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The treatment path in hepatocellular carcinoma.

Tue, 10/17/2017 - 12:45

The treatment path in hepatocellular carcinoma.

Clin Adv Hematol Oncol. 2017 Aug;15 Suppl 9(8):1-20

Authors: El-Serag HB, Zhu AX, Johnson MS

Abstract
The treatment approach for hepatocellular carcinoma (HCC) depends on the stage and extent of disease, the severity of the underlying liver disease, and the overall performance status of the patient. Treatment consists of 4 main strategies: surgery (eg, resection and liver transplant), locoregional procedures (eg, ablation and transarterial embolization), systemic therapies, and best supportive care. For patients with early-stage tumors, surgical treatment or ablation can be curative. Patients with intermediate-stage disease can be candidates for embolization, administered as either transarterial chemoembolization (TACE) or transarterial radioembolization (TARE). Systemic therapy is reserved for patients with advanced or unresectable disease. For the past decade, the multitargeted kinase inhibitor sorafenib has been the only agent approved for unresectable HCC. This approval was followed by several clinical trials investigating other multitargeted kinase inhibitors, but none showed any benefit over single-agent sorafenib. Most patients progress after treatment with first-line sorafenib. In April 2017, the US Food and Drug Administration approved regorafenib for patients with HCC who have been previously treated with sorafenib. In a phase 3 trial, regorafenib significantly improved overall survival vs placebo. A consideration with systemic treatments is the proactive management of adverse events, including toxicities associated with the drugs and progression of liver disease.

PMID: 29036035 [PubMed - in process]

Ethnic Disparity in the Incidence and Outcome of Biliary Atresia in New Zealand.

Tue, 10/17/2017 - 12:45

Ethnic Disparity in the Incidence and Outcome of Biliary Atresia in New Zealand.

J Pediatr Gastroenterol Nutr. 2017 Oct 13;:

Authors: Evans HM, Asher MI, Cameron-Christie S, Farthing S, McCall J, Robertson SP, Wong H, Morreau PN

Abstract
In order to determine incidence and outcome of biliary atresia (BA) between ethnic groups in New Zealand (NZ), a retrospective review was undertaken of children with BA born 2002-2014. Prioritised ethnicity was used to determine ethnicity and was compared to population data. Uni- and multivariate analyses were undertaken to determine demographic and biochemical factors associated with outcome. Overall incidence was 1 in 9,181 (Māori 1 in 5,285; European 1 in 16,228; p < 0.0001). Overall and transplant-free survival rates at 1, 2 and 5 years were 92%, 86%, 82% and 70%, 49%, 30% respectively with Māori having improved transplant-free survival (p < 0.05) despite European children undergoing Kasai earlier (49 versus 63 days). BA is more common in NZ than Europe and North America which is attributable to a higher incidence in Māori but overall outcome is poorer. Māori have improved transplant-free survival compared to NZ European children but the reason is unknown.

PMID: 29036008 [PubMed - as supplied by publisher]

Nutritional Needs and Support for Children with Chronic Liver Disease.

Tue, 10/17/2017 - 12:45

Nutritional Needs and Support for Children with Chronic Liver Disease.

Nutrients. 2017 Oct 16;9(10):

Authors: Yang CH, Perumpail BJ, Yoo ER, Ahmed A, Kerner JA

Abstract
Malnutrition has become a dangerously common problem in children with chronic liver disease, negatively impacting neurocognitive development and growth. Furthermore, many children with chronic liver disease will eventually require liver transplantation. Thus, this association between malnourishment and chronic liver disease in children becomes increasingly alarming as malnutrition is a predictor of poorer outcomes in liver transplantation and is often associated with increased morbidity and mortality. Malnutrition requires aggressive and appropriate management to correct nutritional deficiencies. A comprehensive review of the literature has found that infants with chronic liver disease (CLD) are particularly susceptible to malnutrition given their low reserves. Children with CLD would benefit from early intervention by a multi-disciplinary team, to try to achieve nutritional rehabilitation as well as to optimize outcomes for liver transplant. This review explains the multifactorial nature of malnutrition in children with chronic liver disease, defines the nutritional needs of these children, and discusses ways to optimize their nutritional.

PMID: 29035331 [PubMed - in process]

Nutritional Therapy in Liver Transplantation.

