Kyeong Deok Kim, Gyu-Seong Choi, Sunghae Park, Young Ju Oh, Sang Oh Yun, Manuel Lim, Eun Sung Jeong, Ji Eun Kwon, Jaehun Yang, Jinsoo Rhu, Jong Man Kim, Jae-Won Joh. Korean J Transplant 2021;35:131. https://doi.org/10.4285/ATW2021.PO-1257
Sunghae PARK, Jinsoo RHU*, Gyu-Seong CHOI, Jong Man KIM, Jae-Won JOH, Sang Oh YUN, Namkee OH, Sung Jun JO, Sunghyo AN, Seung Wook HAN. Ann Hepatobiliary Pancreat Surg 2023;27:S82. https://doi.org/10.14701/ahbps.2023S1.OP-4-2
Introduction: Although hepatocellular carcinoma (HCC) is rare in hepatitis C virus (HCV) patients without cirrhosis, little is known about the postoperative results of these patients.We performed this study to compare the outcomes of cirrhotic and non-cirrhotic HCV patients with solitary treatment-naïve HCC and to assess ability of non-invasive markers to predict prognosis in these patients.Methods: Two hundred seven adult hepatectomy patients with HCV-related HCC were prospectively identified at our institution between July 2005 and May 2019.Results: One hundred sixteen (56%) hepatectomy patients had HCC in a non-cirrhotic liver.The non-cirrhotic group had better liver function than the cirrhotic group.Consistently, the FIB-4 grade, ALBI grade, and APRI were higher in the cirrhotic group than in the non-cirrhotic group.The cumulative disease-free survival rates and patient survival rates in the non-cirrhotic group were significantly better than in the cirrhotic group.HCC recurrence is related to major liver resection (LR) and alpha-fetoprotein (AFP) > 40 ng/mL, death is related to long hospitalization, and AFP > 40 in multivariate analysis.APRI was the only predisposing factor for HCC recurrence in non-cirrhotic patients in multivariate analysis.The FIB-4 grade, ALBI grade, and the presence of cirrhosis were not related to HCC recurrence or patient survival in multivariate analyses. Conclusions:The non-cirrhotic group had a higher survival than the cirrhotic group after curative LR, although the difference was not significant in multivariate analysis.The factors influencing HCC recurrence and patient survival were different in the cirrhotic and non-cirrhotic groups.
Living liver donation with high model for end-stage liver disease (MELD) score was discouraged despite organ shortage. This study aimed to compare graft survival between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) recipients with extremely high-MELD (score of ≥35).Between 2008 and 2018, 359 patients who underwent liver transplantation with a MELD score ≥35 were enrolled. We compared graft survival between LDLT and DDLT after propensity score matching (PSM) and performed subgroup analysis according to donor type.After PSM, there was no statistical difference in graft survival between the LDLT and DDLT groups (p = .466). Old age, acute on chronic liver failure, re-transplantation, preoperative intensive care unit stay and red blood cell (RBC) transfusion during the operation were risk factors for graft failure (p = .046, .005, .032, .015 and .001, respectively). Biliary complications were more common in the LDLT group (p = .021), while viral infection, postoperative uncontrolled ascites, and postoperative hemodialysis were more common in the DDLT group (p = .002, .018, and .027, respectively). In the LDLT group, acute chronic liver failure, intraoperative RBC transfusion, and early postoperative complications were risk factors for graft failure (p = .007, <.001, and .001, respectively).Our study showed that LDLT is not inferior to DDLT in graft survival if appropriate risk evaluation is performed in cases of extremely high-MELD scores. This result will help overcome organ shortages in high-MELD liver transplantation.
