Transit time ultrasound perivascular flow probe technology is superior to MR imaging on hepatic blood flow measurement in a porcine model

Background: The hepatic hemodynamics is an essential parameter in surgical planning as well as in various disease processes. The transit time ultrasound(TTUS) perivascular flow probe technology is widely used in clinical practice to evaluate the hepatic inflow, yet invasive. The phase-contrast-MRI(PC-MRI) is not invasive and potentially applicable in assessing the hepatic blood flow. In the present study, we compared the hepatic inflow rates using the PC-MRI and the TTUS probe, and evaluated their predictive value of post-hepatectomy adverse events. Methods: Eighteen large white pigs were anaesthetized for PC-MRI and approximately 75% hepatic resection was performed under a unified protocol. The blood flow was measured in the hepatic artery(Qha), the portal vein(Qpv), and the aorta above the celiac trunk(Qca) using PC-MRI, and was compared to the TTUS probe. The Bland-Altman method was conducted and a partial least squares regression(PLS) model was implemented. Results: The mean Qpv measured in PC-MRI was 0.55 ± 0.12 L/min, and in the TTUS probe was 0.74 ± 0.17 L/min. Qca was 1.40 ± 0.47 L/min in the PC-MRI and 2.00 ± 0.60 L/min in the TTUS probe. Qha was 0.17 ± 0.10 L/min in the PC-MRI, and 0.13 ± 0.06 L/min in the TTUS probe. The Bland-Altman method revealed that the estimated bias of Qca in the PC-MRI was 32%(95% CI:-49% to 15%); Qha 17%(95% CI:-15% to 51%); and Qpv 40%(95% CI:-62% to 18%). The TTUS probe had a higher weight in predicting adverse outcomes after 75% resection compared to the PC-MRI( β= 0.35 and 0.43 vs β = 0.22 and 0.07, for tissue changes and premature death, respectively). Conclusions: There is a tendency of the PC-MRI to underestimate the flow measured by the TTUS probes. The TTUS probe measures are more predictive of relevant post-hepatectomy outcomes.

Clinical anatomy of hepatic vessels by computed tomography angiography:A minireview

The liver has a complex vascular anatomy with a unique dual blood supply.Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma.In most vascular disorders,the effects on the liver are generally subclinical because of its abundant blood supply.However,early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality.Because imaging findings of vascular disease are not always readily apparent,diagnosis can be difficult.Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning.In this review article,we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

AIM: To evaluate the prognostic factors and efficacy of hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis. METHODS: Fifty hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) were treated using hepatic arterial infusion chemotherapy (HAIC) via a subcutaneously implanted port. The epirubicin-cisplatin-5-fluorouracil (ECF) chemotherapeutic regimen consisted of 35 mg/m 2 epirubicin on day 1, 60 mg/m 2 cisplatin for 2 h on day 2, and 500 mg/m 2 5-fluorouracil for 5 h on days 1-3. The treatments were repeated every 3 or 4 wk. RESULTS: Three (6%) of the 50 patients achieved a complete response (CR), 13 (26%) showed partial responses (PR), and 22 (44%) had stable disease (SD).The median survival and time to progression were 7 and 2 mo, respectively. After 2 cycles of HAIC, CR was achieved in 1 patient (2%), PR in 10 patients (20%) and SD in 26 patients (52%). Significant pre-treatment prognostic factors were a tumor volume of < 400 cm 3 (P = 0.01) and normal levels of protein induced by vitamin K absence or antagonist (PIVKA)-Ⅱ (P = 0.022). After 2 cycles of treatment, disease control (CR + PR + SD) (P = 0.001), PVTT response (P = 0.003) and α-fetoprotein reduction of over 50% (P = 0.02) were independent factors for survival. Objective response (CR + PR), disease control, PVTT response, and combination therapy during the HAIC were also significant prognostic factors. Adverse events were tolerable and successfully managed. CONCLUSION: HAIC may be an effective treatment modality for advanced HCC with PVTT in patients with tumors < 400 cm 3 and good prognostic factors.

Transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed for hepatocellular carcinoma with major portal vein tumor thrombus

AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma(HCC) with major portal vein tumor thrombus(MPVTT).METHODS eighty-six patients with MPVTT accepted routine embolization. The catheter was kept in the hepatic artery and oxaliplatin(50 mg in 250 m L of glucose) was infused by pump for 4 h,followed by raltitrexed(2 mg in 100 m L of 0.9% saline) infusion by pump for the next 1 h. The efficacy and safety were evaluated afterthe transarterial chemoembolization(TACe).RESULTS Full or partial embolization was achieved in 86 cases,where all the cases received low dose continuous hepatic arterial infusion chemotherapy. Complete responses(CRs),partial responses(PRs),stable disease(SD),and disease progression(PD) for intrahepatic disease were observed in 0,45,20,and 21 patients,respectively. The 1-,2-and 3-year overall survival rates of the 86 patients were 40.7%,22.1%,and 8.1% respectively,and the median survival time was 8.7 mo. Complication was limited. CONCLUSION TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be an option in MPVTT patient; it was shown to be effective in patients with advanced HCC with MPVTT with less toxicity.

Efficacy of 5-Fluorouracil and High-Concentration Cisplatin Suspended in Lipiodol by Short-Term Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Background: Since advanced hepatocellular carcinoma (HCC) is potentially fatal, and patients’ quality of life (QOL) often deteriorates during their treatment, improving the prognosis and QOL of patients given chemotherapy is very important. In addition, cost-effective treatments are highly desirable when chemotherapy must be given repeatedly. The aim of this study was to evaluate the efficacy and usefulness of 5-fluorouracil (5-FU) and high-concentration cisplatin by short-term hepatic arterial infusion chemotherapy (3-day FPL) in advanced HCC patients. Methods: Thirty patients with unresectable advanced HCC were enrolled. The patients underwent hepatic arterial infusion chemotherapy via the implanted port system with 5-FU on days 1 - 3 and a fine-powder formulation of cisplatin in suspended pre-warmed lipiodol on day 2 every 4 to 10 weeks. Tumor response was assessed one month later with CT. Results: All patients had evidence of portal vein invasion (Vp2-4). Four patients achieved a complete response (CR), 8 patients achieved a partial response (PR), and 7 patients had stable disease (SD). The median progression-free survival (PFS) and overall survival (OS) were 198 days and 452 days, respectively. The OS was significantly longer in the successful disease control group (CR, PR, and SD) than in the progressive disease group (P < 0.005). Conclusions: Three-day FPL was effective and tolerable in advanced HCC patients due to its shorter time of administration than conventional FP therapy. Therefore, repetitive 3-day FPL appears useful and contributes to improving the prognosis and QOL of patients with advanced HCC. In addition, this protocol is a cost-effective treatment.

More Peripheral Visualization of Hepatic Arteries by Using Respiratory-Triggered 3D True Steady-State Free-Precession Projection Magnetic Resonance Angiographic Sequences with Time-Spatial Labeling Inversion Pulse

Purpose: To evaluate respiratory-triggered three-dimensional (3D) true steady-state free-precession (SSFP) projection magnetic resonance angiographic sequences with time-spatial labeling inversion pulse (Time-SLIP) for visualizing the hepatic arteries and to optimize the image acquisition protocol. Materials and Methods: A 1.5-T clinical magnetic resonance imager was used to perform abdominal magnetic resonance angiography (MRA) in 25 consecutive patients before transcatheter arterial chemoembolization or surgery. We compared two selective space-labeling inversion pulse (tag pulse) patterns (Patterns I and II, oblique and parallel tag pulses, respectively). Two experienced radiologists evaluated the number of hepatic arterial branches visible on the acquired MRA images, and the results were referenced with those on images from intra-arterial digital subtraction angiography. Results: Images were acquired from all patients. The two radiologists clearly visualized branches of the left and right hepatic arteries. More peripheral hepatic arterial branches were identified in MRA images captured by using tag pulse Pattern I than in those acquired by using Pattern II (P P > 0.05). Conclusion: Non-contrast-enhanced Time-SLIP hepatic MRA with true SSFP allowed selective visualization of peripheral hepatic vessels.

