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Interventional radiology procedures in adult patients who underwent liver transplantation

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World Journal of Gastroenterology 2009年第6期15卷 684-693页

作者： Roberto Miraglia luigi maruzzelli Settimo Caruso Mariapina Milazzo Gianluca Marrone Giuseppe Mamone Vincenzo Carollo Salvatore Gruttadauria Angelo Luca Bruno Gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical CenterVia Tricomi 1 Palermo 90127Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical CenterVia Tricomi 1 Palermo 90127Italy

Interventional radiology has acquired a key role in every liver transplantation(LT)program by treating the majority of vascular and non-vascular post-transplant complications,improving graft and patient survival and avoiding,in the majority of cases,surgical revision and/or *** aim of this paper is to review indications,technical consideration,results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

关键词： Liver transplantation Interventional radiology Complication Review Liver

Liver regeneration after liver resection: Clinical aspects and correlation with infective complications

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World Journal of Gastroenterology 2014年第22期20卷 6953-6960页

作者： Duilio Pagano Marco Spada Vishal Parikh Fabio Tuzzolino Davide Cintorino luigi maruzzelli Giovanni Vizzini Angelo Luca Alessandra Mularoni Paolo Grossi Bruno Gridelli Salvatore Gruttadauria Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione University of Pittsburgh Medical Center in Italy90127 PalermoItaly Department of Surgery University of Pittsburgh Medical CenterPittsburghPA 15213United States School of Medicine University of Pittsburgh Medical CenterPittsburghPA 15261United States Infectious Diseases Section Department of Surgical and Morphological SciencesUniversity of Insubria21100 VareseItaly

AIM:To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective ***:A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January *** was evaluated by multidetector computed tomographyat a mean follow-up of 43.85 *** Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation,and Centers for Disease Control and Prevention definitions were used for healthcare associated infections *** linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver ***:Ten of the 27 patients(37%)underwent chemotherapy prior to surgery,with a statistically significant prevalence of patients with metastasis(P=0.007).Eight patients(30%)underwent embolization,3 with primary tumors,and 5 with secondary *** patients(74%)experienced complications,with 12(60%)experiencing Clavien-Dindo Grade 3a to 5 ***≥100%occurred in 10(37%)*** predictors were smaller future remnant liver volume(-0.002;P<0.001),and a greater spleen volume/future remnant liver volume ratio(0.499;P=0.01).Patients with a resection of≥5 Couinaud segments experienced greater early regeneration(P=0.04).Nine patients experienced surgical site infections,and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected(P=0.016).There were no significant differences between patients with primary or secondary tumors,and either onset or infections or severity of surgical ***:Regardless of the onset of infective complications,future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver.

关键词： Liver regeneration Liver resection Liver tumor

A case of biliary stones and anastomotic biliary stricture after liver transplant treated with the rendez-vous technique and electrokinetic lithotritor

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World Journal of Gastroenterology 2008年第18期14卷 2920-2923页

作者： Marta Di Pisa Mario Traina Roberto Miraglia luigi maruzzelli Riccardo Volpes Salvatore Piazza Angelo Luca Bruno Gridelli Department of Gastroenterology IsMeTT UPMC Via Tricomi Palermo 90100 Italy Department of Radiology IsMeTT UPMC Via Tricomi 1 Palermo 90100 Italy Department of Hepatology IsMeTT UPMC Palermo 90100 Italy Civico Hospital Via Tricomi Palermo 90100 Italy Department of Radiology IsMeTT UPMC Palermo 90100 Italy Department of Surgery IsMeTT UPMC Palermo 90100 Italy

The paper studies the combined radiologic and endoscopic approach (rendez vous technique) to the treatment of the biliary complications following liver transplant. The "rendez-vous" technique was used with an electrokinetic lithotripter, in the treatment of a biliary anastomotic stricture with multiple biliary stones in a patient who underwent orthotopic liver transplant. In this patient, endoscopic or percutaneous transhepatic management of the biliary complication failed. The combined approach, percutaneous transhepatic and endoscopic treatment (rendez-vous technique) with the use of an electrokinetic lithotritor, was used to solve the biliary stenosis and to remove the stones. Technical success, defined as disappearance of the biliary stenosis and stone removal, was obtained in just one session, which definitively solved the complications. The combined approach of percutaneous transhepatic and endoscopic (rendez-vous technique) treatment, in association with an electrokinetic lithotritor, is a safe and feasible alternative treatment, especially after the failure of endoscopic and/or percutaneous trans-hepatic isolated procedures.