Tue, 10/17/2017 - 12:45

Nutritional Therapy in Liver Transplantation.

Nutrients. 2017 Oct 16;9(10):

Authors: Hammad A, Kaido T, Aliyev V, Mandato C, Uemoto S

Abstract
Protein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation.

PMID: 29035319 [PubMed - in process]

The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma.

Tue, 10/17/2017 - 12:45

The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma.

Aliment Pharmacol Ther. 2017 Oct 16;:

Authors: Pinato DJ, Sharma R, Citti C, Platt H, Ventura-Cots M, Allara E, Chen TY, Dalla Pria A, Jain M, Mínguez B, Kikuchi L, Kaufman West E, Merli M, Kaplan DE, Hasson H, Marks K, Nelson M, Núñez M, Aytaman A, Bower M, Bräu N, Liver Cancer in HIV Study Group

Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is a leading cause of liver-related mortality in people living with HIV, where co-infection with hepatotropic viruses accelerates the course of chronic liver disease.
AIM: To evaluate whether the albumin-bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co-infection.
METHODS: Using uni- and multi-variable analyses, we studied the albumin-bilirubin grade as a predictor of overall survival (OS) in a large, multi-center cohort of patients with HIV-associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded.
RESULTS: A total of 387 patients, predominantly HCV co-infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti-retrovirals for a median duration of 8.8 years. The albumin-bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13-180 months), 17 months for grade 2 (95% CI 11-22 months) and 6 months for grade 3 (95% CI 4-9 months, P < .001). A more advanced albumin-bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm(3) for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P < .001).
CONCLUSIONS: In this large, multi-center retrospective study, the albumin-bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV-associated HCC.

PMID: 29034998 [PubMed - as supplied by publisher]

Review article: the gut microbiome in inflammatory bowel disease-avenues for microbial management.

Tue, 10/17/2017 - 12:45

Review article: the gut microbiome in inflammatory bowel disease-avenues for microbial management.

Aliment Pharmacol Ther. 2017 Oct 16;:

Authors: McIlroy J, Ianiro G, Mukhopadhya I, Hansen R, Hold GL

Abstract
BACKGROUND: The concept of an altered collective gut microbiota rather than identification of a single culprit is possibly the most significant development in inflammatory bowel disease research. We have entered the "omics" era, which now allows us to undertake large-scale/high-throughput microbiota analysis which may well define how we approach diagnosis and treatment of inflammatory bowel disease (IBD) in the future, with a strong steer towards personalised therapeutics.
AIM: To assess current epidemiological, experimental and clinical evidence of the current status of knowledge relating to the gut microbiome, and its role in IBD, with emphasis on reviewing the evidence relating to microbial therapeutics and future microbiome modulating therapeutics.
METHODS: A Medline search including items 'intestinal microbiota/microbiome', 'inflammatory bowel disease', 'ulcerative colitis', 'Crohn's disease', 'faecal microbial transplantation', 'dietary manipulation' was performed.
RESULTS: Disease remission and relapse are associated with microbial changes in both mucosal and luminal samples. In particular, a loss of species richness in Crohn's disease has been widely observed. Existing therapeutic approaches broadly fall into 3 categories, namely: accession, reduction or indirect modulation of the microbiome. In terms of microbial therapeutics, faecal microbial transplantation appears to hold the most promise; however, differences in study design/methodology mean it is currently challenging to elegantly translate results into clinical practice.
CONCLUSIONS: Existing approaches to modulate the gut microbiome are relatively unrefined. Looking forward, the future of microbiome-modulating therapeutics looks bright with several novel strategies/technologies on the horizon. Taken collectively, it is clear that ignoring the microbiome in IBD is not an option.

PMID: 29034981 [PubMed - as supplied by publisher]

Massive ascites and the heterozygous alpha 1 antitrypsin (α1 AT) living related donor liver in the homozygous child.

Tue, 10/17/2017 - 12:45
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Massive ascites and the heterozygous alpha 1 antitrypsin (α1 AT) living related donor liver in the homozygous child.

