Inflammatory markers have been studied in cancers and chronic states of inflammation. They are thought to correlate with tumor pathology through disruption of normal homeostasis. Markers such as neutrophil to lymphocyte ratio (NLR) among others have shown promise as prognostic tools in various cancers. In this study, we evaluate complete blood count based inflammatory markers in hepatocellular carcinoma (HCC) to predict overall and recurrence-free survival of patients after liver transplant. Between 2001 and 2017, all HCC indicated liver transplants were retrospectively reviewed. Inclusion criteria included presence of complete blood cell counts with differential within three months prior to transplantation. Exclusion criteria included retransplantation and inadequate posttransplant followup. A total of 160 patients with HCC were included in the study. Of those, 74.4% had hepatitis C virus as the underlying cause of HCC. Calculated Model for End stage Liver Disease (MELD) scores were statistically worse in patients with elevated NLR (≥5), derived NLR (≥3), and low lymphocyte to monocyte ratio (LMR) (<3.45), whereas elevated platelet to lymphocyte ratio (PLR) (≥150) did not correlate with MELD. Of the tumor characteristics, low LMR was associated with tumor presence and microvascular invasion on explant. Though overall survival trended towards better outcomes with low NLR and dNLR and high LMR, these did not reach statistical significance. High LMR also trended towards better recurrence-free survival without statistical significance. Low PLR was associated with statistically significant overall and recurrence-free survival. In conclusion, while prior studies in HCC have identified NLR as surrogate for tumor burden and survival, in this study we highlight that PLR is a good surrogate of mortality and recurrence-free survival in HCC transplant patients. Further, future study of PLR, NLR, and LMR in larger HCC populations before and after interventions may help clarify their clinical utility as a simple and noninvasive clinical tool as prognostic markers.

Objective: The objective of this study was to compare posttransplant outcomes in patients undergoing bridging locoregional therapy (LRT) with Y-90 transarterial radioembolization (TARE) based protocol compared with transarterial chemoembolization based protocol for hepatocellular carcinoma (HCC) prior liver transplantation (LT). Materials and Methods: Patients listed for LT with HCC within the Milan criteria at our center who had bridging LRT were treated according to transarterial chemoembolization (TACE) based protocol from May 2012 to April 2014 and a TARE based protocol from October 2014 to December 2017. Early posttransplant survival and tumor recurrence were compared between the groups. Tumor response to LRT, microvascular invasion (mVI), and the rate of delisting was also evaluated. Results: One hundred three patients who were listed for LT with HCC within the Milan criteria received LRT. LT was performed in 65 patients, 28 treated with TARE protocol and 37 on TACE protocol. There were no statistical differences in baseline pretransplant characteristics and tumor recurrence. There was a trend toward improved 3-year survival in the TARE group (92.9% vs. 75.7%; P=0.052). The mVI was seen in 1/28 (3.6%) explants in the TARE group compared with 10/37 (27%) in the TACE group (P=0.013). The TARE group also required fewer LRT treatments (1.46 vs. 2.43; P=0.001) despite no difference in time on the transplant list. Conclusions: Despite requiring fewer LRT treatments, there was significantly less mVI in the explants of patients treated with TARE protocol LRT as a bridge to LT as well as a trend toward improved 3-year survival. Therefore, TARE may be associated with improved tumor control and reduced post-LT recurrence.

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Background: Left ventricular assist devices (LVAD) improve functional class and survival in selected patients with advanced heart failure. Right Ventricular Failure (RVF) after LVAD implantation is associated with increased mortality, morbidity and hospitalization. Identification of LVAD candidates at risk for RVF remains challenging. The purpose of this research is to determinate association of clinical and echocardiographic parameters with early and late RVF, clinical outcomes, and mortality after LVAD implantation. Methods: We retrospectively reviewed 156 consecutive LVAD implantations at the University of Florida at Gainesville, FL, from 2006 to 2016. Clinical and transthoracic echocardiographic data were studied. Early RVF was defined as the unplanned need for a right ventricular assist device or inotrope dependence for ≥14 days. Late RVD defined as either starting IV inotropes after 6 months of LVAD implantation or need for LVAD speed reduction after 6 months of LVAD implantation. Results: Data were collected for 91 patients whose longitudinal follow up data were available. Our cohort was predominantly males (78%) with a mean age of 59.1 years. Early RVF was detected in 27 patients (29.7%) late RVF was detected in 10 patients (11%). Obesity was associated with increased late RVF (P = .035). There was a negative correlation between pre-implantation right ventricular diameter and late RVF (r = −250, P = .021), however, it did not predict RVF on linear regression analysis. Pre-implantation echocardiographic right ventricular parameters such as tricuspid regurgitation severity, right ventricular fractional area change, and tricuspid annular excursion showed no correlation with post-LVAD implantation RVF, hospitalization, or mortality. Conclusions: Right ventricular dilation was inversely related to the development of late RVF after LVAD implantation, but predictors may extend beyond routine echocardiographic parameters. In our institution, these parameters were not predictive of outcomes. Obesity was associated with late RVF suggesting that patient factors play an important role in this disease process. There is need for in-depth investigation of the pathophysiological changes to the right ventricular in LVAD patients. Our results also highlight the responsibility for centers to determine center-specific risk factors and approaches to RVF.