Karademir S, Csete M E, Jurim O, Finstad T, Hawkins R, Bussuttil R W, Shaked A
Department of Surgery, University of California at Los Angeles 90024.
Clin Transplant. 1994 Feb;8(1):54-8.
Accurate prognostic indicators are lacking for livers with early marginal graft function, making the decision to re-transplant a difficult one. Therefore, we studied 99mTc-labeled DISIDA scanning as a predictor of recovery of marginal grafts. Records of 28 liver transplant recipients with prolonged periods of marginal graft function after liver transplantation were analyzed. Twelve of 28 (Group I) had delayed PNF and were re-transplanted within 3-8 days (mean 5.3) of surgery. The remaining 16 (Group II) recovered slowly, with normal graft function at 1 month. All patients received DISIDA scans 2 to 5 d after surgery. Clearance of tracer from the blood pool was slower in Group I patients (77S +/- 241 sec) than in Group II (260 +/- 38 sec; p < 0.01). Qualitative differences in the pattern of parenchymal uptake were also noted. Homogenous uptake, consistent with cholestasis, was seen in 15/16 (94%) Group II patients, with improved uptake after 7-35 d. In contrast, 11/12 Group I patients had non-homogenous uptake, consistent with multiple liver infarctions. This pattern correlated with higher peak SGOT in Group I (4358 +/- 658 U/dl vs 1636 +/- 127 U/dl p < 0.01), and PT (20 +/- 0.7 sec vs. 16.5 +/- 0.36 sec; p < 0.01). In summary, delays in DISIDA tracer clearance from blood, and non-homogenous hepatic uptake correlate with elevated liver function tests and with delayed PNF. Homogenous uptake correlates with graft recovery. DISIDA scans may, therefore, be useful in predicting recovery of marginal grafted livers.
目前缺乏针对早期边缘性移植物功能肝脏的准确预后指标，这使得再次移植的决策变得困难。因此，我们研究了99mTc标记的二异丙基乙酰苯胺（DISIDA）扫描作为边缘性移植物恢复的预测指标。分析了28例肝移植受者肝移植后边缘性移植物功能持续较长时间的记录。28例中的12例（第一组）发生延迟性原发性无功能，并在术后3 - 8天（平均5.3天）内再次移植。其余16例（第二组）恢复缓慢，1个月时移植物功能正常。所有患者在术后2至5天接受DISIDA扫描。第一组患者示踪剂从血池清除的速度（77S±241秒）比第二组（260±38秒；p<0.01）慢。还注意到实质摄取模式的定性差异。15/16例（94%）第二组患者可见与胆汁淤积一致的均匀摄取，7 - 35天后摄取改善。相比之下，11/12例第一组患者有不均匀摄取，与多发性肝梗死一致。这种模式与第一组较高的谷草转氨酶峰值相关（4358±658 U/dl对1636±127 U/dl，p<0.01），以及凝血酶原时间（20±0.7秒对16.5±0.36秒；p<0.01）。总之，DISIDA示踪剂从血液中清除延迟以及肝脏摄取不均匀与肝功能检查升高和延迟性原发性无功能相关。均匀摄取与移植物恢复相关。因此，DISIDA扫描可能有助于预测边缘性移植肝脏的恢复情况。