Efficacy of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma

AIM:To investigate the efficacy of hepatic arterial infusion chemotherapy(HAIC) using floxuridine(FUDR) in patients with advanced hepatocellular carcinoma(HCC) confined to the liver.METHODS:Thirty-four patients who had advanced HCC with unresectability or unsuccessful previous therapy in the absence of extrahepatic metastasis were treated with intra-arterial FUDR chemotherapy at ourhospital between March 2005 and May 2008.Among the 34 patients,9 patients were classified as Child class C,and 18 patients had portal vein tumor thrombus(PVTT).One course of chemotherapy consisted of continuous infusion of FUDR(0.3 mg/kg during day 1-14) and dexamethasone(10 mg on day 1,4,7 and 11),and this treatment was repeated every 28 d.RESULTS:Two patients(5.9%) displayed a complete response,and 12 patients(35.3%) had a partial response.The tumor control rate was 61.8%.The median overall survival times were 15.3 mo,12.4 mo and 4.3 mo for the patients who were classified as Child class A,Child class B and Child class C,respectively(P = 0.0392).The progression-free survival was 12.9 mo,7.7 mo and 2.6 mo for the patients who were classified as Child class A,Child class B and Child class C,respectively(P = 0.0443).The cumulative survival differed significantly according to the Child-Pugh classification and the presence of PVTT.In addition to hepatic reserve capacity and PVTT,the extent of HCC was an independent factor in determining a poor prognosis.The most common adverse reactions to HAIC were mucositis,diarrhea and peptic ulcer disease,but most of these complications were improved by medical treatment and/or a delay of HAIC.CONCLUSION:The present study demonstrates that intra-arterial FUDR chemotherapy is a safe and effective treatment for advanced HCC that is recalcitrant to other therapeutic modalities,even in patients with advanced cirrhosis.

Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus

The prognosis of patients with hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT) is generally poor if left untreated: a median survival time of 2.7-4.0 mo has been reported. Furthermore, while transcatheter arterial chemoembolization (TACE) has been shown to be safe in selected patients, the median survival time with this treatment is still only 3.8-9.5 mo. Systemic single-agent chemotherapy for HCC with PVTT has failed to improve the prognosis, and the response rates have been less than 20%. While regional chemotherapy with low-dose cisplatin and 5-fluorouracil or interferon and 5-fluorouracil via hepatic arterial infusion has increased the response rate, the median survival time has not exceeded 12 (range 4.5-11.8) mo. Combined treatment consisting of radiation for PVTT and TACE for liver tumor has achieved a high response rate, but the median survival rates have still been only 3.8-10.7 mo. With hepatic resection as monotherapy, the 5-year survival rate and median survival time were reportedly 4%-28.5% and 6-14 mo. The most promising results were reported for combined treatments consisting of hepatectomy and TACE, chemotherapy, or internal radiation. The reported 5-year survival rates and median survival times were 42% and 31 mo for TACE followed by hepatectomy; 36.3% and 22.1 mo for hepatectomy followed by hepatic arterial infusion chemotherapy; and 56% for chemotherapy or internal radiation followed by hepatectomy.

Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is very poor although sorafenib is recommended as the first-line treatment. Therefore, an effective treatment regime is needed for treating HCC with PVTT. This review summarized seven potential treatment regimes which including transarterial chemoembolization (TACE), TACE combined with sorafenib, TACE combined with radiotherapy (RT), hepatectomy, hepatic arterial infusion chemotherapy (HAIC), HAIC combined with sorafenib and HAIC combined with RT in the treatment of HCC with PVTT. In conclusion, hepatectomy or the combination of HAIC and sorafenib may be a more effective modality in the treatment of HCC patients with type I - II PVTT. HAIC combined with or without sorafenib/RT or the combination of RT and TACE is an alternative treatment choice for HCC patients with type III - IV PVTT. Further randomized controlled studies are warranted.

