Cardiophrenic lymph nodes in liver transplant candidates with hepatocellular carcinoma: Imaging characteristics and post-transplant outcomes

Christopher Lee, Andrew Kim, Idoia Santos, Yong Cen, Sophoclis Alexopoulos, Shannon Navarro, Melissa Wallman, Kiran Dhanireddy, Edward Grant

Research output: Contribution to journalArticle


Background: No guidelines exist for the management of cardiophrenic lymph nodes in patients with hepatocellular carcinoma (HCC) being evaluated for liver transplantation. Methods: One hundred and seventy-eight patients with HCC listed for liver transplant received both pre-transplant computed tomography (CT) and follow-up CT scans. Enlarged cardiophrenic lymph nodes on CT were characterized and followed on subsequent scans; lymph node outcomes were assigned to "reduced" and "not reduced" categories. Tumor and patient characteristics were also recorded. Results: Seventy-one of one hundred and seventy-eight patients (39.9%) had at least one cardiophrenic lymph node larger than 8 mm in diameter on pre-transplant CT. One hundred and sixty-six total lymph nodes were characterized. Six lymph nodes (3.6%) in two patients increased in size on follow-up imaging; all six cardiophrenic lymph nodes were presumed to represent metastases. There was a statistically significant reduction in lymph node size in patients who were transplanted vs. those who were not transplanted. Furthermore, a statistically significant association was found between increasing Model for End-Stage Liver Disease score and lymph node size reduction. There were no significant differences in post-transplant survival between patients with different lymph node outcomes. Conclusion: In the absence of metastatic disease in other sites, these lymph nodes are probably reactive; further workup is likely not necessary.

Original languageEnglish (US)
Pages (from-to)1402-1409
Number of pages8
JournalClinical Transplantation
Issue number12
StatePublished - Jan 1 2014
Externally publishedYes



  • Hepatocellular carcinoma
  • Liver transplantation
  • Lymph nodes
  • Metastasis
  • Multidetector computed tomography

ASJC Scopus subject areas

  • Transplantation

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