Pediatr Transplant. 2017 Oct 15;:

Authors: Khorsandi SE, Thompson R, Vilca-Melendez H, Dhawan A, Heaton N

Abstract
The following is a short report on the use of a heterozygous (PiMZ) alpha 1 antitrypsin (α1AT) living related donor liver in a homozygous (PiZ) child that was complicated by massive ascites early after transplant. This clinical report is then followed by a brief summary of present knowledge on the α1 AT protein and management of massive ascites in the pediatric liver transplant recipient.

PMID: 29034613 [PubMed - as supplied by publisher]

Variability index of tacrolimus serum levels in pediatric liver transplant recipients younger than 12 years: Non-adherence or risk of non-adherence?

Tue, 10/17/2017 - 12:45
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Variability index of tacrolimus serum levels in pediatric liver transplant recipients younger than 12 years: Non-adherence or risk of non-adherence?

Pediatr Transplant. 2017 Oct 15;:

Authors: de Oliveira JTP, Kieling CO, da Silva AB, Stefani J, Witkowski MC, Smidt CR, Mariano da Rocha CR, Hirakata VN, Grossini MDG, Zanotelli ML, Gonçalves Vieira SM

Abstract
MLVI has been used to assess adherence. To determine the MLVI in children <12 years of age at transplantation and to identify demographic correlates and consequences for the graft. This is a retrospective study of 50 outpatients (4.0 ± 3.5 years), at least 13-month post-liver transplantation. The outcomes evaluated were MLVI, ALT > 60 IU/L, ACR, death, and graft loss. We analyzed demographic and socioeconomic characteristics, indication for transplantation, and type of donor. Student's t test and the chi-square test were used. Statistical significance was set at P ≤ .05. Seventy-two percent were infants or preschoolers, 62% biliary atresia. Seventy-four percent of the mothers had middle-school education, and 54% of the families had an income ≤3632.4 US$/y. Twenty-two (44%) patients had a MLVI ≥ 2 SD; this was more prevalent in families with higher incomes (P = .045). ALT levels > 60 IU/L were more common in MLVI ≥ 2 SD group (P = .035). ACR episodes were similar between groups (P = 1.000). No patient died or lost the graft. MLVI ≥ 2 SD may be an indicator of the risk of medication non-adherence.

PMID: 29034612 [PubMed - as supplied by publisher]

Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

Tue, 10/17/2017 - 12:45
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Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

Transl Gastroenterol Hepatol. 2017;2:78

Authors: Coletta M, Nicolini D, Benedetti Cacciaguerra A, Mazzocato S, Rossi R, Vivarelli M

Abstract
Liver transplant (LT) is considered the best curative treatment for patients with cirrhosis and hepatocellular carcinoma (HCC) within Milan criteria. The possibility to perform LT in HCC patients is limited by the liver grafts supply; indeed, the shortage of donors often leads to a long time on waiting list and then to dropout because of tumor progression. Bridging therapies are neo-adjuvant treatments given to patients on LT waitlist, with the aim to prevent tumor progression and to reduce dropout rate. Many bridging modalities have been proposed. The choice of each treatment is based on the characteristics of the patient, liver function, comorbidities and on the number, dimensions and localization of HCC. This review article describes several types of bridging therapies, focusing on the indications for different kind of patients.

PMID: 29034351 [PubMed]

Selection of patients with hepatocellular cancer: a difficult balancing between equity, utility, and benefit.

Tue, 10/17/2017 - 12:45
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Selection of patients with hepatocellular cancer: a difficult balancing between equity, utility, and benefit.

Transl Gastroenterol Hepatol. 2017;2:75

Authors: Vitale A, Lai Q

Abstract
Although liver transplantation (LT) represents the gold-standard strategy for hepatocellular cancer (HCC), its use is circumscribed by several factors like donor shortage, perioperative complications, or competition with other candidates without HCC. Moreover, different alternative approaches like resection or loco-regional therapies may be attempted in selected cases. The best option for the treatment of an HCC patient is a complex decision, involving several ethical principles including: equity (horizontal equity and vertical equity or urgency), and utility. These principles influence the different phases of the patient selection process for LT: inscription in the waiting list (WL), deciding upon patient priority and drop-out before LT, allocating the liver donor to the best matched recipient. The best end-point for describing the principle of utility is the "transplant benefit" (TB). This concept expresses the survival gain obtained comparing LT with the best alternative therapies (i.e., difference between life years obtained with and without LT). The TB used with a mid-term time horizon (post-transplant 5-10 years), has the intrinsic potential to reach the dignity of an independent LT selection principle. Thus, the present review investigates the role of organ allocation using a TB model with the intent to introduce equity among patients transplanted having HCC or non-tumoral diseases.