Multimodality treatment in hepatocellular carcinoma patients with tumor thrombi in portal vein

AIM To compare the therapeutic effect andsignificances of multimodality treatment forhepatocellular carcinoma (HCC) with tumorthrombi in portal vein (PVTT).METHODS HCC patients (n = 147) with tumortrombi in the main portal vein or the first branchof portal vein were divided into four groups bythe several therapeutic methods. There wereconservative treatment group in 18 out ofpatients (group A); and hepatic artery ligation(HAL) and/or hepatic artery infusion (HAl)group in 18 patients (group B), in whompostoberative chemoembolization was doneperiodically; group of removal of HCC with PVTTin 79 (group C) and group of transcatheterhepatic arterial chemoembolization (TACE) orHAl and/or portal vein infusion (PVI) afteroperation in 32 (group D).RESULTS The median survival period was 12months in our series and the 1-, 3-, and 5-yearsurvival rates were 44.3%, 24.5% and 15.2%,respectively. The median survival times were 2,5, 12 and 16 months in group A, B, C and D,respectively. The 1-, 3- and 5-year survival rateswere 5.6%, 0% and 0% in group A; 22.2%,5.6% and 0% in group B; 53.9%, 26.9% and16.6% in group C; 79.3%, 38.9% and 26.8% ingroup D, respectively. Significant differenceappeared in the survival rates among the groups(P＜0.05).CONCLUSION Hepatic resection with removalof tumor thrombi and HCC should increase thecurative effects and be encouraged for theprolongation of life span and quality of life forHCC patients with PVTT, whereas the besttherapeutic method for HCC with PVTT is withregional hepatic chemotherapy orchemoemblization after hepatic resection withremoval of tumor thrombi.

Color Doppler sonography and angioscintigraphy in hepatic Hodgkin's lymphoma

AIM:To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography (HRA) in secondary Hodgkin's hepatic lymphoma.METHODS:The research included patients with a diagnosis of Hodgkin's lymphoma with metastatic focal lesions in the liver and controls.Morphologic characteristics of focal liver lesions and hemodynamic parameters were examined by pulsed and Color Doppler in the portal,hepatic and splenic veins were examined.Hepatic perfusion index (HPI) estimated by HRA was calculated.RESULTS:In the majority of patients,hepatomegaly was observed.Lesions were mostly hypoechoic and mixed,solitary or multiple.Some of the patients presented with dilated splenic veins and hepatofugal blood flow.A pulse wave was registered in the centre and at the margins of lymphoma.The average velocity of the pulse wave was higher at the margins (P>0.05).A continuous venous wave was found only at the margins of lymphoma.There was no linear correlation between lymphoma size and velocity of pulse and continuous wave (r=390,P<0.01).HPI was significantly lower in patients with lymphomas than in controls (P<0.05),pointing out increased arterial perfusion in comparison to portal perfusion.CONCLUSION:Color Doppler ultrasonography is a sensitive method for the detection of neovascularization in Hodgkin's hepatic lymphoma and estimation of its intensity.Hepatic radionuclide angiography can additionally help in the assesment of vascularisation of liver lesions.

Dual transformation therapy for giant hepatocellular carcinoma: Two case reports and review of literature

BACKGROUND In the translational therapy of giant hepatocellular carcinoma(HCC),hepatic arterial infusion chemotherapy(HAIC)combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors(TKI)after laparoscopic portal vein ligation(PVL)is extremely rare.This is a dual conversion therapy that combines surgery and oncology.Here,we report two cases of successful surgical completion after dual conversion therapy.CASE SUMMARY We report that a 54-year-old man and a 69-year-old woman were diagnosed with primary HCC combined with hepatitis B cirrhosis(case 2 also combined with fatty liver)on physical examination.Due to the insufficient residual liver volume assessed before surgery,laparoscopic right PVL was performed,followed by HAIC combined with anti-PD-1 immunotherapy and TKI.Finally,surgical resection was successfully completed,and pathology confirmed that the tumor was mostly necrotic(90%)in one case,and no live tumor tissue was found in the other case.CONCLUSION In the process of surgical transformation,our treatment plan takes into account the control and transformation of oncology at the same time,which is expected to provide more opportunities for radical hepatectomy and improve the prognosis of patients with large liver cancer.

