TACE is an effective treatment that allows achievement of long-term survival rates comparable to those with HR and RFA in patients with small single-nodule hepatocellular carcinoma.

With the decrease in the average donor age and the increase in the proportion of female donors, both donor safety and cosmetic appearance are major concerns for some living donors in living donor liver transplantation (LDLT) because a large abdominal incision is needed that may influence the donor's quality of life. In all, 429 donors who underwent donor hepatectomy for LDLT from April 2010 to February 2013 were included in the study. Donors were divided into 3 groups based on the type of incision: conventional inverted L incision (n 5 268; the C group), upper midline incision (n 5 147; the M group), and transverse incision with laparoscopy (n 5 14; the T group). Demographics, perioperative outcomes, postoperative complications for donors and recipients, and questionnaire-derived donor satisfaction with cosmetic appearance were compared. The mean age was lower (P < 0.001), the female ratio was higher (P < 0.001), and the body mass index (BMI) was lower (P 5 0.017) in the M and T groups versus the C group. The operation time (P < 0.001) and the hospital stay duration (P 5 0.010) were lowest in the M group. The postoperative complications did not differ by the type of incision and also did not show any significant effect in a multivariate analysis (P 5 0.867). In the assessment of questionnaire-derived donor satisfaction matched by age (65 years), sex, graft, height, weight, and BMI, a more satisfactory cosmetic result and more selfconfidence were noted in the M and T groups versus the C group. In conclusion, the use of a minimal incision is technically feasible for some donor hepatectomy cases with a favorable safety profile. The patient satisfaction levels were greater with improved cosmetic outcomes in cases of minimal incision versus cases of conventional incision. Liver Transpl 21:72-78, 2015. V C 2014 AASLD.

Donor safety remains an important concern in living donor liver transplantation (LDLT). In the present study, we assessed recent advancements in the donor operation for LDLT through our experience with this procedure. A total of 886 donor hepatectomies performed between January 1999 and December 2012 were analyzed. Three chronological periods were investigated: the initial period (1999-2004, n 5 239), the period in which the right liver with middle hepatic vein reconstruction was primarily used (2005-2010, n 5 422), and the period in which the right liver with a standardized protocol, including a preoperative donor diet program, an evaluation of steatosis with magnetic resonance spectroscopy, no systemic heparin administration or central venous pressure monitoring, exact midplane dissection, and incremental application of minimal incisions, was exclusively used (2011-2012, n 5 225). The proportion of patients > 50 years old increased (2.5% versus 4.7% versus 8.9%), whereas the proportion of patients with a remnant liver volume 30% (6.5% versus 13.9% versus 6.3%) and with macrosteatosis 10% (7.9% versus 11.1% versus 4.4%) decreased throughout the periods. The operative time (292.7 versus 290.0 versus 272.8 minutes), hospital stay (12.4 versus 11.2 versus 8.5 days), and overall morbidity rate (26.4% versus 13.3% versus 5.8%), including major complications (>grade 3; 1.7% versus 1.9% versus 0.9%) and biliary complications (7.9% versus 5.0% versus 0.9%), were markedly reduced in the most recent period. No intraoperative transfusion was required. No cases of irreversible disability or mortality were noted. In conclusion, the quality of the donor operation has recently been standardized through a large volume of experience, and the operation has been proven to have minimal risk. However, a constant evaluation of our experience is critical for remaining prepared for any unavoidable crisis.

Background: Allograft damage (hepatic parenchymal damage) after liver transplant is associated with the degree of necroinflammation in graft liver. According to a recent animal study, shear-wave dispersion slope obtained at US shear-wave elastography (SWE) is associated with necroinflammatory activity in the liver. Purpose:To evaluate the role of shear-wave dispersion slope in detecting allograft damage after liver transplant. Materials and Methods:In this prospective study, 104 liver transplant recipients underwent percutaneous liver biopsy for allograft evaluation from December 2017 to November 2018. All participants underwent allograft SWE examination just before liver biopsy, and liver stiffness and shear-wave dispersion slope were obtained. Allograft damage was diagnosed by histopathologic analysis. Clinical and imaging factors related to liver stiffness and shear-wave dispersion slope were determined by multivariable linear regression analysis. Diagnostic performance of each variable in detecting allograft damage was evaluated by comparing area under the receiver operating curve (AUC) values.Results: There were 104 study participants (35 women); median age was 56 years (interquartile range, 50-62 years). Allograft damage was found in 46 of 104 (44.2%) of participants. The median liver stiffness (8.2 kPa vs 6.3 kPa; P , .01) and shear-wave dispersion slope (14.4 [m/sec]/kHz vs 10.4 [m/sec]/kHz; P , .01) were higher in participants with allograft damage than in those without damage, respectively. Fibrosis stage was the only determinant factor for liver stiffness (coefficient, 1.8 kPa per fibrosis stage; 95% confidence interval: 0.1, 3.5; P = .03), whereas both fibrosis stage (coefficient, 1.4 [m/sec]/kHz per fibrosis stage; 95% confidence interval: 0.3, 2.6; P = .02) and necroinflammatory activity (coefficient, 1.6 [m/sec]/kHz per necroinflammatory activity grade; 95% confidence interval: 0.5, 2.7; P , .01) affected shear-wave dispersion slope. The AUC for shear-wave dispersion slope in detecting allograft damage was 0.86, which was higher than that of liver stiffness (AUC, 0.75; P , .01). Conclusion:Shear-wave dispersion slope determined at US shear-wave elastography may help in detecting allograft damage after liver transplant.

