Incidentally small pulmonary nodule in candidates for living donor liver transplantation

Background: The methods of differentiation and management of incidental small pulmonary nodules (ISN) in candidates for living donor liver transplantation (LDLT) are not well clarified. We aimed to share our experience and investigate the role of nodular size in application of ISN. Material/Methods: From October 2009 to December 2012, 360 primary adult LDLTs were performed. Thirty-seven candidates with ISN and follow-up of over 2 years were collected. Subjects with pathologic reports of malignancy or infection composed group A, and those with pathologic reports of benign disease or stable lesions on CT image within 3~6 months composed group B. Results: Nodular size was significantly different between group A and B (7.68±3.77 mm versus 4.10±1.37 mm, respectively, p<0.001). Receiver-operating characteristic analysis showed area under the cure values (0.839 (95% confidence interval, 0.701~0.977); sensitivity, 81.3%; and specificity, 76.2%). Recurrent infection was not seen in 13 candidates with infectious ISN up to the median post-transplant follow-up of 40.70 months (range=24.4-61.7 months). Excluding 3 malignancy, 100% of the 34 candidates survived for over 2 years. Conclusions: With 5 mm as the optimal cutoff, nodular size is a good predictor to differentiate malignant and infectious from benign ISN. For sizes less than 5 mm, follow-up of 3 months is recommended. For over 5 mm of ISN, it is recommended to obtain pathologic diagnosis and treat as diagnosis of infectious ISN.