Late-onset acute rejection after living donor liver transplantation

AIM: To investigate the incidence and risk factors of late-onset acute rejection (LAR) and to clarify the effectiveness of our immunosuppressive regime consisting of life-long administration of tacrolimus and steroids. METHODS: Adult living donor liver transplantation recipients (n = 204) who survived more than 6 mo after living donor liver transplantation were enrolled. Immunosuppression was achieved using tacrolimus and methylprednisolone. When adverse effects of tacrolimus were detected, the patient was switched to cyclosporine. Six months after transplantation, tacrolimus or cyclosporine was carefully maintained at a therapeutic level. The methylprednisolone dosage was maintained at 0.05 mg/kg per day by oral administration. Acute rejections that occurred more than 6 mo after the operation were defined as late-onset. The median follow- up period was 34 mo. RESULTS: LAR was observed in 15 cases (7%) and no chronic rejection was observed. The incidence of hyperlipidemia, chronic renal failure, new-onset post- transplantation diabetes, and deep fungal infection were 13%, 2%, 24%, and 17%, respectively. Conversion from tacrolimus to cyclosporine was required in 38 patients (19%). Multivariate analysis revealed that a cyclosporine- based regimen was significantly associated with LAR. CONCLUSION: Both LAR and drug-induced adverseevents happen at a low incidence, supporting the safety and efficacy of the present immunosuppression regimen for living donor liver transplantation.

Efficacy of mycofenolate mofetil for steroid-resistant acute rejection after living donor liver transplantation

瞄准：在类固醇作为抑制免疫力的药讨论 mycophenolate mofetil (MMF ) 的使用在肝移植以后的抵抗拒绝。方法：经历了生活施主肝移植(LDLT ) 的 260 个成年病人的临床的记录被考察。Tacrolimus 和甲基氢化尼松被用于主要免疫力的抑制。尖锐拒绝首先与类固醇被对待。当类固醇抵抗发生了时，病人与类固醇和 MMF 的联合被对待。Anti-T-cell 单音的同种细胞的抗体予不对在有 MMF 的联合的类固醇应答的病人被以。结果：90 的一个总数(35%) 病人们开发了尖锐拒绝。第一个事件的从移植的中部的间隔时间是 15 d。54 个病人是类固醇抵抗。44 个病人与 MMF 并且留下被对待 10 要求的 anti-T-cell 单音的同种细胞的抗体治疗。到长期的拒绝的前进在一个病人被观察。骨髓抑制和胃肠的症状是与 MMF 使用联系的最普通的副作用。机会主义的感染没有重要增加。结论：我们的结果证明 MMF 为在有在 LDLT 以后的尖锐拒绝的病人的营救治疗是一个有势力和安全抑制免疫力的代理人。

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Although alcoholic liver disease(ALD) is regarded as a common indication for liver transplantation(LT), debatable issues exist on the requirement for preceding alcoholic abstinence, appropriate indication criteria, predictive factors for alcoholic recidivism, and outcomes following living-donor LT. In most institutions, an abstinence period of six months before LT has been adopted as a mandatory selection criterion. Data indicating that pre-transplant abstinence is an associated predictive factor for alcoholic recidivism supports the reasoning behind this. However, conclusive evidence about the benefit of adopting an abstinence period is yet to be established. On the other hand, a limited number of reports available on living-donor LT experiences for ALD patients suggest that organ donations from relatives have no suppressive effect on alcoholic recidivism. Prevention of alcoholic recidivism has proved to be the most important treatment after LT based on the resultant inferior long-term outcome of patients. Further evaluations are still needed to establish strategies before and after LT for ALD.

Validation of novel Japanese indication criteria and biomarkers among living donor liver transplantation recipients with hepatocellular carcinoma - a single center retrospective study

Aim:To validate a novel Japanese indication criteria for liver transplantation(LT)for hepatocellular carcinoma(HCC),i.e.,the 5-5-500 criteria(nodule size≤5 cm in diameter,nodule number≤5,and alfa-fetoprotein(AFP)value≤500 ng/mL)and the Japanese double eligibility criteria(DEC)(patients meeting the Milan or the 5-5-500 criteria)in the University of Tokyo cohort.The usefulness of biomarkers in predicting the recurrence of HCC was also verified.Methods:The overall survival and recurrence rates of patients meeting the Milan,5-5-500,and the Japanese DEC were compared among 153 patients who underwent living donor LT(LDLT)between 1996 and 2019.A receiver-operating characteristics curve analysis was conducted to evaluate the usefulness of AFP,lens culinaris agglutinin-reactive fraction of AFP,des-gamma-carboxy prothrombin,neutrophil-lymphocyte ratio,and the platelet-lymphocyte ratio to detect recurrence.Results:The 5-year recurrence rate for all patients,those meeting the Japanese DEC,5-5-500 criteria,and the Milan criteria was 10.9%,9.2%,7.4%,and 7.6%,respectively.Compared with the conventional Milan criteria,the 5-5-500 criteria and the Japanese DEC could increase the number of eligible LDLT candidates by 6.1%and 11.4%.Among five biomarkers,the area under the curve value of AFP was the highest(0.852).Conclusion:The results suggest that the 5-5-500 criteria and the Japanese DEC are the appropriate selection criteria for patients with HCC in LDLT.Among five biomarkers investigated,AFP was most reliable to predict HCC recurrence,which justified the utilization of AFP in the 5-5-500 criteria and the Japanese DEC.

Automated liver tumor detection in abdominal ultrasonography with a modified faster region-based convolutional neural networks(Faster R-CNN)architecture

Background:Although diagnostic ultrasound can non-invasively capture the image of abdominal viscera,diagnosis of the continuous ultrasound liver images to detect a liver tumor effectively and to determine whether the detected is benign or malignant is nontrivial.In order to minimize the gaps in diagnostic accuracy depending on doctor’s proficiency,we built an automated system to support the ultrasonography of liver tumors by employing deep learning technologies.Methods:We constructed a neural network model for the automated detection of tumor tissues and blood vessels from the sequential liver ultrasound images.Faster region-based convolutional neural networks(Faster R-CNN)is employed as a base model for the object detection,which can output the detection results in 4 frames per second and enable the system to be particularly suitable for the real time ultrasonography.Moreover,we proposed a new neural network architecture feeding both the current and previous images into Faster R-CNN.For training the models,intraoperative ultrasound images obtained from one hepatocellular carcinoma(HCC)patient were used.The obtained image was a multifaceted observation of the liver and includes one HCC and some blood vessels.We labeled 91 images with the help of a liver specialist.We compared the tumor detection performance of the plain Faster R-CNN model with that of the proposed model.Results:We find that both the models performed well in detecting HCC and blood vessels,after training with 400 epochs using Adam.However,the mean precision of our model reaches 0.549,which is 0.019 better than that of the plain Faster R-CNN,and the mean sensitivity of our model about HCC reaches 0.623±0.385 for 30 scenes of sequential liver ultrasound images,which is also 0.146 better than that of the plain Faster R-CNN model.Conclusions:The comparison between the proposed model and the plain Faster R-CNN model shows that we achieved better accuracy in tumor detection,in terms of the mean precision as well as the mean sensitivity,with the proposed model.