AIM To evaluate the relationship between the state of transplanted liver graft and the recipient quality of life(QOL) of histologically proven lesions in a 10-year post liver transplantation(LT) cohort of patients. ME...AIM To evaluate the relationship between the state of transplanted liver graft and the recipient quality of life(QOL) of histologically proven lesions in a 10-year post liver transplantation(LT) cohort of patients. METHODS Seventy-two recipients with a functional first graft at 10 years post-LT underwent liver biopsy and completed a QOL questionnaire. Logistic regression analysis was used to explore associations between histological, clinical andQOL criteria. RESULTS Ten years after LT, fibrosis was detected in 53% of patients, and affected the general health perception, while ductopenia, present in 36%, affected the well-being(P = 0.05). Hepatic steatosis(HS) was present in 33% of patients and was associated with the worst QOL score on multiple domains. When compared to patients without HS, patients with HS had significantly higher incidence of fibrosis(P = 0.03), hepatitis C virus(HCV) infection(P = 0.007), and more patients had retired from their job(P = 0.03). Recurrent or de novo HCV-associated fibrosis and patient retirement as objective variables, and abdominal pain or discomfort and joint aches or pains as subjective variables, emerged as independent determinants of HS. CONCLUSION Long-term liver graft lesions, mainly HS presumably as a surrogate marker of HCV infection, may have a substantial impact on QOL 10 years after LT.展开更多
Dear Editor,In recent years,criteria based on the combinationof morphology and biology have been proposed forimproving the selection of hepatocellular cancer(HCC)patients waiting for liver transplantation(LT)[1,2].Sin...Dear Editor,In recent years,criteria based on the combinationof morphology and biology have been proposed forimproving the selection of hepatocellular cancer(HCC)patients waiting for liver transplantation(LT)[1,2].Since all the proposed models showed suboptimalresults in predicting the risk of postLT recurrence,aprediction model constructed using artificial intelligence(Al)could be an attractive way to surpass this limit[3,4].Therefore,the Time_Radiological-response_Alpha-fetoproteIN_Artificial-Intelligence(TRAIN-AI)modelwas developed,combining morphology and biology tumorvariables.展开更多
Aim:We analysed outcomes using multimodality therapy in patients with hepatocellular carcinoma(HCC)recurrence post living donor liver transplantation(LDLT).Methods:Of 2363 LDLT’s performed between 2005 to mid 2018,43...Aim:We analysed outcomes using multimodality therapy in patients with hepatocellular carcinoma(HCC)recurrence post living donor liver transplantation(LDLT).Methods:Of 2363 LDLT’s performed between 2005 to mid 2018,435(18.4%)were for HCC within our expanded selection criteria(absence of extrahepatic disease and vascular invasion,irrespective of tumor size and number).Survival after recurrence,and prognostic factors for these patients were studied.Results:Of 435 LDLT patients,51%had HCC beyond Milan and 43%beyond UCSF criteria at the time of LDLT.pre-LT AFP>100 ng/mL and tumour FDG-18 PET avidity predicted overall survival(OS),whereas pre-LT AFP>100 ng/mL,UCSF criteria,and FDG-18 PET avidity predicted recurrence-free survival.Hundred patients(23%)developed HCC recurrence at a median time of 16 months(range 2-108 months)post LDLT.Lungs(53%),liver(37%),and bone(21%)were the most common sites of recurrence.Ninety-five patients received tyrosine kinase inhibitors(TKI)after recurrence and 62 received mTOR inhibitors(protocol-based after LDLT,or post recurrence).Surgical resection of metastases was performed in 14 patients,15 received stereotactic body radiotherapy,and 18 underwent ablation(radiofrequency,microwave ablation,transarterial chemoembolisation,or percutaneous ethanol injection).One-and 3-yr OS after recurrence were 57%,and 24%respectively,with a maximum post recurrence survival of 7.5 years.HCC recurrence within one year after LDLT(P=0.004,HR=2.38,95%CI:1.325-4.276),AFP>200 ng/mL at the time of recurrence(P=0.02,HR=2.075,95%CI:1.121-3.841),and recurrence at multiple sites(P=0.047,HR=1.831,95%CI:1.009-3.321)were poor prognostics factors for post recurrence survival.Multimodality management of recurrence using combined medical,surgical,ablative treatments and radiotherapy significantly improved survival compared to the use of TKI’s or mTORi’s alone,or in combination.Conclusion:In patients accepted for LDLT beyond the conventional size-number criteria,even after HCC recurrence,an aggressive approach using multimodality therapy,when possible,aids in further prolongation of survival.展开更多
