Backgrounds/AimsThe protective effect of everolimus (EVR) in hepatocellular carcinoma (HCC) patients who receive liver transplantation in terms of reducing the recurrence has not been sufficiently investigated in clinical trials. In this second stage of our ongoing study, we intend to analyze the effects of EVR as an immunosuppressant, when it is started in the early phase after living donor liver transplantation (LDLT), on HCC recurrence in patients with HCC within the University of California at San Francisco (UCSF) criteria.MethodsFrom January 2011 to June 2013, a total of 250 patients underwent LDLT for HCC at our institute. The patients with HCC within the UCSF criteria were included in the study and divided in two groups depending upon the postoperative immunosuppression. Group A: HCC patients that received EVR+TAC based immunosuppressive regimen (n=37). Group B: HCC patients that received standard TAC based immunosuppressive regimen without EVR (n=29). The target trough level for EVR was 3 to 5 ng/ml while for TAC it was 8–10 ng/ml.ResultsFor group A patients, the mean trough level of the EVR was 3.47±1.53 ng/ml (range, 1.5–11.2) with a daily dose of 1.00±0.25 mg/day. For group A and B, the average TAC trough levels were 6.97±3.98 ng/ml (range, 2.50 to 11.28 ng/ml) and 6.93±2.58 (range, 2–16.30), respectively. The 1-year, 3-year and 4-year overall survival achieved for Group A patients was 94.95%, 86.48% and 86.48%, respectively while for Group B patients it was 82.75%, 68.96%, and 62.06%, respectively (p=0.0217).ConclusionsEVR use in liver transplant recipients in the early stage after transplantation reduces the HCC recurrence rates in HCC patients within the UCSF criteria.
Background: Endoscopic retrograde cholangiography (ERC) with balloon dilation and stenting is the curative treatment for biliary anastomotic (AS) strictures after living donor liver transplantation (LDLT). The aim of this study was to assess the technical feasibility and clinical outcomes of combined endoscopic and percutaneous therapy for biliary AS stricture in adult right-lobe living donor liver transplantation with duct to duct anastomosis. Materials and methods: Between January 2008 and December 2015, 648 patients receiving right-lobe LDLT in our hospital were analyzed for biliary complications. When biliary strictures were diagnosed, patients underwent ERC first as a diagnostic as well as treatment modality to dilate the strictures and biliary stenting. If ERC failed, percutaneous transhepatic cholangiography (PTC) and/or combined PTC and ERC were done. Results: Eighty-two biliary strictures were diagnosed in 648 recipients (13%; 82/648) at an average of 256 (7-1979) days after LDLT. Among 82 patients (age 52.6 ± 9.6 years, range 24-72), 40 patients were successfully treated by ERC, 5 by PTC, and 9 by combined PTC and ERC. In successful ERC with an average of 5.03 ± 2.96 sessions, 11±11.0 plastic stents in total and 2±1 stents at each ERC session were placed. The mean time to stricture resolution was 708 ± 532 (28-1967), 298 ± 135 (145-398), and 499 ± 239 (288-827) days for patients receiving ERC, PTC, and combined PTC and ERC, respectively. Conclusions: Biliary complications following LDLT is associated with high mortality. In severe biliary strictures, the procedure that combines PTC and ERC can be curative in patients with prior failed ERC treatment.
long-term outcomes To reduce peri-operative blood loss, the Pringle manoeuvre is commonly used, which may result in an ischaemia-reperfusion injury (IRI) and transient liver dysfunction. Post-operative liver transaminases are often used to assess IRI. There is a paucity of data with conflicting evidence on the short-and long-term outcomes of post-operative transaminases post liver resection. Method: This is a retrospective review of all colorectal liver metastasis (CRLM) resections in a single tertiary centre from 2005 to 2012. The primary objective was to examine the relationship between post-operative alanine transaminase (ALT) level (day 2) and overall survival (OS) and recurrence free survival (RFS). Kaplan-Meier survival curves were studied using log-rank analysis to identify the predictors of OS and RFS. Secondary objectives included examining post-operative ALT levels with length of stay (LOS) and complication rates. Post-operative ALT level of 280 U/L i.e., five times upper limit of normal (56 U/L) were considered clinically relevant moderate/severe transaminitis and was compared with ALT level of <280 U/L. Result: Between 2005-2012, seven hundred and fifty-two patients underwent a hepatectomy and had a day 2 postoperative ALT measurement. Post-operative ALT (Low <280 U/L vs. High >280 U/L) did not affect OS (p=0.883) or RFS (p= 0.063) after liver resection. Factorsassociated with a worse OS and RFS were pre-operative chemotherapy, number of tumours, largest tumour size (>4cm). Higher post-operative ALT was not associated with increased LOS or more complications.
Conclusion:Post-operative ALT level does not affect overall survival or recurrence free survival post hepatectomy for colorectal liver metastases.
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