Liver transplant rejection and cholestasis: comparison of technetium 99m-diisopropyl iminodiacetic acid hepatobiliary imaging with liver biopsy

Abstract

To determine whether the scintigraphic evaluation of technetium-99m diisopropyl iminodiacetic acid (DISIDA) uptake and excretion can distinguish among liver transplant patients with biopsy evidence for rejection, cholestasis or neither condition, we reviewed scintigrams and biopsies in 36 patients. There were 76 scintigrams with corresponding biopsies. Uptake and excretion were graded from image data on scales reflecting normal through severely abnormal values. Biopsies were evaluated for findings of cholestasis and rejection. The majority of scintigrams demonstrated normal uptake (60/75, 80%) and delayed excretion (65/76, 85%), which was most marked immediately after transplantation. One-way analysis of variance showed that the mean excretion values significantly differed between patients with normal biopsies and those with cholestasis and/or rejection (P = 0.0003). However, mean uptake scores demonstrated no statistically significant difference between these two groups of patients (P = 0.1). These findings suggest that 99mTc-DISIDA scintigraphy can differentiate between transplants with and without rejection/cholestasis but not between rejection and cholestasis. If 99mTc-DISIDA excretion is normal, rejection and cholestasis are unlikely.

Nuclear Imaging Techniques for the Assessment of Hepatic Function in Liver Surgery and Transplantation

“…Brunot et al demonstrated a close relation between early biopsy results and liver uptake function measured by HBS, implying that HBS is valuable in distinguishing graft rejection from cholestasis (89). In contrast, others reported that HBS can distinguish between normal grafts and those experiencing rejection or cholestasis but not between biliary complications and rejection (85,90).…”

Blood Clearance of ^99mTc-Trimethyl-Br-IDA Discriminates between Different Degrees of Severe Liver Ischaemia – Reperfusion Injury in the Rat

“…Excretion of technetiumlabeled imidoacetate compounds has been proposed for the study of functional hepatic reserve in chronic liver disease [ 1 ] and in liver transplant patients [2][3][4][5][6]. Uptake of HIDA derivatives is useful for in vitro functional analysis of hcpatocytes in culture [7], and scintigraphic analysis of these radionuclides has been reported in a study of experimental cold and warm liver ischaemia [5].…”

Comparison of SPECT lung perfusion with transbronchial lung biopsy after lung transplantation.

“…Echocardiography, magnetic resonance imaging, immunologic markers, positron-emission scintigraphy, and other radioisotopic techniques are being considered as potential screening tests for rejection after heart transplantation (29)(30)(31). Hepatobiliary nuclear imaging has been used in liver transplant recipients to help differentiate normal recipients from those with rejection and/or cholestasis (32).…”