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Yaras S, Demir M, Barutcu S, Yildirim AE, Gurel S, Ucbilek E, Kurtulmus IA, Kayhan MA, Vatansever S, Adanir H, Danis N, Duman S, Turan I, Ari D, Kose S, Alkim H, Harputluoglu MM, Dilber F, Akyildiz M, Cosar AM, Durak S, Sirin G, Kefeli A, Gokcan H, Avcioglu U, Ayyildiz T, Sezgin O, Akarsu M, Dincer D, Guzelbulut F, Gunsar F, Akarca US, Idilman R. The efficacy and tolerability of glecaprevir/pibrentasvir treatment in a real-world chronic hepatitis C patients cohort. Hepatol Forum 2023; 4:92-96. [PMID: 37822314 PMCID: PMC10564251 DOI: 10.14744/hf.2023.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 10/13/2023]
Abstract
Background and Aim The aims of the present study were to evaluate the real-life efficacy and tolerability of glecaprevir (GLE)/pibrentasvir (PIB) in the treatment of patients with chronic hepatitis C (CHC). Materials and Methods Between May 2019 and May 2022, 686 patients with CHC, treated with GLE/PIB combination from 21 participating centers in Turkiye, were enrolled in the study. Results All patients were Caucasian, and their median age was 56 years. At the start of GLE/PIB treatment, the median serum Hepatitis C virus RNA and serum alanine amino transaminase (ALT) levels were 6.74 log10 IU/mL and 47 U/L, respectively. Fifty-three percent of the patients were infected with genotype 1b, followed by genotype 3 (17%). Diabetes was the more common concomitant disease. The sustained virological response (SVR12) was 91.4% with intent-to-treat analysis and 98.5% with per protocol analysis. The SVR12 rates were statistically significant differences between the patients who were i.v. drug users and non-user (88.0% vs. 98.8%, p=0.025). From the baseline to SVR12, the serum ALT levels and Model for End-Stage Liver Disease score were significantly improved (p<0.001 and p=0.014, respectively). No severe adverse effect was observed. Conclusion GLE/PIB is an effective and tolerable treatment in patients with CHC.
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Affiliation(s)
- Serkan Yaras
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | - Mehmet Demir
- Department of Gastroenterology, Mustafa Kemal University, School of Medicine, Hatay, Turkiye
| | - Sezgin Barutcu
- Department of Medical Sciences, Gaziantep University, School of Medicine, Gaziantep, Turkiye
| | | | - Selim Gurel
- Department of Internal Medicine, Uludag University, School of Medicine, Bursa, Turkiye
| | - Enver Ucbilek
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | | | - Meral Akdogan Kayhan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, Ankara City Hospital, Ankara, Turkiye
| | - Sezgin Vatansever
- Department of Gastroenterology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkiye
| | - Haydar Adanir
- Department of Internal Medicine, Akdeniz University, School of Medicine, Antalya, Turkiye
| | - Nilay Danis
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Serkan Duman
- Department of Gastroenterology, Toros State Hospital, Mersin, Turkiye
| | - Ilker Turan
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Derya Ari
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, Ankara City Hospital, Ankara, Turkiye
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, School of Medicine, Izmir, Turkiye
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkiye
| | | | - Feyza Dilber
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkiye
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University, School of Medicine, Istanbul, Turkiye
| | - Arif Mansur Cosar
- Department of Gastroenterology, Karadeniz Technical University, School of Medicine, Trabzon, Turkiye
| | - Serdar Durak
- Department of Gastroenterology, Karadeniz Technical University, School of Medicine, Trabzon, Turkiye
| | - Goktug Sirin
- Department of Gastroenterology, Kocaeli University, School of Medicine, Kocaeli, Turkiye
| | - Ayse Kefeli
- Department of Gastroenterology, Tokat Gaziosmanpasa University, School of Medicine, Tokat, Turkiye
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University, School of Medicine, Ankara, Turkiye
| | - Ufuk Avcioglu
