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Growth rates of pulmonary metastases after liver transplantation for unresectable colorectal liver metastases.

Fri, 11/24/2017 - 13:45

Growth rates of pulmonary metastases after liver transplantation for unresectable colorectal liver metastases.

Br J Surg. 2017 Nov 23;:

Authors: Grut H, Solberg S, Seierstad T, Revheim ME, Egge TS, Larsen SG, Line PD, Dueland S

Abstract
BACKGROUND: The previously reported SECA study demonstrated a dramatic 5-year survival improvement in patients with unresectable colorectal liver metastases (CLM) treated with liver transplantation (LT) compared with chemotherapy. The objective of this study was to assess whether immunosuppressive therapy accelerates the growth of pulmonary metastases in patients transplanted for unresectable CLM.
METHODS: Chest CT scans from 11 patients in the SECA study resected for 18 pulmonary metastases were reviewed retrospectively. Tumour diameter, volume and CT characteristics were registered and tumour volume doubling time was calculated. Findings in the SECA group were compared with those of a control group consisting of 12 patients with non-transplanted rectal cancer resected for 26 pulmonary metastases. Disease-free survival (DFS) and overall survival (OS) after first pulmonary resection were determined.
RESULTS: Median doubling time based on tumour diameter and volume in the SECA and control groups were 125 and 130 days (P = 0·658) and 110 and 129 days (P = 0·632) respectively. The metastases in both groups were distributed to all lung lobes and were mostly peripheral. Median DFS after LT in the SECA group and after primary pelvic surgery in the control group was 17 (range 6-42) and 18 (2-57) months respectively (P = 0·532). In the SECA group, estimated 5-year DFS and OS rates after first pulmonary resection were 39 and 51 per cent respectively.
CONCLUSION: Patients treated by LT for unresectable CLM have a good prognosis following resection of pulmonary metastases. Doubling time did not appear to be worse with the immunosuppression used after LT.

PMID: 29168565 [PubMed - as supplied by publisher]

PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art.

Fri, 11/24/2017 - 13:45

PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art.

Minim Invasive Ther Allied Technol. 2017 Nov 23;:1-6

Authors: Cazzato RL, Garnon J, Shaygi B, Koch G, Tsoumakidou G, Caudrelier J, Addeo P, Bachellier P, Namer IJ, Gangi A

Abstract
Positron emission tomography/computed tomography (PET/CT) represents an emerging imaging guidance modality that has been applied to successfully guide percutaneous procedures such as biopsies and tumour ablations. The aim of the present narrative review is to report the indications, advantages and disadvantages of PET/CT-guided procedures in the field of interventional oncology and to briefly describe the experience gained with this new emerging technique while performing biopsies and tumor ablations.

PMID: 29168421 [PubMed - as supplied by publisher]

Potential Effect of Recombinant Thrombomodulin on Ischemia-Reperfusion Liver Injury in Rats.

Fri, 11/24/2017 - 13:45

Potential Effect of Recombinant Thrombomodulin on Ischemia-Reperfusion Liver Injury in Rats.

Hepatol Res. 2017 Nov 23;:

Authors: Kimura K, Yoshizumi T, Inokuchi S, Itoh S, Motomura T, Mano Y, Toshima T, Harada N, Harimoto N, Ikegami T, Soejima Y, Maehara Y

Abstract
BACKGROUND: Liver ischemia-reperfusion (I/R) injury is a severe complication of liver surgery. However, the responsible molecular mechanism remains unclear. High-mobility group box 1 (HMGB1) is released from the nuclei of cells and behaves as a damage-associated molecular pattern. The aim of this study is to reveal the roles of HMGB1 and the effects of recombinant thrombomodulin in I/R liver injury.
METHODS: Rats underwent partial hepatic ischemia followed by reperfusion, and changes in HMGB1 were assessed. Recombinant thrombomodulin (rTM) was used as an inhibitor of HMGB1.
RESULTS: In rats with I/R injury, the HMGB1 level significantly decreased in the liver tissue and significantly increased in the serum after surgery (P < 0.001 for both). No difference in the HMGB1 level in the hepatocytes was observed between the rTM (-) group and rTM (+) group after surgery. Conversely, the serum HMGB1 level was significantly lower in the rTM (+) group than rTM (-) group after surgery (P < 0.001). The levels of tumor necrosis factor-alpha and interleukin-6 in the liver tissue 24 hours after surgery were significantly lower in the rTM (+) group than rTM (-) group (P < 0.001). The plasma alanine aminotransferase level at 24 hours after surgery of the rTM (+) group was significantly decreased after surgery compared with that of the rTM (-) group (P < 0.001). The necrotic area of the liver tissue 24 hours after surgery was significantly smaller in the rTM (+) group than rTM (-) group (P < 0.001).
CONCLUSIONS: rTM can serve as a treatment for I/R liver injury by inhibiting HMGB1.

