Efficacy and safety of once daily tacrolimus compared to twice daily tacrolimus after liver transplantation

BACKGROUND Once daily tacrolimus regimen was found to exhibits similar bioavailability,safety and efficacy properties compared to twice-daily tacrolimus in kidney transplantation patients.AIM To compare the efficacy and safety of once-daily prolonged release tacrolimus compared to twice-daily tacrolimus in liver transplantation patients.METHODS MEDLINE,EMBASE,CENTRAL databases were searched for clinical trials until December 2020.Efficacy outcome measured as the rate of treatment failure indicated by biopsy-proven acute rejection,Serum creatinine,graft loss,or death.Two reviewers independently selected studies,collected data and assessed risk of bias.The results are reported as risk ratio with 95%confidence interval(CI)for dichotomous data.RESULTS Seven studies included with 965 patients.All the included studies were of moderate quality according to the risk of bias assessment using Cochrane Risk of Bias tool.Biopsy-proven acute rejection was reported in four studies,and pooled analysis of those studies indicated similar rejections in both twice daily and once daily tacrolimus groups(risk ratio:1.06,95%CI:0.84-1.34,n=758,I2=0%)and also we found no significant difference between both groups for renal outcome(serum creatinine;mean difference,0.001 mg/dL,95%CI:-0.042 to 0.043,n=846,I2=18.6%).Similarly,there was similar number of adverse events such as hypertension,headache,back pain,blood related disorders,infections and nausea observed in both groups.CONCLUSION The analysis findings confirm that both once daily and twice daily tacrolimus formulations are comparable in terms of efficacy and safety outcomes.

Natural products and hepatocellular carcinoma:a review

Hepatocellular carcinoma(HCC)is the fi fth commonest cause of malignancy and the third cause of cancer mortality.There are different treatment options for HCC ranging from loco-regional therapy to surgical treatment.Different regimen of systemic chemotherapy has been tried with a poor response.Several studies aimed at discovering more molecules for the management of HCC.Those studies aimed at recognizing and targeting several signaling and molecular pathways that lead to cellular proliferation and tumor formation.In this review,we discussed the role of several agents found in natural and dietary products such as curcumin,resveratrol,fl avonoids,Rubus aleaefolius Poir total alkaloids,Livistona chinensis seed,and crocetin.We had used the names of the above-mentioned products as key words in addition to“HCC”on PubMed to fi nd studies that discussed their roles in HCC.Articles were downloaded for reviewing and discussing natural products that had adequate studies in treating HCC.

Big size is not all, even better!

We read with interest the article entitled"Comprehensive Complication Index validates improved outcomes over time despiteincreased complexity in 3707 consecutive hepatectomies"by Cloydet al.(1).This article focused on the correlation betweensurgical volume and the development of competency in openliver surgery.