التفاصيل البيبلوغرافية
| العنوان: |
Pre-operative CT scan helps predict outcome after liver transplantation for acute-on-chronic grade 3 liver failure. |
| المؤلفون: |
Wackenthaler, Antoine, Molière, Sébastien, Artzner, Thierry, Michard, Baptiste, Schenck, Maleka, Addeo, Pietro, Besch, Camille, Bachellier, Philippe, Schneider, Francis, Veillon, Francis, Faitot, François |
| المصدر: |
European Radiology; Jan2022, Vol. 32 Issue 1, p12-21, 10p, 1 Black and White Photograph, 1 Diagram, 3 Charts, 3 Graphs |
| مصطلحات موضوعية: |
COMPUTED tomography, LIVER transplantation, LIVER failure, PROGNOSIS, VENAE cavae, PORTAL hypertension |
| مستخلص: |
Objectives: The aim of this study was to identify the prognostic value of pre-operative imaging to predict post-transplantation survival in critically ill cirrhotic patients with severe acute-on-chronic liver failure (ACLF). Methods: Patients with grade 3 ACLF who underwent liver transplantation between January 2010 and January 2020 and with available contrast-enhanced abdominal computed tomography (CT) performed less than 3 months before LT were retrospectively included (n = 82). Primary endpoint was 1-year mortality. Imaging parameters (sarcopenia, liver morphology and volumetry, and signs of portal hypertension) were screened and tested to build a prognostic score. Results: In the multivariate analysis, three independent CT-derived prognostic factors were found: splenomegaly (p = 0.021; HR = 5.6 (1.29–24.1)), liver atrophy (p = 0.05; HR = 2.93 (1.01–10.64)), and vena cava diameter ratio (p < 0.0001; HR = 12.7 (3.4–92)). A simple prognostic score was proposed, based on the presence of splenomegaly (5 points), liver atrophy (5 points), and vena cava diameter ratio < 0.2 (12 points). A cutoff at 10 points distinguished a high-risk group (score > 10) from a low-risk group (score ≤ 10) with 1-year survival of 27% vs. 67% respectively (p < 0.001). It was found to be an independent predictive factor in association with the Transplantation for ACLF3 Model (TAM) score. Conclusion: Pre-transplantation contrast-enhanced abdominal CT has a significant impact on selection of patients in ACLF3 in order to predict 1-year survival after LT. Key Points: • Splenomegaly, liver atrophy, and vena cava diameter ratio are independent CT-derived prognostic factors after transplantation for severe acute-on-chronic liver failure. • A simple CT-based prognostic score is an independent predictive factor, complementary to clinical and biological parameters. • The use of the CT-derived score allows stratification based on 1-year mortality for patients with otherwise uncertain prognosis with clinical and biological parameters alone. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
