Hypoattenuation in unenhanced CT reflects histological graft dysfunction and predicts 1-year mortality after living donor liver transplantation.
Early postoperative graft function assessments are essential after living donor liver transplantation (LDLT) to predict patient and graft outcome. Computed tomography (CT) is usually used to evaluate various complications and parenchymal abnormalities after LDLT. Here, we attempted to determine the prognostic values of CT attenuation changes of grafts for predicting 1-year patient survival. Liver attenuation indices (LAIs), derived from differences between hepatic and splenic attenuations, were calculated on unenhanced CT images obtained 10 days after LDLT in 62 adult LDLT recipients between September 2002 and August 2004. Patients were assigned to 1 of 2 groups according to LAI value on the 10th postoperative day, as follows: group L (LAI < or = 5, n = 14) or group H (LAI > 5, n = 48). Parenchymal dysfunction scores, summed parameters for histological dysfunction including both portal tract and centrilobular features, were also assessed on the 10th postoperative day using liver biopsy specimens. Histological parenchymal dysfunction, especially in the centrilobular area, in terms of cholestasis, centrilobular necroinflammation, central vein fibrosis, steatosis, mononuclear infiltrates, and hepatocyte ballooning, was more prominent in group L than in group H, while that in the portal area was similar between the 2 study groups. Significant negative linear correlations were observed between LAI and parenchymal dysfunction scores (r = 0.486, P < 0.001). Group L patients showed lower 1-year survival (69.7%) than group H patients (95.8%; P = 0.0002). Moreover, group H patients died with a functioning graft (n = 3), whereas group L patients died of graft failure (n = 6). After multivariate analysis, LAI alone remained independently associated with 1-year mortality (P = 0.014; odds ratio = 0.845; 95% confidence interval, 0.739-0.967). The sensitivity and specificity of LAI were 84.6% and 75%, respectively, and LAI outperformed MELD score as a predictor of 1-year mortality after LDLT by receiver operating characteristic curve analysis. In conclusion, LAI, as determined by unenhanced CT 10 days after LDLT, well predicts 1-year patient survival after LDLT.
Cho
Jai Young
JY
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Suh
Kyung-Suk
KS
Lee
Hae Won
HW
Cho
Eung-Ho
EH
Yang
Sung Hoon
SH
Cho
Yong Beom
YB
Yi
Nam-Joon
NJ
Kim
Min A
MA
Jang
Ja-June
JJ
Lee
Kuhn Uk
KU
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed