Risk Factors for Severe Complications in Patients with Orthotopic Liver Transplantation: Clinical Parameters and Imaging Evaluation

• Main Authors: Zun-Cheng Tang, 湯尊丞
• Other Authors: Jyh-Cheng Chen
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/5eh595

碩士 === 國立陽明大學 === 生物醫學影像暨放射科學系 === 105 === The aim of this study was to determine the risk factors of severe complications in patients with orthotopic liver transplantation. There were 307 adults who underwent liver transplantations performed in one institution between September 2011 and December 2016. Among them 110 patients were evaluated with pre and post-transplant CT scan during 3 months, 31of the 110 patients died or had severe complications within 3 months (Severe Complication group; Com group). The other 79 patients were included the non-COM group. We analyzed the clinical data and evaluated the CT parameters qualitatively and quantitatively. We recorded the diameters differences of the hepatic vessels for each patient between recipient and donor. We also evaluated their post-operation imaging findings including: Perfusion defect, hyperdense hematoma, biloma or liver abscess, ascites or pleural effusion Multivariate logistic regression model was used to analyze the risk factors. The inter-observer variability of CT measurements was assessed by Inter-class correlation coefficient and Bland-Altman difference plot. Patients who had severe complications had significant higher ALT levels (174.92±529.44 U/L, p<0.05) 05) as compared to the non-Com group. The diameters of the portal vein in patients with severe complications were slightly larger than the non-Com group (15.36±2.27mm vs. 13.80±3.11mm, p<0.05). The Recipient/Donor ratios of the portal vein in the severe complications groups (1.19±0.17 vs. 1.06±0.23, p<0.05) were significant higher than the non-Com group. The appearance of ascites and perfusion defect were significant higher (p<0.05) in the Com group. Using the receiver operating characteristic (ROC) analysis, the cutoff value for warm ischemia time is 47.5 min and the recipient/donor portal vein ratio is 1.09 for appearance of Com group. Using logistic regression, the appearance perfusion defect is the most important risk factor regarding the complication of liver transplantation. Besides, the warm ischemia time, recipient/donor portal vein diameter ratio, ascites are also important risk factors for Com group. In conclusion, perfusion defect, portal vein difference and presence of ascites are the most important risk factors for severe complication in patients with orthotopic liver transplantation.