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Tesi etd-04202015-214428


Thesis type
Tesi di specializzazione (5 anni)
Author
CINI, LORENZO
URN
etd-04202015-214428
Title
Early post-transplantation period after orthotopic liver transplantation: the role of imaging
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
RADIODIAGNOSTICA
Supervisors
relatore Prof. Bartolozzi, Carlo
Parole chiave
  • TOF
  • TC
  • RM
  • ecodoppler
Data inizio appello
19/05/2015;
Consultabilità
Completa
Riassunto analitico
Purpose
To evaluate the role of imaging - Doppler Ultrasound (US) and/or multidetector row
computed tomography (MDCT) - performed within 30 days after orthotopic liver
transplantation (OLT) in a prospective cohort of patients. Current imaging schedule was
validated and patient-and procedure-related factors that could prompt a different
management investigated.
Material and Methods
Patients submitted to OLT at the Pisa University Hospital in the period between 1 January
2014 and 25 March 2015 were prospectively enrolled. US and Doppler US were routinely
scheduled one month after surgery and earlier Doppler US or MDCT performed in case of
clinical or laboratory abnormalities. Analysis of clinical, operative, procedural, and
radiologic findings was performed to determine the incidence of vascular complications,
biliary complications, large hematomas/fluid collections, extra-hepatic complications.
Logistic regression analysis was used to analyze which factors among age, sex, donor age
(>65 years and > 80 years), cause of liver disease (HCV-, HBV-,alcool-related cirrhosis)
and presence of hepatocellular carcinoma were predictive of an earlier (within 30 days)
positive imaging.
Results
One-hundred and twentyfive subjects were enrolled. Fifty patients out of 125 (40%)
received early imaging for clinical or laboratory abnormalities; 31/125 patients (25%) had
postoperative complications depicted by imaging. Seventyfive out of 125 patients (60%)
underwent Doppler US about 30 days after OLT; in 64/125 (51,2%) Doppler US did not
show any abnormal findings, 11/125 (8,8%) had positive Doppler US at 30 days
examination in the absence of clinical or laboratory signs and 4/125 (3,2%) underwent
interventional radiology procedures or ERCP. At logistic regression analysis no variable
was determined as significant in predicting a positive earlier imaging, apart from a slight
significance of female sex. In particular donor age, higher than 65 years and 80 years, was
not demonstrated to be a significant variable in predicting the need of an earlier imaging.
Conclusions
Planning a first Doppler US at 30 days after OLT, reserving earlier imaging by Doppler US
and MDCT in the case of clinical or laboratory abnormalities, allow to correctly diagnose
and treat complications after OLT.
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