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkiye
| | - Talat Ayyildiz
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkiye
| | - Orhan Sezgin
- Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkiye
| | - Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylul, School of Medicine, Izmir, Turkiye
| | - Dinc Dincer
- Department of Gastroenterology, Akdeniz University, School of Medicine, Antalya, Turkiye
| | - Fatih Guzelbulut
- Departments of Gastroenterology and Pathology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkiye
| | - Fulya Gunsar
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkiye
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University, School of Medicine, Ankara, Turkiye
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Samaha C, Chaaban H, Simsek C, Danis N, Lin JS, Gurakar A. Practice patterns and considerations in liver transplantation from living donors with high BMI: A review. Hepatol Forum 2023; 4:145-149. [PMID: 37822307 PMCID: PMC10564250 DOI: 10.14744/hf.2023.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023]
Abstract
Living Donor Liver Transplantation (LDLT) is a valuable solution to the shortage of donor organs for patients with end-stage liver disease. However, the eligibility of obese donors for LDLT remains a subject of debate. This literature review explores global practices and perceptions of LDLT, identifies donor eligibility criteria, and discusses special considerations and ethical caveats. The review highlights the need for standardized guidelines for donor selection, considering the global distribution of Body mass index and variations in population-specific criteria. It also emphasizes the importance of non-invasive testing and pre-operative optimization of liver steatosis for select obese donors. Furthermore, the review examines the outcomes and complications associated with obese donors in LDLT. The findings of this review contribute to the ongoing discussion on the inclusion of obese donors in LDLT and provide insights for future research and guideline development.
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Affiliation(s)
- Carl Samaha
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hadi Chaaban
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cem Simsek
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nilay Danis
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica S. Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Gurakar
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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3
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Danis N, Weeks SR, Kim A, Baghdadi A, Ghadimi M, Kamel IR, Saberi B, Woreta T, Garonzik-Wang J, Philosophe B, Gurakar A, Loomba R. Noninvasive Risk Stratification for Nonalcoholic Fatty Liver Disease Among Living Liver Donor Candidates: A Proposed Algorithm. Liver Transpl 2022; 28:670-677. [PMID: 34753223 PMCID: PMC9683539 DOI: 10.1002/lt.26365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 12/16/2022]
Abstract
To reduce waitlist mortality, living donor liver transplantation (LDLT) has increased over the past decade in the United States, but not at a rate sufficient to completely mitigate organ shortage. As a result, there are ongoing efforts to expand the living liver donor pool. Simultaneously, the prevalence of nonalcoholic fatty liver disease (NAFLD) in the general population has increased, which has significant implications on the pool of potential living liver donors. As such, a clinical assessment algorithm that exhaustively evaluates for NAFLD and fibrosis is critical to the safe expansion of LDLT. An ideal algorithm would employ safe and noninvasive methods, relying on liver biopsy only when necessary. While exclusion of NAFLD and fibrosis by noninvasive means is widely studied within the general population, there are no well-accepted guidelines for evaluation of living donors using these modalities. Here we review the current literature regarding noninvasive NALFD and fibrosis evaluation and propose a potential algorithm to apply these modalities for the selection of living liver donors.
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Affiliation(s)
- Nilay Danis
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sharon R. Weeks
- Division of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahyoung Kim
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Azarakhsh Baghdadi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maryam Ghadimi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ihab R. Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Behnam Saberi
- Division of Gastroenterology and Hepatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Tinsay Woreta
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Benjamin Philosophe
- Division of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahmet Gurakar
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rohit Loomba
- NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, CA,Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA,Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA
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Danis N, Comlekci A, Yener S, Durak M, Calan M, Solmaz D, Yalcin M, Gulcu A, Demir T, Bayraktar F, Canda T. ASSOCIATION BETWEEN HASHIMOTO'S THYROIDITIS AND PAPILLARY THYROID CANCER: A SINGLE CENTER EXPERIENCE. Acta Endocrinol (Buchar) 2022; 18:74-78. [PMID: 35975248 PMCID: PMC9365403 DOI: 10.4183/aeb.2022.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE To investigate the association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis (HT). DESIGN This study is a retrospective study that conducted during 7 consecutive years with a median 119.5 months follow-up. SUBJECTS AND METHOD Patients who underwent thyroidectomy in Dokuz Eylül University Hospital during 7 consecutive years were included. Patients' demographics, biochemical, radiological, and pathological results were retrospectively assessed. RESULTS Four hundred sixty nine patients were evaluated. Among 469 patients who underwent thyroidectomy, 132 (28.1%) were malignant, while 182 patients were diagnosed with HT (38.8%). PTC was ranked first at 92.4% (n: 122). The prevalence of HT was 54.9% in patients with PTC and 33.1% in patients without PTC diagnosis (p<0.001). Younger age and the presence of HT were independently associated with PTC. The presence of HT was associated with increased risk of development of PTC (OR: 2.2, %95 CI: 1.4-3.5, p<0.001) but not with TNM stage or recurrence. Lymph node metastasis at presentation was the strongest predictor of recurrence (OR: 13.9, CI: 3.5-54.6, p<0.001). CONCLUSIONS HT was an independent risk factor for development of PTC. According to our findings, HT patients (particularly with nodular HT) should be observed carefully and thyroid fine needle aspiration biopsy (TFNAB) should be encouraged if necessary.
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Affiliation(s)
- N. Danis
- Karabuk University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Karabuk, Turkey
- Correspondence to: Nilay Danis MD, Karabuk University Education and Research Hospital, Department of Internal Medicine, Division of Gastroenterology, Alpaslan Street No: 1, 78200, Karabuk, Turkey, E-mail:
| | - A. Comlekci
- “Dokuz Eylül” University School of Medicine, Department of Internal Medicine, Division of Endocrinology, Izmir, Turkey
| | - S. Yener
- “Dokuz Eylül” University School of Medicine, Department of Internal Medicine, Division of Endocrinology, Izmir, Turkey
| | - M. Durak
- “Dokuz Eylül” University School of Medicine, Department of Pathology, Izmir, Turkey
| | - M. Calan
- Bozyaka Education and Research Hospital, Department of Internal Medicine, Division of Endocrinology, Izmir, Turkey
| | - D. Solmaz
- Katip Celebi University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
| | - M.M. Yalcin
- Gazi University, School of Medicine, Department of Internal Medicine, Division of Endocrinology, Ankara, Turkey
| | - A. Gulcu
- “Dokuz Eylül” University, School of Medicine, Department of Interventional Radiology, Izmir, Turkey
| | - T. Demir
- “Dokuz Eylül” University School of Medicine, Department of Internal Medicine, Division of Endocrinology, Izmir, Turkey
| | - F. Bayraktar
- “Dokuz Eylül” University School of Medicine, Department of Internal Medicine, Division of Endocrinology, Izmir, Turkey
| | - T. Canda
- “Dokuz Eylül” University School of Medicine, Department of Pathology, Izmir, Turkey
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Akarsu M, Onem S, Turan I, Adali G, Akdogan M, Akyildiz M, Aladag M, Balaban Y, Danis N, Dayangac M, Gencdal G, Gokcan H, Sertesen E, Gurakar M, Harputluoglu M, Kabacam G, Karademir S, Kiyici M, Idilman R, Karasu Z. Recommendations for Hepatitis B Immunoglobulin and Antiviral Prophylaxis Against Hepatitis B Recurrence After Liver Transplantation. Turk J Gastroenterol 2021; 32:712-719. [PMID: 34609299 DOI: 10.5152/tjg.2021.21608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t) ide analogs after liver transplantation.
