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Monitoring of graft function recovery after orthotopic liver transplantation (OLT)
Diagnostic procedures (including radiology and hnaging techniques)
LIVER COLLAGEN ESTIMATION FROM NEEDLE LIVER BIOPSIES SECTIONS : A COMPLEMENTARY INVESTIGATION OF FIBROSIS TO ROUTINE DIAGNOSIS S. Guerret'. P. Chossegros', M. Chevallier', C. Tr~po", J.A. Grimaud" "CNRS URA 1459 Institut Pasteur de Lyon, France "Unit6 d'H~patologie, H6tel Dieu, Lyon, France As liver biopsy is, up to now, the only way to precisely assess hepatic fibrosis, a colorimetric method (CM) (J. Histochem. Cytochem. 1985;33:737-743) based on tinctorial affinities of collagen to picro sirius red has been developed for routine use. The aim of the study was to validate liver collagen assessment in hdpatopathies of various etiologies. The colorimetric method has been applied on 1247 consecutive needle liver biopsies from patients with various liver diseases : alcohol n= 168; chronic viral hepatitis n=736; PBC n=32; drug n=46; non specific reactive hepatitis n=229; miscellaneous n=36. The values in each group were compared to a semiquantitative morphological evaluation (SM) of fibrosis in four classes : 0=absent, n=54; l=early fibrosis, n=353; 2=septal fibrosis, n=507; 3=cirrhosis, n=333. Values of CM for each class were respectively : 34 +/- 1,35 (class 0), 36,28 +/- 0,41 (class I), 43,42 +/- 0,45 (class 2), 64,24 +/- 1,01 /zg Coll/mg prot (class 3). If a significant correlation (r=0,74, p<0,0001) was observed between CM and SM, the dispersion of CM values inside each class of SM, reflects the crude estimation of the latter method. The only difference between etiologies was observed for alcoholic cirrhosis which were significantly more fibrotic (p>0,001) than the others. CM gives a more accurate reflection of the extent of liver fibrosis than SM and it should be useful for the monitoring of the evolution of liver diseases.
S 159
MONITORING OF GRAFT FUNCTION RECOVERY AFTER ORTHOTOP! C LIVER TRANSPLANTATION (OLT) R.M.lemmolo, L.Fabris, M.Stmzzabosco, C.Destro, °C.D.Palead, *F.Ba~azza, *R.Merenda, *D.Ned, *G.E.Gerunda, *A. Mallei Faccioli, G.Crepaldi. Inst.lnt.Med., *lnst.Chem.Clin., *lnst.Gen.Surg., Univ. of Padua, Italy. Cdteda for the eady assessment of graft function alter OLT remain a controversial, but very important issue, since pdmary graft non-function requires urgent retrasplantaUon. In this study the usefulness of monoethylglycinexylidide (MEGX) formation test and routine liver function tests (LFT) as eady indicators of graft viability in OLT patients was evaluated. PATIENTS AND METHODS: 31 OLT patients were retrospectively divided into three groups: good allograft function (GF) (n=17, 54.8%), allogrelt dysfunction (AD)(n=8, 25.8%), and pdmary allograft non-function (PNF)(n=6, 19.4%)(retrasplantation within the 1st week after OLT). Following Lidocaine i.v. bolus (lmg/kg) serum MEGX levels at 45*min. were measured (FPIA, TDx) in liver donors and their respective recipients 2,4,7,14,21 and 28 days after OLT; LFT were also determined at the same time-intervals. RESULTS: the PNF group showed a quick and sustained reduction of MEGX formation test, together with a decrease in prethrombin activity and an increase in transaminases and serum total bilirubin (reaching a significant difference, p<0.001, as respect to GF and AD between days 2 and 4). On the other hand, the AD group was charactedzed by a slowly progressive decrease of MEGX (p<0.05 at day 28) and increase of GGT (p<0.05 at day 21). In CONCLUSION the sedal evaluation of MEGX formation test and LFT may be helpful in the eady detection of pdmary graft nonfunction.
COMPARISON BETWEEN THE ASPIRATION AND THE CUTTING NEEDLES IN ULTRASONICALLY GUIDED BIOPSY OF FOCAL LIVER LESIONS G. Jankovie, R. Grbie, D. Tomic, Z. Jankovie, M. Krstie, S. Dojcinov, R. Jesic and I. Cabrie Institute of Digestive Diseases, Belgrade, Yugoslavia. The aim of the study was to assess the value of ultrasonically guided biopsy in focal liver lesions using an aspirating needle in 207 cases, a cutting needle in 62 eases, and both needles in 49 cases. Adequate samples were obtained from 95% aspiration biopsies, 96,8% cutting biopsies and 95,9% double biopsies. We obtained 64,5% vs. 58,3% vs. 80,8% true positive results, 27,4% vs. 38,3% vs. 14,9% true negative, and 8,1% vs. 3,3% vs. 4,3% false negative, with a sensitivity of 88,8% vs. 94,6% vs. 95%, specificity o f 100% (all), and overall accuracy of 91,9% vs. 96,7% vs. 95,7%. Two intraperitoneal hemorrhages following puncture with fine cutting needle were observed, and no ease of death. The results suggest that echo-guided fine needle biopsy is valuable and safe method in the diagnosis of focal hepatic lesions. Although better results were obtained with cutting needle as histological examination provided additional valuable data in some cases, we consider that aspiration biopsy should be the first step method, due to lower risk of bleeding.