PMID: 29034348 [PubMed]

Using a weaning immunosuppression protocol in liver transplantation recipients with hepatocellular carcinoma: a compromise between the risk of recurrence and the risk of rejection?

Tue, 10/17/2017 - 12:45
Related Articles

Using a weaning immunosuppression protocol in liver transplantation recipients with hepatocellular carcinoma: a compromise between the risk of recurrence and the risk of rejection?

Transl Gastroenterol Hepatol. 2017;2:74

Authors: Angelico R, Parente A, Manzia TM

Abstract
Hepatocellular carcinoma (HCC) recurrence rate after liver transplantation (LT) is still up to 15-20%, despite a careful selection of candidates and optimization of the management within the waiting list. To reduce tumour recurrence, the currently adopted post-transplant strategies are based on the administration of a tailored immunosuppression (IS) regimen. Drug-induced depression of the immune system is essential in preventing graft rejection, however has a well-established association with oncogenesis. The immune system has a key role as a defending mechanism against cancer development, preventing vascular invasion and metastasis. Thus, IS drugs represent one of few modifiable non-oncological risk factors for tumour recurrence. In HCC recipients, a tailored IS therapy, with the aim to minimize drugs' doses, is essential to gain the optimal balance between the risk of rejection and the risk of tumour recurrence. So far, a complete withdrawal of IS drugs after LT is reported to be safely achievable in 25% of patients (defined as "operational tolerant"), without the risk of patient and graft loss. The recent identification of non-invasive "bio-markers of tolerance", which permit to identify patients who could successfully withdraw IS therapies, opens new perspectives in the management of HCC after LT. IS withdrawal could potentially reduce the risk of tumour recurrence, which represents the major drawback in HCC recipients. Herein, we review the current literature on IS weaning in patients who underwent LT for HCC as primary indication and we report the largest experiences on IS withdrawal in HCC recipients.

PMID: 29034347 [PubMed]

Enlarged selection criteria for hepatocellular cancer: is the upper limit needed?

Tue, 10/17/2017 - 12:45
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Enlarged selection criteria for hepatocellular cancer: is the upper limit needed?

Transl Gastroenterol Hepatol. 2017;2:73

Authors: Peloso A, Oldani G

Abstract
Liver transplantation (LT) for hepatocellular carcinoma (HCC) is strategically challenging because the very good mid-term outcomes of this treatment jar with the risk of cancer recurrence. Although Milan criteria (MC) tap the balance on the safe side, they tend to be considered too restrictive and new, enlarged criteria have been conceived in order to enlarge the pool of potential recipients. Some extended criteria are more audacious then others, but they seem to be well tailored on the local reality they are applied to. Being HCC epidemiology and organs availability very variable between regions, a universally valid 'upper limit' is yet to be determinable.

PMID: 29034346 [PubMed]

The growing impact of alpha-fetoprotein in the field of liver transplantation for hepatocellular cancer: time for a revolution.

Tue, 10/17/2017 - 12:45
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The growing impact of alpha-fetoprotein in the field of liver transplantation for hepatocellular cancer: time for a revolution.

Transl Gastroenterol Hepatol. 2017;2:72

Authors: Lai Q, Iesari S, Melandro F, Mennini G, Rossi M, Lerut J

Abstract
The role of alpha-fetoprotein (AFP) in the specific setting of the diagnosis and prognosis of patients with hepatocellular cancer (HCC) waiting for liver transplantation (LT) is still controversial. Recently, a marked interest for this marker has been reported, mainly related to its ability to predict the outcome of HCC patients after LT. The growing number of papers in PubMed indicates that AFP has begun a "second life" in the particular context of LT. Looking at the most recent International Guidelines on HCC, it looks obvious that time is ripe to reevaluate the value of AFP in relation to its prognostic ability to identify HCC patients at high-risk for drop-out before and recurrence after LT. Many discrepancies exist worldwide regarding the use of biomarkers in HCC. In contrast to the Western world, AFP is widely used in Asian countries, the reason why being unclear. Indeed, in the (merely Western-dominated) HCC treatment algorithms, the role of AFP as a prognostic tumor marker is still considered to be "under investigation". One should however realize that the underestimation of the value of AFP in the LT context will hamper further refinements of both the liver allograft allocation process and the selection of the best candidates for this procedure. Moreover, AFP has an important role to play in the monitoring of bridging and/or downstaging procedures bringing eventually the patient to transplantation. So, time has come to reconsider the role and value of AFP (dynamics) in the field of transplant oncology.

