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Normothermic Ex-vivo Liver Perfusion and the Clinical Implications for Liver Transplantation

Journal of Clinical and Translational Hepatology 2018年第3期6卷 276-282页

作者： clifford akateh Eliza W.Beal Bryan A.Whitson Sylvester M.Black General and Gastrointestinal Surgery Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA Division of Cardiac Surgery Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA Division of Transplant Surgery Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA

Despite significant improvements in outcomes after liver trans-plantation,many patients continue to die on the waiting list,while awaiting an available organ for transplantation.Organ shortage is not only due to an inadequate number of available organs,but also the inability to adequately assess and evaluate these organs prior to transplantation.Over the last few decades,ex-vivo perfusion of the liver has emerged as a useful technique for both improved organ preservation and assessment of organs prior to transplantation.Large animal studies have shown the superiority of ex-vivo perfusion over cold static storage.However,these studies have not,necessa-rily,been translatable to human livers.Small animal studies have been essential in understanding and improving this tech-nology.Similarly,these results have yet to be translated into clinical use.A few Phase 1 clinical trials have shown promise and confirmed the viability of this technology.However,more robust studies are needed before ex-vivo liver perfusion can be widely accepted as the new clinical standard of organ preser-vation.Here,we aimed to review al relevant large and smal animal research,as well as human liver studies on normother-mic ex-vivo perfusion,and to identify areas of deficiency and opportunities for future research endeavors.

关键词： Liver Transplantation Ex-vivo perfusion

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Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma

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World Journal of Hepatology 2020年第10期12卷 693-708页

作者： clifford akateh Aslam M Ejaz Timothy Michael Pawlik Jordan M Cloyd Department of Surgery The Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Surgery The Ohio State UniversityColumbusOH 43210United States

Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver malignancy and is increasing in incidence.Long-term outcomes are optimized when patients undergo margin-negative resection followed by adjuvant chemotherapy.Unfortunately,a significant proportion of patients present with locally advanced,unresectable disease.Furthermore,recurrence rates are high even among patients who undergo surgical resection.The delivery of systemic and/or liver-directed therapies prior to surgery may increase the proportion of patients who are eligible for surgery and reduce recurrence rates by prioritizing early systemic therapy for this aggressive cancer.Nevertheless,the available evidence for neoadjuvant therapy in ICC is currently limited yet recent advances in liver directed therapies,chemotherapy regimens,and targeted therapies have generated increasing interest its role.In this article,we review the rationale for,current evidence for,and ongoing research efforts in the use of neoadjuvant therapy for ICC.

关键词： Biliary tract cancer Preoperative therapy Conversion therapy Down-staging Hepatectomy Liver resection

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Neoadjuvant and adjuvant treatment strategies for hepatocellular carcinoma

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World Journal of Gastroenterology 2019年第28期25卷 3704-3721页

作者： clifford akateh Sylvester M Black Lanla Conteh Eric D Miller Anne Noonan Eric Elliott Timothy M Pawlik Allan Tsung Jordan M Cloyd Department of Surgery The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Transplant Surgery Department of Surgery The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Gastroenterology Hepatology and Nutrition Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH 43210 United States Department of Radiation Oncology The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Medical Oncology Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Diagnostic Radiology Department of Radiology The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Surgical Oncology Department of Surgery The Ohio State University Wexner Medical Center Columbus OH 43210 United States

Hepatocellular carcinoma (HCC) is the most common liver malignancy worldwide and a major cause of cancer-related mortality for which liver resection is an important curative-intent treatment option. However, many patients present with advanced disease and with underlying chronic liver disease and/or cirrhosis, limiting the proportion of patients who are surgical candidates. In addition, the development of recurrent or de novo cancers following surgical resection is common. These issues have led investigators to evaluate the benefit of neoadjuvant and adjuvant treatment strategies aimed at improving resectability rates and decreasing recurrence rates. While high-level evidence to guide treatment decision making is lacking, recent advances in locoregional and systemic therapies, including antiviral treatment and immunotherapy, raise the prospect of novel approaches that may improve the outcomes of patients with HCC. In this review, we evaluate the evidence for various neoadjuvant and adjuvant therapies and discuss opportunities for future clinical and translational research.

关键词： Hepatocellular carcinoma Neoadjuvant therapy Adjuvant therapy Neoplasm recurrence Hepatectomy Liver cirrhosis

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