Search

Introduction There is still no consensus about the actual role of liver transplantation (LT) in the therapeutic algorithm of combined hepatocellular-cholangiocarcinoma (cHCC-CC) because of low incidence and few clinical information. Methods We retrospectively identified 111 patients at nine centers from 2001 to 2019 in Korea. Results Of the 111 patients, 85.6% (n = 95) was male and the median age was 54 years (range, 31-66 years). HBV is 82% (n = 91) and HCC is 96% (86.3%) preoperatively. Seventy-four patients (66.7%) received locoregional therapy (LRT) before LT. Median tumor size was 2.5 cm (range, 0.5-7.2 cm) and the ratio of beyond Milan criteria was 40.5% (n = 45). The 1-year, 3-year, and 5-year disease-free survival rates and tumor-related patient survival rates were 77.6%, 56.3%, and 51.1% and 84.4%, 63.8%, and 56.7%, respectively. The extrahepatic site was 75.5% as an initial tumor recurrence site in recurrent tumor patients. Numbers of LRT before LT > 3 and tumor size > 3 cm were closely associated tumor recurrence and early tumor recurrence within 1 year after LT. Tumor size > 3 cm was only predisposing factor for tumor-related death. Conclusions It is difficult to diagnose cHCC-CC before LT, but a good prognosis can be expected if the tumor size is less than 3 cm in pathology.

Introduction Old donors have gradually been used as an alternative living liver donor to alleviate the organ shortage or avoid offspring donation. The aim of the present study is to determine the impact of elderly donors more than 60 years in living donor liver transplantation (LDLT) on donor safety and recipient outcomes compared with donors from fifty to fifty-nine years. Methods We retrospectively identified 209 patients at nine centers from 2005 to 2017 in Korea. Results Sixty group represented 10.0% (n = 21) of the patient donors. The incidence of male donor in the sixty group was higher than in the fifty group (61.9% vs. 37.8%; p = 0.039). Postoperative complications were more common in the sixty group. There was no in-hospital mortality and no mortality was reported during the observation period. There were no statistically significant differences in operation time, blood loss, intraoperative and postoperative transfusion rate, postoperative total bilirubin, and hospitalization between the two groups. In recipient operation, median blood loss, transfusion rates during operation, and postoperative bleeding control operations were more than in the fifty group. Postoperative total bilirubin and hospitalization in the sixty group were higher and longer in the fifty group. Cumulative patient survival rate in the fifty group was better than in the sixty group (p = 0.011). Sixty group was predisposing factor for recipient death in multivariate analysis. Conclusions Present study suggests that highly selected elderly living donors (≥ 60 years) can safely donate, but their recipient outcomes are worse compared with the fifty group.

We assessed the change in the therapeutic decision among curative treatments after adding Gd-EOB-DTPA-enhanced MRI to triple-phase MDCT for patients with early-stage HCC. This study retrospectively investigated two groups: 33 pathologically confirmed HCC patients after liver transplantation in group 1; 34 HCC patients without pathology in group 2. In group 1, we simulated the therapeutic decision-making process by pretransplant MDCT and Gd-EOB-DTPA-enhanced MRI. In group 2, including the 34 early-stage HCC patients consecutively enrolled, we investigated the change of therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT. In the simulation from group 1, after adding Gd-EOB-DTPA-enhanced MRI, 33.3 % (11/33 patients) of treatment decisions were changed from the decision based on MDCT alone. Among 22 patients considered eligible for resection and 33 patients for radiofrequency ablation, the therapeutic decision was changed for 10 patients in the surgical group and 4 patients for the RFA group (45.5 and 12.1 %). In group 2, the rate of change in the therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT was 41.2 % (14/34 patients). In group 1 with explants pathology, the median diameter of HCCs not detected by MDCT but detected by Gd-EOB-DTPA-enhanced MRI was 1.15 cm (0.3–3.0 cm). The median diameter of HCCs seen only in the explanted liver was 1.0 cm (0.3–1.7 cm), and 60.7 % of them were well-differentiated HCCs. This study suggests that performing Gd-EOB-DTPA-enhanced MRI before deciding on curative treatment for early-stage HCC may improve the accuracy of treatment decision for early-stage HCC.

Aliment Pharmacol Ther 31, 415–423 Summary Background Long-term results after downstaging hepatocellular carcinoma (HCC) prior to liver transplantation (LT) remain unknown. Aims To investigate dropouts and post-transplant outcome among patients with downstaged HCC by transarterial chemo-lipiodolization (TACL). Methods Between 2000 and 2007, 386 patients with HCC initially exceeding Milan criteria underwent TACL for tumour downstaging and were consecutively enrolled. Results Overall, 160 (41.5%) patients achieved successful downstaging of HCC to within Milan criteria. During the follow-up, 82 eventually dropped off the waiting list for LT, with estimated dropout rates at 1, 2 and 5 years of 46.7%, 70.2%, and 87.2%, respectively. The overall post-transplant survival rates at 1, 2 and 5 years were 89.2%, 70.3% and 54.6% and the corresponding rates for recurrence-free survival were 74.7%, 71.8% and 66.3% respectively. Multivariate analysis indentified alpha-fetoprotein (AFP) levels ≥100 ng/mL at LT (P = 0.003), maximum tumour size ≥7 cm (P = 0.002) and the lack of complete necrosis by TACL (P = 0.048) as independent predictors of HCC recurrence after LT. Patients with none of these risk factors had an excellent post-transplant outcome, with an 87.5% probability of recurrence-free survival up to 6 years. Conclusions These long-term results may contribute to the database for optimizing management of LT candidates with downstaged HCC. Based on our data, patients with a maximum tumour size

Purpose: Infertility due to ovarian failure that is caused by antineoplastic chemotherapeutic agents is one of the primary problems of female cancer patients who are in their reproductive years. It has become important to preserve the reproductive potential of female cancer patients. This study was conducted to determine whether autotransplantation of frozen ovaries can restore reproductive potential. Methods: This study included 30 female mice that had normal reproductive potential. The mice were divided into 4 groups: the positive control, the negative control, the comparison group, and the experimental group. The positive control group received right total oophorectomy, and the negative control group received bilateral total oophorectomy. Greater than or equal to 90% of the left ovary was removed in the mice of the comparison group, and then cyclophosphamide was administered. In the experimental group, the right ovary taken out by right total oophorectomy, and this was crypreserved using the vitrification method. And then cyclophosphamide was administered. The cryopreserved ovary was autotransplanted to the left gonadal fat pad after greater than or equal to 90% of the left ovary was removed. The reproductive performance in each group was analyzed according to the pregnancy rate after mating. Results: In the positive control group, all five mice became pregnant, and the number of fetuses was 4 to 5 (mean= 4.60±0.55). In the comparison group, the pregnancy rate was 50%, and the mean number of fetuses was 1.40±0.55. In the experimental group, 7 of 10 (70%) mice became pregnant, and the mean number of fetuses was 4.71±2.56. There was no significant difference in the number of fetuses between the positive control and the experimental group (p=0.093), but there was a significant difference in the number of fetuses between the comparison group and the experimental group (p=0.019). Conclusion: The results of this study suggest that autotransplantation of frozen ovaries using the vitrification method may restore the impaired ovarian function induced by antineoplastic chemotherapeutic agents.