title: Exposure to ionizing radiation during liver transplantation evaluation, waitlist time, and in the postoperative period: a cause for concern.
abstract: Substantial evidence has linked ionizing radiation exposure (RE) to oncogenesis. Patients evaluated for transplantation undergo extensive diagnostic imaging and have increased baseline cancer risk factors. The objective was to examine exposure in a cohort of patients undergoing evaluation and liver transplantation. Radiation exposure from all diagnostic examinations and procedures were retrospectively recorded. Radiation exposure is reported in mSv, a standardized measure of the detrimental biologic effect of radiation which allows for population-level comparisons. Seventy-four patients (69% male, mean 57 years) were evaluated, of which 13 of 35 subsequently listed patients were transplanted; an additional 18 previously evaluated patients were also transplanted during 2010. The most common indications were hepatitis C (55%) and hepatocellular carcinoma (HCC) (30%). The median observation period was 14 months. In all, 1,826 imaging examinations were performed, of which 408 (22%) involved considerable ionizing radiation and were the focus of investigation. Median annualized effective RE was 51 mSv (interquartile range [IQR]: 19,126), with 10% exposed to almost twice the amount of radiation recommended for a 5-year period. Patients with HCC received significantly (P < 0.00001) higher median annualized effective RE than patients without HCC, 137 mSv (IQR: 87,259) versus 32 mSv (IQR: 13,57), respectively. Computed tomography (CT) abdomen (23%) and chest (16%) accounted for the most common exposures, with CT abdomen accounting for 46% of overall cohort RE.
  
  
  CONCLUSIONS
  Patients undergoing evaluation and liver transplantation at our center are exposed to very high levels of ionizing radiation. Although long-term effects in these patients are yet to be defined, the theoretical increased risk of malignancy must be given its due consideration. Routine use of nonradiation imaging and reconsideration of indications may be preferred and justified in this population.
authors.affiliation: Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, New York Presbyterian Hospital - Weill-Cornell Medical Center, New York, NY.
authors.forename: Ser Yee
authors.initials: SY
authors.lastname: Lee
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mooney
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Inra
authors.forename: Krishna
authors.initials: K
authors.lastname: Juluru
authors.forename: Alyson N
authors.initials: AN
authors.lastname: Fox
authors.forename: Sonja K
authors.initials: SK
authors.lastname: Olsen
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kluger
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D003952:Diagnostic Imaging / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D008099:Liver / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000453:epidemiology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011839:Radiation, Ionizing; D012189:Retrospective Studies; D012307:Risk Factors; D014850:Waiting Lists