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