Radionuclide evaluation of liver transplants.
Orthotopic liver transplantation is now an established technique for treating patients with various forms of end stage liver disease. The number of centers performing the procedure is increasing and, as the number of transplant recipients in the population increases, many institutions performing nuclear medicine studies will be confronted with requests to evaluate these patients. While a variety of radionuclides are proving useful in this evaluation, the 99mTc iminodiacetic acid (IDA) compounds, particularly 99mTc diisopropyl IDA (DISIDA), will probably account for the majority of radionuclide evaluations of these patients because they are well suited to monitor both structural and functional changes of the graft. The primary application of radionuclide studies is focused in the postoperative period, when problems with the vascular and biliary anastomoses, rejection, infections, and bile leaks all produce alterations in radionuclide hepatobiliary studies. Abnormalities such as rejection and infection produce primarily functional, rather than structural changes and are not easily differentiated based upon the kinetics of 99mTc-DISIDA extraction and excretion by the liver, serial imaging and correlation with clinical data is necessary in such situations. Quantitative analyses of kinetic 99mTc IDA (DISIDA) studies and quantitative approaches with other compounds such as 99mTc galactosyl-neoglycoalbumin (NGA) may permit better assessments of relatively subtle changes in liver function in the posttransplant period.
D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D006084:Graft Rejection; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D016031:Liver Transplantation; D009894:Opportunistic Infections / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology; D014055:Tomography, Emission-Computed; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods