title: Liver transplantation: impaired biliary excretion of gadoxate is associated with an inferior 1-year retransplantation-free survival.
abstract: OBJECTIVE
  The aim of this study was to evaluate gadoxate-enhanced magnetic resonance imaging (MRI) in liver transplant recipients with regard to graft function and mortality at 1 year from imaging.
  
  
  METHODS
  This was a retrospective, proof-of-concept study of gadoxate-enhanced 3-T MRI in 51 patients with orthotopic liver transplantation. Relative liver enhancement was calculated as the ratio between the signal intensities in unenhanced and gadoxate-enhanced T1-weighted gradient echo sequences with fat saturation. Impaired excretion was defined as the absence of gadoxate visualization in the common bile duct 20 minutes after intravenous injection.
  
  
  RESULTS
  Of the 51 liver transplant recipients, 31 patients showed a normal hepatobiliary excretion of gadoxate after 20 minutes (group A), whereas 20 patients showed an impaired excretion (group B). Group B had significantly higher serum levels of bilirubin (P < 0.001), aspartate-aminotransferase (P = 0.003), and alkaline phosphatase (P = 0.007), and a higher median Model for End-Stage Liver Disease score (P < 0.001). Within one-year of MRI, 55% of group B died (n = 7) or had to undergo retransplantation (n = 4), whereas all patients in group A survived without retransplantation (P < 0.001). The relative liver enhancement 20 minutes after gadoxate injection was directly related to serum levels of cholinesterase (P < 0.001) and inversely related to the serum levels of bilirubin (P = 0.0098), aspartate-aminotransferase (P = 0.007), and the Model for End-Stage Liver Disease score (P < 0.001). The relative liver enhancement 20 minutes after contrast injection was directly related to the probability of 1-year retransplantation-free survival in proportional hazard regression analysis (P = 0.005).
  
  
  CONCLUSIONS
  Gadoxate-enhanced MRI may be a helpful noninvasive prognostic biomarker for chronic rejection and increased risk for 1-year mortality or retransplantation.
authors.affiliation: Department of Radiology, Medical University of Vienna, Vienna, Austria. andreas.wibmer@meduniwien.ac.at
authors.forename: Andreas
authors.initials: A
authors.lastname: Wibmer
authors.forename: Qayyum
authors.initials: Q
authors.lastname: Aliya
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steininger
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.forename: Judith
authors.initials: J
authors.lastname: Maresch
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mühlbacher
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ba-Ssalamah
mesh_terms: D000328:Adult; D001317:Austria / Q000453:epidemiology; D001652:Bile Ducts / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA