To the Editor:Donor steatosis represents a well-known risk factor for primary non-function,early allograft dysfunction,and biliary complications after liver transplantation(LT)[1,2].Recently,machine perfusion(MP)techn...To the Editor:Donor steatosis represents a well-known risk factor for primary non-function,early allograft dysfunction,and biliary complications after liver transplantation(LT)[1,2].Recently,machine perfusion(MP)technology has been implemented in the clinical practice,with the primary intent to assess the graft quality and to optimize the organ selection process[3].A limited number of articles has been published specifically investigated the role of MP in steatotic livers[4–10],with few of them looking at the role of hypothermic MP.展开更多
AIM To perform a systematic review and meta-analysis on platelet-to-lymphocyte ratio(PLR) as a risk factor for post-transplant hepatocellular cancer(HCC) recurrence. METHODS A systematic literature search was performe...AIM To perform a systematic review and meta-analysis on platelet-to-lymphocyte ratio(PLR) as a risk factor for post-transplant hepatocellular cancer(HCC) recurrence. METHODS A systematic literature search was performed using PubM ed. Participants of any age and sex, who underwent liver transplantation for HCC were considered following these criteria:(1) studies comparing pre-transplant low vs high PLR values;(2) studies reporting post-transplant recurrence rates; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measure was set for HCC recurrence after transplantation. RESULTS A total of 5 articles, published between 2014 and 2017, fulfilled the selection criteria. As for the quality of the reported studies, all the investigated articles presented an overall high quality. A total of 899 cases were investigated: 718 cases(80.0%) were males. Three studies coming from European countries and one from Japan presented HCV as the main cause of cirrhosis. On the opposite, one Chinese study presented a greater incidence of HBV-related cirrhotic cases. In all the studies apart one, the PLR cut-off value of 150 was reported. At meta-analysis, high PLR value was associated with a significant increase in recurrence after transplantation(OR = 3.33; 95%CI: 1.78-6.25; P < 0.001). A moderate heterogeneity was observed among the identified studies according to the Higgins I^2 statistic value.CONCLUSION Pre-transplant high PLR values are connected with an increased risk of post-operative recurrence of hepatocellular cancer. More studies are needed for better clarify the biological mechanisms of this results.展开更多
BACKGROUND Prediction of survival after the treatment of hepatocellular carcinoma(HCC)has been widely investigated,yet remains inadequate.The application of artificial intelligence(AI)is emerging as a valid adjunct to...BACKGROUND Prediction of survival after the treatment of hepatocellular carcinoma(HCC)has been widely investigated,yet remains inadequate.The application of artificial intelligence(AI)is emerging as a valid adjunct to traditional statistics due to the ability to process vast amounts of data and find hidden interconnections between variables.AI and deep learning are increasingly employed in several topics of liver cancer research,including diagnosis,pathology,and prognosis.AIM To assess the role of AI in the prediction of survival following HCC treatment.METHODS A web-based literature search was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis guidelines using the keywords“artificial intelligence”,“deep learning”and“hepatocellular carcinoma”(and synonyms).The specific research question was formulated following the patient(patients with HCC),intervention(evaluation of HCC treatment using AI),comparison(evaluation without using AI),and outcome(patient death and/or tumor recurrence)structure.English language articles were retrieved,screened,and reviewed by the authors.The quality of the papers was assessed using the Risk of Bias In Non-randomized Studies of Interventions tool.Data were extracted and collected in a database.RESULTS Among the 598 articles screened,nine papers met the inclusion criteria,six of which had low-risk rates of bias.Eight articles were published in the last decade;all came from eastern countries.Patient sample size was extremely heterogenous(n=11-22926).AI methodologies employed included artificial neural networks(ANN)in six studies,as well as support vector machine,artificial plant optimization,and peritumoral radiomics in the remaining three studies.All the studies testing the role of ANN compared the performance of ANN with traditional statistics.Training cohorts were used to train the neural networks that were then applied to validation cohorts.In all cases,the AI models demonstrated superior predictive performance compared with traditional statistics with significantly improved areas under the curve.CONCLUSION AI applied to survival prediction after HCC treatment provided enhanced accuracy compared with conventional linear systems of analysis.Improved transferability and reproducibility will facilitate the widespread use of AI methodologies.展开更多