PD-1抗体联合胸腺肽α1、肝动脉灌注化疗治疗原发性肝癌合并门静脉癌栓的疗效观察

目的探究程序性死亡蛋白-1(PD-1)抗体联合胸腺肽α1、肝动脉灌注化疗(HAIC)治疗原发性肝癌合并门静脉癌栓(PVTT)的疗效。方法选择2021年8月—2022年8月石家庄市第五医院介入医学科治疗的原发性肝癌合并PVTT患者50例,以随机数字表法分为PD-1组(n=25)和对照组(n=25)。对照组给予胸腺肽α1与HAIC治疗,PD-1组给予PD-1抗体联合胸腺肽α1、HAIC治疗。比较2组患者客观缓解率、肝功能指标、血清肿瘤标志物、免疫功能指标。结果PD-1组的客观缓解率高于对照组(48.00%vs.20.00%,χ^(2)/P=4.367/0.037)。治疗6周、12周后,2组Alb均升高,TBil、ALT均降低,且治疗12周后PD-1组升高/降低幅度显著大于对照组(t/P=2.897/0.006、3.424/<0.001、2.658/<0.001);2组患者甲胎蛋白(AFP)、胰岛素样生长因子结合蛋白-2(IGFBP-2)均降低,且治疗12周后PD-1组低于对照组(t/P=3.934/<0.001、5.992/<0.001);2组患者CD8^(+)均降低,CD4^(+)/CD8^(+)均升高,且治疗12周后PD-1组降低/升高幅度大于对照组(t/P=3.110/<0.001、2.414/0.020)。结论PD-1抗体联合胸腺肽α1、HAIC治疗能够改善原发性肝癌合并PVTT患者的肝功能和免疫功能,降低血清肿瘤标志物水平,延缓肿瘤进展,疗效显著。

双源CT双动脉期增强扫描对肝动脉-门静脉瘘的评估价值及风险因素分析

目的:探讨双源CT双动脉期增强扫描模式对肝动脉-门静脉瘘(HAPVF)的评估价值及风险因素分析。方法:选取HAPVF和非HAPVF患者各60例,分别为HAPVF组和非HAPVF组,行双源CT双动脉期增强扫描,比较2组临床指标及CT征象差异。以DSA为金标准,对比动脉早期、动脉晚期和双动脉期对HAPVF的诊断敏感度、特异度,以及对HAPVF分型的诊断准确率。应用logistic回归分析探讨HAPVF的危险因素,采用ROC曲线评估危险因素预测HAPVF的价值。结果:双动脉期诊断HAPVF的敏感度、特异度、阳性预测值、阴性预测值及分型准确率均明显高于单独2期(均P<0.05)。2组肝癌大小、包膜类型、门静脉癌栓比较,差异均有统计学意义(均P<0.05)。logistic回归分析显示,肝癌大小、包膜类型、门静脉癌栓均是HAPVF的独立危险因素。ROC曲线表明,单因素预测HAPVF效果最好的是包膜类型,其次是门静脉癌栓,再次是肝癌大小。综合多因素联合预测分析显示,肝癌大小+包膜类型+门静脉癌栓预测效果最好。结论:双源CT双动脉期增强扫描模式对HAPVF的诊断敏感度、特异度较高,且在HAPVF分型中具有较好的诊断效果。HAPVF的临床及影像学征象具有一定特点,其中肝癌大小、包膜类型、门静脉癌栓均是HAPVF的独立危险因素,三者联合预测效果最好,能为临床及时诊治提供可靠依据。

