Liver cirrhosis and fibrosis in the post-kidney transplant population: misdiagnosis of fibroscan assessment
Giselle Guerra1, Phillipe Abreu1, Juliano Riella1, Lucas Ernani1, Vighnesh Venkatasamy1, Rafael Miyashiro1, Jose Figueiro1, Rodrigo Vianna1.
1Department of Transplantation Surgery, Jackson Memorial Hospital, University of Miami, Miami Transplant Institute, Miami, FL, United States
Introduction: There is an increased use of hepatitis C positive donors to negative recipients in organ transplantation, with special interest in the Kidney transplant (KT) population. Patients are assessed for liver cirrhosis and fibrosis prior to listing for KT. We report here a case series of XX patients submitted to robotic-assisted cholecystectomies post-KT with incidental intra-operative finding of liver cirrhosis not previously known.
Methods: Prospectively collected data of patients submitted to robotic-assisted cholecystectomies at the Jackson Memorial Hospital, University of Miami, Miami Transplant Institute, in the period of Aug-2021 to Mar-2022, during the first phase of implantation of the Transplant Robotic Program. Data relative to the pre-operative, intra-operative and post-operative periods were collected, including clinic-demographic characteristic of the patients, surgical metrics, and pathology findings. Continuous variables were analyzed with Student t-test, categorical variables were analyzed with chi-square test. A p-value of less than 0.05 was considered to be statistically significant.
Results: 16 patients were included, of those 10 (62.5%) were male. The median age was 57 years old (IQR 50-77.8). Of all cases analyzed, 10 (62.5%) were indicated for surgery based on symptomatic cholelithiasis only, without preoperative radiologic signs of chronic or acute cholecystitis. None of the patients had previously known liver fibrosis or cirrhosis per fibroscan assessment. The median intra-operative robotic console time was 30 (IQR 23-49) min. Intra-operatively, 10 (62.5%) patients were found to have macroscopic liver fibrosis/cirrhosis, 8 (50%) had chronic cholecystitis, and 4 (25%) had acute cholecystitis. The median length of stay was 0.93 (IQR 0.9-1.1) days. There were no postoperative readmissions or complications associated to the procedure.
Conclusion: Liver fibrosis/cirrhosis can be underdiagnosed with fibroscan assessment, and special careful attention should be dedicated to patients undergoing hepatitis positive to negative organ transplantation.