PMID: 29168258 [PubMed - as supplied by publisher]

In vivo therapeutic potential of Inula racemosa in hepatic ischemia-reperfusion injury following orthotopic liver transplantation in male albino rats.

Fri, 11/24/2017 - 13:45

In vivo therapeutic potential of Inula racemosa in hepatic ischemia-reperfusion injury following orthotopic liver transplantation in male albino rats.

AMB Express. 2017 Nov 22;7(1):211

Authors: Wang Z, Geng L, Chen Z, Lin B, Zhang M, Zheng S

Abstract
Hepatic ischemia-reperfusion (I/R) injury mainly occurs following hepatic resection and liver transplantation and cause severe liver damage, organ injuries, and dysfunction. Pro-inflammatory cytokines that promote injury are released when kupffer cell activates after getting induced by I/R. Repercussions of oxidative stress and cardiac function against isoproterenol based myocardial infarction are caused by flavonol glycosides which are found in high concentrations in Inula racemosa (Ir).The root was deemed to have analgesic and anti-inflammatory effects, and no report has been published about the liver-protective activity against hepatic I/R. Therefore, the present study was aimed to understand the therapeutic impact of Ir in hepatic I/R injury. Male albino, Wistar strain rats were used and were grouped into four total phenolic content, free radical scavenging activity and serum enzymes were determined. Histopathological and immunohistochemical analysis were also carried out. Inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin (IL-6) and protein expression of p53, bax, and bcl-2 were determined. The administration of extracts of Ir significantly increased total phenolic and free radical scavenging activity. Altered cellular morphology, cytokines and aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were returned to near normal level. IL-6 and TNF-α levels were reduced more than 25% following treatment. Also, the protein expression of p53, bax, and bcl-2 were also returned to near normal level. Taking all these data together, it is suggested that the extracts of Ir may be a potential therapeutic agent for providing several beneficial effects in hepatic I/R injury.

PMID: 29168056 [PubMed]

Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer.

Fri, 11/24/2017 - 13:45

Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer.

Transl Gastroenterol Hepatol. 2017;2:83

Authors: Lucatelli P, Argirò R, Bascetta S, Saba L, Catalano C, Bezzi M, Levi Sandri GB

Abstract
Cone-beam CT (CBCT) application to the field of trans-arterial chemoembolization has been recently the focus of several researches. This imaging modality is performed with a rotation of the C-arm around the patient, without needs of patient repositioning. Datasets are immediately processed, obtaining volumetric CT-like images with the possibility of post-processing and reconstruction of images. Dual phase CBCT recently introduced in clinical practice consists in a first arterial acquisition followed by a delayed acquisition corresponding to a venous phase. The introduction of this feature has overcome the limit of single-phase acquisitions, allowing lesions characterization. Moreover these recent advantages have several intra-procedural implications. Detailed technical and acquisition parameters will be widely exposed in this review with particular attention to: catheter positioning, acquisition delay, injection parameters, patient positioning and contrast dilution. Comparison with standard of practice second line imaging [multidetector computer tomography (MDCT) and MDCT/arteriography] demonstrate the capability of detecting occult nodules providing some clinical implications thus potentially identifying a sub set of patients with aggressive disease behaviour. Other intra-procedural advantages of dual phase CBCT usage consist in a better tumor feeder visualization, reduction of proper DSA and fluoroscopic time, suggestion the presence of an extrahepatic parasitic feeder thus resulting in a more accurate treatment. Finally, the volumetrical intraprocedural evaluation of accumulation of embolic agent has proved to be correlate with treatment response if compared with MRI.

PMID: 29167830 [PubMed]

Hepatocellualr cancer and liver transplantation: from the tower of babel towards a uniform language.

Fri, 11/24/2017 - 13:45

Hepatocellualr cancer and liver transplantation: from the tower of babel towards a uniform language.

