Liver transplantation as an alternative for the treatment of intrahepatic cholangiocarcinoma: Past, present, and future directions

Intrahepatic cholangiocarcinoma(iCCA)is a rare biliary tract cancer with high mortality rate.Complete resection of the iCCA lesion is the first choice of treatment,with good prognosis after margin-negative resection.Unfortunately,only 12%-40% of patients are eligible for resection at presentation due to cirrhosis,portal hypertension,or large tumor size.Liver transplantation(LT)offers margin-negative iCCA extirpation for patients with unresectable tumors.Initially,iCCA was a contraindication for LT until size-based selection criteria were introduced to identify patients with satisfied post-LT outcomes.Recent studies have shown that tumor biology-based selection can yield high post-LT survival in patients with locally advanced iCCA.Another selection criterion is the tumor response to neoadjuvant therapy.Patients with response to neoadjuvant therapy have better outcomes after LT compared with those without tumor response to neoadjuvant therapy.Another index that helps predict the treatment outcome is the biomarker.Improved survival outcomes have also opened the door for living donor LT for iCCA.Patients undergoing LT for iCCA now have statistically similar survival rates as patients undergoing resection.The combination of surgery and locoregional and systemic therapies improves the prognosis of iCCA patients.

Women’s health issues in solid organ transplantation:Breast and gynecologic cancers in the post-transplant population

The success of solid organ transplant has steadily improved which has led to a unique set of post-transplant issues.The rates of de novo cancer in the solid organ transplant recipient population are higher than those in the general population.There is growing evidence that breast and gynecologic cancers may have a higher mortality rate in post-transplant patients.Cervical and vulvovaginal cancers specifically have a significantly higher mortality in this population.Despite this increased mortality risk,there is currently no consistent standard in screening and identifying these cancers in post-transplant patients.Breast,ovarian and endometrial cancers do not appear to have significantly increased incidence.However,the data on these cancers remains limited.Further studies are needed to determine if more aggressive screening strategies would be of benefit for these cancers.Here we review the cancer incidence,mortality risk and current screening methods associated with breast and gynecologic cancers in the post-solid organ transplant population.

Viral hepatitis:A narrative review of hepatitis A–E

Viral hepatitis continues to be a major health concern leading to hepatic decompensation ranging from acute hepatitis to cirrhosis and hepatocellular carcinoma.The hepatic and extrahepatic manifestations are not only debilitating but also associated with a significant economic burden.Over the last two decades,the field of virology has made significant breakthroughs leading to a better understanding of the pathophysiology of viral hepatitis,which in turn has led to new therapeutic options.The advent of direct-acting antiviral agents changed the landscape of hepatitis C virus(HCV)therapy,and new drugs are in the pipeline for chronic hepatitis B virus(HBV)treatment.There has also been a significant emphasis on screening and surveillance programs,widespread availability of vaccines,and linkage of care.Despite these efforts,significant gaps persist in care,and there is a pressing need for increased collaboration and teamwork across the globe to achieve a reduction of disease burden and elimination of HBV and HCV.

Nonalcoholic Fatty Liver Disease after Liver Transplant

Nonalcoholic fatty liver disease(NAFLD)is one of the most common causes of chronic liver disease in the world.The rising prevalence of nonalcoholic steatohepatitis(NASH)has led to a 170%increase in NASH cirrhosis as the listing indication for liver transplantation from 2004 to 2013.As of 2018,NASH has overtaken hepatitis C as an indication for liver transplantation in the USA.After liver transplantation,the allograft often develops recurrent NAFLD among patients with known NASH cirrhosis.In addition to recurrent disease,de novo NAFLD has been reported in patients with other indications for liver transplantation.In this review,we will discuss the risk factors associated with recurrent and de novo NAFLD,natural course of the disease,and management strategies after liver transplantation.

Potent suppression of hepatitis B virus and hepatocellular carcinoma: how long is good enough?

Approximately one third of the world's population has serological evidence of past or present infection with hepatitis B virus (HBV). The natural history of chronic HBV infection, ranges from an inactive carrier state to progressive chronic hepatitis B (CHB), which may evolve to cirrhosis and hepatocellular carcinoma (HCC) (1,2). HBV-related end stage liver disease is responsible for over 0.5–1 million deaths per year and currently represent 5–10% of cases of liver transplantation (1). Many factors can potentially induce development of HCC in HBV infected patients. These are (I) chronic necroinflammatory activity induced by immune response to the virus, (II) apoptosis of cells with cellular damage resulting in dysplasia of the hepatocytes, and (III) direct oncogenic potential of HBV with integration of its DNA with the host DNA.