BIOPSY AND QUANTITATIVE HEPATOBILIARY SCINTIGRAPHY IN THE EVALUATION OF LIVER-TRANSPLANTATION

Methods: Hepatobiliary scintigraphy with technetiumm-99m-mebrofenin in cluding a first-pass study of 60 two-sec images and a functional phase of 40 one-min images was performed in 26 patients (42.5 +/- 12.5 yr) in the early postoperative period (9.1 +/- 4.3 days) after liver graft ing. Needle biopsy was carried out within a mean of 0.5 +/- 2.2 days o f the scintigraphy study, Considering only rejection and cholestasis, biopsy results were used to classify the patients in three groups: con trol group I (11 patients) with minimal lesions, group II (9 patients) with moderate histologic modifications, and group III (6 patients) wi th severe dysfunction showing important structural changes. First-pass time-activity curves were used to calculate arterial (alpha-A) and po rtal (alpha-P) angles as well as a portal perfusion index. Functional time-activity curves were used to define two blood retention indices ( BRI1 and BRI2) and two liver uptake indices (LUI1 and LUI2), Excretion was not quantified. Results: Simple linear regression analysis showed a significant correlation between portal perfusion index and BRI1 (p < 0.05, r = -0.43) and BRI2 (p = 0.01, r = -0.53). The validity of the histologic classification was assessed by the existence of significan tly different (p < 0.05) mean values for alpha-P, portal perfusion ind ex and LUI1 in the three groups. All other indices could distinguish s ignificantly between groups I and II, Furthermore, arterial angle alph a-A allowed differentiation of group II from group III but not group I from group II; on the contrary, LUI2 and BRI1 distinguished group I f rom group II but not group II from group III. Conclusion: This study d emonstrated a close correlation between early biopsy results and perfu sion indices in patients with a liver graft as well as uptake paramete rs determined by hepatobiliary scintigraphy.