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Affiliation(s)
- Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Soner Onem
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | - Ilker Turan
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | - Gupse Adali
- Department of Gastroenterology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Meral Akdogan
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey
| | - Murat Aladag
- Department of Gastroenterology, Turgut Özal University School of Medicine, Malatya, Turkey
| | - Yasemin Balaban
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nilay Danis
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | - Murat Dayangac
- Center for Organ Transplantation, Medipol University Hospital, Istanbul, Turkey
| | - Genco Gencdal
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Sertesen
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Merve Gurakar
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology, Liver Transplantation Institute, İnönü University School of Medicine, Malatya, Turkey
| | - Gokhan Kabacam
- Department of Gastroenterology, Güven Hospital, Ankara, Turkey
| | - Sedat Karademir
- Department of Gastroenterology, Güven Hospital, Ankara, Turkey
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
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Danis N, Ozkan AE, Karatas F, Cakici C, Yigitbasi T, Sevencan NO, Kayhan B. The importance of antioxidant status in gastric intestinal metaplasia. J Med Biochem 2021; 40:378-383. [PMID: 34616227 PMCID: PMC8451221 DOI: 10.5937/jomb0-29349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Oxidative stress status in different cancer types was investigated before, but not studied in gastric intestinal metaplasia to the best of our knowledge. Purpose of this study is to examine whether there is a difference between oxidative stress status in patients with intestinal metaplasia (IM) compared to individuals without IM, we compared the serum levels of disulfide (SS), total thiol (TT) and native thiol (NT). METHODS This was a prospective, non-randomized casecontrol study including 67 patients with histopathologically confirmed IM and 60 individuals demographically matched in terms of age, gender, BMI, smoking status, and chronic diseases as control group. RESULTS The mean NT, TT and NT to TT (NT/TT) ratios were statistically significantly higher in IM group compared to controls ((351.71 ± 81.9 mol/L vs. 271.82 ± 54.13 mol/L, p=0.000), (391.5 ± 92.69 mol/L vs. 308.59 ± 55.53 mol/L, p=0.000) and (0.89 ± 0.6 vs. 0.87 ± 0.29, p=0.022), respectively). The mean SS to TT (SS/TT) ratio was significantly lower in IM group than control group (0.050 ± 0.31 vs. 0.060 ± 0.014, P=0.022). Median SS and mean SS/NT ratio was similar in both groups (16.3 (3.3-78) vs. 18.3 (10-32.7), p=0.271 and 0.055 ± 0.041 vs. 0.070 ± 0.019, p=0.068, respectively). In ROC analysis, cut off value of SS/NT for IM was found 0.062, in regression analysis, SS/NT <0.062 was found as an independently prognostic marker for IM (OR, 2.38; 95%CI: 1.168-4.865, P=0.017). CONCLUSIONS SS/NT ratio lower than 0.062 was found as an independently prognostic marker for IM. This ratio could help to distinguish which patients should be followed closely for gastric cancer.
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Affiliation(s)
- Nilay Danis
- Karabuk University Education and Research Hospital, Gastroenterology, Karabuk, Turkey
| | - Aysegul Ertinmaz Ozkan
- Karabuk University Education and Research Hospital, Department of Internal Madicine, Karabuk, Turkey
| | - Fatih Karatas
- Karabuk University Education and Research Hospital, Medical Oncology, Karabuk, Turkey
| | - Cagri Cakici
- Medipol University, Regenerative and Restorative Medicine Research Center, Istanbul, Turkey
| | - Turkan Yigitbasi
- Medipol University, Regenerative and Restorative Medicine Research Center, Istanbul, Turkey
| | - Nurhayat Ozkan Sevencan
- Karabuk University Education and Research Hospital, Department of Internal Madicine, Karabuk, Turkey
| | - Burcak Kayhan
- Karabuk University Education and Research Hospital, Department of Internal Madicine, Karabuk, Turkey
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Abstract
Trichobezoars present with stomach ache and with a mass in the stomach. It's common in the young and middle-aged women having psychiatric disorder, presenting with stomach ache and existence of mass in the stomach. Although it's one of the rare causes of anaemia it should be considered when dealing with cases of chronic and unresponsive anaemia.
