From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
From the Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Exp Clin Transplant. 2022 Aug;20(8):742-749. doi: 10.6002/ect.2022.0142. Epub 2022 Jul 22.
This study was designed to investigate the frequency of computed tomography features indicating progression of portal hypertension and their clinical relevance in patients who experienced acute cellular rejection after liver transplantation.
This retrospective study included 141 patients with pathologically diagnosed acute cellular rejection following liver transplant. Patients were divided into early and late rejection groups according to the time of diagnosis. Two radiologists analyzed the interval changes in spleen size and variceal engorgement on computed tomography images obtained at the times of surgery and biopsy. Aggravation of splenomegaly and variceal engorgement were considered computed tomography features associated with the progression of portal hypertension. Clinical outcomes, including responses to treatment and graft survival, were compared between patients with and without these features.
The frequency of progression of portal hypertension was 31.9% and did not differ significantly in patients who experienced early (30.8% [28/91]) and late (34.0% [17/50]) rejection (P = .694). In the late rejection group, computed tomography features indicating progression of portal hypertension were significantly associated with poor response to treatment (P = .033). Graft survival in both the early and late rejection groups did not differ significantly in patients with and without progression of portal hypertension.
Computed tomography features suggesting the progression of portal hypertension were encountered in about one-third of patients who experienced acute cellular rejection after liver transplant. Progression of portal hypertension was significantly related to poor response to treatment in the late rejection group.
本研究旨在探讨在肝移植后发生急性细胞排斥反应的患者中，提示门静脉高压进展的计算机断层扫描（CT）特征的频率及其临床相关性。
本回顾性研究纳入了 141 例经病理诊断为肝移植后急性细胞排斥反应的患者。根据诊断时间将患者分为早期和晚期排斥组。两位放射科医生分析了手术和活检时获得的 CT 图像上脾肿大和静脉曲张程度的间隔变化。脾肿大和静脉曲张程度加重被认为是与门静脉高压进展相关的 CT 特征。比较了具有和不具有这些特征的患者的临床结局，包括治疗反应和移植物存活率。
门静脉高压进展的频率为 31.9%，在早期（30.8%[28/91]）和晚期（34.0%[17/50]）排斥的患者中没有显著差异（P=.694）。在晚期排斥组中，提示门静脉高压进展的 CT 特征与治疗反应不佳显著相关（P=.033）。在早期和晚期排斥组中，具有和不具有门静脉高压进展的患者的移植物存活率均无显著差异。
在肝移植后发生急性细胞排斥反应的患者中，约有三分之一出现提示门静脉高压进展的 CT 特征。在晚期排斥组中，门静脉高压进展与治疗反应不佳显著相关。
