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Background: Higher liver caspase-3 activity has been found in patients with different liver diseases. However, there is no published data about circulating caspase-3 levels in patients with hepatocellular carcinoma (HCC) who underwent liver transplantation (LT). Therefore, our objective in this study was to determine whether an association between circulating caspase-3 levels in HCC patients prior to LT and one-year mortality after LT exists. Methods: In this observational and retrospective study, we included HCC patients who underwent LT. We measured serum levels of caspase-3 (as the main executor of apoptosis) and caspase-cleaved cytokeratin (CCCK)-18 (to estimate apoptosis degree) before LT. Results: One-year surviving LT patients (n = 129) showed lower serum levels of caspase-3 (p = 0.004) and CCCK-18 (p = 0.001) than non-surviving LT patients (n = 16). Logistic regression analysis showed that serum caspase-3 levels prior to LT were associated with one-year after LT mortality (Odds Ratio = 2.612; 95% CI = 1.519-4.493; p = 0.001). We found a positive association between serum levels of caspase-3 and CCCK-18 (rho = 0.26; p = 0.002). Conclusions: Our study is the first one reporting data of circulating caspase-3 levels prior to LT for HCC, and an association between high serum caspase-3 levels previously to LT and survival at first year after LT.

Melatonin administration has been associated with different benefits in animals and patients suffering from liver diseases. However, there is no published data about circulating melatonin levels in patients with hepatocellular carcinoma (HCC) who underwent liver transplantation (LT). Thus, the objective of this observational and retrospective study was to determine whether patients with HCC with lower serum melatonin levels prior to LT have a higher risk of one-year mortality after LT. We measured serum levels of melatonin, malondialdehyde (to assess lipid peroxidation), and total antioxidant capacity (to assess antioxidant state) before LT. One-year surviving LT patients (n = 129) showed higher serum levels of melatonin (p = 0.001) and total antioxidant capacity (p = 0.001) and lower serum levels of malondialheyde (p = 0.01) than non-surviving LT patients (n = 16). Logistic regression analysis showed that high serum melatonin levels prior to LT were associated with lower one-year LT mortality (odds ratio = 0.525, 95% confidence interval (CI) = 0.331&ndash, 0.834, p = 0.006). We found an association between serum levels of melatonin with serum levels of malondialheyde (rho = &minus, 0.22, p = 0.01) and total antioxidant capacity (rho = 0.21, p = 0.01). Thus, the novel findings of our study were the association between high serum melatonin levels prior to LT and survival at first year after LT and the association between serum levels of melatonin with malondialheyde and total antioxidant capacity.

We were interested in the report of Razafindratsira et al. of complications after intra-operative radiofrequency ablation (IRFA) of liver metastases.1 While the report suggested that a hepatic abscess had not been reported as a complication of IRFA when combined with an additional potentially contaminated procedure such as colectomy, we recently witnessed the development of severe septic shock associated with liver abscess secondary to Enterobacter cloacae. This resulted on day 12 after a sigmoid colectomy and IRFA of a single liver metastasis with a simultaneous prophylactic cholecystectomy. IRFA of a single, 2.5 cm diameter liver metastasis was achieved with 5-day prophylactic cover (piperacillin-tazobactam) with the application of three superimposed circles but subsequent ultrasound revealed a large hepatic collection at the IRFA site. This resulted in intrahepatic obstructive cholestasis, with high-volume biliary leakage managed by intrahepatic stenting. Treatment was effective, and the patient who had multiple comorbid disease and had been classified as American Society of Anesthesiology Classification class IV, was discharged after approximately 2 months in hospital.