AIM:To investigate the diagnostic accuracy of hepatobiliary scintigraphy(HBS) in detecting biliary strictures in living donor liver transplantation(LDLT) patients.METHODS:We retrospectively reviewed 104 adult LDLT rec...AIM:To investigate the diagnostic accuracy of hepatobiliary scintigraphy(HBS) in detecting biliary strictures in living donor liver transplantation(LDLT) patients.METHODS:We retrospectively reviewed 104 adult LDLT recipients of the right hepatic lobe with duct-toduct anastomosis,who underwent HBS and cholangiography.The HBS results were categorized as normal,parenchymal dysfunction,biliary obstruction,or bile leakage without re-interpretation.The presence of biliary strictures was determined by percutaneous cholangiography or endoscopic retrograde cholangiopancreatography(ERCP).RESULTS:In 89 patients with biliary strictures,HBS showed biliary obstruction in 50 and no obstruction in 39,for a sensitivity of 56.2%.Of 15 patients with no biliary strictures,HBS showed no obstruction in 11,for a specificity of 73.3%.The positive predictive value(PPV) was 92.6%(50/54) and the negative predictive value(NPV) was 22%(11/50).We also analyzed the diagnostic accuracy of the change in bile duct size.The sensitivity,NPV,specificity,and PPV were 65.2%,27.9%,80% and 95%,respectively.CONCLUSION:The absence of biliary obstruction on HBS is not reliable.Thus,when post-LDLT biliary strictures are suspected,early ERCP may be considered.展开更多
Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V...Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V and FLR-F changes after portal vein embolization(PVE)and LVD.Methods:This study included all patients referred for liver preparation before major hepatectomy over 26 months.Exclusion criteria were:unavailable baseline/follow-up imaging,cirrhosis,Klatskin tumor,two-stage hepatectomy.99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7,14 and 21 after PVE or LVD.FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models(joint modelling)with/without missing data imputation.Results:Baseline FLR-F was lower in the LVD(n=29)than PVE group(n=22)(P<0.001).Technical success was 100%in both groups without any major complication.Changes in FLR-V at day 14 and 21(+14.2%vs.+50%,P=0.002;and+18.6%vs.+52.6%,P=0.001),and in FLR-F at day 7,14 and 21(+23.1%vs.+54.3%,P=0.02;+17.6%vs.+56.1%,P=0.006;and+29.8%vs.+63.9%,P<0.001)differed between PVE and LVD group.LVD(P=0.009),age(P=0.027)and baseline FLR-V(P=0.001)independently predicted FLR-V variations,whereas only LVD(P=0.01)predicted FLR-F changes.After missing data handling,LVD remained an independent predictor of FLR-V and FLR-F variations.Conclusions:LVD is safe and provides greater FLR-V and FLR-F increase than PVE.These results are now evaluated in the HYPERLIV-01 multicenter randomized trial.展开更多
基金Supported by The IN-Sung Foundation for Medical Research and Samsung Biomedical Research Institute, Grant No. SBRIC-B1-118-1
文摘AIM:To investigate the diagnostic accuracy of hepatobiliary scintigraphy(HBS) in detecting biliary strictures in living donor liver transplantation(LDLT) patients.METHODS:We retrospectively reviewed 104 adult LDLT recipients of the right hepatic lobe with duct-toduct anastomosis,who underwent HBS and cholangiography.The HBS results were categorized as normal,parenchymal dysfunction,biliary obstruction,or bile leakage without re-interpretation.The presence of biliary strictures was determined by percutaneous cholangiography or endoscopic retrograde cholangiopancreatography(ERCP).RESULTS:In 89 patients with biliary strictures,HBS showed biliary obstruction in 50 and no obstruction in 39,for a sensitivity of 56.2%.Of 15 patients with no biliary strictures,HBS showed no obstruction in 11,for a specificity of 73.3%.The positive predictive value(PPV) was 92.6%(50/54) and the negative predictive value(NPV) was 22%(11/50).We also analyzed the diagnostic accuracy of the change in bile duct size.The sensitivity,NPV,specificity,and PPV were 65.2%,27.9%,80% and 95%,respectively.CONCLUSION:The absence of biliary obstruction on HBS is not reliable.Thus,when post-LDLT biliary strictures are suspected,early ERCP may be considered.
文摘Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V and FLR-F changes after portal vein embolization(PVE)and LVD.Methods:This study included all patients referred for liver preparation before major hepatectomy over 26 months.Exclusion criteria were:unavailable baseline/follow-up imaging,cirrhosis,Klatskin tumor,two-stage hepatectomy.99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7,14 and 21 after PVE or LVD.FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models(joint modelling)with/without missing data imputation.Results:Baseline FLR-F was lower in the LVD(n=29)than PVE group(n=22)(P<0.001).Technical success was 100%in both groups without any major complication.Changes in FLR-V at day 14 and 21(+14.2%vs.+50%,P=0.002;and+18.6%vs.+52.6%,P=0.001),and in FLR-F at day 7,14 and 21(+23.1%vs.+54.3%,P=0.02;+17.6%vs.+56.1%,P=0.006;and+29.8%vs.+63.9%,P<0.001)differed between PVE and LVD group.LVD(P=0.009),age(P=0.027)and baseline FLR-V(P=0.001)independently predicted FLR-V variations,whereas only LVD(P=0.01)predicted FLR-F changes.After missing data handling,LVD remained an independent predictor of FLR-V and FLR-F variations.Conclusions:LVD is safe and provides greater FLR-V and FLR-F increase than PVE.These results are now evaluated in the HYPERLIV-01 multicenter randomized trial.