关键词： Biliary complications Liver transplant Endoscopic retrograde cholangiopancreatography Percutaneous TranshepatJc Cholangiography Percutaneous libhot^ipsy

Efficacy of transcatheter embolization/chemoembolization (TAE/TACE) for the treatment of single hepatocellular carcinoma

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World Journal of Gastroenterology 2007年第21期13卷 2952-2955页

作者： Roberto Miraglia Giada Pietrosi luigi maruzzelli Ioannis Petridis Settimo Caruso Gianluca Marrone Giuseppe Mamone Giovanni Vizzini Angelo Luca Bruno Gridelli Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (IsMeTT).University of Pittsburgh Medical Center Italy

AIM:To investigate the efficacy of transcatheter embolization/chemoembolization (TAE/TACE) in cirrhotic patients with single hepatocellular carcinoma (HCC) not suitable for surgical resection and percutaneous ablation therapy. METHODS:A cohort of 176 consecutive cirrhotic patients with single HCC undergoing TAE/TACE was reviewed; 162 patients had at least one image examination (helical CT scan or triphasic contrastenhanced MRI) after treatment and were included into the study. TAE was performed with Lipiodol followed by Gelfoam embolization; TACE was performed with Farmorubicin prepared in sterile drip at a dose of 50 mg/m2,infused over 30 min using a peristaltic pump,and followed by Lipiodol and Gelfoam embolization. RESULTS:Patients characteristics were:mean age,62 years; male/female 117/45; Child-Pugh score 6.2 ± 1.1; MELD 8.7 ± 2.3; mean HCC size,3.6 (range 1.0-12.0) cm. HCC size class was ≤ 2.0 cm,n = 51; 2.1-3.0 cm,n = 35; 3.1-4.0 cm,n = 29; 4.1-5.0 cm,n = 22; 5.1-6.0 cm,n = 11; and > 6.0 cm,n = 14. Patients received a total of 368 TAE/TACE (mean 2.4 ± 1.7). Complete tumor necrosis was obtained in 94 patients (58%),massive (90%-99%) necrosis in 16 patients (10%),partial (50%-89%) necrosis in 18 patients (11%) and poor ( 6.0 cm,respectively. Kaplan-Mayer survival at 24-mo was 88%,68%,59%,59%,45%,and 53% for lesions of ≤ 2.0,2.1-3.0,3.1-4.0,4.1-5.0,5.1-6.0,and > 6.0 cm,respectively. CONCLUSION:Our study showed that in cirrhotic patients with single HCC smaller than 6.0 cm,TAE/TACE produces complete local control of tumor in a significant proportion of patients. TAE/TACE is an effective therapeutic option in patients with single HCC not suitable for surgical resection or percutaneous ablation therapies. Further studies should investigate if the new available embo

关键词： Transcatheter embolization/chemoembolization Hepatocellular carcinoma

Predictive factors of tumor response to trans-catheter treatment in cirrhotic patients with hepatocellular carcinoma:A multivariate analysis of pre-treatment findings

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World Journal of Gastroenterology 2007年第45期13卷 6022-6026页

作者： Roberto Miraglia Giada Pietrosi luigi maruzzelli Ioannis Petridis Settimo Caruso Gianluca Marrone Giuseppe Mamone Giovanni Vizzini Angelo Luca Bruno Gridelli Department of Radiology Mediterranean Institute for Transplantation and A dvanced Specialized Therapies(IsMeTT)University of Pittsburgh Medical Center Palermo90127Italy Department of Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) University of Pittsburgh Medical Center Palermo 90127 Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and AdvancedSpecialized Therapies (IsMeTT) University of Pittsburgh MedicalCenter Palermo 90127 Italy

