Aim:We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma recurrence.Methods:We reviewed the data for 26 patients who had tumor recurrence after d...Aim:We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma recurrence.Methods:We reviewed the data for 26 patients who had tumor recurrence after deceased donor liver transplant for hepatocellular carcinoma at the Johns Hopkins Hospital from January 2005 to December 2015.Results:In total,88%of recipients were males.The mean age was 59 years.On explant,poor differentiation was detected in 43%,while 73%had microvascular invasion.Overall,62%were diagnosed to be outside of Milan criteria.Out of these,15%met the criteria for downstaging.Twenty(77%)patients had pre-transplant alpha fetoprotein levels≥20 ng/mL.In 54%of patients,the location of hepatocellular carcinoma(HCC)recurrence was extrahepatic,followed by intrahepatic in 31%and both intra-and extrahepatic in 15%.The post-transplant tumor recurrence was diagnosed at a mean of 427 days(range 34-1502).Fifty percent of HCC recurrences were diagnosed within one year following liver transplant.Twenty(77%)patients received treatment for their recurrent HCC:external radiation(n=10),surgical resections(n=8;brain 4,spine 2,bone 1,and Whipple surgery 1),sorafenib(n=7),locoregional therapy(n=5).Overall,24 out of 26(92%)recipients died within four years after the transplant.Conclusion:HCC recurrence after liver transplant is infrequent.More than fifty percent of HCC recurrences following liver transplant are extrahepatic.Despite better recipient selection for liver transplant,the curative options are limited in recurrent cases and associated with extremely poor outcomes.展开更多
Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for ...Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for organ allocation for liver transplantation.However,there are limited studies to compare the MELD with MELD-Na to predict mortality after TIPS.Methods:We performed a retrospective chart review of patients who underwent TIPS placement between 2006 and 2016 at our institution.The primary outcome was mortality,and the secondary outcomes sought to assess which variables could provide prognostic information for mortality after TIPS placement.We performed receiver operating characteristic(ROC)curve analysis to assess the performance of MELD and MELD-Na.Results:There were 186 eligible patients in the analysis.The mean pre-TIPS MELD and MELD-Na were 13 and 15,respectively.Overall,mortality after TIPS was 15%at 30 days and 16.7%at 90 days.In a comparison of the areas under the ROCs for MELD and MELD-Na,MELD was superior to MELD-Na for 30-day(0.762 vs.0.709)and 90-day(0.780 vs.0.730)mortality after TIPS.The optimal cutoff score for 30-day mortality was 15(0.676–0.848)for MELD and 17(0.610–0.808)for MELD-Na,whereas the optimal cutoff score for 90-day mortality was 16(95%CI:0.705–0.855)for MELD and 17(95%CI:0.643–0.817)for MELDNa.There were 24 patients with high MELD-Na≥17,but with low MELD<15,and 90-day mortality in this group was 8.3%.Conclusions:Although MELD-Na is a superior prognostic tool to MELD for predicting overall mortality in cirrhotic patients,MELD tended to outperform MELD-Na to predict mortality after TIPS.展开更多
基金This Research is partially supported by NIH GrantsR44 CA165312-Development of a urine test for the early detection of liver cancer.U01 CA230690-Pathway Specific Functional Biomarkers for the Early Detection of Liver Cancer
文摘Aim:We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma recurrence.Methods:We reviewed the data for 26 patients who had tumor recurrence after deceased donor liver transplant for hepatocellular carcinoma at the Johns Hopkins Hospital from January 2005 to December 2015.Results:In total,88%of recipients were males.The mean age was 59 years.On explant,poor differentiation was detected in 43%,while 73%had microvascular invasion.Overall,62%were diagnosed to be outside of Milan criteria.Out of these,15%met the criteria for downstaging.Twenty(77%)patients had pre-transplant alpha fetoprotein levels≥20 ng/mL.In 54%of patients,the location of hepatocellular carcinoma(HCC)recurrence was extrahepatic,followed by intrahepatic in 31%and both intra-and extrahepatic in 15%.The post-transplant tumor recurrence was diagnosed at a mean of 427 days(range 34-1502).Fifty percent of HCC recurrences were diagnosed within one year following liver transplant.Twenty(77%)patients received treatment for their recurrent HCC:external radiation(n=10),surgical resections(n=8;brain 4,spine 2,bone 1,and Whipple surgery 1),sorafenib(n=7),locoregional therapy(n=5).Overall,24 out of 26(92%)recipients died within four years after the transplant.Conclusion:HCC recurrence after liver transplant is infrequent.More than fifty percent of HCC recurrences following liver transplant are extrahepatic.Despite better recipient selection for liver transplant,the curative options are limited in recurrent cases and associated with extremely poor outcomes.
文摘Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for organ allocation for liver transplantation.However,there are limited studies to compare the MELD with MELD-Na to predict mortality after TIPS.Methods:We performed a retrospective chart review of patients who underwent TIPS placement between 2006 and 2016 at our institution.The primary outcome was mortality,and the secondary outcomes sought to assess which variables could provide prognostic information for mortality after TIPS placement.We performed receiver operating characteristic(ROC)curve analysis to assess the performance of MELD and MELD-Na.Results:There were 186 eligible patients in the analysis.The mean pre-TIPS MELD and MELD-Na were 13 and 15,respectively.Overall,mortality after TIPS was 15%at 30 days and 16.7%at 90 days.In a comparison of the areas under the ROCs for MELD and MELD-Na,MELD was superior to MELD-Na for 30-day(0.762 vs.0.709)and 90-day(0.780 vs.0.730)mortality after TIPS.The optimal cutoff score for 30-day mortality was 15(0.676–0.848)for MELD and 17(0.610–0.808)for MELD-Na,whereas the optimal cutoff score for 90-day mortality was 16(95%CI:0.705–0.855)for MELD and 17(95%CI:0.643–0.817)for MELDNa.There were 24 patients with high MELD-Na≥17,but with low MELD<15,and 90-day mortality in this group was 8.3%.Conclusions:Although MELD-Na is a superior prognostic tool to MELD for predicting overall mortality in cirrhotic patients,MELD tended to outperform MELD-Na to predict mortality after TIPS.
