Adnan Arif, Sana Sayeed, Samreen Aslam, Amna Mehboob, Farheen Raza, Abu Bakar Hafeez Bhatti.
Liver CT: imaging features associated with recurrence following liver transplant.
Pak J Radiol Jan ;33(4):191-9.

The aim of this study is to determine the association of imaging spectrum of hepatocellular carcinoma with post transplant pattern of metastatic disease. METHOD AND MATERIAL: A seven-year retrospective study (2014-2020) of live donor liver transplant (LDLT) patients at Shifa International Hospital (SIH) involved comparing pre-transplant CT scans to post-transplant dynamic CT images using a Picture Archiving and Communication System. Disease recurrence in potential sites, including the hepatic graft, abdomino-pelvic viscera, lungs, bones, and more, was documented. Data was analyzed using frequency statistics, histograms, and tables. RESULTS: Out of 221 transplants, 36 individuals (4F, 32M) experienced recurrences; 27.8% had prior Transarterial chemo-embolization (TACE). Segment VII had the most HCCs (14 patients, 38.9%); Segments V and VI had 6 patients each (16.7%) with average sizes of 4.372 +- 1.912 cm. Most patients (69.4%) showed capsular involvement on pre-transplant CT, followed by diaphragmatic involvement in 8, segmental portal venous (PV) tumor in 6, and APS in 3 individuals (22%, 16.7%, 8.3% respectively). Post-transplant CT showed recurrence in the lungs (44.4%), bones (41.6%), hepatic graft (30.5%), lymph nodes (22.2%), adrenals (8.3%), and other sites. Pre-transplant factors had varying associations with recurrence, but none were statistically significant (P-values > 0.05). CONCLUSION: Our study does not show significant association between presence of diaphragmatic involvement, hepatic capsular invasion, thrombosed segmental branches, and arterioportal shunting (APS) and the site of tumor recurrence. However, presence of significant capsular and diaphragmatic bulge particularly in segment VII and VIII HCCs, robust scrutiny should be carried out for evaluation of these areas both intra-operatively by surgeon and in post-transplant follow-up CT reporting by radiologist. Furthermore, in post-transplant CTs, comparison and correlation with pre-transplant CT findings should be carried out. The study also highlights the key role of radiologist in highlighting these features of HCCs for assistance in ensuring safe surgical practices.

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