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ObjectiveTo investigate the risk factors for tumor recurrence and death after liver transplantation in patients with hepatocellular carcinoma (HCC) and their survival. MethodsThe patients with HCC who underwent liver transplantation in The Fifth Medical Center of Chinese PLA General Hospital from January 2005 to February 2019 were enrolled, and according to the presence or absence of HCC recurrence after liver transplantation, they were divided into recurrence group and non-recurrence group. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to determine the risk factors for HCC recurrence and death after liver transplantation. The Kaplan-Meier method was used for survival analysis, and the receiver operating characteristic (ROC) curve was used to investigate the predictive value of death-related risk factors after liver transplantation. ResultsA total of 391 HCC patients who underwent liver transplantation were enrolled, with a median follow-up time of 2 years, among whom 78(19.95%) experienced HCC recurrence. Preoperative alpha-fetoprotein (AFP) level＞200 ng/ml (recurrence: hazard ratio ［HR］=252, 95% confidence interval ［CI］: 1.58-4.03, P＜0.001; death: HR=2.99, 95%CI: 1.59-5.62, P＜0.001］, total tumor diameter (recurrence: HR=1.20, 95%CI: 1.12-1.28, P＜0.001; death: HR=1.10, 95%CI: 1.02-1.17, P=0.002), and vascular invasion (recurrence: HR=1.15, 95%CI: 1.04-1.26, P=0.016; death: HR=1.10, 95%CI: 1.03-1.18, P=0.004) were independent risk factors for tumor recurrence and death after liver transplantation. The 1-, 5-, and 10-year overall survival rates after liver transplantation were 94.8%, 84.2%, and 83.5%, respectively, and the 1-, 5-, and 10-year disease-free survival rates were 840%, 75.1%, and 75.1%, respectively. AFP, involvement of major blood vessels, body mass index, and total tumor diameter had a certain value in predicting the death of HCC patients with recurrence, with an area under the ROC curve of 0.789 (95% CI: 0.719-0858). ConclusionTumor biological features before transplantation are the key factors for tumor recurrence after transplantation.

ObjectiveTo investigate the clinical features of patients with pure red cell aplasia (PRCA) associated with human parvovirus B19 (HPV B19) infection after liver transplantation. MethodsThe clinical data of 420 patients who underwent liver transplantation in 302 Hospital of PLA from July 2007 to July 2016 and were followed up regularly were collected, and among these patients, five had a progressive reduction in hemoglobin (Hb) level within a short period of time. Bone marrow cytological examination showed erythropoiesis disorders and positive HPV B19 IgM, and the patients were diagnosed with PRCA after the exclusion of other causes. The patients were given human gamma-globulin, glucocorticoids, and adjustment of immunosuppressants. The patients′ clinical manifestations during treatment and the changes in reticulocyte count (RC), Hb, white blood cell count (WBC), platelet count (PLT), and myelogram findings determined by peripheral blood cell analysis were observed, as well as the changes in liver and renal function parameters. ResultsAfter the multimodality therapy using human gamma-globulin, glucocorticoids, and red blood cell infusion, the five patients had significant alleviation in the symptoms of weakness, short breath, and dizziness, and the peripheral blood cell analysis showed recovery of Hb and RC, suggesting that anemia was corrected. ConclusionAs for patients with PRCA associated with HPV B19 infection, early diagnosis and treatment with human gamma-globulin and glucocorticoids can achieve a good therapeutic effect.