße 1, 67655 Kaiserslautern, Germany;
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Aleksandar R. Zivkovic
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (A.K.); (H.W.); (F.U.); (M.A.W.); (T.B.)
- Correspondence: (S.O.D.); (A.R.Z.); Tel.: +49-(0)62-215636380 (S.O.D.); +49-(0)62-215636843 (A.R.Z.); Fax: +49-(0)62-21565345 (S.O.D. & A.R.Z.)
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