Role of 99mTc-labeled DISIDA scan in the assessment of marginal liver grafts after orthotopic transplantation.
Accurate prognostic indicators are lacking for livers with early marginal graft function, making the decision to re-transplant a difficult one. Therefore, we studied 99mTc-labeled DISIDA scanning as a predictor of recovery of marginal grafts. Records of 28 liver transplant recipients with prolonged periods of marginal graft function after liver transplantation were analyzed. Twelve of 28 (Group I) had delayed PNF and were re-transplanted within 3-8 days (mean 5.3) of surgery. The remaining 16 (Group II) recovered slowly, with normal graft function at 1 month. All patients received DISIDA scans 2 to 5 d after surgery. Clearance of tracer from the blood pool was slower in Group I patients (77S +/- 241 sec) than in Group II (260 +/- 38 sec; p < 0.01). Qualitative differences in the pattern of parenchymal uptake were also noted. Homogenous uptake, consistent with cholestasis, was seen in 15/16 (94%) Group II patients, with improved uptake after 7-35 d. In contrast, 11/12 Group I patients had non-homogenous uptake, consistent with multiple liver infarctions. This pattern correlated with higher peak SGOT in Group I (4358 +/- 658 U/dl vs 1636 +/- 127 U/dl p < 0.01), and PT (20 +/- 0.7 sec vs. 16.5 +/- 0.36 sec; p < 0.01). In summary, delays in DISIDA tracer clearance from blood, and non-homogenous hepatic uptake correlate with elevated liver function tests and with delayed PNF. Homogenous uptake correlates with graft recovery. DISIDA scans may, therefore, be useful in predicting recovery of marginal grafted livers.
Karademir
S
S
Department of Surgery, University of California at Los Angeles 90024.
Csete
M E
ME
Jurim
O
O
Finstad
T
T
Hawkins
R
R
Bussuttil
R W
RW
Shaked
A
A
D000328:Adult; D002648:Child; D006085:Graft Survival; D006801:Humans; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000000981:diagnostic imaging* / Q000401:mortality; D015609:Organotechnetium Compounds; D011379:Prognosis; D011877:Radionuclide Imaging; D019785:Technetium Tc 99m Disofenin
D007098:Imino Acids; D015609:Organotechnetium Compounds; D019785:Technetium Tc 99m Disofenin