Hepatobiliary & Pancreatic Diseases International最新文献

Liver transplantation is hindered by organ shortage. The potential way to relieve this issue is to expand the donor pool via extending the donor criteria and make full use of all available grafts. The concept of "no-donor" liver transplantation allows grafts to be recovered from other liver recipients. This review summarizes the current clinical practice of "no-donor" liver transplantation, focusing on the experiences of Chinese transplant teams. Domino liver transplantation was introduced by Furtado in 1995 and implemented later in 2013 in China, and novel donor indications including some essential-to-treat inherited metabolic liver-based diseases have emerged. The concept of cross-auxiliary domino liver transplantation brings a further expansion of the domino liver graft pool, and the first pair of liver transplantation performed "rigorously without donation" was accomplished in our center in 2018. Our experience with this original transplantation procedure is hereby reviewed. In order to further promote and make successful "no-donor" liver transplantation, close co-operation between researchers, surgeons, physicians, organ procurement organizations, as well as ethical committees is required.

Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the "classical" recipient hepatectomy is believed to be one of the potential reasons to cause tumor evasion because of the possible increase of circulating tumor cells, thus leading to an increased recurrent rate. On this background, the no-touch oncological recipient hepatectomy technique has been developed. A comprehensive review of the development and the key surgical steps of the no-touch recipient hepatectomy is presented. This technique might improve clinical outcomes, especially for those recipients who are at a high risk for tumor recurrence. Multicenter prospective studies should be set up to further validate the prognostic role of this technique in patients with liver cancer treated with liver transplantation.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seqLDLT) after LR as a strategy for HCC patients with high-risk of recurrence.

Methods: We analyzed data from 27 adult patients who underwent seqLDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).

Results: Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqLDLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqLDLT as a preemptive strategy. The median age was 53.5 years with 85% males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0% and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors > 5 cm (19%), and a total tumor diameter > 10 cm (7%).

Conclusions: SeqLDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seqLDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.

Ischemia-reperfusion injury (IRI) is an inherent issue in organ transplantation. Because of the allograft shortage, more and more extended criteria donor (ECD) organs are used, unfortunately these grafts are more susceptible to IRI. Although machine perfusion technology has brought hope to alleviate IRI, this technology is still unable to eradicate IRI-related organ damage. Ischemia-free liver transplantation (IFLT) can completely avoid IRI, thereby improve graft function and recipient outcome, and allow to expand organ pool. This review summarized the latest progresses in IFLT, and speculated the future development of this concept.

Background: Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-guided percutaneous microwave ablation (MWA) in treating liver cancer in difficult anatomical locations.

Methods: Data of 132 patients with 145 difficult-site liver cancer treated with ultrasound-guided percutaneous MWA were retrospectively analyzed. Participants were classified into the isolation (n = 40) and non-isolation (n = 92) groups based on whether the patients were treated using a balloon catheter prior to ablation. The major complication rates, local tumor residuals (LTR), and tumor follow-up for local tumor progression (LTP) at 6 and 12 months post-ablation were compared between the two groups.

Results: The rates of major postoperative complications did not significantly differ between the isolation and non-isolation groups (2.5% vs. 4.3%, P = 0.609). The postoperative LTR rates were significantly different between the isolation and non-isolation groups (4.8% vs. 17.5%, P = 0.032). Balloon catheter isolation [odds ratio (OR) = 0.225, 95% confidence interval (CI): 0.085-0.595, P = 0.009] and tumor diameter (OR = 2.808, 95% CI: 1.186-6.647, P = 0.019) were identified as independent factors influencing LTR rate. The cumulative LTP rates at 6 and 12 months after ablation showed no significant differences between the isolation and non-isolation groups (2.6% vs. 7.9%, P = 0.661; 4.9% vs. 9.8%, P = 0.676, respectively). Cox proportional hazards regression analysis showed that tumor diameter was an independent risk factor for cumulative LTP rate (OR = 3.445, 95% CI: 1.406-8.437, P = 0.017).

Conclusions: Balloon catheter isolation-assisted MWA was safe and effective in the treatment of difficult-site liver cancer. Additionally, tumor diameter significantly influenced LTR and LTP rates after ablation.

Gallbladder cancer (GBC) is the most common malignant tumor in the biliary system, characterized by high malignancy, aggressiveness, and poor prognosis. Early diagnosis holds paramount importance in ameliorating therapeutic outcomes. Presently, the clinical diagnosis of GBC primarily relies on clinical-radiological-pathological approach. However, there remains a potential for missed diagnosis and misdiagnose in the realm of clinical practice. We firstly analyzed the blood-based biomarkers, such as carcinoembryonic antigen and carbohydrate antigen 19-9. Subsequently, we evaluated the diagnostic performance of various imaging modalities, including ultrasound (US), endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT) and pathological examination, emphasizing their strengths and limitations in detecting early-stage GBC. Furthermore, we explored the potential of emerging technologies, particularly artificial intelligence (AI) and liquid biopsy, to revolutionize GBC diagnosis. AI algorithms have demonstrated improved image analysis capabilities, while liquid biopsy offers the promise of non-invasive and real-time monitoring. However, the translation of these advancements into clinical practice necessitates further validation and standardization. The review highlighted the advantages and limitations of current diagnostic approaches and underscored the need for innovative strategies to enhance diagnostic accuracy of GBC. In addition, we emphasized the importance of multidisciplinary collaboration to improve early diagnosis of GBC and ultimately patient outcomes. This review endeavoured to impart fresh perspectives and insights into the early diagnosis of GBC.

Background: Currently, there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreato-biliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019 (COVID-19). This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.

Methods: This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1, 2023 from four hospitals in China. All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries. Additionally, two groups of patients without preoperative COVID-19 infection were included as comparative controls. Surgical complications were meticulously documented and evaluated using the comprehensive complication index (CCI), which ranged from 0 (uneventful course) to 100 (death). A CCI value of 20.9 was identified as the threshold for defining severe complications.

Results: Among 2636 patients who were included in this study, 873 were included in the reference group I, 941 in the reference group II, 389 in the internal cohort, and 433 in the external validation cohort. Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination > 6 months before surgery, undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection, operation duration of 4 h or longer, cancer-related surgery, and major surgical procedures were significantly linked to a CCI > 20.9. A nomogram model was constructed utilizing CCI > 20.9 in the training cohort [area under the curve (AUC): 0.919, 95% confidence interval (CI): 0.881-0.957], the internal validation cohort (AUC: 0.910, 95% CI: 0.847-0.973), and the external validation cohort (AUC: 0.841, 95% CI: 0.799-0.883). The calibration curve for the probability of CCI > 20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.

Conclusions: The developed model holds significant potential in aiding clinicians with clinical decision-making and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.

Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.