Risk factors for bile leakage after hepatectomy

In the current issue,Panaro et al^([1])presented a retrospective single-center study on 411 hepatectomies for benign and malignant liver tumors.After exclusion of hilar cholangiocarcinomas and hepatectomies with simultaneous biliary or pancreatic resection,risk factors for postoperative bile leakage were analyzed.Progress

Hepatotropic growth factors protect hepatocytes during inflammation by upregulation of antioxidative systems

AIM:To investigate effects of hepatotropic growth factors on radical production in rat hepatocytes during sepsis.METHODS:Rat hepatocytes,isolated by collagenase perfusion,were incubated with a lipopolysaccharide(LPS)-containing cytokine mixture of interleukin-1β,tumor necrosis factor-α and interferon-γ to simulate sepsis and either co-incubated or pre-incubated with hepatotropic growth factors,e.g.hepatocyte growth factor,epidermal growth factor and/or transforming growth factor-α.Cells were analyzed for glutathione levels.Culture supernatants were assayed for produc-tion of reactive oxygen intermediates(ROIs) as well as NO2-,NO3-and S-nitrosothiols.To determine cellular damage,release of aspartate aminotransferase(AST) into the culture medium was analyzed.Activation of nuclear factor(NF)-κB was measured by electrophoretic mobility shift assay.RESULTS:Rat hepatocytes treated with the LPS-containing cytokine mixture showed a significant increase in ROI and nitrogen oxide intermediate formation.AST leakage was not significantly increased in cells treated with the LPS-containing cytokine mixture,independent of growth-factor co-stimulation.However,pretreatment with growth factors significantly reduced AST leakage and ROI formation while increasing cellular glutathione.Application of growth factors did not result in increased NF-κB activation.Pretreatment with growth factors further increased formation of NO2-,NO3-and S-nitrosothiols in hepatocytes stimulated with LPS-containing cytokine mixture.Thus,we propose that,together with an increase in glutathione increased NO2-,NO3-formation might shift their metabolism towards non-toxic products.CONCLUSION:Our data suggest that hepatotropic growth factors positively influence sepsis-induced hepatocellular injury by reducing cytotoxic ROI formation via induction of the cellular protective antioxidative systems.

Evaluating twenty-years of follow-up after orthotopic liver transplantation, best practice for donor-recipient matching: What can we learn from the past era?

AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.

The CRAFITY score can identify patients with hepatocellular carcinoma showing poor response to treatment with atezolizumab and bevacizumab

With great interest we have read the comment of Dr.Khakoo on the recently published CRAFITY score for the prediction of response to anti-programmed death(ligand)1[PD-(L)1]-based immunotherapy in patients with unresectable hepatocellular carcinoma(HCC)(1).

Intraoperative reperfusion assessment of human pancreas allografts using hyperspectral imaging(HSI)

Background:The most common causes of early graft loss in pancreas transplantation are insufficient blood supply and leakage of the intestinal anastomosis.Therefore,it is critical to monitor graft perfusion and oxygenation during the early post-transplant period.The goal of our pilot study was to evaluate the utility of hyperspectral imaging(HSI)in monitoring the microcirculation of the graft and adequate perfusion of the intestinal anastomosis during pancreatic allotransplantation.Methods:We imaged pancreatic grafts and intestinal anastomosis in real-time in three consecutive,simultaneous pancreas-kidney transplantations using the TIVITA®HSI system.Further,the intraoperative oxygen saturation(StO_(2)),tissue perfusion(near-infrared perfusion index,NIR),organ hemoglobin index(OHI),and tissue water index(TWI)were measured 15 minutes after reperfusion by HSI.Results:All pancreas grafts showed a high and homogeneous StO_(2)(92.6%±10.45%).Intraoperative HSI analysis of the intestinal anastomosis displayed significant differences of StO_(2)(graft duodenum 67.46%±5.60%vs.recipient jejunum:75.93%±4.71%,P<0.001)and TWI{graft duodenum:0.63±0.09[I(Index)]vs.recipient jejunum:0.72±0.09[I],P<0.001}.NIR and OHI did not display remarkable differences{NIR duodenum:0.68±0.06[I]vs.NIR jejunum:0.69±0.04[I],P=0.747;OHI duodenum:0.70±0.12[I]vs.OHI jejunum:0.68±0.13[I],P=0.449}.All 3 patients had an uneventful postoperative course with one displaying a Banff 1a rejection which was responsive to steroid treatment.Conclusions:Our study shows that contact-free HSI has potential utility as a novel tool for real-time monitoring of human pancreatic grafts after reperfusion,which could improve the outcome of pancreas transplantation.Further investigations are required to determine the predictive value of intraoperative HSI imaging.