AIM To perform a systematic review and meta-analysis on donor-to-recipient gender mismatch as a risk factor for post-transplant graft loss. METHODS A systematic literature search was performed using PubM ed, Cochrane ...AIM To perform a systematic review and meta-analysis on donor-to-recipient gender mismatch as a risk factor for post-transplant graft loss. METHODS A systematic literature search was performed using PubM ed, Cochrane Library database and EMBASE. The primary outcome was graft loss after liver transplantation. Odds ratios and 95% confidence intervals were calculated to compare the pooled data between groups with different donor-to-recipient gender matches. Three analyses were done considering(1) gender mismatches(F-M and M-F) vs matches(M-M and F-F);(2) Femaleto-Male mismatch vs other matches; and(3) Male-toFemale mismatch vs other matches.RESULTS A total of 7 articles were analysed. Gender mismatch(M-F and F-M) was associated with a significant increase of graft loss respect to match(M-M and F-F)(OR: 1.30; 95%CI: 1.13-1.50; P < 0.001). When F-M mismatch was specifically investigated, it confirmed its detrimental role in terms of graft survival(OR: 1.83; 95%CI: 1.20-2.80; P = 0.005). M-F mismatch failed to present a significant role(OR: 1.09; 95%CI: 0.73-1.62; P = 0.68).CONCLUSION Gender mismatch is a risk factor for poor graft survival after liver transplantation. Female-to-male mismatch represents the worst combination. More studies are needed with the intent to better clarify the reasons for these results.展开更多
Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)represents an innovative surgical technique used for the treatment of large hepatic lesions at high risk for post-resection liver failu...Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)represents an innovative surgical technique used for the treatment of large hepatic lesions at high risk for post-resection liver failure due to a small future liver remnant.The most significant amount of literature concerns the use of ALPPS for the treatment of hepatocellular carcinoma(HCC),cholangiocarcinoma(CCC),and colorectal liver metastases(CRLM).On the opposite,few is known about the role of ALPPS for the treatment of uncommon liver pathologies.The objective of the present study was to evaluate the current literature on this topic.A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Eligible articles published up to February 2020 were included using the MEDLINE,Scopus,and Cochrane databases.Among the 486 articles screened,45 papers met the inclusion criteria,with 136 described cases of ALPPS for rare indications.These 136 cases were reported in 18 different countries.Only in two countries,namely Germany and Brazil,more than ten cases were observed.As for the ALPPS indications,we reported 41(30.1%)cases of neuroendocrine tumor(NET)metastases,followed by 27(19.9%)cases of gallbladder cancer(GBC),nine(6.6%)pediatric cases,six(4.4%)gastrointestinal stromal tumors,six(4.4%)adult cases of benign primary liver disease,four(2.9%)adult cases of malignant primary liver disease,and 43(31.6%)adult cases of malignant secondary liver disease.According to the International ALPPS Registry data,less than 10%of the ALPPS procedures have been performed for the treatment of uncommon liver pathologies.NET and GBC are the unique pathologies with acceptable numerosity.ALPPS for NET appears to be a safe procedure,with satisfactory long-term results.On the opposite,the results observed for the treatment of GBC are poor.However,these data should be considered with caution.The rationale for treating benign pathologies with ALPPS appears to be weak.No definitive response should be given for all the other pathologies.Multicenter studies are needed with the intent to clarify the potentially beneficial effect of ALPPS for their treatment.展开更多
文摘To the Editor:Donor steatosis represents a well-known risk factor for primary non-function,early allograft dysfunction,and biliary complications after liver transplantation(LT)[1,2].Recently,machine perfusion(MP)technology has been implemented in the clinical practice,with the primary intent to assess the graft quality and to optimize the organ selection process[3].A limited number of articles has been published specifically investigated the role of MP in steatotic livers[4–10],with few of them looking at the role of hypothermic MP.
文摘AIM To perform a systematic review and meta-analysis on platelet-to-lymphocyte ratio(PLR) as a risk factor for post-transplant hepatocellular cancer(HCC) recurrence. METHODS A systematic literature search was performed using PubM ed. Participants of any age and sex, who underwent liver transplantation for HCC were considered following these criteria:(1) studies comparing pre-transplant low vs high PLR values;(2) studies reporting post-transplant recurrence rates; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measure was set for HCC recurrence after transplantation. RESULTS A total of 5 articles, published between 2014 and 2017, fulfilled the selection criteria. As for the quality of the reported studies, all the investigated articles presented an overall high quality. A total of 899 cases were investigated: 718 cases(80.0%) were males. Three studies coming from European countries and one from Japan presented HCV as the main cause of cirrhosis. On the opposite, one Chinese study presented a greater incidence of HBV-related cirrhotic cases. In all the studies apart one, the PLR cut-off value of 150 was reported. At meta-analysis, high PLR value was associated with a significant increase in recurrence after transplantation(OR = 3.33; 95%CI: 1.78-6.25; P < 0.001). A moderate heterogeneity was observed among the identified studies according to the Higgins I^2 statistic value.CONCLUSION Pre-transplant high PLR values are connected with an increased risk of post-operative recurrence of hepatocellular cancer. More studies are needed for better clarify the biological mechanisms of this results.
