From the Postgraduate School in Radiodiagnostic, University of Milan.
Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda.
J Comput Assist Tomogr. 2024;48(1):26-34. doi: 10.1097/RCT.0000000000001511. Epub 2023 Jul 7.
In liver transplantation, chronic rejection is still poorly studied. This study aimed to investigate the role of imaging in its recognition.
This study is a retrospective observational case-control series. Patients with histologic diagnosis of chronic liver transplant rejection were selected; the last imaging examination (computed tomography or magnetic resonance imaging) before the diagnosis was evaluated. At least 3 controls were selected for each case; radiological signs indicative of altered liver function were analyzed. χ 2 Test with Yates correction was used to compare the rates of radiologic signs in the case and control groups, also considering whether patients suffered chronic rejection within or after 12 months. Statistical significance was set at P < 0.050.
A total of 118 patients were included in the study (27 in the case group and 91 in the control group). Periportal edema was appreciable in 19 of 27 cases (70%) and in 6 of 91 controls (4%) ( P < 0.001); ascites and hepatomegaly were present in 14 of 27 cases (52%) and 12 of 27 cases (44%), respectively, and in 1 of 91 controls (1%) ( P < 0.001); splenomegaly was present in 13 of 27 cases (48%) and in 8 of 91 controls (10%) ( P < 0.001); and biliary tract dilatation was present in 13 of 27 cases (48%) and in 11 of 91 patients controls (5%) ( P < 0.001). In the controls, periportal edema was significantly less frequent beyond 12 months after transplant (1% vs 11%; P = 0.020); the other signs after 12 months were not significant.
The identification of periportal edema, biliary dilatation, ascites, and hepatosplenomegaly can serve as potential warning signs of ongoing chronic liver rejection. It is especially important to investigate periportal edema if it is present 1 year or more after orthotopic liver transplantation.
在肝移植中，慢性排斥反应仍研究不足。本研究旨在探讨影像学在其识别中的作用。
本研究为回顾性观察性病例对照系列研究。选择组织学诊断为慢性肝移植排斥反应的患者；评估诊断前的最后一次影像学检查（计算机断层扫描或磁共振成像）。每个病例至少选择 3 个对照；分析提示肝功能改变的影像学征象。χ 2 检验（Yates 校正）用于比较病例组和对照组的影像学征象发生率，同时考虑患者是否在 12 个月内或之后发生慢性排斥反应。统计学意义设定为 P < 0.050。
本研究共纳入 118 例患者（病例组 27 例，对照组 91 例）。27 例病例中有 19 例（70%）可见门静脉周围水肿，91 例对照中有 6 例（4%）（P < 0.001）；腹水和肝肿大分别存在于 27 例中的 14 例（52%）和 12 例（44%），91 例对照中有 1 例（1%）（P < 0.001）；脾肿大存在于 27 例中的 13 例（48%）和 91 例对照中的 8 例（10%）（P < 0.001）；胆道扩张存在于 27 例中的 13 例（48%）和 91 例对照中的 11 例（5%）（P < 0.001）。在对照组中，移植后 12 个月以上门静脉周围水肿明显较少（1%比 11%；P = 0.020）；12 个月后其他征象无显著差异。
门静脉周围水肿、胆道扩张、腹水和肝脾肿大可作为慢性肝排斥反应的潜在预警征象。如果在原位肝移植后 1 年或更长时间出现门静脉周围水肿，则尤其需要进行调查。