PMID: 29034345 [PubMed]

Clodronate Improves Survival of Transplanted Hoxb8 Myeloid Progenitors with Constitutively Active GMCSFR in Immunocompetent Mice.

Tue, 10/17/2017 - 12:45
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Clodronate Improves Survival of Transplanted Hoxb8 Myeloid Progenitors with Constitutively Active GMCSFR in Immunocompetent Mice.

Mol Ther Methods Clin Dev. 2017 Dec 15;7:60-73

Authors: Lee S, Kivimäe S, Szoka FC

Abstract
New methods to produce large numbers of myeloid progenitor cells, precursors to macrophages (MΦs), by maintaining Hoxb8 transcription factor activity(1) has reinvigorated interest in MΦ cell therapies. We generated Hoxb8-dependent myeloid progenitors (HDPs) by transducing lineage-negative bone marrow cells with a constitutively expressed Hoxb8 flanked by loxP. HDPs proliferate indefinitely and differentiate into MΦ when Hoxb8 is removed by a tamoxifen-inducible Cre. We genetically modified HDPs with a constitutively active GMCSF receptor and the tamoxifen-induced transcription factor IRF8, which we have termed "HDP-on." The HDP-on proliferates without GMCSF and differentiates into the MΦ upon exposure to tamoxifen and ruxolitinib (GMCSF inhibitor via JAK1/2 blockade). We quantified the biodistribution of HDPs transplanted via intraperitoneal injection into immunodeficient NCG mice with a luciferase reporter; HDPs are detected for 14 days in the peritoneal cavity, liver, spleen, kidney, bone marrow, brain, lung, heart, and blood. In immunocompetent BALB/c mice, HDP-on cells, but not HDPs, are detected 1 day post-transplantation in the peritoneal cavity. Pretreatment of BALB/c mice with liposomal clodronate significantly enhances survival at day 7 for HDPs and HDP-on cells in the peritoneal cavity, spleen, and liver, but cells are undetectable at day 14. Short-term post-transplantation survival of HDPs is significantly improved using HDP-on and liposomal clodronate, opening a path for MΦ-based therapeutics.

PMID: 29034260 [PubMed]

Cell-Based Therapies for Tissue Fibrosis.

Tue, 10/17/2017 - 12:45
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Cell-Based Therapies for Tissue Fibrosis.

Front Pharmacol. 2017;8:633

Authors: Lim R, Ricardo SD, Sievert W

Abstract
The development of tissue fibrosis in the context of a wound-healing response to injury is common to many chronic diseases. Unregulated or persistent fibrogenesis may lead to structural and functional changes in organs that increase the risk of significant morbidity and mortality. We will explore the natural history, epidemiology, and pathogenesis of fibrotic disease affecting the lungs, kidneys, and liver as dysfunction of these organs is responsible for a substantial proportion of global mortality. For many patients with end-stage disease, organ transplantation is the only effective therapy to prolong life. However, not all patients are candidates for the major surgical interventions and life-long immunosuppression required for a successful outcome and donor organs may not be available to meet the clinical need. We will provide an overview of the latest treatment strategies for these conditions and will focus on stem or progenitor cell-based therapies for which there is substantial pre-clinical evidence based on animal models as well as early phase clinical trials of cell-based therapy in man.

PMID: 29033833 [PubMed]

Hemorrhagic Cholecystitis in a Patient on Maintenance Dialysis.

Tue, 10/17/2017 - 12:45
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Hemorrhagic Cholecystitis in a Patient on Maintenance Dialysis.

