Ksh Chok

Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma.

Hepatic resection and radiofrequency ablation (RFA) are treatment options for early‐stage hepatocellular carcinoma (HCC). Whether tumour recurrence and long‐term survival favour either treatment has not been established. This randomized trial aimed to test the hypothesis that RFA is superior to hepatic resection in terms of lower tumour recurrence rate and better long‐term survival.

Rare cause of jaundice in a post liver transplant patient

A hepatitis B virus carrier suffering from acute flare of chronic hepatitis B infection underwent deceased‐donor liver transplantation. He was put on the immunosuppressive agent tacrolimus. On routine follow‐up, he was found to have abnormal liver function. Computed tomography scan of the abdomen did not show any dilatation of the biliary system. Liver biopsy showed scattered microabscesses, and a microgranuloma was detected. Endoscopic retrograde cholangiography was performed and a biliary anastomotic stricture (BAS) was noted. In addition, the Chinese liver fluke, Clonorchis sinensis, was discovered. Balloon dilatation and stenting were performed. The patient was given a course of praziquantel. His liver function improved and normalized. We present the case of a liver transplant recipient with cholangitis caused by C. sinensis infestation and infection and biliary obstruction resulting from BAS.

Risk Factors for Graft Steatosis after Liver Transplantation using Controlled Attenuation Parameter Measurements

Background Liver steatosis is a cause of graft dysfunction after liver transplantation. The current study aims to determine the risk factors associated with the development of graft steatosis in a large cohort of liver transplant recipients. Methods Consecutive adult patients transplanted from 2003 to 2014 underwent liver stiffness and controlled attenuation parameter (CAP) measurements using transient elastography. Liver steatosis was defined as minimal (<5%), mild (5-33%), moderate (34-66%), and severe (≥67%) if the CAP score was <248, 248-267, 268-279, and ≥280 dB/m respectively. Longitudinal history including diabetes, hyperlipidemia, hypertension, and immunosuppressive regimen were recorded. Results A total of 549 liver transplant recipients underwent valid transient elastography, of which 359 (72%) were male. Using the predefined CAP cut-offs, 345 (63%), 48 (9%), 27 (5%), and 129 (23%) had minimal, mild, moderate, and severe steatosis respectively. There was a significant correlation between the CAP score and age at transplant (r=0.104), age at CAP measurement (r=0.116), and body mass index (BMI) at the time of CAP measurement (r=0.567)(all p<0.05). A higher CAP score was observed for male patients (229 vs 212 dB/m, p=0.011), on-treatment diabetes (232 vs 219 dB/m, p=0.029), on-treatment hypertension (237 vs 200 dB/m, p<0.001), and on-treatment hyperlipidemia (239 vs 217 dB/m, p<0.001). No difference in CAP score was observed for those requiring mTOR-inhibitors or mycophenolate, although a lower CAP was observed for prednisone (212 vs 227, p=0.022). A significant correlation was observed between CAP scores and age at the time of liver transplant (r=0.104, p=0.015), age at the time of CAP score measurement (r=0.116, p=0.007), and the BMI (r=0.567, p<0.001). No significant correlation was observed between CAP score and time from transplant to CAP measurement. After multivariate analysis, only hypertension (OR 0.54) and BMI (OR 1.41) remains significant factors associated with moderate-severe graft steatosis. There was no correlation between the CAP score and liver stiffness measurement (p=0.89). Discussion The liver stiffness and CAP score is a non-invasive method of diagnosing hepatic fibrosis and steatosis respectively, with validated cut-offs correlating to different severity. After multivariate analysis on significant univariate variables, only hypertension and BMI was significantly associated with moderate-severe steatosis. However, there was no correlation between liver stiffness and CAP score, suggesting that other causes other than steatosis were responsible for graft fibrosis. Conclusion Post-transplant graft steatosis was common, with 28% developing moderate-severe steatosis. Increase in BMI and the presence of hypertension was significantly associated with the development of moderate-severe graft steatosis. However, there was no correlation between liver stiffness and CAP scores to suggest increase in fibrosis.

Advantage of anterior resection in major resection for colorectal liver metastases

Objective: We described histologic findings bile canalicular–ductule networks in the future liver remnant (FLR) during associating liver partition with portal vein ligation for staged hepatectomy (ALPPS). Background: Little is known about regeneration of bile canalicular–ductule networks during short interval of ALPPS. Methods: Bile canalicular–ductule networks were examined using specimens obtained from 8 patients treated with ALPPS and 6 patients with hepatectomy following portal vein embolization (PVE). The expression of multidrug resistance 1 (MDR1), a membrane transporter of the bile canaliculi (BC), was analyzed immunohistochemically. The morphological changes of the BC and tight junction (TJ) surrounding BC were also assessed electron microscopically. Results: Extrapolated kinetic growth of FLR was greater during ALPPS (17.2 ± 6.8 mL/day) than that after PVE (6.3 ± 3.4 mL/day, P=0.005). The continuity of MDR1–positive bile canalicular networks was less evident in ALPPS than in PVE (P<0.001). Electron microscopically, no significant difference was evident in number of BC, size of BC s̓ lumen between the 2 groups. However, in the ALPPS group, development of microvilli in the BC was poorer than the PVE group (P<0.001). Length of the TJ and desmosome complex were shorter in the ALPPS group (0.69±0.52μm) than in the PVE group (1.09±0.50μm; P<0.001). Leaky TJ was more evident in the ALPPS group (64.9% vs. 23.6%; P=0.001). Conclusions: Regeneration of bile canalicular–ductule networks in FLR was less evident in ALPPS than PVE. This phenomenon may be associated with prolonged cholestasis following final hepatectomy in ALPPS. J Hepatobiliary Pancreat Sci (2017) 24.S1 Oral A150

