SIMAP500: A novel risk score to identify recipients at higher risk of hepatocellular carcinoma recurrence following liver transplantation

BACKGROUND Recurrence of hepatocellular carcinoma(HCC)following liver transplantation(LT)has a devastating influence on recipients’survival;however,the risk of recur-rence is not routinely stratified.Risk stratification is vital with a long LT waiting time,as that could influence the recurrence despite strict listing criteria.AIM This study aims to identify predictors of recurrence and develop a novel risk pre-diction score to forecast HCC recurrence following LT.METHODS A retrospective review of LT for HCC recipients at University Hospitals Bir-mingham between July 2011 and February 2020.Univariate and multivariate analyses were performed to identify recurrence predictors,based on which the novel SIMAP500(satellite nodules,increase in size,microvascular invasion,AFP>500,poor differentiation)risk score was proposed.RESULTS 234 LTs for HCC were performed with a median follow-up of 5.3 years.Recurrence developed in 25 patients(10.7%).On univariate analyses,RETREAT score>3,α-fetoprotein(AFP)at listing 100-500 and>500,bridging,increased tumour size between imaging at the listing time and explant histology,increase in the size of viable tumour between listing and explant,presence of satellite nodules,micro-and macrovascular invasion on explant and poor differentiation of tumours were significantly associated with recurrence,based on which,the SIMAP500 risk score is proposed.The SIMAP500 demonstrated an excellent predictive ability(c-index=0.803)and outper-formed the RETREAT score(c-index=0.73).SIMAP500 is indicative of the time to disease recurrence.CONCLUSION SIMAP500 risk score identifies the LT recipients at risk of HCC recurrence.Risk stratification allows patient-centric post-transplant surveillance programs.Further validation of the score is recommended.

Liver transplantation for cholangiocarcinoma:Current status and new insights

Cholangiocarcinoma is a malignant tumor of the biliary system that can be classified into intrahepatic(i CCA),perihiliar(ph CCA) and distal. Initial experiences with orthotopic liver transplantation(OLT) for patientswith i CCA and ph CCA had very poor results and this treatment strategy was abandoned. In the last decade,thanks to a strict selection process and a neoadjuvant chemoradiation protocol,the results of OLT for patients with non-resectable phC CA have been shown to be excellent and this strategy has been extended worldwide in selected transplant centers. Intrahepatic cholangiocarcinoma is a growing disease in most countries and can be diagnosed both in cirrhotic and in non-cirrhotic livers. Even though OLT is contraindicated in most centers,recent investigations analyzing patients that were transplanted with a misdiagnosis of HCC and were found to have an iC CA have shown encouraging results. There is some information suggesting that patients with early stages of the disease could benefit from OLT. In this review we analyze the current stateof-the-art of OLT for cholangiocarcinoma as well as the new insights and future perspectives.

Hemobilia with acute pancreatitis secondary to biliary tract infection

Hemobilia is a rare medical condition with variety of etiologies.Among them,two in thirds are iatrogenic.Hemobilia combined with acute pancreatitis is unusual.Herein we reported a case of hemobilia with acute pancreatitis secondary to biliary tract infection.A 76-year-old male patient had intermittent abdominal pain for 2 days,which was aggravated for 1 day.He was admitted to the Emergency Department on August 29,2017.The patient developed paroxysmal abdominal pain after consuming greasy foods,accompanied by nausea.The physical examination revealed the following:temperature 37.0°C,pulse 76 bpm,respiratory rate 19 per minute,blood pressure 164/77 mmHg;no jaundice;abdominal distention;and mild total abdominal tenderness,mainly located in the left upper abdomen.Murphy’s sign was positive.Urgent abdominal ultrasound showed postprandial gallbladder emptying,gallbladder stones,unclear gallbladder cavity,and focal hepatic lesions.Hemangioma was suggested.The intrahepatic bile duct was mildly dilated,and the abdominal and pelvic cavity showed no obvious accumulation of fluid.The laboratory findings were as follows:serum amylase 922.1 U/L,white blood cell count 18.2×109/L(neutrophils,83.4%),and hemoglobin 13.8 g/dL.

腹腔镜技术促进结直肠癌肝转移同期肝大部切除术发展

背景 对于结直肠癌肝转移（CRLM）行同期肝大部及结直肠肿瘤切除术，因其手术死亡率高且需要高超的腹部外科手术技巧目前仍存在较大争议。腹腔镜因其创伤小可提高手术效果并推进同期手术的开展。

Liver venous deprivation:a bright future for liver metastases-but what about hepatocellular carcinoma?

Liver venous deprivation(LVD)refers to the percutaneous procedure aiming to simultaneously abrogate both portal inflow and hepatic venous outflow to accelerate liver regeneration of the future liver remnant(FLR),which limits patient drop-out from resection due either to insufficient FLR or tumor progression.Some authors have designated the exact same technique under the acronym RASPE(Radiological Simultaneous Porto-hepatic Vein Embolization)(1)while others reported on‘double embolization’for designating portal vein embolization(PVE)and proximal embolization of one hepatic vein,keeping patent distal venous branches and veno-venous collaterals(2).