文摘BACKGROUND Prediction of survival after the treatment of hepatocellular carcinoma(HCC)has been widely investigated,yet remains inadequate.The application of artificial intelligence(AI)is emerging as a valid adjunct to traditional statistics due to the ability to process vast amounts of data and find hidden interconnections between variables.AI and deep learning are increasingly employed in several topics of liver cancer research,including diagnosis,pathology,and prognosis.AIM To assess the role of AI in the prediction of survival following HCC treatment.METHODS A web-based literature search was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis guidelines using the keywords“artificial intelligence”,“deep learning”and“hepatocellular carcinoma”(and synonyms).The specific research question was formulated following the patient(patients with HCC),intervention(evaluation of HCC treatment using AI),comparison(evaluation without using AI),and outcome(patient death and/or tumor recurrence)structure.English language articles were retrieved,screened,and reviewed by the authors.The quality of the papers was assessed using the Risk of Bias In Non-randomized Studies of Interventions tool.Data were extracted and collected in a database.RESULTS Among the 598 articles screened,nine papers met the inclusion criteria,six of which had low-risk rates of bias.Eight articles were published in the last decade;all came from eastern countries.Patient sample size was extremely heterogenous(n=11-22926).AI methodologies employed included artificial neural networks(ANN)in six studies,as well as support vector machine,artificial plant optimization,and peritumoral radiomics in the remaining three studies.All the studies testing the role of ANN compared the performance of ANN with traditional statistics.Training cohorts were used to train the neural networks that were then applied to validation cohorts.In all cases,the AI models demonstrated superior predictive performance compared with traditional statistics with significantly improved areas under the curve.CONCLUSION AI applied to survival prediction after HCC treatment provided enhanced accuracy compared with conventional linear systems of analysis.Improved transferability and reproducibility will facilitate the widespread use of AI methodologies.
文摘AIM To perform a systematic review and meta-analysis on donor-to-recipient gender mismatch as a risk factor for post-transplant graft loss. METHODS A systematic literature search was performed using PubM ed, Cochrane Library database and EMBASE. The primary outcome was graft loss after liver transplantation. Odds ratios and 95% confidence intervals were calculated to compare the pooled data between groups with different donor-to-recipient gender matches. Three analyses were done considering(1) gender mismatches(F-M and M-F) vs matches(M-M and F-F);(2) Femaleto-Male mismatch vs other matches; and(3) Male-toFemale mismatch vs other matches.RESULTS A total of 7 articles were analysed. Gender mismatch(M-F and F-M) was associated with a significant increase of graft loss respect to match(M-M and F-F)(OR: 1.30; 95%CI: 1.13-1.50; P < 0.001). When F-M mismatch was specifically investigated, it confirmed its detrimental role in terms of graft survival(OR: 1.83; 95%CI: 1.20-2.80; P = 0.005). M-F mismatch failed to present a significant role(OR: 1.09; 95%CI: 0.73-1.62; P = 0.68).CONCLUSION Gender mismatch is a risk factor for poor graft survival after liver transplantation. Female-to-male mismatch represents the worst combination. More studies are needed with the intent to better clarify the reasons for these results.
文摘Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)represents an innovative surgical technique used for the treatment of large hepatic lesions at high risk for post-resection liver failure due to a small future liver remnant.The most significant amount of literature concerns the use of ALPPS for the treatment of hepatocellular carcinoma(HCC),cholangiocarcinoma(CCC),and colorectal liver metastases(CRLM).On the opposite,few is known about the role of ALPPS for the treatment of uncommon liver pathologies.The objective of the present study was to evaluate the current literature on this topic.A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Eligible articles published up to February 2020 were included using the MEDLINE,Scopus,and Cochrane databases.Among the 486 articles screened,45 papers met the inclusion criteria,with 136 described cases of ALPPS for rare indications.These 136 cases were reported in 18 different countries.Only in two countries,namely Germany and Brazil,more than ten cases were observed.As for the ALPPS indications,we reported 41(30.1%)cases of neuroendocrine tumor(NET)metastases,followed by 27(19.9%)cases of gallbladder cancer(GBC),nine(6.6%)pediatric cases,six(4.4%)gastrointestinal stromal tumors,six(4.4%)adult cases of benign primary liver disease,four(2.9%)adult cases of malignant primary liver disease,and 43(31.6%)adult cases of malignant secondary liver disease.According to the International ALPPS Registry data,less than 10%of the ALPPS procedures have been performed for the treatment of uncommon liver pathologies.NET and GBC are the unique pathologies with acceptable numerosity.ALPPS for NET appears to be a safe procedure,with satisfactory long-term results.On the opposite,the results observed for the treatment of GBC are poor.However,these data should be considered with caution.The rationale for treating benign pathologies with ALPPS appears to be weak.No definitive response should be given for all the other pathologies.Multicenter studies are needed with the intent to clarify the potentially beneficial effect of ALPPS for their treatment.