文摘AIM To evaluate the relationship between the state of transplanted liver graft and the recipient quality of life(QOL) of histologically proven lesions in a 10-year post liver transplantation(LT) cohort of patients. METHODS Seventy-two recipients with a functional first graft at 10 years post-LT underwent liver biopsy and completed a QOL questionnaire. Logistic regression analysis was used to explore associations between histological, clinical andQOL criteria. RESULTS Ten years after LT, fibrosis was detected in 53% of patients, and affected the general health perception, while ductopenia, present in 36%, affected the well-being(P = 0.05). Hepatic steatosis(HS) was present in 33% of patients and was associated with the worst QOL score on multiple domains. When compared to patients without HS, patients with HS had significantly higher incidence of fibrosis(P = 0.03), hepatitis C virus(HCV) infection(P = 0.007), and more patients had retired from their job(P = 0.03). Recurrent or de novo HCV-associated fibrosis and patient retirement as objective variables, and abdominal pain or discomfort and joint aches or pains as subjective variables, emerged as independent determinants of HS. CONCLUSION Long-term liver graft lesions, mainly HS presumably as a surrogate marker of HCV infection, may have a substantial impact on QOL 10 years after LT.
文摘Dear Editor,In recent years,criteria based on the combinationof morphology and biology have been proposed forimproving the selection of hepatocellular cancer(HCC)patients waiting for liver transplantation(LT)[1,2].Since all the proposed models showed suboptimalresults in predicting the risk of postLT recurrence,aprediction model constructed using artificial intelligence(Al)could be an attractive way to surpass this limit[3,4].Therefore,the Time_Radiological-response_Alpha-fetoproteIN_Artificial-Intelligence(TRAIN-AI)modelwas developed,combining morphology and biology tumorvariables.
文摘Aim:We analysed outcomes using multimodality therapy in patients with hepatocellular carcinoma(HCC)recurrence post living donor liver transplantation(LDLT).Methods:Of 2363 LDLT’s performed between 2005 to mid 2018,435(18.4%)were for HCC within our expanded selection criteria(absence of extrahepatic disease and vascular invasion,irrespective of tumor size and number).Survival after recurrence,and prognostic factors for these patients were studied.Results:Of 435 LDLT patients,51%had HCC beyond Milan and 43%beyond UCSF criteria at the time of LDLT.pre-LT AFP>100 ng/mL and tumour FDG-18 PET avidity predicted overall survival(OS),whereas pre-LT AFP>100 ng/mL,UCSF criteria,and FDG-18 PET avidity predicted recurrence-free survival.Hundred patients(23%)developed HCC recurrence at a median time of 16 months(range 2-108 months)post LDLT.Lungs(53%),liver(37%),and bone(21%)were the most common sites of recurrence.Ninety-five patients received tyrosine kinase inhibitors(TKI)after recurrence and 62 received mTOR inhibitors(protocol-based after LDLT,or post recurrence).Surgical resection of metastases was performed in 14 patients,15 received stereotactic body radiotherapy,and 18 underwent ablation(radiofrequency,microwave ablation,transarterial chemoembolisation,or percutaneous ethanol injection).One-and 3-yr OS after recurrence were 57%,and 24%respectively,with a maximum post recurrence survival of 7.5 years.HCC recurrence within one year after LDLT(P=0.004,HR=2.38,95%CI:1.325-4.276),AFP>200 ng/mL at the time of recurrence(P=0.02,HR=2.075,95%CI:1.121-3.841),and recurrence at multiple sites(P=0.047,HR=1.831,95%CI:1.009-3.321)were poor prognostics factors for post recurrence survival.Multimodality management of recurrence using combined medical,surgical,ablative treatments and radiotherapy significantly improved survival compared to the use of TKI’s or mTORi’s alone,or in combination.Conclusion:In patients accepted for LDLT beyond the conventional size-number criteria,even after HCC recurrence,an aggressive approach using multimodality therapy,when possible,aids in further prolongation of survival.
