Evaluation of pediatric liver transplant recipients using quantitative hepatobiliary scintigraphy

Abstract

THE first successful liver transplantation was performed in 1963. Since then, advances in surgical technique, immunosuppressive therapy, and treatment of posttransplant complications have dramatically improved the prognosis for patients who undergo this procedure. Further, refinement of preoperative nutritional management and the advent of techniques for reduced-size transplants have made liver transplantation the preferred treatment for pediatric patients with end-stage liver disease. The postoperative period is a critical and uncertain time for pediatric liver transplant recipients because of the possibility of various complications that lead to liver dysfunction. Possible complications include infection, rejection, hepatocyte damage, cholestasis, vascular occlusion, and biliary obstruction. Another important issue is that there may be no accompanying clinical signs when a graft starts to fail. Biochemical testing lacks sensitivity, especially in the early postoperative period. Biopsy is currently considered the only definitive method for identifying liver transplant problems, but this is an invasive procedure. Quantitative, non invasive methods are needed to diagnose graft dysfunction in the early stage. Radionuclide imaging methods may meet these requirements. The aim of this study was to assess the clinical value of serial quantitative hepatobiliary scintigraphy for monitoring graft function in pediatric liver transplant recipients.