Alfredo Escartin

Resection for hepatocellular carcinoma is a good option in Child‐Turcotte‐Pugh class A patients with cirrhosis who are eligible for liver transplantation

The best treatment option for patients with single, early hepatocellular carcinoma (HCC) and cirrhosis, good liver function, and absence of portal hypertension remains to be established. The aim of this work was to compare the outcome of liver resection (LR) with that of liver transplantation (LT) for single, early HCC in Child‐Turcotte‐Pugh class A patients with cirrhosis younger than 70 years of age. Thirty‐seven of 134 patients who underwent LR and 36 of 125 who underwent LT for HCC in our unit fulfilled the inclusion criteria. No differences were observed in mean tumor size (3 cm); HCV cirrhosis predominated in the LT group and older age in the LR group. Postoperative mortality was higher and hospital stay longer in the LT group. Patient survival was similar in both groups. Tumor recurrence was higher in the LR group (59% vs. 11%), extrahepatic recurrences predominated after LT and hepatic recurrences after LR. Disease‐free survival was significantly better after LT. Eighteen patients presented hepatic recurrence after LR: 5 advanced and 13 early. Seventeen patients—13 with early HCC recurrence and 4 with liver failure—were potential candidates for salvage LT. However, 10 of 17 patients were older than 70 years at this time. Salvage LT could only be performed in 6 patients: 5 for HCC recurrence and 1 for liver failure. Results of salvage LT were similar to those of primary LT. In conclusion, only 27.6% of resected patients were eligible for LT. LR is a good option since it offers similar survival to LT. Salvage liver transplantation was performed in 16.2% of resected patients, with older age being the main contraindication. Outcome of salvage LT was similar to that of primary LT. (Liver Transpl 2005;11:1242–1251.)

A prospective randomized trial comparing tacrolimus and steroids with tacrolimus monotherapy in liver transplantation: the impact on recurrence of hepatitis C

The aim of this prospective randomized trial was to study the efficacy and safety of tacrolimus monotherapy (TACRO) and compare it with our standard treatment of tacrolimus plus steroids (TACRO + ST) after liver transplant (LT). Furthermore, the impact of steroid‐free immunosuppression on outcome of hepatitis C virus (HCV) was analysed. Between 1998 and 2000, 60 patients (mean age: 57 years) were included in the study and randomized to receive TACRO (n = 28) or TACRO + ST (n = 32). Indication for LT was postnecrotic cirrhosis in all cases (58.3% were HCV‐positive). Mean follow‐up was 44 months. Survival, incidence of rejection, infection and side‐effects were compared between the two groups. In patients with HCV infection, incidence and severity of acute hepatitis C, long‐term outcome of recurrent hepatitis C and survival were studied in an intention‐to‐treat analysis or in the real group analysis (real‐TACRO versus real‐TACRO + ST). Patient survival at 1, 3 and 5 years, tacrolimus pharmacokinetics, incidence of rejection infections and side‐effects were similar. In patients with HCV, the incidence and severity of graft hepatitis C tended to be lower in TACRO (47%) compared with TACRO + ST (67%) (P = NS), and also in real‐TACRO (42%) compared with real‐TACRO + ST (61%) (P = NS). A poor outcome considered as evolution to cirrhosis at 3 years was observed in one (9%) living patient in real‐TACRO and nine (45%) in real‐TACRO + ST (P = 0.04). Patient survival at 1, 3 and 5 years was 92%, 92% and 73% for real‐TACRO and 78%, 61% and 51% for real TACRO + ST (P = 0.07). Steroid‐free immunosuppression appears to be safe and efficacious. The main advantage of this regimen could be in HCV patients, as recurrence of hepatitis in the graft was less severe in the group of patients in whom steroids could be avoided completely.

Our experience in liver transplantation in patients over 65 yr of age

Abstract: Objectives:  The aim of this study was to analyze short‐ and long‐term results of liver transplantation (LT) in patients over 65 yr.

Home hospitalization for the surgical and conservative treatment of acute calculous cholecystitis: Home hospitalization for acute cholecystitis

Acute calculous cholecystitis is a frequent complication of gallstones that can manifest in up to 10–15 per cent of previously asymptomatic patients. Current guidelines recommend laparoscopic cholecystectomy as the gold standard treatment; however, the presence of surgery risk factors might compel physicians to opt for conservative treatment, which is often associated with longer hospital stay. Home hospitalization could be an alternative to inpatient stay for these patients.