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      저자 : ( Vasudevan Ramaswamy ) (검색결과 2 건)
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      • Hepatic Steatosis Quantification in Live Related Liver Donors: Can MRI-PDFF Replace Liver Biopsy?

        ( Vasudevan Ramaswamy ),( Manoj Gupta ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

        Aims: Hepatic steatosis (HS) in donors has implications for the donor and recipient in live donor liver transplantation (LDLT). Liver biopsy is the gold standard for assessing HS but is invasive. The current practice: measuring liver attenuation index (LAI) in a non contrast CT, has poor accuracy in mild to moderate steatosis. MRI determined PDFF (Proton Density Fat Fraction) is a promising non invasive tool. No study comparing MRI, CT with liver biopsy in LDLT, has been performed, to our knowledge. Methods: A prospective study of consecutive healthy, voluntary liver donors undergoing NCCT, MRI and intra-operative liver biopsy. We aimed to determine whether the MRI determined PDFF using IDEAL (IDEAL: Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation) sequence correlated with histologic quantification of steatosis. Non contrast CT of the abdomen was done preoperatively in all the donors. Results: 30 donors were analysed during the study period. The mean age of donors was 30.4 years, mean BMI was 22.4 kg/m2. Mean LAI on CT scan was +9.35. One of the donors had a CT LAI of -5 and MRI-PDFF of 2.175 and HS of 5% on liver biopsy; postoperative course of the recipient and the donor was uneventful. The average MRI-PDFF correlated well with the pathology grading of HS with Pearson’s coefficient of 0.81. The sensitivity and specificity of MRI-PDFF in diagnosing HS>5% was 100% and 96.6%. Conclusions: MRI-PDFF using IDEAL sequence has good correlation with histology and could potentially replace liver biopsy in quantifying HS in potential LDLT donors. If CT LAI suggests rejection of the donor, MRI-PDFF is a better modality to non-invasively quantify HS and expanding the donor pool. This has changed our clinic practice to routinely evaluate HS by MRI-PDFF.

      • A Randomised Clinical Trial Pilot: Effect of Internal Biliary Stent on Biliary Complications in Living Related Liver Transplantation

        ( Vasudevan Ramaswamy ),( Manoj Gupta ),( Aneela T ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

        Aims: Wether internal biliary stenting can alter the occurrence of biliary complications and overall outcome in living donor liver transplantation (LDLT) is not clear. There are no randomised studies to suggest if stenting helps, in the current literature. Methods: Aim Describe our technique of placing the stent Assess impact of stent on biliary complications and overall outcome Methods: 30 consecutive recipients were randomized to biliary anastomosis with and without intraductal stent. Stent: 6F infant feeding tube, cut to15 cm, extending across anastomosis into duodenum & was placed before securing the corner knot on the posterior wall. Biliary anastomosis was performed using interrupted PDS 6-0 sutures. Stent was passed into the smaller duct when two ducts were anastomosed. Sten removal: endoscopically at six weeks, earlier in case of problems. Exclusion criteria: ABO incompatible transplant, retransplantation and hepaticojejunostomy Results: Demographic features & characteristics were similar in both groups. Right lobe without MHV was the commonest graft used, 2 patients in group B had right posterior sectoral graft. 60% of patients in both groups had bile duct diameter ≤ 4mm. Hospital & ICU stay was not statistically different between the groups (P=0.89). Incidence of biliary complications: 26.6% (8/30), 10% bile leak, 16.6% stricture. Group A: No Stent (%) Group B: Stent (%) Two duct to duct anastomosis 40 26.6 Biliary Complications 33.3 20 (p=0.49) Bile leak 6.6 13.3 Stricture 13.3 20 3 & 12month survival 93 100 18month survival 93 93 All patients with bile leaks in group A developed late strictures. There were no complications attributable to the stent or stent removal process. Conclusions: Use of internal biliary stent is safe and potentially beneficial in LDLT, quantum of which needs to be clarified by the full study.

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