Analysis of Native Kidney Function Recovery With Renal Scintigraphy Following Simultaneous Liver-Kidney Transplantation.

BACKGROUND: Patients undergoing simultaneous liver-kidney transplantation (SLK) have impaired native kidney function. The relative contribution of allograft versus native function after SLK is unknown. We sought to characterize the return of native kidney function following SLK. METHODS: Following SLK, patients underwent technetium-99 m-mercaptoacetyltriglycine renal scintigraphy following serum creatinine nadir. Kidney contributions to estimated glomerular filtration rate (eGFR) were determined. Patients with native kidney function at serum creatinine nadir contributing eGFR ≥30 versus <30 mL/min/1.73 m 2 were compared, and multiple linear regression analysis for native eGFR improvement was performed. RESULTS: Thirty-one patients were included in this analysis. Average native kidney contribution to overall kidney function following SLK was 51.1% corresponding to native kidney eGFR of 44.5 mL/min/1.73 m 2 and native kidney function eGFR improvement of 30.3 mL/min/1.73 m 2 ( P < 0.001). Twenty-six of 31 patients had native kidney contribution of eGFR ≥30 mL/min/1.73 m 2 . Hepatorenal syndrome as the sole primary etiology of kidney dysfunction was 100% specific for native kidney eGFR >30 mL/min/1.73 m 2 and predicted native eGFR improvement ( P = 0.03). CONCLUSIONS: Substantial improvement in native kidney function follows SLK, and hepatorenal syndrome as the sole primary etiology of kidney dysfunction is predictive of improvement. Whether such patients are suitable for liver transplant followed by surveillance with option for subsequent kidney transplants requires investigation.

The utility of near infrared autofluorescence imaging for detecting small bowel carcinoid tumors in comparison to DOTATATE PET: A pilot study.

BACKGROUND: Small bowel carcinoid (SBC) primary tumors can be multifocal in 40%-55% of patients and challenging to detect. Near infrared autofluorescence (NIRAF) is used for detection of parathyroid glands. It is unknown if this technology can be used to identify SBCs and how it would compare with current imaging modalities. METHODS: This was a prospective institutional review board-approved pilot study of three patients undergoing resection of SBCs. NIRAF was used to image SBCs and mesenteric lymph nodes intraoperatively and at back table. Findings were compared with preoperative imaging, surgical exploration and pathology. Statistics were performed using Mann-Whitney U test. RESULTS: Eleven SBCs and 12 mesenteric lymph nodes were analyzed. All SBCs had a brighter focal autofluorescence (AF) signal compared to background. Normalized pixel intensity of SBCs was 2.2 (0.7) and normal small bowel 1.4 (0.6) (p < 0.0001). NIRAF was less accurate in detecting occult lymph node metastasis, but was superior to DOTATATE PET for detecting SBCs in two of three patients. CONCLUSIONS: This preliminary report suggests that SBCs exhibit distinctly bright AF signals on NIRAF to create a contrast distinction from normal small bowel. This technology may have a utility as an adjunctive tool for intraoperative detection of occult SBCs.

Microgallbladder: Self-Remitting Acute Cholecystitis-Like Condition Unique to Patients with Cystic Fibrosis.

Microgallbladder is a nonsurgical medical condition characterized by chronic inflammation and atrophy of the gallbladder, which is considered a highly specific imaging finding unique to patients with cystic fibrosis (CF), and has been incidentally reported on abdominal imaging in up to 45% of cases with CF. The impairment of exocrine water efflux in CF leads to the production of hyperviscous biliary secretions, cholestasis, and transient cystic duct obstruction of the microgallbladder causing microcholecystitis-interestingly a self-remitting acute cholecystitis-like condition without surgical intervention. We present a case report of a 22-year-old male patient with history of CF with multiple hospital admissions for unexplained chronic abdominal pain found to be caused by microgallbladder, which was managed conservatively.

Painful knee arthroplasty.

A triple-tracer nuclear medicine study that incorporates (99m)Tc-sulfur colloid, (111)In-labeled leukocytes, and (99m)Tc-methylene diphosphonate can be useful for the diagnosis of aseptic loosening in a patient after total-knee arthroplasty, as demonstrated in this case study. The triple-tracer technique takes less time and is more accurate than a bone scan alone.