Transl Gastroenterol Hepatol. 2017;2:82

Authors: Lerut PJ

PMID: 29167829 [PubMed]

Hepatocellular cancer and recurrence after liver transplantation: what about the impact of immunosuppression?

Fri, 11/24/2017 - 13:45

Hepatocellular cancer and recurrence after liver transplantation: what about the impact of immunosuppression?

Transl Gastroenterol Hepatol. 2017;2:80

Authors: Lerut J, Iesari S, Foguenne M, Lai Q

Abstract
Liver transplantation (LT) has originally been designed to treat hepatobiliary malignancies. The initial results of LT for hepatocellular cancer (HCC) were, however, dismal this mainly due to the poor patient selection procedure. Better surgical and perioperative care and, especially, the refinement of selection criteria led to a major improvement of results, making HCC nowadays (again!) one of the leading indications for LT. This evolution is clearly shown by the innumerable reports aiming to further extend inclusion criteria for LT in HCC patients. Nonetheless, the vast majority of papers only deals with morphologic (tumour diameter and number) and (only recently) biologic (tumour markers and response to locoregional treatment) parameters to do so. Curiously enough, the role of both the immune competent state of the recipient as well as the impact of both immunosuppression (IS) type and load has been very poorly addressed in this context, even if it has been shown for a long time, based on both basic and clinical research, that they all play a key role in the outcome of any oncologic treatment and in the development of de novo as well as recurrent tumours. This chapter aims to give, after a short introductive note about the currently used inclusion criteria of HCC patients for LT and about the role of IS in carcinogenesis, a comprehensive overview of the actual literature related to the impact of different immunosuppressive drugs and schemes on outcome of LT in HCC recipients. Unfortunately, up to now solid conclusions cannot be drawn due to the lack of high-level evidence studies caused by the heterogeneity of the studied patient cohorts and the lack of prospectively designed and randomized studies. Based on long-term personal experience with immunosuppressive handling in LT some proposals for further clinical research and practice are put forward. The strategy of curtailing and minimising IS should be explored in the growing field of transplant oncology taking thereby into account the immunological privilege of the liver allograft. These strategies will become more and more compelling when further extending the indications in which adjuvant chemotherapy will probably become an inherent part of the therapeutic scheme of HCC liver recipients.

PMID: 29167827 [PubMed]

Splenectomy after partial hepatectomy accelerates liver regeneration in mice by promoting tight junction formation via polarity protein Par 3-aPKC.

Thu, 11/23/2017 - 13:45

Splenectomy after partial hepatectomy accelerates liver regeneration in mice by promoting tight junction formation via polarity protein Par 3-aPKC.

Life Sci. 2017 Nov 19;:

Authors: Liu G, Xie C, Fang Y, Qian K, Liu Q, Liu G, Cao Z, Du H, Fu J, Xu X

Abstract
AIMS: Several experimental studies have demonstrated that removal of the spleen accelerates liver regeneration after partial hepatectomy. While the mechanism of splenectomy promotes liver regeneration by the improvement of the formation of tight junction and the establishment of hepatocyte polarity is still unknown.
MAIN METHODS: We analyzed the cytokines, genes and proteins expression between 70% partial hepatectomy mice (PHx) and simultaneous 70% partial hepatectomy and splenectomy mice (PHs) at predetermined timed points.
KEY FINDINGS: Compared with the PHx group mice, splenectomy accelerated hepatocyte proliferation in PHs group. The expression of Zonula occludens-1 (ZO-1) indicated that splenectomy promotes the formation of tight junction during liver regeneration. TNF-α, IL-6, HGF, TSP-1 and TGF-β1 were essential factors for the formation of tight junction and the establishment of hepatocytes polarity in liver regeneration. After splenectomy, Partitioning defective 3 homolog (Par 3) and atypical protein kinase C (aPKC) regulate hepatocyte localization and junctional structures in regeneration liver.
SIGNIFICANCE: Our data suggest that the time course expression of TNF-α, IL-6, HGF, TSP-1, and TGF-β1 and the change of platelets take part in liver regeneration. Combination with splenectomy accelerates liver regeneration by improvement of the tight junction formation which may help to establish hepatocyte polarity via Par 3-aPKC. This may provide a clue for us that splenectomy could accelerate liver regeneration after partial hepatectomy of hepatocellular carcinoma and living donor liver transplantation.