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Affiliation(s)
- Aysegul Ertinmaz Ozkan
- Department of Internal Medicine, Education and Research Hospital, Karabuk University, Karabuk, Turkey
| | - Nilay Danis
- Department of Gastroenterology, Education and Research Hospital, Karabuk University, Karabuk, Turkey
| | - Mustafa Altundal
- Department of General Surgery, Education and Research Hospital, Karabuk University, Karabuk, Turkey
| | - Nurhayat Ozkan Sevencan
- Department of Internal Medicine, Education and Research Hospital, Karabuk University, Karabuk, Turkey
| | - Fatih Karatas
- Department of Medical Oncology, Education and Research Hospital, Karabuk University, Karabuk, Turkey
| | - Burcak Kayhan
- Department of Internal Medicine, Education and Research Hospital, Karabuk University, Karabuk, Turkey
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Simsek C, Kim A, Ma M, Danis N, Gurakar M, Cameron AM, Philosophe B, Garonzik-Wang J, Ottmann S, Gurakar A, Saberi B. Recurrence of hepatocellular carcinoma following deceased donor liver transplantation: case series. ACTA ACUST UNITED AC 2020; 6. [PMID: 32582866 PMCID: PMC7313412 DOI: 10.20517/2394-5079.2019.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma recurrence. Methods We reviewed the data for 26 patients who had tumor recurrence after deceased donor liver transplant for hepatocellular carcinoma at the Johns Hopkins Hospital from January 2005 to December 2015. Results In total, 88% of recipients were males. The mean age was 59 years. On explant, poor differentiation was detected in 43%, while 73% had microvascular invasion. Overall, 62% were diagnosed to be outside of Milan criteria. Out of these, 15% met the criteria for downstaging. Twenty (77%) patients had pre-transplant alpha fetoprotein levels ≥ 20 ng/mL. In 54% of patients, the location of hepatocellular carcinoma (HCC) recurrence was extrahepatic, followed by intrahepatic in 31% and both intra- and extrahepatic in 15%. The post-transplant tumor recurrence was diagnosed at a mean of 427 days (range 34-1502). Fifty percent of HCC recurrences were diagnosed within one year following liver transplant. Twenty (77%) patients received treatment for their recurrent HCC: external radiation (n = 10), surgical resections (n = 8; brain 4, spine 2, bone 1, and Whipple surgery 1), sorafenib (n = 7), locoregional therapy (n = 5). Overall, 24 out of 26 (92%) recipients died within four years after the transplant. Conclusion HCC recurrence after liver transplant is infrequent. More than fifty percent of HCC recurrences following liver transplant are extrahepatic. Despite better recipient selection for liver transplant, the curative options are limited in recurrent cases and associated with extremely poor outcomes.
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Affiliation(s)
- Cem Simsek
- Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, MD 21205, USA
| | - Amy Kim
- Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, MD 21205, USA
| | - Michelle Ma
- Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, MD 21205, USA
| | - Nilay Danis
- Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, MD 21205, USA
| | - Merve Gurakar
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Andrew M Cameron
- Johns Hopkins University School of Medicine, Division of Transplant Surgery, Baltimore, MD 21205, USA
| | - Benjamin Philosophe
- Johns Hopkins University School of Medicine, Division of Transplant Surgery, Baltimore, MD 21205, USA
| | - Jacqueline Garonzik-Wang
- Johns Hopkins University School of Medicine, Division of Transplant Surgery, Baltimore, MD 21205, USA
| | - Shane Ottmann
- Johns Hopkins University School of Medicine, Division of Transplant Surgery, Baltimore, MD 21205, USA
| | - Ahmet Gurakar
- Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, MD 21205, USA
| | - Behnam Saberi
- Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, MD 21205, USA
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