Liver fibrosis plays an important role in the development of hepatocellular carcinoma (HCC) and determining its prognosis. Although many staging systems and liver reserve models have been developed without the intention of predicting prognosis of HCC, some studies have investigated their prognostic values in HCC after curative liver resection (LR). The aim of this study is to evaluate prognostic value of non-invasive biomarkers after curative LR.Between 2006 and 2013, HCC patients underwent LR were included and total 962 patients were enrolled. All non-invasive biomarkers (fibrosis 4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), AAR-to-platelet ratio index (AARPRI), and albumin-bilirubin (ALBI) score) were measured at the time of HCC diagnosis. To binarize each biomarker, an optimal cut-off value for fibrosis stage was selected using the value of minimum distance from the left-upper corner of the receiver operating characteristic curve with a specificity >60%. We performed Cox regression analysis on 2-year recurrence-free survival (RFS) and overall survival (OS).The area under curve values for FIB-4 and APRI were the largest for fibrosis stage compared to other biomarkers, 0.669 (95% confidential interval (CI), 0.610-0.719) and 0.748 (95% CI, 0.692-0.800), respectively. Between those two indices, FIB-4 is considered a statistically significant prognostic factor of RFS in HCC patients after LR. The HR for 2-year RFS and OS were 1.81 (95% CI, 1.18-2.77; P = 0.007) and 2.36 (95% CI, 0.99-5.65; P = 0.054), respectively.FIB-4 is identified as a statistically significant predictor of HCC prognosis after curative LR even in HBV dominant populations.
Sunghae PARK, Young Ju OH, Sang Oh YUN, Manuel LIM, Ji Eun KWON, Jaehun YANG, Eun Sung JEONG, Kyeong Deok KIM, Jinsoo RHU, Gyu Seong CHOI, Jong Man KIM*, Jae Won JOH. Ann Hepatobiliary Pancreat Surg 2022;26:S193. https://doi.org/10.14701/ahbps.2022S1.LV-PP-3-6
Background: Systemic treatment options for hepatocellular carcinoma (HCC) after liver transplantation (LT) are limited in patients in whom sorafenib treatment was failed. The purpose of our study was to compare outcomes among sorafenib, regorafenib, and nivolumab treatment groups in patients with recurrent HCC after LT.
Methods: This study retrospectively evaluated patients who received sorafenib for recurrent HCC treatment after LT at a single center from March 2007 to December 2018. Some patients received regorafenib or nivolumab after sorafenib treatment failure.
Results: Fifty-six patients were treated with sorafenib due to HCC recurrence. Among these, 38 patients (67.9%) continued treatment with sorafenib only; the other 18 patients (32.1%) were converted to regorafenib treatment. Ten patients (17.9%) of these 18 were converted to nivolumab after sorafenib and regorafenib therapy failed. The disease-free survival and overall survival (OS) from LT were not different among the three groups. In addition, OS from HCC recurrence, sorafenib usage, and usage of each systemic therapeutic agent were not different among the three groups. Three cases in the nivolumab group developed acute rejection; one of these led to graft failure and death due to antibody-mediated rejection.
Conclusion: Sequential regorafenib or nivolumab treatment in recurrent HCC LT patients does not improve OS compared sorafenib treatment.
Jaehun YANG, Jong Man KIM*, Sunghae PARK, Young Ju OH, Sang Oh YUN, Manuel LIM, Eun Sung JEONG, Ji Eun KWON, Kyeoung Deok KIM, Jinsoo RHU, Gyu-Seong CHOI, Jae-Won JOH. Ann Hepatobiliary Pancreat Surg 2022;26:S184. https://doi.org/10.14701/ahbps.2022S1.LV-PP-2-3
Introduction:As the general population continues to age, elderly patients have dramatically increased for detecting hepatocellular carcinoma (HCC) and required for surgical management.The aim of this study was to compare the postoperative and long-term outcomes of hepatectomy those patients according to the operation time.Methods: This study included 130 elderly patients who underwent surgical resection for solitary, treatment-naïve HCC between November 1998 and March 2020.Group 1 was defined as patients undergoing LR before 2016 (n = 68) and Group 2 was defined as those undergoing liver resection (LR) after 2016 (n = 62).Results: The proportion of major LR and laparoscopic LR in the Group 2 were significantly higher than in the Group 1. Median operation time and blood loss during operation in the Group 2 were smaller than in the Group 1.In addition, intraoperative red blood cell (RBC) transfusion rate, complication rates, and median hospitalization in Group 2 were significantly lower than Group 1.The disease-free survival and patient survival in the Group 2 were better than in the Group 1 even though the presence of tumor grade 3 or 4 and the incidence of microvascular invasion in the Group 1 were higher than in the Group 2. Group 1, long hospitalization, presence of satellite nodule, and intraoperative RBC transfusion were predisposing factors for patient death.Conclusions: Laparoscopic LR in elderly HCC patients, was performed more frequently than in the past, resulting in an increase in the number of liver surgeries and improved survival.
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