LIVER COLLAGEN ESTIMATION FROM NEEDLE LIVER BIOPSIES SECTIONS : A COMPLEMENTARY INVESTIGATION OF FIBROSIS TO ROUTINE DIAGNOSIS S. Guerret'. P. Chossegros', M. Chevallier', C. Tr~po", J.A. Grimaud" "CNRS URA 1459 Institut Pasteur de Lyon, France "Unit6 d'H~patologie, H6tel Dieu, Lyon, France As liver biopsy is, up to now, the only way to precisely assess hepatic fibrosis, a colorimetric method (CM) (J. Histochem. Cytochem. 1985;33:737-743) based on tinctorial affinities of collagen to picro sirius red has been developed for routine use. The aim of the study was to validate liver collagen assessment in hdpatopathies of various etiologies. The colorimetric method has been applied on 1247 consecutive needle liver biopsies from patients with various liver diseases : alcohol n= 168; chronic viral hepatitis n=736; PBC n=32; drug n=46; non specific reactive hepatitis n=229; miscellaneous n=36. The values in each group were compared to a semiquantitative morphological evaluation (SM) of fibrosis in four classes : 0=absent, n=54; l=early fibrosis, n=353; 2=septal fibrosis, n=507; 3=cirrhosis, n=333. Values of CM for each class were respectively : 34 +/- 1,35 (class 0), 36,28 +/- 0,41 (class I), 43,42 +/- 0,45 (class 2), 64,24 +/- 1,01 /zg Coll/mg prot (class 3). If a significant correlation (r=0,74, p<0,0001) was observed between CM and SM, the dispersion of CM values inside each class of SM, reflects the crude estimation of the latter method. The only difference between etiologies was observed for alcoholic cirrhosis which were significantly more fibrotic (p>0,001) than the others. CM gives a more accurate reflection of the extent of liver fibrosis than SM and it should be useful for the monitoring of the evolution of liver diseases.
S 159
MONITORING OF GRAFT FUNCTION RECOVERY AFTER ORTHOTOP! C LIVER TRANSPLANTATION (OLT) R.M.lemmolo, L.Fabris, M.Stmzzabosco, C.Destro, °C.D.Palead, *F.Ba~azza, *R.Merenda, *D.Ned, *G.E.Gerunda, *A. Mallei Faccioli, G.Crepaldi. Inst.lnt.Med., *lnst.Chem.Clin., *lnst.Gen.Surg., Univ. of Padua, Italy. Cdteda for the eady assessment of graft function alter OLT remain a controversial, but very important issue, since pdmary graft non-function requires urgent retrasplantaUon. In this study the usefulness of monoethylglycinexylidide (MEGX) formation test and routine liver function tests (LFT) as eady indicators of graft viability in OLT patients was evaluated. PATIENTS AND METHODS: 31 OLT patients were retrospectively divided into three groups: good allograft function (GF) (n=17, 54.8%), allogrelt dysfunction (AD)(n=8, 25.8%), and pdmary allograft non-function (PNF)(n=6, 19.4%)(retrasplantation within the 1st week after OLT). Following Lidocaine i.v. bolus (lmg/kg) serum MEGX levels at 45*min. were measured (FPIA, TDx) in liver donors and their respective recipients 2,4,7,14,21 and 28 days after OLT; LFT were also determined at the same time-intervals. RESULTS: the PNF group showed a quick and sustained reduction of MEGX formation test, together with a decrease in prethrombin activity and an increase in transaminases and serum total bilirubin (reaching a significant difference, p<0.001, as respect to GF and AD between days 2 and 4). On the other hand, the AD group was charactedzed by a slowly progressive decrease of MEGX (p<0.05 at day 28) and increase of GGT (p<0.05 at day 21). In CONCLUSION the sedal evaluation of MEGX formation test and LFT may be helpful in the eady detection of pdmary graft nonfunction.
COMPARISON BETWEEN THE ASPIRATION AND THE CUTTING NEEDLES IN ULTRASONICALLY GUIDED BIOPSY OF FOCAL LIVER LESIONS G. Jankovie, R. Grbie, D. Tomic, Z. Jankovie, M. Krstie, S. Dojcinov, R. Jesic and I. Cabrie Institute of Digestive Diseases, Belgrade, Yugoslavia. The aim of the study was to assess the value of ultrasonically guided biopsy in focal liver lesions using an aspirating needle in 207 cases, a cutting needle in 62 eases, and both needles in 49 cases. Adequate samples were obtained from 95% aspiration biopsies, 96,8% cutting biopsies and 95,9% double biopsies. We obtained 64,5% vs. 58,3% vs. 80,8% true positive results, 27,4% vs. 38,3% vs. 14,9% true negative, and 8,1% vs. 3,3% vs. 4,3% false negative, with a sensitivity of 88,8% vs. 94,6% vs. 95%, specificity o f 100% (all), and overall accuracy of 91,9% vs. 96,7% vs. 95,7%. Two intraperitoneal hemorrhages following puncture with fine cutting needle were observed, and no ease of death. The results suggest that echo-guided fine needle biopsy is valuable and safe method in the diagnosis of focal hepatic lesions. Although better results were obtained with cutting needle as histological examination provided additional valuable data in some cases, we consider that aspiration biopsy should be the first step method, due to lower risk of bleeding.