预见性护理预防肝动脉化疗栓塞术后深静脉血栓形成的效果分析

目的:分析预见性护理预防肝动脉化疗栓塞术(TACE)后深静脉血栓形成(DVT)的效果。方法:选取2022年1月—2023年5月复旦大学附属中山医院青浦分院收治的拟行TACE治疗的原发性肝癌患者82例作为研究对象,采用随机数字表法分为对照组与试验组,各41例。对照组开展常规围术期护理,试验组在对照组基础上开展预见性护理干预。比较两组心理状况、疼痛程度及DVT发生情况。结果:术后1 d,两组汉密尔顿焦虑量表(HAMA)评分比较,差异无统计学意义(P>0.05);术后3 d,两组HAMA评分低于术后1 d,且试验组低于对照组,差异有统计学意义(P<0.001)。术后1 d,两组视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);术后2 d、3 d,两组VAS评分低于术后1 d,且试验组低于对照组,差异有统计学意义(P<0.05)。试验组DVT发生率低于对照组,差异有统计学意义(P=0.040)。结论:预见性护理应用于TACE围术期护理中可缓解患者焦虑情绪,减轻疼痛,降低DVT发生率。

Treatment of hepatocellular carcinoma with portal venous tumor thrombosis: A comprehensive review

The natural history of hepatocellular carcinoma(HCC)with portal vein tumor thrombosis(PVTT)is dismal(approximately 2-4 mo),and PVTT is reportedly found in 10%-40%of HCC patients at diagnosis.According to the Barcelona Clinic Liver Cancer(BCLC)Staging System(which is the most widely adopted HCC management guideline),sorafenib is the standard of care for advanced HCC(i.e.,BCLC stage C)and the presence of PVTT is included in this category.However,sorafenib treatment only marginally prolongs patient survival and,notably,its therapeutic efficacy is reduced in patients with PVTT.In this context,there have been diverse efforts to develop alternatives to current standard systemic chemotherapies or combination treatment options.To date,many studies on transarterial chemoembolization,3-dimensional conformal radiotherapy,hepatic arterial chemotherapy,and transarterial radioembolization report better overall survival than sorafenib therapy alone,but their outcomes need to be verified in future prospective,randomized controlled studies in order to be incorporated into current treatment guidelines.Additionally,combination strategies have been applied to treat HCC patients with PVTT,with the hope that the possible synergistic actions among different treatment modalities would provide promising results.This narrative review describes the current status of the management options for HCC with PVTT,with a focus on overall survival.

Combined vascular resection and analysis of prognostic factors for hilar cholangiocarcinoma

BACKGROUND： Hilar cholangiocarcinoma （HCCA） is a devastating malignancy arising from the bifurcation of the hepatic duct, whether combined vascular resection benefits HCCA patients is controversial. This study was undertaken to assess the effect of combined vascular resection in HCCA patients and to analyze the prognostic factors.

Intraoperative thromboelastography as a tool to predict postoperative thrombosis during liver transplantation

BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients.Early postoperative portal vein thrombosis(PVT,incidence 2%-2.6%)and early hepatic artery thrombosis(HAT,incidence 3%-5%)have a poor prognosis in transplant patients,having impacts on graft and patient survival.In the present study,we attempted to identify the predictive factors of these complications for early detection and therefore monitor more closely the patients most at risk of thrombotic complications.AIM To investigate whether intraoperative thromboelastography(TEG)is useful in detecting the risk of early postoperative HAT and PVT in patients undergoing liver transplantation(LT).METHODS We retrospectively collected thromboelastographic traces,in addition to known risk factors(cold ischemic time,intraoperative requirement for red blood cells and fresh-frozen plasma transfusion,prolonged operating time),in 27 patients,selected among 530 patients(≥18 years old),who underwent their first LT from January 2002 to January 2015 at the Liver University Transplant Center and developed an early PVT or HAT(case group).Analyses of the TEG traces were performed before anesthesia and 120 min after reperfusion.We retrospectively compared these patients with the same number of nonconsecutive control patients who underwent LT in the same study period without developing these complications(1:1 match)(control group).The chosen matching parameters were:Patient graft and donor characteristics[age,sex,body mass index(BMI)],indication for transplantation,procedure details,United Network for Organ Sharing classification,BMI,warm ischemia time(WIT),cold ischemia time(CIT),the volume of blood products transfused,and conventional laboratory coagulation analysis.Normally distributed continuous data are reported as the mean±SD and compared using one-way Analysis of Variance(ANOVA).Nonnormally distributed continuous data are reported as the median(interquartile range)and compared using the Mann-Whitney test.Categorical variables were analyzed with Chi-square tests with Yates correction or Fisher’s exact test depending on best applicability.IBM SPSS Statistics version 24(SPSS Inc.,Chicago,IL,United States)was employed for statistical analysis.Statistical significance was set at P<0.05.RESULTS Postoperative thrombotic events were identified as early if they occurred within 21 d postoperatively.The incidence of early hepatic artery occlusion was 3.02%,whereas the incidence of PVT was 2.07%.A comparison between the case and control groups showed some differences in the duration of surgery,which was longer in the case group(P=0.032),whereas transfusion of blood products,red blood cells,fresh frozen plasma,and platelets,was similar between the two study groups.Thromboelastographic parameters did not show any statistically significant difference between the two groups,except for the G value measured at basal and 120’postreperfusion time.It was higher,although within the reference range,in the case group than in the control group(P=0.001 and P<0.001,respectively).In addition,clot lysis at 60 min(LY60)measured at 120’postreperfusion time was lower in the case group than in the control group(P=0.035).This parameter is representative of a fibrinolysis shutdown(LY60=0%-0.80%)in 85%of patients who experienced a thrombotic complication,resulting in a statistical correlation with HAT and PVT.CONCLUSION The end of surgery LY60 and G value may identify those recipients at greater risk of developing early HAT or PVT,suggesting that they may benefit from intense surveillance and eventually anticoagulation prophylaxis in order to prevent these serious complications after LT.

Hepatic arterial infusion of oxaliplatin plus raltitrexed in unresectable hepatocellular carcinoma with or without portal vein tumour thrombosis

Background Unresectable hepatocellular carcinoma(HCC)has a poor prognosis.According to the HCC management guidelines in China,the standard treatment of Barcelona Clinic Liver Cancer(BCLC)stage B or C HCC with portal vein tumour thrombosis(PVTT)is chemoembolization.However,some patients with BCLC stage B or C HCC with PVTT respond poorly to chemoembolization.We aimed to compare tumour responses and survival benefits between patients with unresectable HCC with or without PVTT.Methods We reviewed 119 consecutive patients with unresectable HCC with PVTT(n=67)and without PVTT(n=52)who underwent hepatic arterial infusion of oxaliplatin plus raltitrexed between January 2018 and April 2021.Overall survival,progression-free survival,tumour responses,and adverse events were compared between the groups.Results There were no significant between-group differences in the objective response rates and median progression-free survival.The median overall survival was significantly longer in the group without PVTT than in that with PVTT(17.0 vs 10.4 months,respectively;P=0.024).Conclusion Hepatic arterial infusion of oxaliplatin plus raltitrexed may be efficacious in patients with unresectable HCC with or without PVTT.

Hepatocellular carcinoma with inferior vena cava and right atrium thrombus: A case report

BACKGROUND Hepatocellular carcinoma(HCC)with inferior vena cava and right atrium thrombus is rare,accounting for approximately 1.4%-4.9%of cases.These patients are rarely reported,but the condition is being increasingly discovered with advances in imaging techniques,and their prognosis is extremely pessimistic with no current effective treatment.This condition is further associated with unexpected sudden death by cardiac arrest and acute large area pulmonary embolism.CASE SUMMARY A 34-year-old man with advanced HCC with a hepatic vein thrombus extending into the right atrium had a long-term,disease-free survival following 5-mo sequential treatment combined with transcatheter arterial chemoembolization and curative liver resection.No severe adverse effects were encountered,such as massive hemorrhage or pulmonary embolism.The proper selection of operative method is an important factor.CONCLUSION HCC with a tumor thrombus extending into the right atrium has a significant impact on the survival of patients.Thrombectomy combined with adjuvant therapy may be beneficial for these patients.