PMID: 29166570 [PubMed - as supplied by publisher]

DYSTROPHIC CALCIFICATION OF MAXILLARY SINUS IN PEDIATRIC PATIENTS WITH LIVER TRANSPLANTATION AND PIGMENTATION OF DENTAL ORGAN.

Thu, 11/23/2017 - 13:45

DYSTROPHIC CALCIFICATION OF MAXILLARY SINUS IN PEDIATRIC PATIENTS WITH LIVER TRANSPLANTATION AND PIGMENTATION OF DENTAL ORGAN.

Rev Paul Pediatr. 2017 Nov 17;:0

Authors: Macedo AF, Costa C, Mattar RHGDM, Azevedo RA

Abstract
OBJECTIVE: To report a case of severe dystrophic calcification in maxillary sinus of a child with liver transplantation and dental organs pigmented by hyperbilirubinemia.
CASE DESCRIPTION: female patient, 12 years old, with liver transplantation performed at the age of 7 due to extrahepatic biliary atresia (EHBA). The patient was receiving the immunosuppressant tacrolimus (2 mg daily). Intraoral clinical exam showed tooth green pigmentation by bilirubin. Cone-beam volumetric computed tomography (CT) was performed to verify radiographic density of pigmented dental elements. Hounsfield scale measurement did not show changes in radiographic density of dental structures. However, CT scan showed intense dystrophic calcification in the maxillary sinus region.
COMMENTS: CT scan indicated relevant radiographic findings, with radiopacity of the maxillary sinus due to fungal or non-fungal sinusitis. This case report highlights the presence of radiographic image associated with acute infectious processes that could compromise the systemic state of immunosuppressed patients.

PMID: 29166493 [PubMed - as supplied by publisher]

Neurological complications of solid organ transplantation.

Thu, 11/23/2017 - 13:45

Neurological complications of solid organ transplantation.

Arq Neuropsiquiatr. 2017 Oct;75(10):736-747

Authors: Pedroso JL, Dutra LA, Braga-Neto P, Abrahao A, Andrade JBC, Silva GLD, Viana LA, Pestana JOM, Barsottini OG

Abstract
Solid organ transplantation is a significant development in the treatment of chronic kidney, liver, heart and lung diseases. This therapeutic approach has increased patient survival and improved quality of life. New surgical techniques and immunosuppressive drugs have been developed to achieve better outcomes. However, the variety of neurological complications following solid organ transplantation is broad and carries prognostic significance. Patients may have involvement of the central or peripheral nervous system due to multiple causes that can vary depending on time of onset after the surgical procedure, the transplanted organ, and the intensity and type of immunosuppressive therapy. Neurological manifestations following solid organ transplantation pose a diagnostic challenge to medical specialists despite extensive investigation. This review aimed to provide a practical approach to help neurologists and clinicians assess and manage solid organ transplant patients presenting with acute or chronic neurological manifestations.

PMID: 29166466 [PubMed - in process]

The Impact of Hepatectomy Time of the Liver Graft on Post-transplant Outcome: A Eurotransplant Cohort Study.

Thu, 11/23/2017 - 13:45

The Impact of Hepatectomy Time of the Liver Graft on Post-transplant Outcome: A Eurotransplant Cohort Study.

Ann Surg. 2017 Nov 21;:

Authors: Jochmans I, Fieuws S, Tieken I, Samuel U, Pirenne J

Abstract
OBJECTIVE: Assessing the effect of donor hepatectomy time on outcome after transplantation.
SUMMARY OF BACKGROUND DATA: When blood supply in a deceased organ donor stops, ischemic injury starts. Livers are cooled to reduce cellular metabolism and minimize ischemic injury. This cooling is slow and livers are lukewarm during hepatectomy, potentially affecting outcome.
METHODS: We used the Eurotransplant Registry to investigate the relationship between donor hepatectomy time and post-transplant outcome in 12,974 recipients of deceased-donor livers (January 1, 2004, to December 31, 2013). Cox regression analyses for patient and graft survival (censored and uncensored for death with a functioning graft) were corrected for donor, preservation, and recipient variables. Donor hepatectomy time was defined as time between start of aortic cold flush and placement of the liver in the ice-bowl.
RESULTS: Median donor hepatectomy time was 41 minutes [interquartile range (IQR) 32 to 52]. Livers donated after circulatory death had longer hepatectomy times than those from brain-dead donors [50 minutes (35 to 68) vs 40 minutes (32 to 51), P < 0.001]. Donor hepatectomy time was independently associated with graft loss [adjusted hazard ratio (HR) 1.03 for every 10-minute increase, 95% confidence interval (95% CI) 1.02-1.05; P < 0.001]. The magnitude of this effect was comparable to the effect of each hour of additional cold ischemia time (adjusted HR 1.04, 95% CI 1.02-1.05; P < 0.001). Donor hepatectomy time had a similar effect on death-censored graft survival and patient survival. Livers donated after circulatory death and those with a higher donor risk index were more susceptible to the effect of donor hepatectomy time on death-censored graft survival.
CONCLUSION: Donor hepatectomy time impairs liver transplant outcome. Keeping this time short together with efficient cooling during hepatectomy might improve outcome.

