Severe thrombocytopenia before liver transplantation is associated with delayed recovery of thrombocytopenia regardless of donor type

AIM: To compare the recovery of thrombocytopenia and splenomegaly during long-term follow-up after liver transplantation in patients receiving a living donor transplant or a cadaveric donor transplant. METHODS: This was a retrospective cohort study of 216 consecutive liver transplant patients who survived for > 6 mo after transplantation; 169 received a liver transplant from a living donor and 47 from a cadaveric donor. The platelet counts or spleen volumes were examined before transplant, 1, 6, and 12 mo after transplant, and then annually until 5 years after transplant. RESULTS: The mean follow-up period was 49 mo (range, 21-66). Platelet counts increased continu-ously for 5 years after orthotopic liver transplant. The restoration of platelet counts after transplant was sig-nificantly slower in patients with severe pretransplant thrombocytopenia (< 50 000/μL) until 4 years after transplant (P = 0.005). Donor type did not significantly affect the recovery of platelet count and spleen vol-ume in either patient group. In multivariate analysis, pretransplant severe thrombocytopenia (< 50 000/μL) was an independent factor associated with sustained thrombocytopenia (P < 0.001, odds ratio 6.314; con-fidence interval, 2.828-14.095). Thrombocytopenia re-appeared after transplant in seven patients with portal flow disturbance near the anastomosis site. CONCLUSION: Our study suggests that severe throm-bocytopenia before transplant is closely associated with delayed recovery of platelet count after transplant and donor type did not affect the recovery of throm-bocytopenia. The reappearance of thrombocytopenia after transplant should be considered a possible indica-tor of flow disturbance in the portal vein.

Sugar, Starch, and Proline in Peach Trees Exposed to Freezing Temperatures during Dehardening

Freezing temperatures cause different levels of freezing injury and change biochemical components of trees. In this study, the range of survival temperature and variation in electrolyte leakage, and in concentrations of sugar, starch, and proline were determined in peach twigs (Jinmi, Changhowonhwangdo, and Kawanakajima Hakuto) exposed to artificially controlled freezing temperature. Freezing temperatures at which the plants were damaged by stress were found to be -21&degC in Jan. and Feb., -18&degC in Mar., and -6&degC in Apr. Electrolyte leakage increased as temperature decreased from -15&degC to -24&degC at each assessment time. Sugar gradually decreased after the endodormancy period in the late part of winter, and sugar concentration was overall lower in freezing temperature treatments, while starch increased as a result of changing seasons from Jan. to Apr. The trend of proline concentration was related to the survival rate of peach trees during winter. This study suggests possible safe temperatures for survival and cultivation of peach trees as well as identifying freezing temperature effects on internal components of freeze-injured peach twigs.

The interplay between direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C

Direct-acting antivirals(DAAs)have been introduced for the treatment of hepatitis C virus,and the sustained virological response rate after DAAs was reported to be over 95%.Because of the high sustained virological response rate,the risk of hepatocellular carcinoma(HCC)was expected to be reduced.However,an unexpected high risk of HCC recurrence after DAA treatment was reported,and thus the dispute about the association of DAA and HCC arose.The present article reviews the interplay between DAAs and HCC.