AIM： To elucidate the pre-treatment clinical and imaging findings affecting the tumor response to the transcatheter treatment of unresectable hepatocellular carcinoma （HCC）. METHODS： Two hundred cirrhotic patients with HCC received a total of 425 transcatheter treatments. The tumor response was evaluated by helical CT and a massive necrosis （MN） was defined as a necrosis 〉 90%. Twenty-five clinical and imaging variables were analyzed： uninodular/multinodular HCC, unilobar/bilobar, tumor capsula, hypervascular lesion, portal vein thrombosis, portal hypertension, ascites, platelets count, aspartate transaminases/alanine transaminases （AST/ALT）, alfa- fetoprotein （AFP）〉 100, AFP 〉 400, serum creatinine, virus hepatitis C （VHC） cirrhosis, performance status, age, Okuda stage, ChUd-Pugg stage, sex, CLIP （Cancer of the Liver Italian Program） score, serum bilirubin, constitutional syndrome, serum albumine, prothrombin activity, BCLC （Barcelona Clinic Liver Cancer） stage. Prognostic factors of response were subjected to univariate analysis and thereafter, when significant, to the multivariate analyses. RESULTS： On imaging analysis, complete response wasobtained in 60 （30%） patients, necrosis 〉 90% in 38 （19%） patients, necrosis 〉 50% in 44 （22%） patients, and necrosis 〈 50% in 58 （29%） patients. Ninety-eight （49%） of the 200 patients were considered to have a MN. In univariate analysis, significant variables （P 〈 0.01） were： uninodular tumor, unilobar, tumor size 2-6 cm, CLIP score 〈 2, absence of constitutional syndrome, and BCLC stage 〈 2. In a multivariate analysis, the variables reaching statistical significance were： presence of tumor capsule （P 〈 0.0001）, tumor size 2-6 cm （P 〈 0.03）, CLIP score 〈 2 （P 〈 0.006）, and absence of constitutional syndrome （P 〈 0.03）. Kaplan-Mayer cumulative survival at 12 mo was 80% at 24 mo was 56%. MN was associated with a longer survival （P 〈 0.0001）. CONCLUSION： MN after transcatheter treatment is more common in the presence of tumor

关键词： Hepatocellular carcinoma Trans-catheterembolization/chemoembolization Tumor response

MDCT, MR and interventional radiology in biliary atresia candidates for liver transplantation

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World Journal of Radiology 2011年第9期3卷 215-223页

作者： Roberto Miraglia Settimo Caruso luigi maruzzelli Marco Spada Silvia Riva Marco Sciveres Angelo Luca Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies University of Pittsburgh Medical Center 90127 Palermo Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies University of Pittsburgh Medical Center 90127 Palermo Italy Department of Pediatric Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies University of Pittsburgh Medical Center 90127 Palermo Italy

The multi-detector computed tomography (MDCT) scan and magnetic resonance (MR) of the abdomen play a key role in the work-up to liver transplantation (LT) by identifying congenital anomalies or cirrhosis-related modifications, conditions that can require changes in surgical technique. Moreover, the MDCT and MR scans allow identification of cirrhotic liver hepatic masses, extrahepatic porto-systemic shunts, eventual thrombosis of portal system and radiological signs of portal hypertension associated with biliary atresia (BA). The aim of this paper is to review MDCT, MR imaging and interven-tional radiology procedures performed to evaluate morphological changes and degree of portal hypertension in pediatric patients with end-stage liver disease secondary to BA, who are candidates for LT. Advances in the field of MR, MDCT and in percutaneous minimally invasive techniques have increased the importance of radiology in the management of pediatric patients with BA who are candidates for LT.

关键词： Portal hypertension Imaging Children Chol- angiopathy Transplant