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Hepatobiliary Surgery and Nutrition 2024年第4期13卷 745-748页

作者： arno kornberg Department of Surgery Klinikum rechts der IsarSchool of MedicineTechnical University of MunichMunichGermany

Data from the literature favour liver transplantation(LT)as best curative-intent treatment in patients with early-stage hepatocellular carcinoma(HCC)arising from cirrhosis,as this approach targets both malignancy and the underlying cancerogenic *** strictly adhering to well-defined morphometric tumor burden limits,such as the Milan criteria,excellent recurrence-free survival(RFS)rates beyond 70%at 5 years may be achieved after ***,growing donor liver shortage has significantly increased waiting times and thereby risk of tumor-related dropout from the waiting list,ultimately resulting in inferior survival *** recent years,this critical situation further aggravated by growing evidence that beyond Milan patients may also benefit from LT,when being successfully downstaged by neoadjuvant locoregional interventions like transarterial chemoembolization(TACE)or radiofrequency ablation(RFA)(1).Therefore,even though being associated with an extraordinary risk of HCC recurrence accounting for 50%to 70%,upfront liver resection(LR)still represents the preferred surgical procedure in patients with resectable tumor stage,especially in those who do not suffer from severe portal hypertension.

关键词： Liver resection(LR) hepatocellular carcinoma(HCC) early recurrence late recurrence

Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation

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World Journal of Hepatology 2015年第11期7卷 1494-1508页

作者： arno kornberg Department of Surgery Klinikum rechts der Isar Technical University

Shortage of appropriate donor grafts is the foremost current problem in organ transplantation. As a logical consequence, waiting times have extended and pretransplant mortality rates were significantly increasing. The implementation of a priority-based liver allocation system using the model of end-stage liverdisease(MELD) score helped to reduce waiting list mortality in liver transplantation(LT). However, due to an escalating organ scarcity, pre-LT MELD scores have significantly increased and liver recipients became more complex in recent years. This has finally led to posttransplant decreasing survival rates, attributed mainly to elevated rates of infectious and immunologic complications. To meet this challenging development, an increasing number of extended criteria donor grafts are currently accepted, which may, however, aggravate the patients' infectious and immunologic risk profiles. The administration of intravenous immunoglobulins(IVIg) is an established treatment in patients with immune deficiencies and other antibody-mediated diseases. In addition, IVIg was shown to be useful in treatment of several disorders caused by deterioration of the cellular immune system. It proved to be effective in preventing hyperacute rejection in highly sensitized kidney and heart transplants. In the liver transplant setting, the administration of specific Ig against hepatitis B virus is current standard in post-LT antiviral prophylaxis. The mechanisms of action of IVIg are complex and not fully understood. However, there is increasing experimental and clinical evidence that IVIg has an immuno-balancing impact by a combination of immuno-supporting and immuno-suppressive properties. It may be suggested that, especially in the context of a worsening organ shortage with all resulting clinical implications, liver transplant patients should benefit from immuno-regulatory capabilities of IVIg. In this review, perspectives of immune modulation by IVIg and impact on outcome in liver t

关键词： Intravenous immunoglobulins Immunemodulation Hyperimmunoglobulin Model of end-stageliver disease Liver transplantation

18F-FDG-PET for Assessing Biological Viability and Prognosis in Liver Transplant Patients with Hepatocellular Carcinoma

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Journal of Clinical and Translational Hepatology 2017年第3期5卷 224-234页

作者： arno kornberg Martina Schernhammer Helmut Friess Department of Surgery Klinikum rechts der Isar Technical University Munich Germany

Liver transplantation (LT) has become standard of care in patients with non-resectable early stage hepatocellular carcinoma (HCC) in liver ***,patient selection for LT is strictly based on tumor size and number,provided by the Milan *** may,however,exclude patients with advanced tumor load but favourable biology from a possibly curative treatment *** became clear in recent years that biological tumor viability rather than tumor macromorphology determines posttransplant *** particular,microvascular invasion and poor grading reflect tumor aggressiveness and promote the risk of tumor *** biopsy is not applicable due to tumor heterogeneity and risk of tumor cell seeding.18F-fludeoxyglucose (18F-FDG) positron emission tomography (PET),an established nuclear imaging device in oncology,was demonstrated to non-invasively correlate with unfavorable histopathologic ***,there is an increasing amount of evidence that 18F-FDG-PET is very useful for identifying eligible liver transplant patients with HCC beyond standard criteria but less aggressive tumor *** order to safely expand the HCC selection criteria and the pool of eligible liver recipients,tumor evaluation with 18F-FDG-PETshould be implemented in pretransplant decision process.

关键词： Hepatocellular carcinoma Liver transplantation 18F-fludeoxyglucose positron emission tomography Tumor biology Tumor recurrence

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

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Hepatoma Research 2018年第9期4卷 123-141页

作者： arno kornberg Martina Schernhammer Department of Surgery Klinikum rechts der IsarTechnical University MunichMunich D-81675Germany

Liver transplantation (LT) is recognized as best treatment option in patients with early hepatocellular cancer (HCC) in underlying liver cirrhosis. Apart from tumor size and number implemented in the Milan criteria, which are current worldwide standards for patient selection, several biological tumor factors have been identified to affect cancer-specific outcome. In particular, grading and vascular tumor invasions were shown to correlate with aggressive biological tumor behavior and poor survival following LT. Identifying tumors with favorable biology is one important approach for expanding the pool of eligible liver recipients beyond the Milan burden limits. Improving the immunological state and condition for appropriate defense against circulating cancer cell attack may be another important prognostic aspect. Therefore, there is increasing interest in non-cancer factors related to the peritransplant period that may influence the oncological outcome by providing negative immunomodulatory actions. Considering and modulation of these non-HCC factors of prognosis might contribute in safely expanding the HCC LT selection criteria.

关键词： Hepatocellular carcinoma liver transplantation tumor biology non-cancer factors outcome