Significance of interventional radiology on liver transplatation

Transplatacija jetre je metoda koja se razvila u svrhu liječenja raznih jetrenih patoloških stanja. Fokus djelovanja intervencijske radiologije (IR) je na onkološkim bolesnicima, ponajprije onima sa hepatocelularnim karcinomom. Značaj tehnika intervencijske radiologije je u sprječavanju progresije trenutne jetrene bolesti u onih bolesnika koji čekaju transplataciju jetre; te u pomaku u niži stadij tumorske bolesti koji je pogodan za transplataciju kod bolesnika s neresektabilnim jetrenim tumorom. Transarterijska kemoembolizacija (TACE), odnosno konvencionalna transarterijska kemoembolizacija (cTACE) ili pomoću čestica s lijekom (DEB-TACE), radioembolizacija, BLAND-embolizacija, radiofrekvencijska ablacija (RFA) i mikrovalna ablacija (MWA) najkorištenije su IR metode u liječenju karcinoma jetre. TACE je IR metoda liječenja tumora uz pomoć citostatika lokalno apliciranog u područje tumora jetre. cTACE je oblik TACE pri čemu se injicira visoka doza citostatika u žilu hranilicu i mikrookoliš tumora, a potom se emboliziraju krvne žile koje hrane taj tumor. DEB-TACE je oblik TACE, pri kojoj se lijek- citostatik veže uz čestice-perle koje otpuštaju postepeno taj lijek unutar samog tumora jetre po injiciranju. BLAND-embolizacija je IR metoda TACE koja se temelji na ishemiji tumorskog tkiva IR postupkom embolizacije i okluzije žile koja opskrbljuje tumor, bez korištenja kemoterapeutika. Transarterijska radioembolizacija je IR metoda liječenja tumora jetre endovaskularnim pristupom kada se u blizinu tumora jetre dovode mikrosfere koje sadržavaju radioaktivnu tvar. Radiofrekvencijska ablacija (RFA) je IR perkutana metoda liječenja pri kojoj se uvedenom RF iglom u tumor jetre, oslobađa toplina koja uzrokuje koagulacijsku nekrozu tumorskih stanica. Mikrovalna ablacija (MWA) IR perkutana je metoda liječenja koja se koristi molekulama s unutarnjim dipolnim momentom čijim gibanjem nastaje kinetička energija te potom toplina unutar tumora, putem perkutano uvedene MWA igle u tm.Liver transplantation is a method that has been developed for the purpose of treating various liver pathological conditions. The focus of interventional radiology(IR) is on oncology patients, primarily those with hepatocellular carcinoma. The importance of interventional radiology techniques is in preventing the progression of current liver disease in those patients awaiting liver transplantation and in ‘downstaging’ in patients with unresectable liver tumor to the stage where transplantation is possible. Transarterial chemoembolization(TACE), ie conventional transarterial chemoembolization (cTACE) or with drug particles (DEB-TACE), radioembolization, BLAND embolization, radiofrequency ablation (RFA), and microwave ablation (MWA) are the most widely used IR methods in the treatment of liver cancer. TACE is an IR method of treating a tumor using a cytostatic topically applied to the area of the liver tumor. cTACE is a form of TACE in which a high dose of cytostatics is injected into the feeding vessel and the microenvironment of the tumor, and then the blood vessels that feed the tumor are embolized. DEB-TACE is a form of TACE in which a cytostatic binds to bead particles that gradually release the drug within the liver tumor itself after injection. BLAND embolization is an IR method of TACE based on ischemia of tumor tissue by IR procedure of embolization and occlusion of the feeding vessel that supplies the tumor, without the use of chemotherapeutics. Transarterial radioembolization is a method by which radiospheres containing a radioactive substance are brought near the tumor by endovascular techniques. Radiofrequency ablation (RFA) is an IR percutaneous method of treatment in which an RF needle inserted into a liver tumor releases heat that causes coagulation necrosis of tumor cells. MWA is an IR percutaneous method of treatment that uses molecules with an internal dipole moment, which move kinetic energy and then heat inside the tumor, via a percutaneously inserted MWA needle into the tumor