Solitary pulmonary nodule in the liver transplant candidate: importance of diagnosis and treatment.

Abstract

Our objectives were to define the incidence and etiology of solitary pulmonary nodules (SPNs) in patients undergoing living donor liver transplantation (LDLT), describe a diagnostic approach to the management of SPNs in LDLT, and define the impact of SPNs on the overall survival of adult LDLT recipients. Nine patients (9/152, 5.9%) were diagnosed with an SPN on the basis of chest radiography findings during the pretransplant survey. All were male. The mean age was 52 years. All the patients had hepatitis B virus-related cirrhosis with hepatocellular carcinoma. All were asymptomatic for the lung lesion. All underwent contrast-enhanced chest computed tomography (CT) to verify the presence and possible etiology of the SPNs. In 3 cases, CT was used to definitely determine that there was no pulmonary nodule; in 2, CT led to a definite diagnosis of pulmonary tuberculosis. In 4, CT led to a definite identification of an SPN but not to an etiological diagnosis. Two patients underwent outright thoracoscopy and biopsy of their SPNs. Biopsy showed cryptococcosis in both patients. One received a therapeutic trial of an antituberculosis treatment, and repeat CT after 1 month showed a regression in the size of the SPN. A diagnosis of tuberculosis was made. One patient had an inconclusive whole body positron emission tomography scan and subsequently underwent thoracoscopy where biopsy showed tuberculosis. A concomitant malignancy, either primary lung cancer or metastasis from the liver tumor, was not identified. All patients were surviving with their original grafts and were lung infection-free. The overall mean posttransplant follow-up was 54 months (range = 33-96 months).

• Authors: Allan M Concejero, Chee-Chien Yong, Chao-Long Chen, Hung-I Lu, Chih-Chi Wang, Shih-Ho Wang, Yueh-Wei Liu, Chin-Hsiang Yang, Yu-Fan Cheng, Bruno Jawan
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 16 Issue 6 Pg. 760-6 (Jun 2010) ISSN: 1527-6473 [Electronic] United States
• PMID: 20517910 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: (c) 2010 AASLD.

Chemical References

• Antifungal Agents
• Antitubercular Agents
• Contrast Media

Topics

• Antifungal Agents (therapeutic use)
• Antitubercular Agents (therapeutic use)
• Biopsy
• Clinical Protocols
• Contrast Media
• Cryptococcosis (complications, diagnosis, drug therapy)
• Humans
• Liver Diseases (complications, surgery)
• Liver Transplantation
• Living Donors
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Positron-Emission Tomography
• Predictive Value of Tests
• Retrospective Studies
• Solitary Pulmonary Nodule (complications, diagnosis, drug therapy)
• Taiwan
• Thoracoscopy
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Tuberculosis, Pulmonary (complications, diagnosis, drug therapy)