CLIF-SOFA enables more accurate prediction of short-term mortality in patients with acutely decompensated alcoholic cirrhosis than other available scoring systems and is useful in predicting both 12-week mortality and the need for mechanical support after liver transplantation.

Background:To date, no adjuvant treatment has been shown to have a clear benefit in patients with hepatocellular carcinoma (HCC). In this prospective phase I/IIa study, we evaluated the safety and efficacy of adjuvant dendritic cell (DC) therapy in HCC patients who received primary treatment for HCC.Methods:Twelve HCC patients who had no viable tumour after primary treatments were included. Dendritic cell vaccines pulsed with cytoplasmic transduction peptide-attached alpha-fetoprotein, glypican-3 and melanoma-associated antigen 1 recombinant fusion proteins were injected subcutaneously near to inguinal lymph nodes. Adverse effects, time to progression (TTP), and associated immune responses were evaluated after DC vaccination.Results:Nine of 12 patients had no tumour recurrence up to 24 weeks after DC vaccination. Among a total of 144 adverse events, 129 events (89.6%) were regarded as adverse drug reactions, all of which were grade 1 or 2. The majority of patients showed enhanced anti-tumour immune responses after DC vaccination. Recurrence-free patients exhibited relatively stronger anti-tumour immune responses than patients who developed recurrence after DC vaccination, as evidenced by lymphocyte proliferation and IFN-γ ELISPOT assays. The median time of TTP was 36.6 months in the DC-vaccination group and 11.8 months in the control group (hazard ratio, 0.41; 95% confidence interval, 0.18–0.95; P=0.0031 by log-rank test).Conclusions:Adjuvant DC vaccine for HCC was safe and well tolerated in phase I/IIa study, and preliminary efficacy data are encouraging to warrant further clinical study in patients with HCC after primary treatments.

In conclusion, LDLT showed poorer outcome than DDLT. This should be considered to select optimal strategy for HCC.

).q RSNA, 2015 Purpose:To investigate the diagnostic performance of acoustic structure quantification (ASQ) for the assessment of hepatic steatosis by using hydrogen 1 ( 1 H) magnetic resonance (MR) spectroscopy as the reference standard and to compare ASQ with hepatorenal ratio. Materials andMethods:This prospective study was approved by an institutional review board, and informed written consent was obtained from all participants. ASQ and MR spectroscopy were performed in 89 participants (mean age, 41.48 years 6 14.16; 35 men, 54 women) without history of chronic liver disease. Obtained were focal disturbance (FD) ratio by using ASQ, hepatic fat fraction (HFF) by using MR spectroscopy, and hepatorenal ratio by using a histogram. Correlation coefficient, intraclass correlation coefficient, and receiver operating curve analyses were performed. Results:FD ratio measured with ASQ had a strong linear correlation with HFF measured with MR spectroscopy after logarithmic transformation of both variables (r = 20.87; P , .001). By using HFF of 5.79% as a cutoff value of 10% hepatic steatosis, 29 of 89 participants (32.6%) were categorized into the group with hepatic steatosis of 10% or greater (mean HFF, 13.18% 6 4.89). The area under curve of the FD ratio for diagnosing hepatic steatosis 10% or greater was 0.959 (95% confidence interval: 0.895, 0.990) with sensitivity of 86.2% (95% confidence interval: 68.3%, 96.0%) and specificity of 100% (95% confidence interval: 94.0%, 100.0%) by using a cutoff value of 0.1; the area under curve and specificity of the FD ratio were significantly higher than those of the hepatorenal ratio (respectively, 0.772 and 73.3%; respective P values, .001 and ,.001). Conclusion:This pilot study in a cohort of patients with hepatic steatosis without other parenchymal disease suggested ASQ may be valuable for the quantification of hepatic steatosis and detection of hepatic steatosis 10% or greater in living liver donors.q RSNA, 2015