Case Rep Gastroenterol. 2017 May-Aug;11(2):488-493

Authors: Shishida M, Ikeda M, Karakuchi N, Ono K, Tsukiyama N, Shimomura M, Oishi K, Miyamoto K, Toyota K, Sadamoto S, Takahashi T

Abstract
The present paper describes a case of hemorrhagic cholecystitis in a patient on maintenance dialysis. The patient presented with right upper quadrant abdominal pain. Computed tomography revealed swelling of the gallbladder, high- and isodensity contents of the gallbladder, and high-density stone in the gallbladder neck. He was hospitalized for suspected acute cholecystitis. After hospitalization, his levels of total bilirubin, aspartate aminotransferase, and alanine aminotransferase increased. T2-weighted magnetic resonance imaging showed low-intensity contents expanded to include a wide area from the common bile duct to the cystic duct and gallbladder neck. Endoscopic retrograde cholangiopancreatography revealed clotting from the duodenal papilla. After cannulation of the bile duct, old blood and pus began to flow from the mammary papilla, and an endoscopic nasobiliary drainage tube was placed. After his liver function had improved, the patient underwent laparoscopic cholecystectomy. His sample revealed that the gallbladder was filled with blood clots and stones. His postoperative course was uneventful and he was discharged on day 19 after the procedure. Although hemorrhagic cholecystitis is rare, it should be considered as a differential diagnosis for patients on dialysis who have acute abdominal symptoms.

PMID: 29033767 [PubMed]

Downstaging therapy followed by liver transplantation for hepatocellular carcinoma beyond Milan criteria.

Tue, 10/17/2017 - 12:45
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Downstaging therapy followed by liver transplantation for hepatocellular carcinoma beyond Milan criteria.

Surgery. 2017 Oct 12;:

Authors: Kim Y, Stahl CC, Makramalla A, Olowokure OO, Ristagno RL, Dhar VK, Schoech MR, Chadalavada S, Latif T, Kharofa J, Bari K, Shah SA

Abstract
BACKGROUND: Orthotopic liver transplantation is a curative treatment for hepatocellular carcinoma within Milan criteria, but these criteria preclude many patients from transplant candidacy. Recent studies have demonstrated that downstaging therapy can reduce tumor burden to meet conventional criteria. The present study reports a single-center experience with tumor downstaging and its effects on post-orthotopic liver transplantation outcomes.
METHODS: All patients with hepatocellular carcinoma who were evaluated by our multidisciplinary liver services team from 2012 to 2016 were identified (N = 214). Orthotopic liver transplantation candidates presenting outside of Milan criteria at initial radiographic diagnosis and/or an initial alpha-fetoprotein >400 ng/mL were categorized as at high risk for tumor recurrence and post-transplant mortality.
RESULTS: Of the 214 patients newly diagnosed with hepatocellular carcinoma, 73 (34.1%) eventually underwent orthotopic liver transplantation. The majority of patients who did not undergo orthotopic liver transplantation were deceased or lost to follow-up (47.5%), with 14 of 141 (9.9%) currently listed for transplantation. Among transplanted patients, 21 of 73 (28.8%) were considered high-risk candidates. All 21 patients were downstaged to within Milan criteria with an alpha-fetoprotein <400 ng/mL before orthotopic liver transplantation, through locoregional therapies. Recurrence of hepatocellular carcinoma was higher but acceptable between downstaged high-risk and traditional candidates (9.5% vs 1.9%; P > .05) at a median follow-up period of 17 months. Downstaged high-risk candidates had a similar overall survival compared with those transplanted within Milan criteria (log-rank P > .05).
CONCLUSIONS: In highly selected cases, patients with hepatocellular carcinoma outside of traditional criteria for orthotopic liver transplantation may undergo downstaging therapy in a multidisciplinary fashion with excellent post-transplant outcomes. These data support an aggressive downstaging approach for selected patients who would otherwise be deemed ineligible for transplantation.

PMID: 29033224 [PubMed - as supplied by publisher]

Long-term survival in a patient with low-level inflammatory markers and liver metastasis, converted resectable by TACE.

Tue, 10/17/2017 - 12:45
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Long-term survival in a patient with low-level inflammatory markers and liver metastasis, converted resectable by TACE.

