Survival of patients receiving a liver transplant for hepatocellular carcinoma, and risk of tumor recurrence

OBJECTIVE

The goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of post-transplant tumor relapse and factors related to this complication.

DESIGN

Retrospective study of a consecutive series of patients having had liver transplant for HCC.

PATIENTS AND METHODOLOGY

Transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis.

RESULTS

The survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR=1,7944) (IC 95%=1,1332-2,8413) and the vascular invasion (OR=6,6346) (IC 95%=1,4624-30,1003) as risk factors of relapse.

CONCLUSIONS

The liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion.

[Comparison of 2 treatment strategies with prednisone and interferon in chronic hepatitis B]

Twenty patients with chronic B hepatitis and viral replication were included in a randomized study comparing the efficacy of sequential treatment with prednisone for 6 weeks followed by alpha-2a interferon (IFN) for 6 months (group A, 9 cases), versus concomitant administration of both drugs (group B, 11 cases). There were no significant differences between the two groups regarding age, sex, AST, ALT, DNA-VHB values, index of histological activity or type of underlying chronic hepatitis. Two patients from each group were excluded. The mean follow-up of the patients was 22.2 months. In group A, four responses were achieved (57.1%), of which 2 were complete and 2 partial. The overall response rate in group B was 77.7% (7 cases), 6 of them were complete responses (66.7%). Among HBsAg-positive patients from group B, one seroconverted to anti-HBs. A total of 7 patients with anti-HBe were included in the study. Two belonged to group A, in which a partial response was achieved, and another 5 were in group B, with 4 reaching a complete response and one reaching a partial response. There were no statistical differences with regards to the type of response in both groups. The AST, ALT values, as well as the pre-treatment levels of DNA-VHB, showed a significant statistical association with the response (p < 0.05). In all patients responding to treatment a histological improvement was observed that became even more evident in the biopsy performed 12 months after IFN withdrawal. In conclusion, concomitant therapy with prednisone and IFN is as effective as sequential therapy in the treatment of chronic B hepatitis. The results achieved with concomitant therapy suggest that new controlled trials are need to establish if this therapeutic schedule is the elective treatment in chronic B hepatitis.

[Laryngeal fibrosarcoma. Report of 2 new cases]

Sarcomas constitute less than one percent of laryngeal neoplasms. Fibrosarcomas are by far the most commonly reported mesenchymal tumors of the larynx. We report two cases of fibrosarcoma of the larynx and discuss clinical aspects, diagnosis and treatment.

Immunocytochemical localization of retinal binding protein in the octopus retina: a shuttle protein for 11-cis retinal

The cephalopod retina contains two photopigments that are spatially separated within the photoreceptors; rhodopsin, localized in the light-sensitive rhabdoms, and retinochrome, present in the myeloid bodies of the photoreceptor inner segments. In the light, the chromophore of retinochrome, all-trans retinal, is photoisomerized to 11-cis to form metaretinochrome. Metaretinochrome is believed to serve as a store for 11-cis retinal used in the regeneration or biosynthesis of rhodopsin. Previous studies suggest that a soluble retinal binding protein (RALBP) serves as a shuttle between retinochrome and rhodopsin, and, in the dark, may transport chromophore from the myeloid bodies to the rhabdoms. Our study supports this hypothesis and demonstrates that RALBP is in the correct cellular locations to function as a shuttle. Dark- and light-adapted octopus retinas were labeled with anti-RALBP using immunofluorescence and immunogold techniques. Our results showed that RALBP was distributed differently in the dark- and light-adapted retinas. Our most significant observation was that myeloid bodies from light-adapted retinas were more heavily labeled by anti-RALBP than myeloid bodies in dark-adapted retinas. The rhabdomeres, interphotoreceptor matrix, and inner limiting membrane were also labeled in both light and dark conditions. Based on these results and evidence from previous biochemical studies, we conclude that in the dark RALBP leaves the myeloid bodies and transports 11-cis retinal to the rhabdoms where chromophore exchange with metarhodopsin may occur.