Pulmonary nodules in liver transplant candidates with hepatocellular carcinoma: Imaging characteristics and clinical outcomes.

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

PubMedID: 25845578

Lee C, Ihde L, Kim A, Santos I, Matsuoka L, Cen SY, Wallman M, Grant E. Pulmonary nodules in liver transplant candidates with hepatocellular carcinoma: Imaging characteristics and clinical outcomes. Liver Transpl. 2015;.
No guidelines exist for the management of pulmonary nodules in patients with hepatocellular carcinoma (HCC) being evaluated for liver transplantation. 172 patients with HCC listed for liver transplant at our institution received both pre-transplant chest computed tomography (CT) and follow-up CT. Pulmonary nodules on CT were characterized and followed on subsequent scans by a blinded radiologist, with consensus review with a second radiologist performed for equivocal cases. Nodule characteristics and outcomes were examined with Chi-square tests, and post-transplant survival of patients with different nodule outcomes was compared. Cumulative probabilities of waiting list removal for non-transplanted patients and cumulative probabilities of undergoing transplantation for all patients were also compared between patients with and without pulmonary nodules. 76. 2% of patients had at least one pulmonary nodule on pre-transplant CT, with 301 total nodules characterized. 2. 7% of nodules represented HCC metastases, 1. 0% represented other bronchopulmonary malignancies, and 2. 7% represented infection. None of the malignant nodules exhibited a triangular/lentiform shape or calcifications. There were no statistically significant differences in pulmonary nodule outcomes between patients who were transplanted versus those who were not transplanted. No significant differences in post-transplant survival were found between patients with different nodule outcomes. There was also no significant difference between patients with and without nodules in the cumulative probabilities of waiting list removal. However, the cumulative probability of undergoing liver transplantation was borderline significantly higher in patients without pulmonary nodules. In conclusion, despite the low prevalence of malignant nodules, all pulmonary nodules besides triangular/lentiform-shaped or calcified nodules should be followed with serial CT while the patient is on the transplant list, with biopsy of new and/or enlarging nodules. Both malignancy and active infection must be excluded when confronted with enlarging pulmonary nodules. Clinicians should also be aware of the possibility of reactivation of granulomatous infection following transplantation. This article is protected by copyright. All rights reserved.