Impact of treatment modalities on patients with recurrent hepatocellular carcinoma after liver transplantation:Preliminary experience

Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods:A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study.Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Results:Of the 64 patients with recurrent HCC after LT,those who received radical resection followed by nonsurgical therapy had a median overall survival(OS)of 20.9 months after HCC recurrence,significantly superior to patients who received only nonsurgical therapy(9.4 months)or best supportive care(2.4 months).The one-and two-year OS following recurrence was favorable for patients receiving radical resection followed by nonsurgical therapy(93.8%,52.6%),poor for patients receiving only nonsurgical therapy(30.8%,10.8%),and dismal for patients receiving best supportive care(0%,0%;overall P<0.001).Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months,far surpassing the patients that discontinued sorafenib or were treated with regorafenib after sorafenib failure(12 months,P<0.001).Compared with tacrolimus-based immunosuppressive therapy,OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence(P=0.035).Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival.Conclusions:Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence.A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.

Clinical practice guidelines on liver transplantation for hepatocellular carcinoma in China(2018 edition)

Introduction Over 300000 people in China die each year of hepatocellular carcinoma(HCC),which accounts for approximately half of HCCrelated deaths worldwide.Liver transplantation(LT)is generally recognized as one of the most effective therapeutic approaches for end-stage liver diseases.Since the beginning of the second LT boom in the 1990s,LT in China has been developed rapidly with professional and large-scale trends,and it is approaching or has reached the level of developed countries in terms of quantity and quality.According to the China Liver Transplant Registry,the number of transplants for HCC accounted for 36.8%of the total number of LT cases during the past 5 years in the mainland of China.In order to develop an effective,safe and standardized protocol to guide the national LT practice,the clinical guidelines of LT for HCC was launched in 2014 by multidisciplinary experts from Chinese Society of Organ Transplantation,Chinese Medical Association and Chinese Association of Organ Transplantation,Chinese Medical Doctor Association.Recently,there have been new clinical and scientific advances in the field of LT and to keep abreast of these achievements,the original clinical practice guidelines need to be updated.

Torin2 overcomes sorafenib resistance via suppressing mTORC2-AKT-BAD pathway in hepatocellular carcinoma cells

Background:Sorafenib is an oral multi-kinase inhibitor that was approved by the US Food and Drug Administration for the treatment of patients with advanced hepatocellular carcinoma(HCC).However,resistance to sorafenib is an urgent problem to be resolved to improve the therapeutic efficacy of sorafenib.As the activation of AKT/mTOR played a pivotal role in sorafenib resistance,we evaluated the effect of a dual mTOR complex 1/2 inhibitor Torin2 on overcoming the sorafenib resistance in HCC cells.Methods:The sorafenib-resistant Huh7 and Hep3B cell lines were established from their parental cell lines.The synergistic effect of sorafenib and Torin2 on these cells was measured by cell viability assay and quantified using the Chou-Talalay method.Apoptosis induced by the combination of sorafenib and Torin2 and the alteration in the specific signaling pathways of interest were detected by Western blotting.Results:Sorafenib treatment inversely inhibited AKT in parental but activated AKT in sorafenib-resistant Huh7 and Hep3B HCC cells,which underscores the significance of AKT activation.Torin2 and sorafenib synergistically suppressed the viability of sorafenib-resistant cells via apoptosis induction.Torin2 successfully suppressed the sorafenib-activated mTORC2-AKT axis,leading to the dephosphorylation of Ser136 in BAD protein,and increased the expression of total BAD,which contributed to the apoptosis in sorafenibresistant HCC cells.Conclusions:In this study,Torin2 and sorafenib showed synergistic cytostatic capacity in sorafenibresistant HCC cells,via the suppression of mTORC2-AKT-BAD pathway.Our results suggest a novel strategy of drug combination for overcoming sorafenib resistance in HCC.

Gastrointestinal tract post-transplant lymphoproliferative disorder after liver transplantation

To the Editor:Post-transplant lymphoproliferative disorder（PTLD）is a rare and potentially fatal complication occurring after all types of solid organ transplantation.;PTLD accounts for 20%of all de novo post-transplant tumors.;The most important risk factors for PTLD are prolonged intense immunosuppression and Epstein-Barr virus（EBV）

Liver transplantation in a patient with massive polycystic liver disease

Polycystic liver disease(PLD)is a genetic disorder[1]that is di-agnosed by presence of multiple hepatic cysts.Clinical manifesta-tions of PLD are related to the size of hepatic cysts and associated complications.In the early stage,PLD rarely causes any symptoms.However,patients with advanced stage PLD have a variety of clin-ical manifestations and complications due to severe hepatomegaly.They include abdominal pain,abdominal distension,dyspepsia,as-cites and many others that may result from compression of ad-jacent tissue or organ failure[2,3].Surgical treatment of PLD in-cludes:aspiration with or without sclerotherapy,cyst fenestration,hepatectomy and liver transplantation.Despite some researchers have concluded that cyst fenestration or hepatectomy is effective in treatment of PLD[4–6],the only curative surgical option in se-vere patients is liver transplantation[7,8].All other types of surg-eries present a great challenge to a surgeon,having little or no ef-fect when cysts are diffuse,or even contraindicated due to possi-bility of life-threatening complications arising during or after the procedure.Herein,we report a case of 51-year-old male diagnosed with massive PLD complicated by abdominal adhesion,liver cirrho-sis,splanchnic varices and ascites that successfully underwent liver transplantation.