Intraoperative ICG measurement during major hepatectomy for HCC. Hype or hope

This journal suppl. entitled: Conference Abstracts: 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, JapanAbstracts of the 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, Japans of the 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, Japan Asian Pacific Association for the Study of the Liver 2016 Presidential PlenaryThis journal suppl. entitled: Conference Abstracts: 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, JapanThis journal suppl. entitled: Conference Abstracts: 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, Japan

Survival advantage of primary liver transplantation for resectable hepatocellular carcinoma with vascular invasion

The 21st Conference of the Asian Pacific Association for the Study of the Liver

Late recurrence of HCC after liver transplantation

Conference Theme: Latest Advances in Liver Cancer Research: From Basic Science to Therapeutics

High intensity focused ultrasound as a bridging therapy for patient with HCC - A hype or hope?

Conference Theme: Latest Advances in Liver Cancer Research: From Basic Science to Therapeutics

Salvage Transplantation for Recurrent Hepatocellular Carcinoma within Milan Criteria: Is It Worthwhile?

P-203 DISSEMINATED NOCARDIOSIS: A RARE INFECTIOUS COMPLICATION FOLLOWING NON-HEART-BEATING DONOR LIVER TRANSPLANTATION. Santos JiménezGalanes, Juan Carlos Meneu Diaz, Baltasar Perez-Saborido, Almudena Moreno Elola-Olaso, Yiliam Fundora Suarez, Manuel Abradelo Usera, Alberto Gimeno Calvo, Enrique Moreno González. Surgery and Abdominal Organs Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain INTRODUCTION Nocardiosis is an infrequent disease that use to affect patients who present a cellular immunodeficiency, such as transplant recipients on immunosuppression treatment, and although uncommon associate high rates of morbidity and mortality. Disseminated Nocardiasis affecting central nervous system (CNS), abdomen, skin and lungs has been described in bone marrow, lung and kidney transplanted patients. However, to our knowledge, no cases involving these three structures have been reported in liver transplant recipients. CASE REPORT Herein, we report a case of CNS, pulmonary and cutaneous nocardiosis in a liver transplant recipient from a non-heart-beating donor due to hepatitis C virus related cirrhosis and hepatocellular carcinoma. At 7 postransplant month, patient was admitted at emergency department presenting bad general health status, fever, edema and subcutaneous nodules in legs. A computed tomography scan was performed revealing multiple nodules disseminated thorough both lungs, abdomen, brain a subcutaneous tissue. By these clinical and radiogical fi ndings needle biopsy was performed over one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazoletrimethoprim (SMZ-TMP) shifted after one month to oral. Radiological examination performed after two weeks of treatment showed a 70% reduction on subcutaneous, pulmonary and cerebral lesions. After six months of SMZTMP treatment, patient remained free of the symptoms, with involution of the subcutaneous nodules and signifi cant radiological improvement. CONCLUSION Among opportunistic infections appearing in liver transplant recipients, Nocardia spp. should have special consideration according to the success in early treated patients and bad prognosis in cases of delayed diagnose.This journal supplement labeled: The International Liver Transplantation Society: 16th Annual International Congress

Prediction of hospital mortality after liver transplantation for acute liver failure

P-203 DISSEMINATED NOCARDIOSIS: A RARE INFECTIOUS COMPLICATION FOLLOWING NON-HEART-BEATING DONOR LIVER TRANSPLANTATION. Santos JiménezGalanes, Juan Carlos Meneu Diaz, Baltasar Perez-Saborido, Almudena Moreno Elola-Olaso, Yiliam Fundora Suarez, Manuel Abradelo Usera, Alberto Gimeno Calvo, Enrique Moreno González. Surgery and Abdominal Organs Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain INTRODUCTION Nocardiosis is an infrequent disease that use to affect patients who present a cellular immunodeficiency, such as transplant recipients on immunosuppression treatment, and although uncommon associate high rates of morbidity and mortality. Disseminated Nocardiasis affecting central nervous system (CNS), abdomen, skin and lungs has been described in bone marrow, lung and kidney transplanted patients. However, to our knowledge, no cases involving these three structures have been reported in liver transplant recipients. CASE REPORT Herein, we report a case of CNS, pulmonary and cutaneous nocardiosis in a liver transplant recipient from a non-heart-beating donor due to hepatitis C virus related cirrhosis and hepatocellular carcinoma. At 7 postransplant month, patient was admitted at emergency department presenting bad general health status, fever, edema and subcutaneous nodules in legs. A computed tomography scan was performed revealing multiple nodules disseminated thorough both lungs, abdomen, brain a subcutaneous tissue. By these clinical and radiogical fi ndings needle biopsy was performed over one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazoletrimethoprim (SMZ-TMP) shifted after one month to oral. Radiological examination performed after two weeks of treatment showed a 70% reduction on subcutaneous, pulmonary and cerebral lesions. After six months of SMZTMP treatment, patient remained free of the symptoms, with involution of the subcutaneous nodules and signifi cant radiological improvement. CONCLUSION Among opportunistic infections appearing in liver transplant recipients, Nocardia spp. should have special consideration according to the success in early treated patients and bad prognosis in cases of delayed diagnose.This journal supplement labeled: The International Liver Transplantation Society: 16th Annual International Congress