PMID: 29166361 [PubMed - as supplied by publisher]

Comment on: MARS System Effectively Replaces Hepatic Function in Severe Acute Liver Failure.

Thu, 11/23/2017 - 13:45

Comment on: MARS System Effectively Replaces Hepatic Function in Severe Acute Liver Failure.

Ann Surg. 2017 Nov 21;:

Authors: Karvellas CJ, Stravitz RT, Fontana RJ, Ganger D, Lee WM, US Acute Liver Failure Study Group

PMID: 29166358 [PubMed - as supplied by publisher]

Use of organs from hepatitis C virus positive donors for uninfected recipients: a potential cost-effective approach to save lives?

Thu, 11/23/2017 - 13:45

Use of organs from hepatitis C virus positive donors for uninfected recipients: a potential cost-effective approach to save lives?

Transplantation. 2017 Nov 22;:

Authors: Trotter PB, Summers DM, Ushiro-Lumb I, Robb M, Bradley JA, Powell J, Watson CJE, Neuberger J

Abstract
BACKGROUND: Organs from hepatitis C virus (HCV) seropositive (HCVpos) individuals are seldom used for transplantation because of the risk of disease transmission. Because transmitted HCV is now amenable to effective treatment we estimated the potential impact of using HCVpos deceased donor organs for transplantation.
METHODS: The Potential Donor Audit (PDA) of patients (<80years) dying in UK critical care units and the UK Transplant Registry (UKTR) was searched to identify HCVpos potential and proceeding deceased donors. Donor organ quality was assessed using validated donor organ quality indices. Cost analysis was performed by comparing the cumulative cost of direct acting antivirals with haemodialysis and renal transplantation.
RESULTS: Between 2009-2016, 120 patients identified from the PDA were not considered as potential donors because of the presence of HCV. Between 2000-2015, 244 HCVpos potential deceased donors were identified from the UKTR, and 76 (31%) proceeded to donation, resulting in 63 liver, 27 kidney and 2 heart transplants. Recipient and graft survival was not adversely impacted by donor HCVpos status. Most (69%) offered organs were declined because of positive virology although their quality was similar to that of other transplanted organs. The additional costs of treating recipients exposed to HCV by receiving a HCVpos kidney was cost-neutral with dialysis 5 years from transplantation.
CONCLUSIONS: HCVpos donors represent a potential source of organs for HCVneg recipients as many good quality HCVpos donor organs are not currently used for transplantation. This change in practice may increase access to transplantation without having an adverse effect on transplant outcome.

PMID: 29166338 [PubMed - as supplied by publisher]

Detection of Hepatitis C antibodies without viral transmission in Hepatitis C negative recipients receiving kidneys from Hepatitis C positive donors treated with Direct Acting Anti-Viral Therapy.

Thu, 11/23/2017 - 13:45

Detection of Hepatitis C antibodies without viral transmission in Hepatitis C negative recipients receiving kidneys from Hepatitis C positive donors treated with Direct Acting Anti-Viral Therapy.

Transplantation. 2017 Nov 22;:

Authors: Agarwal N, Davis RJ, Gracey DM, Wong G, Kable K, Wong JKW, Nankivell BJ, Strasser S, Wyburn K

PMID: 29166337 [PubMed - as supplied by publisher]

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review.

Thu, 11/23/2017 - 13:45

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review.

Radiology. 2017 Nov 21;:170554

Authors: Tang A, Bashir MR, Corwin MT, Cruite I, Dietrich CF, Do RKG, Ehman EC, Fowler KJ, Hussain HK, Jha RC, Karam AR, Mamidipalli A, Marks RM, Mitchell DG, Morgan TA, Ohliger MA, Shah A, Vu KN, Sirlin CB, LI-RADS Evidence Working Group

Abstract
The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS. (©) RSNA, 2017 Online supplemental material is available for this article.

