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PubMedID: 31101189 Background: Scarce data are available comparing outcomes of hepatic resection vs orthotopic liver transplantation (OLT)for localized hepatocellular carcinoma (HCC)patients both meeting and exceeding the Milan criteria. This study compared the clinical and oncological outcomes of patients undergoing hepatic resection vs transplantation localized HCC. Method: Between January 2005 and February 2017, clinical and oncological outcomes of patients who underwent liver resection (n = 38)vs OLT (n = 28)for localized HCC were compared using a prospectively maintained database. Results: A total of 66 patients (with a median age of 62)who met the study criteria were analyzed. Comparable postoperative complications (13.2% vs 28.6%, P =.45)and perioperative mortality rates (7.9% vs 10.7%, P =.2)were noted for the resection vs OLT groups. While Child-Pugh Class A patients were more prevalent in the resection group (78.9% vs 7.1%, P =.0001), the rate of patients who met the Milan criteria was higher in the OLT group (89.3% vs 34.25, P =.0001). Recurrence rates were 36.8% in the resection group and 3.6% in the OLT group at the end of the median follow-up period (32 vs 39 months, respectively). The HCC-related mortality rate was significantly higher in the resection group (39.5% vs 10.7%, P =.034). However, a subgroup analysis of patients who met the Milan criteria revealed similar rates of recurrence and HCC-related mortality (15.4% vs 8%, P =.63). Based on logistic regression analysis, number of tumors (P =.034, odds ratio: 2.1)and “resection”-type surgery (P =.008, odds ratio: 20.2)were independently associated with recurrence. Conclusion: Compared to liver transplantation, hepatic resection for localized hepatocellular carcinoma is associated with a higher rate of recurrence and disease-related mortality. © 2019 Elsevier Inc.

PubMedID: 28340836 Background The current study aimed to evaluate the effect of dosage and type (intramuscular [IM] vs intravenous [IV]) of hepatitis B immunoglobulin (HBIG) on hepatitis antibody level in liver transplant recipients. Methods Between September 2000 and August 2016, patients who underwent orthotropic liver transplantation for chronic liver failure or hepatocellular carcinoma secondary to chronic hepatitis B virus (HBV) were retrospectively reviewed from a prospectively maintained database. The analyses of risk factors for postoperative short- and long-term anti-hepatitis B surface antibody levels (as classified level I: 0 to 100 U; II: 100 to 500 U; III: 500 to 1000 U; IV: >1000 U) were performed based on demographic characteristics, hepatitis B envelope antigen, hepatitis B core antibody, HBV DNA, delta antigen, HBIG administration dosage during unhepatic phase (5000 or 10,000 I/U; IM or IV), and type of administration in post-transplant period. Patients who were followed for less than 12 months were excluded from long-term analysis. Results The mean follow-up of 58 orthotropic liver transplant patients was 72 (±45) months. No adverse events were observed during both IM and IV type of administration. Compared with IM type, IV administration was associated with a significantly higher HBV antibody level in the short term (for IM and IV: level I: 24% vs 6%; II: 49% vs 18%; III: 12% vs 35%; IV: 15% vs 41%, respectively, P =.007). In the long term, IV administration of hepatitis B immunoglobulin (HBIG) was reported as the sole factor causing higher antibody level (P =.002). Longer follow-up was associated with decreased levels of anti-hepatitis B surface antibody. Conclusion IV HBIG administration in preoperative anhepatic phase and postoperative prophylaxis is associated with higher antibody level both the short and long term without any adverse event. © 2017 Elsevier Inc.

There are limited convincing data regarding management and outcomes of lower gastrointestinal bleeding (LGB) in renal transplant recipients (RTR). The aim of this study was to evaluate incidence, management strategies, and risk factors associated with LGB in RTR.Between January 2004 and December 2013, RTR with LGB were analyzed. LGB was defined as having clinical evidence of hemorrhage after upper gastrointestinal etiology was ruled out.There were 1578 RTR with a mean age of 50 ± 14 years at the time of transplantation. Mean follow-up time after transplantation was 57 ± 45 months. Forty-five (2.9%) patients had a documented site of LGB. The most common causes of bleeding were colitis and angiodysplasia (n = 17). Mean time to LGB after transplantation was 43 ± 36 months. Twelve patients with LGB required intervention. Three underwent colectomy, endoscopic treatment was utilized in 8, and 1 patient had angiographic embolization to control bleeding. Recurrent LGB developed in 11 patients of 42 patients who did not have surgery at the time of index bleeding. Surgical (n = 1) or endoscopic intervention (n = 4) was required in 5 of recurrent bleeders. LGB was more commonly seen in RTRs who had development of a nonfunctioning kidney (P .0001). RTR who had an LGB had an increased overall mortality rate (not directly related to the bleeding episode) compared with those who did not have a LGB (P = .001). We did not observe any increased risk of LGB bleeding among patients who were receiving anticoagulant or anti-aggregant treatment agents (P = .76).Nonfunctioning kidney after transplant is a risk factor for LGB. Overall mortality rates increased after LGB in RTR. Strategies aiming to prolong transplanted kidney function may reduce the incidence of LGB and improve life expectancy in RTR.

PubMedID: 26093739 Objectives This study presents the overall long-term hepatitis B virus (HBV) recurrence rate with possible associated factors after hepatitis B immunoglobulin (HBIG) was given in combination with 4 different antiviral (lamivudine, adefovir, entecavir, and tenofovir) drugs. Patients and Methods Between September 2000 and October 2013, the medical records of 42 adult patients who underwent liver transplantation at the Cukurova University Medical Hospital for chronic liver failure or hepatocellular carcinoma (HCC) secondary to chronic HBV were reviewed retrospectively. The analyses of risk factors for recurrence were performed based on the efficacy of hepatitis B envelope antigen (HBeAg), hepatitis B core antibody (anti-HBc), HBV DNA, preoperative prophylaxis, and the presence of HCC. Posttransplantation HBV recurrence was defined as persistence of hepatitis B surface antigen (HBsAg) positivity after orthotopic liver transplantation, or the reappearance of HBsAg and HBV DNA after initial HBsAg undetectability despite prophylaxis. Results The mean follow-up of 28 patients having HBIG and lamivudine prophylaxis was 73.25 ± 37.5 months with a recurrence rate of 3.5%. The mean follow-up of 2 patients having HBIG and adefovir prophylaxis was 90 ± 46.6 months with a 50% recurrence rate. The mean follow-up of each 6 patients who received prophylaxis with entecavir and tenofovir groups were 27.5 ± 16.1 and 16.17 ± 5.3 respectively, with no posttransplantation recurrence for both groups. On univariate analysis, preoperative factors such as anti-HBc, HBV DNA, preoperative prophylaxis, and the presence of HCC did not show any correlation with recurrence. However, HBeAg showed statistical significance for recurrence. Conclusions Low-dose HBIG in combination with antiviral agents (lamivudine, entecavir, and tenofovir) is efficacious in preventing recurrence of HBV in posttransplantation patients. © 2015 Elsevier Inc. All rights reserved.