Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients

BACKGROUND Splenectomy has previously been found to increase the risk of cancer development,including lung,non-melanoma skin cancer,leukemia,lymphoma,Hodgkin’s lymphoma,and ovarian cancer.The risk of cancer development in liver transplantation(LT)with simultaneous splenectomy remains unclear.AIM To compare hepatocellular carcinoma(HCC)recurrence and de novo malignancy between patients undergoing LT with and without simultaneous splenectomy.METHODS We retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with(n=35)and without(n=85)simultaneous splenectomy in the Tri-Service General Hospital.Univariate and multivariate Cox regression analyses for cancer-free survival and mortality were established.The comparison of the group survival status and group cancer-free status was done by generating Kaplan–Meier survival curves and log-rank tests.RESULTS The splenectomy group had more hepatitis C virus infection,lower platelet count,higher-fetoprotein level,and longer operating time.Splenectomy and age were both positive independent factors for prediction of cancer development[hazard ratio(HR):2.560 and 1.057,respectively,P<0.05].Splenectomy and hypertension were positive independent factors for prediction of mortality.(HR:2.791 and 2.813 respectively,P<0.05).The splenectomy group had a significantly worse cancer-free survival(CFS)and overall survival(OS)curve compared to the non-splenectomy group(5-year CFS rates:53.4%vs 76.5%,P=0.003;5-year OS rate:68.1 vs 89.3,P=0.002).CONCLUSION Our study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

Factors affecting complications development and mortality after single lung transplant

Lung transplantation(LT)is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease.Furthermore,as a therapeutic option for high-risk candidates,single LT(SLT)can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single(double)LT(SSLTx).Still,the long-term overall survival is,in general,better for SSLTx.Despite the great success over the years,the early post-SLT period remains a perilous time for these patients.Patients who undergo SLT are predisposed to evolving early or late postoperative complications.This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction,native lung complications,anastomosis complications,infections,cardiovascular,gastrointestinal,renal,and metabolite complications,and their association with morbidity and mortality in these patients.Furthermore,we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.

Interactions between human microbiome,liver diseases,and immunosuppression after liver transplant

In liver transplant patients,solid tumors and post-transplant lymphoproliferative disorders have emerged as significant long-term mortality causes.In addition,it is assumed that de novo malignancy after liver transplantation(LT)is the secondleading cause of death after cardiovascular complications.Well-established risk factors for post-transplant lymphoproliferative disorders and solid tumors are calcineurin inhibitors,tacrolimus,and cyclosporine,the cornerstones of all immunosuppressive therapies used after LT.The loss of immunocompetence facilitated by the host immune system due to prolonged immunosuppressive therapy leads to cancer development,including LT patients.Furthermore,various mechanisms such as bacterial dysbiosis,activation through microbe-associated molecular patterns,leaky gut,and bacterial metabolites can drive cancerpromoting liver inflammation,fibrosis,and genotoxicity.Therefore,changes in human microbiota composition may contribute further to de novo carcinogenesis associated with the severe immunosuppression after LT.