Pulmonary nodules at risk in patients undergoing liver transplantation for hepatocellular carcinoma

The aim of this study was to evaluate the accuracy of pretransplant imaging in patients with hepatocellular carcinoma (HCC) considering small pulmonary nodules, and to determine whether preoperatively diagnosed small pulmonary nodules should be considered 'nodules at risk'. We evaluated 10 consecutive liver transplant patients with a diagnosis of HCC and pulmonary nodules detected by preoperative computerized tomography (CT) scanning. Pretransplant CT evaluation of pulmonary nodules showed a 90% accuracy rate. There was only one incorrect reading in the case of a patient, where a metastasis was misdiagnosed as a pulmonary fibroma. Two patients died from multifocal tumor recurrence with pulmonary metastases 17 and 19 months post-transplant. One more patient died 29 months post-transplantation on account of diffuse metastatic prostate carcinoma. Seven patients are currently alive with no evidence of tumor after a median follow-up period of 48 months post-transplantation. Small pulmonary nodules in high-risk HCC patients (low tumor grading, exceeding Milan criteria) may be characterized as nodules at risk, and evaluated very closely prior to listing and during the pre- and post-transplant periods.