PMID: 29166245 [PubMed - as supplied by publisher]

Successful treatment of Ph ALL with hematopoietic stem cell transplantation from the same HLA-haploidentical related donor of previous liver transplantation.

Thu, 11/23/2017 - 13:45

Successful treatment of Ph ALL with hematopoietic stem cell transplantation from the same HLA-haploidentical related donor of previous liver transplantation.

Leuk Lymphoma. 2017 Nov 22;:1-3

Authors: Sasaki K, Mori Y, Yoshimoto G, Sakoda T, Kato K, Inadomi K, Kamezaki K, Takenaka K, Iwasaki H, Maeda T, Miyamoto T, Akashi K

PMID: 29164981 [PubMed - as supplied by publisher]

Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population.

Thu, 11/23/2017 - 13:45

Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population.

Hepatology. 2017 Nov 22;:

Authors: Åberg F, Helenius-Hietala J, Puukka P, Färkkilä M, Jula A

Abstract
The metabolic syndrome and alcohol risk use are both associated with high prevalence of hepatic steatosis, but only a minority develop liver failure or liver cancer. Few general population studies have analyzed metabolic predictors of such severe liver complications. We studied which metabolic factors best predict severe liver complications, stratified by alcohol consumption. 6732 individuals without baseline liver disease who participated in the Finnish population-based Health 2000 Study (2000-2001), a nationally representative cohort. Follow-up data from national registers until 2013 were analyzed for liver-related admissions, mortality, and liver cancer. Baseline alcohol use and metabolic factors were analyzed by backward stepwise Cox regression analysis. 84 subjects experienced a severe liver event during follow-up. In the final multivariate model, factors predictive of liver events were age (HR 1.02, 95%CI 1.004-1.04), gender (women HR 0.55, 0.34-0.91), alcohol use (HR 1.002, 1.001-1.002), diabetes (HR 2.73, 1.55-4.81), LDL cholesterol (HR 0.74, 0.58-0.93), and HOMA-IR (HR 1.01, 1.004-1.02). Among alcohol risk users (average alcohol use ≥210 g/week for men, ≥140 g/week for women), diabetes (HR 6.79, 95%CI 3.18-14.5) was the only significant predictor. Among non-risk drinkers, age, alcohol use, smoking, waist circumference, low LDL cholesterol and HOMA-IR were significant independent predictors. The total cholesterol-to-LDL cholesterol-ratio and waist circumference-to-BMI-ratio emerged as additional independent predictors.
CONCLUSION: Multiple components of the metabolic syndrome independently affected the risk for severe liver disease. Alcohol was significant even when average alcohol consumption was within the limits currently defining non-alcoholic fatty liver disease. This article is protected by copyright. All rights reserved.

PMID: 29164643 [PubMed - as supplied by publisher]

Comparison of Recurrence Between Pancreatic and Duodenal Neuroendocrine Neoplasms After Curative Resection: A Single-Institution Analysis.

Thu, 11/23/2017 - 13:45

Comparison of Recurrence Between Pancreatic and Duodenal Neuroendocrine Neoplasms After Curative Resection: A Single-Institution Analysis.

Ann Surg Oncol. 2017 Nov 21;:

Authors: Masui T, Sato A, Nakano K, Uchida Y, Yogo A, Anazawa T, Nagai K, Kawaguchi Y, Takaori K, Uemoto S

Abstract
BACKGROUND: The primary site of a neuroendocrine neoplasms (NEN) around the head of the pancreas is sometimes difficult to assess before resection, and the characteristics of the primary site around this region have not been elucidated for recurrence after curative resection. In this study, the clinicopathologic characteristics of pancreatic NEN (PanNEN) and duodenal NEN (DuNEN) were evaluated, and the risk factors as well as the recurrence types after resection were investigated.
METHODS: Consecutively diagnosed NEN patients at the authors' hospital from January 2000 to July 2016 were evaluated in this study. For 117 PanNEN patients and 31 non-ampullary DuNEN patients, R0 resection was achieved. The median follow-up period was 8.1 years.
RESULTS: In this study, 27 PanNEN patients (23.1%) had recurrences, with a median disease-free survival (DFS) of 133 months, whereas 11 DuNEN patients (35.5%) had recurrences, with a median DFS of 156 months. The PanNEN patients tended to have primary recurrence in the liver (85.2%), followed by lymph nodes (11.1%). The independent risk factors for short DFS were lymph node metastasis at resection (p = 0.001) and microvascular invasion (p = 0.048). In contrast, the DuNEN patients were likely to have lymph node metastasis (81.8%). The independent risk factors for short DFS were lymph node metastasis at resection (p = 0.003) and large diameter (p = 0.013).
CONCLUSIONS: Most initial recurrences of PanNEN occurred in the liver, whereas those of DuNEN appeared in lymph nodes, suggesting that proper diagnosis of the primary site and appropriate imaging methods for surveillance after resection are necessary.