Immunotherapy. 2017 Oct;9(13):1067-1069

Authors: Mizandari M, Paksashvili N, Kikodze N, Azrumelashvili T, Pantsulaia I, Shanava K, Janikashvili N, Chikovani T

Abstract
Case report presents the successful treatment of unresectable liver metastasis in a patient with colon cancer. A 44-year-old male underwent right hemicolectomy followed by capecitabine for a moderately differentiated adenocarcinoma of the colon. 2 years later, a liver metastatic lesion was detected and had increased in size despite chemotherapy with capecitabine plus oxaliplatin (XELOX). Curative liver resection was conducted after conversion of unresectable tumor to resectable by transarterial chemoembolization followed by chemotherapy - irinotecan with fluorouracil and folinic acid (FOLFIRI). No recurrence was observed during 22-month follow-up after hepatectomy.

PMID: 29032738 [PubMed - in process]

The Impact of Inter-Center Sharing on the Outcomes of Pediatric Split Liver Transplantation.

Tue, 10/17/2017 - 12:45
Related Articles

The Impact of Inter-Center Sharing on the Outcomes of Pediatric Split Liver Transplantation.

Clin Transplant. 2017 Oct 15;:

Authors: Elsabbagh AM, Williams C, Girlanda R, Hawksworth J, Kroemer A, Matsumoto CS, Fishbein TM

Abstract
BACKGROUND: Split liver transplantation allows for expansion of the pool of organs available for pediatric liver transplantation. The impact of sharing segments of the same liver between centers has not been studied.
STUDY DESIGN: Retrospective analysis of 24 pediatric split liver transplant cases in a recent cohort. We evaluated the outcomes of pediatric recipients who shared organs with adult patients in our own center (group A) compared to recipients who shared organs with adult patients in other centers. (group B).
RESULTS: 1-, 3-, and 5-year graft survival for group A was 100%, 100%, and 100% versus 83%, 71%, and 57% for group B (P= 0.039). Postoperative complications included biliary complications (41.7% in group A vs. 50% in group B, P=0.682), vascular complications (8.3% in group A vs. 41.7% in group B, P=0.059), postoperative bleeding (16.7% in group A vs. 25% in group B, P =0.615). High grade Clavien-Dindo complications were 0% in group A vs. 33.3% in group B, P= 0.028.
CONCLUSIONS: Organ sharing between centers appears to be associated with significantly poorer graft survival. Possible explanations include greater procurement related injury or suboptimal vessel distribution. Future larger studies focused on this area may be helpful to formulate policy considerations. This article is protected by copyright. All rights reserved.

PMID: 29032604 [PubMed - as supplied by publisher]

Clinical significance of lactate clearance for the development of early allograft dysfunction and short-term prognosis in deceased donor liver transplantation.

Tue, 10/17/2017 - 12:45
Related Articles

Clinical significance of lactate clearance for the development of early allograft dysfunction and short-term prognosis in deceased donor liver transplantation.

Clin Transplant. 2017 Oct 15;:

Authors: Kim DG, Lee JY, Jung YB, Song SH, Lee JG, Hoon HD, Joo DJ, Ju MK, Choi GH, Choi JS, Kim MS, Kim SI

Abstract
This retrospective study evaluated lactate clearance (LC), measured at 6, 12, 18, and 24 hours after reperfusion, as a predictor of early allograft dysfunction (EAD) and short-term outcomes in patients receiving deceased donor liver transplantation. Of 181 transplant recipients, 44 (24.3%) developed EAD and had lower LCs than those who did not develop EAD. A receiver operating characteristic analysis showed that LC determined at 6 hours showed the highest area under curve value of 0.828 (95% confidence interval [CI]: 0.755-0.990) for predicting the development of EAD at a cutoff value of 25.8% with 76.7% sensitivity and 77.9% specificity. LC values that fell below the cutoff values were significantly associated with EAD in a multivariate analysis, with values at 6 hours having the highest adjusted odds ratio (11.891, 95% CI: 4.469-31.639). In-hospital and 6-month mortalities were higher in patients with LC values below the cutoffs compared with those above the cutoff values at each time point. Thus, LC calculated shortly after reperfusion of an allograft is significantly discriminative for the development of EAD and is associated with short-term prognosis after deceased donor liver transplantation. This article is protected by copyright. All rights reserved.

PMID: 29032588 [PubMed - as supplied by publisher]

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