Drug-eluting bead transarterial chemoembolization as neoadjuvant therapy pre-liver transplantation for advanced-stage hepatocellular carcinoma

BACKGROUND The objectives of this study were to assess the safety and efficacy of drug-eluting bead transarterial chemoembolization(DEB-TACE)as neoadjuvant therapy before liver transplantation(LT)for advanced-stage hepatocellular carcinoma(HCC)and to analyze the prognostic factors.AIM To determine whether DEB-TACE before LT is superior to LT for advanced-stage HCC.METHODS A total of 99 individuals diagnosed with advanced HCC were studied retrospectively.The participants were categorized into the following two groups based on whether they had received DEB-TACE before LT:DEB-TACE group(n=45)and control group(n=54).The participants were further divided into two subgroups based on the presence or absence of segmental portal vein tumor thrombus(PVTT).The DEB-TACE group consisted of two subgroups:Group A(n=31)without PVTT and group B(n=14)with PVTT.The control group also had two subgroups:Group C(n=37)without PVTT and group D(n=17)with PVTT.Data on patient demographics,disease characteristics,therapy response,and adverse events(AEs)were collected.The overall survival(OS)and recurrence-free survival(RFS)rates were assessed using Kaplan-Meier curves.Univariate and multivariate Cox regression analyses were conducted to determine the parameters that were independently related to OS and RFS.RESULTS The DEB-TACE group exhibited an overall response rate of 86.6%.Following therapy,there was a significant decrease in the median alpha-fetoprotein(AFP)level(275.1 ng/mL vs 41.7 ng/mL,P<0.001).The main AE was post-embolization syndrome.The 2-year rates of RFS and OS were significantly higher in the DEB-TACE group than in the control group(68.9%vs 38.9%,P=0.003;86.7%vs 63.0%,P=0.008).Within the subgroups,group A had higher 2-year rates of RFS and OS compared to group C(71.0%vs 45.9%,P=0.038;83.8%vs 62.2%,P=0.047).The 2-year RFS rate of group B was markedly superior to that of group D(64.3%vs 23.5%,P=0.002).Results from multivariate analyses showed that pre-LT DEB-TACE[hazard ratio(HR)=2.73,95%confidence interval(CI):1.44-5.14,P=0.04],overall target tumor diameter≤7 cm(HR=1.98,95%CI:1.05-3.75,P=0.035),and AFP level≤400 ng/mL(HR=2.34;95%CI:1.30-4.19,P=0.009)were significant risk factors for RFS.Additionally,pre-LT DEBTACE(HR=3.15,95%CI:1.43-6.96,P=0.004)was identified as a significant risk factor for OS.CONCLUSION DEB-TACE is a safe and efficient therapy for advanced-stage HCC and also enhances patient survival after LT.

Changes in intestinal microflora in rats with acute respiratory distress syndrome

AIM:To implement high-throughput 16S rDNA sequencing to study microbial diversity in the fecal matter of rats with acute lung injury/acute respiratory distress syndrome(ALI/ARDS).METHODS:Intratracheal instillation of lipopolysaccharide was used to induce ALI,and the pathological changes in the lungs and intestines were observed.D-lactate levels and diamine oxidase(DAO)activities were determined by enzymatic spectrophotometry.The fragments encompassing V4 16S rDNA hypervariable regions were PCR amplified from fecal samples,and the PCR products of V4 were sequenced by Illumina MiSeq.RESULTS:Increased D-lactate levels and DAO activities were observed in the model group(P<0.01).Sequencing results revealed the presence of 3780 and4142 species in the control and model groups,respectively.The percentage of shared species was 18.8419%.Compared with the control group,the model group had a higher diversity index and a lower number of species of Fusobacteria(at the phylum level),Helicobacter and Roseburia(at the genus level)(P<0.01).Differences in species diversity,structure,distribution and composition were found between the control group and early ARDS group.CONCLUSION:The detection of specific bacteria allows early detection and diagnosis of ALI/ARDS.

Safety and efficacy of an integrated endovascular treatment strategy for early hepatic artery occlusion after liver transplantation

Background:Hepatic artery occlusion(HAO)after liver transplantation(LT)is typically comprised of hepatic artery thrombosis(HAT)and stenosis(HAS),both of which are severe complications that coexist and interdependent.This study aimed to evaluate an integrated endovascular treatment(EVT)strategy for the resolution of early HAO and identify the risk factors associated with early HAO as well as the procedural challenge encountered in the treatment strategy.Methods:Consecutive orthotopic LT recipients(n=366)who underwent transplantation between June 2017 and December 2018 were retrospectively investigated.EVT was performed using an integrated strategy that involved thrombolytic therapy,shunt artery embolization plus vasodilator therapy,percutaneous transluminal angioplasty,and/or stent placement.Simple EVT was defined as the clinical resolution of HAO by one round of EVT with thrombolytic therapy and/or shunt artery embolization plus vasodilator therapy.Otherwise,it was defined as complex EVT.Results:Twenty-six patients(median age 52 years)underwent EVT for early HAO that occurred within 30 days post-LT.The median interval from LT to EVT was 7(6–16)days.Revascularization time(OR=1.027;95%CI:1.005–1.050;P=0.018)and the need for conduit(OR=3.558;95%CI:1.241–10.203,P=0.018)were independent predictors for early HAO.HAT was diagnosed in eight patients,and four out of those presented with concomitant HAS.We achieved 100%technical success and recanalization by performing simple EVT in 19 patients(3 HAT+/HAS-and 16 HAT-/HAS+)and by performing complex EVT in seven patients(1 HAT+/HAS-,4 HAT+/HAS+,and 2 HAT-/HAS+),without major complications.The primary assisted patency rates at 1,6,and 12 months were all 100%.The cumulative overall survival rates at 1,6,and 12 months were 88.5%,88.5%,and 80.8%,respectively.Autologous transfusion<600 mL(94.74%vs.42.86%,P=0.010)and interrupted suture for hepatic artery anastomosis(78.95%vs.14.29%,P=0.005)were more prevalent in simple EVT.Conclusions:The integrated EVT strategy was a feasible approach providing effective resolution with excellent safety for early HAO after LT.Appropriate autologous transfusion and interrupted suture technique helped simplify EVT.

Reply to:Endovascular treatment for early hepatic artery occlusion after liver transplantation:Angioplasty or stent

The Author Reply:We thank Dr.Gastaca et al.for the interest toward our arti-cle and the thoughtful comments.We are willing to further dis-cuss the topic of endovascular treatment(EVT)after liver trans-plantation(LT).Congratulation to their successful experience of EVT.As Dr.Gastaca emphasized,most of the transplant centers,even important centers,are hesitant to perform EVT early after LT[1-3].Their team demonstrated successful experience of EVT treating hepatic artery thrombosis and stenosis during very early period with high patency rates and absence of major complications[4].We strongly agree with Dr.Gastaca’s attitude and admire the novel approach.