PMID: 29164413 [PubMed - as supplied by publisher]

Primary biliary cholangitis: a comprehensive overview.

Thu, 11/23/2017 - 13:45

Primary biliary cholangitis: a comprehensive overview.

Hepatol Int. 2017 Nov 21;:

Authors: Lleo A, Marzorati S, Anaya JM, Gershwin ME

Abstract
Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by biliary destruction, progressive cholestasis, and potentially liver cirrhosis. Patients develop a well-orchestrated immune reaction, both innate and adaptive, against mitochondrial antigens that specifically targets intrahepatic biliary cells. A puzzling feature of PBC is that the immune attack is predominantly organ specific, although the mitochondrial autoantigens are found in all nucleated cells. The disease results from a combination of genetic and environmental risk factors; however, the exact pathogenesis remains unclear. Serologically, PBC is characterized by presence of antimitochondrial antibodies, which are present in 90-95 % of patients and are often detectable years before clinical signs appear. Like other complex disorders, PBC is heterogeneous in its presentation, symptomatology, disease progression, and response to therapy. A significant number of patients develop end-stage liver disease and eventually require liver transplantation. Recent studies from large international cohorts have better identified prognostic factors, suggesting a change in patient management based on risk stratification. Therapeutic options are changing. In this review we discuss data on the autoimmune responses and treatment of the disease.

PMID: 29164395 [PubMed - as supplied by publisher]

Risk factors and survival outcomes of biliary complications after adult-to-adult living donor liver transplantation.

Thu, 11/23/2017 - 13:45

Risk factors and survival outcomes of biliary complications after adult-to-adult living donor liver transplantation.

United European Gastroenterol J. 2017 Nov;5(7):997-1006

Authors: Jeong S, Wang X, Wan P, Sha M, Zhang J, Xia L, Tong Y, Luo Y, Xia Q

Abstract
The objective of this study was to evaluate the risk factors and survival outcomes of biliary complications (BCs) after living donor liver transplantation (LDLT) based on our single-center experience. From 2007 to 2010, 112 adult patients were assessed. Forty-nine patients (43.8%) experienced at least one episode of BCs, including biliary stricture and bile leak, occurring in 37.5% and 16.1% of the patients, respectively. Multivariate analysis indicated that hepatic artery thrombosis (relative risk (RR), 5.692; 95% CI, 2.132 to 15.201; p < 0.001), a hepatic duct diameter of less than 3 mm (RR, 2.523; 95% CI, 1.295 to 4.914; p = 0.005), ductoplasty (RR, 2.175; 95% CI, 1.134 to 4.174; p = 0.018), and cytomegalovirus infection (RR, 4.452; 95% CI, 1.868 to 10.613; p = 0.001) were independent risk factors for the development of BCs. However, these factors and BCs showed no prominent impact on the overall survival (OS) and graft survival (GS). In addition, the patients who developed vascular complications demonstrated poor outcomes in terms of OS (five-year, 56.3% vs. 78.1%; p = 0.017), GS (five-year, 56.3% vs. 77.1%; p = 0.023), and BC-free survival (five-year, 25.0% vs. 63.5%; p = 0.007) compared with patients without vascular complications. In conclusion, BCs remain a common problem after LDLT, especially for patients using duct-to-duct anastomosis. Hepatic artery thrombosis, a short duct diameter, ductoplasty, and cytomegalovirus infection lead to an increased incidence of BCs. The occurrence of BCs manifested no significant influence on the long-term survival outcomes. However, our findings await verification through large-scale randomized studies regarding the risk factors for the development of BCs and their impact on the prognosis.

PMID: 29163966 [PubMed]

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