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Early recurrence (ER) of hepatocellular carcinoma (HCC) (within 1 year after resection) is known to be a poor prognostic factor. The aim was to identify the risk factors associated with ER after HCC resection.Data were analyzed retrospectively from patients who underwent primary resection for HCC from two hospitals. For cross-validation, HCC resection cases were divided into the training and testing cohort. The clinicopathological factors between the ER and non-ER groups and factors for predicting ER and prognosis after HCC resection were compared.Out of 173 patients in the training dataset, 33 patients had ER and the ER group showed larger tumor size, more intrahepatic metastasis (IM), and a higher ratio of serum des-gamma-carboxy prothrombin (DCP) to tumor volume (TV) (DCP/TV) than the non-ER group. Out of 203 patients in the testing dataset, 30 patients had ER and the ER group demonstrated larger tumor size, more IM, and higher serum alpha-fetoprotein, AFP/TV, DCP/TV, AFP/tumor maximum diameter (TMD), and DCP/TMD than the non-ER group. The patients were divided into high and low DCP/TV groups and high serum DCP/TV was associated with unfavorable overall survival in the training and testing dataset. Multivariate analysis confirmed that high serum DCP/TV and IM were independently associated with ER.Preoperative high serum DCP/TV may be useful for stratifying patients at risk of early HCC recurrence after curative resection.

Aim Sarcopenia is an independent predictor of mortality and sepsis after living donor liver transplantation (LDLT). However, the exact mechanisms by which sarcopenia affects poor prognosis or worse immunity against postoperative sepsis are unclear, particularly regarding muscular amino acid metabolism, and the authors aimed to identify the role of plasma amino acids in sarcopenia by retrospective study. Methods The area of the psoas muscle in 228 recipients of LDLT was retrospectively measured by dynamic computed tomography. Additionally, plasma amino acid levels were measured both pre- and postoperatively. The impact of plasma amino acids for postoperative sepsis and the relationship between sarcopenia and early nutrition after LDLT were analyzed. Results Among the plasma amino acids, only leucine, isoleucine and glutamine in patients with sarcopenia were significantly lower than those without sarcopenia (each, P

Aim Depletion of skeletal muscle mass (sarcopenia) predicts survival in patients with cancer or liver cirrhosis. Recently, many reports have used computed tomography (CT) to measure muscle area to define sarcopenia. However, the definition of sarcopenia using CT has not been fully determined. The aim of this study was to establish formulae to calculate the standard area of skeletal muscle. Methods Forty-five healthy adults (24 men and 21 women, aged 21–66 years) who wished to donate part of their liver for transplantation underwent CT. Cross-sectional areas (cm2) of skeletal muscle were measured at the caudal end of the third lumbar vertebra. Regression analysis was performed to establish formulae to calculate the standard area of skeletal muscle. A validation conducted on 30 other healthy adults was performed to check the accuracy of formulae. Results Men had a median skeletal muscle area of 155.0 cm2 (range, 114.0–203.0), compared with 111.7 cm2 (range, 89.8–139.3) in women (P

Aim Hepatitis C (HC)-related hepatocellular carcinoma (HCC; HC-HCC) is highly recurrent. Methods From 1995–2007, 183 curative hepatic resections for primary solitary HC-HCC without postoperative interferon therapy were included in this study. The patients were divided into three groups: (i) 2 cm or less (n = 56); (ii) more than 2 cm to less than 5 cm (n = 79); and (iii) 5 cm or more (n = 48). Independent risk factors for HC-HCC recurrence for each group were determined. Results Independent risk factors for recurrence were aspartate aminotransferase or alanine aminotransferase (AST/ALT) of 80 IU/L or more (hazard ratio [HR], 2.1; P = 0.02) in patients with HCC of 2 cm or less, des-γ-carboxy prothrombin of 100 mAU/mL or more (HR, 2.5; P = 0.02) and AST/ALT of 80 IU/L or more (HR, 2.1; P = 0.04) in patients with HCC of more than 2 cm to less than 5 cm, and the presence of macroscopic portal vein tumor thrombus (HR, 2.8; P = 0.02) and AST/ALT of 80 IU/L or more (HR, 2.1; P = 0.04) in patients with HCC of 5 cm or more. All 13 late recurrences of 1 year or more after hepatic resection (27.1%) in patients with HCC of 5 cm or more were accompanied by AST/ALT of 80 IU/L or more. Conclusion AST/ALT of 80 IU/L or more is an independent risk factor for the recurrence of primary solitary HC-HCC after curative resection irrespective of the primary HC-HCC size.

Aim: A genetic polymorphism of inosine triphosphate pyrophosphatase (ITPA) has been associated with pegylated-interferon/ribavirin (PEG-IFN/RBV)-induced anemia in chronic hepatitis C patients. However, correlation of the genetic variant with anemia following liver transplantation has not been determined. Methods: Sixty-three hepatitis C virus (HCV)-positive patients who underwent liver transplantation and PEG-IFN/RBV therapy were enrolled. The rs1127354 was determined for each individual. Results: There was no relationship with anemia or RBV dosage in patients carrying the CC allele (CC group, n = 43) and those carrying the CA allele (CA group, n = 20). The incidence of hemoglobin (Hb) decline >3 g/dL (CC: 4.7%, CA: 0%) was relatively low, whereas the incidence of Hb levels

AIM Virtual touch tissue quantification (VTTQ) is an implementation of ultrasound acoustic radiation force impulse imaging that provides numerical measurements of tissue stiffness. We have evaluated the temporal changes of the remnant liver and spleen after living donor hepatectomy with special reference to the differences between right and left liver donation. METHODS Nineteen living donors who received right lobectomy (small remnant liver [SRL] group; n = 7) or extended left and caudate lobectomy (large remnant liver [LRL] group; n = 12) were enrolled. They underwent measurement of liver and spleen VTTQ before and after donor surgery. RESULTS Virtual touch tissue quantification of the remnant liver increased postoperatively until postoperative day (POD) 3-5, and the values in the SRL group were significantly higher than those in the LRL group at POD 3-9. The values of the spleen also increased after donor surgery and the values in the SRL group were significantly higher than those in the LRL group at POD 3-14. A significant positive correlation between postoperative maximum value of VTTQ and postoperative maximum total bilirubin levels was observed. In liver transplant recipients, there was a significant positive correlation between preoperative spleen VTTQ and the corresponding actual portal venous pressure that was measured at the time of transplant surgery. CONCLUSION Stiffness of the remaining liver and spleen in the smaller remnant liver group became harder than that in the larger remnant liver group. Perioperative measurement of liver and spleen VTTQ seems to be a useful means for assessing the physiology of liver regeneration.