Computed Tomography as Primary Screening for Appraisal of Pulmonary Small Nodules in Liver Transplant Candidates.
BACKGROUND
Chest computed tomography (CT) as a primary screening method in candidates for living donor liver transplantation (LDLT) is not yet a standardized procedure. The aim of this study is to present our methods and result of evaluation of pulmonary small nodules (PSN) after CT as a primary screening tool.


METHODS
A total of 360 primary adult LDLTs were performed between October 2009 and December 2012. The 37 candidates with PSNs found on CT were divided into two groups, with 23 patients in the group that was chest radiography (CXR) positive (+) and 14 in the group that was CXR negative (-).


RESULTS
The nodular size in the CXR (-) group was significantly smaller than in the CXR (+) group (3.86 ± 1.24 vs 7.56 ± 4.08, P = .004). The sensitivity of CT for PSN was 37/360 (10.28%), much higher than the 14/360 (3.89%) for CXR alone. A total of 27 patients underwent video-assisted thoracoscopic surgery for pathologic diagnosis, and 10 were diagnosed as having benign PSNs by stationary sizes on serial CT scans. In the CXR (-) group, there were 2 cases of malignancy, 3 tuberculosis (TB), 3 Cryptococcus, and 15 other benign PS. In the CXR (+) group, there were 1 malignancy, 3 TB, 4 Cryptococcus, and other 6 benign PSNs. Recurrent infection was not seen in the posttransplantation follow-up of 13 candidates with infections. Excluding the 3 malignant PSNs, the 34 candidates in both groups survived 100% for more than 2 years after LDLT.


CONCLUSIONS
To exclude malignancy and to diagnose infectious PSN for further treatment in a timely manner, chest CT should be used as the primary screening tool for asymptomatic candidates for LDLT.
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Y-J
YJ
Wu
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: immunologylin@gmail.com.
C-C
CC
Lin
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Y-M
YM
Chang
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
S-H
SH
Wang
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Y-H
YH
Lin
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
H-I
HI
Lu
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
A M
AM
Concejero
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
C-L
CL
Chen
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
T-L
TL
Lin
D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008171:Lung Diseases; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000473:pathology; D011300:Preoperative Care / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods