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Statin, aspirin and metformin use and risk of hepatocellular carcinoma related outcomes following liver transplantation: A retrospective study

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World Journal of Transplantation 2024年第3期14卷 120-131页

作者： William Chung Kevin Wong Noel Ravindranayagam Lauren Tang Josephine Grace Darren Wong Danny Con Marie Sinclair avik majumdar Numan Kutaiba Samuel Hui Paul Gow Vijayaragavan Muralidharan Alexander Dobrovic Adam Testro Department of Gastroenterology Austin HealthHeidelberg 3084VictoriaAustralia Victorian Liver Transplant Unit Austin HealthHeidelberg 3084VictoriaAustralia Department of Radiology Austin HealthHeidelberg 3084VictoriaAustralia Department of Gastroenterology Monash HealthClayton 3168VictoriaAustralia Department of Surgery University of MelbourneAustin HealthHeidelberg 3048VictoriaAustralia Department of Surgery Beacon LaboratoryAustin PrecinctThe University of MelbourneAustin HospitalHeidelberg 3048VictoriaAustralia

BACKGROUND Liver transplantation(LT)is a potentially curative therapy for patients with hepatocellular carcinoma(HCC).HCC-recurrence following LT is associated with reduced *** is increasing interest in chemoprophylaxis to improve HCC-related outcomes *** To investigate whether there is any benefit for the use of drugs with proposed chemoprophylactic properties against HCC,and patient outcomes following *** This was a retrospective study of adult patients who received Deceased Donor LT for HCC from 2005-2022,from a single Australian *** use was defined as statin,aspirin or metformin therapy for≥29 days,within 24 months post-LT.A cox proportional-hazards model with time-dependent covariates was used for survival *** measures were the composite-endpoint of HCC-recurrence and all-cause mortality,HCC-recurrence and HCC-related *** analysis was performed to account for immortality time bias and statin *** Three hundred and five patients were included in this study,with 253(82.95%)males with a median age of 58.90 *** of liver disease were 150(49.18%)hepatitis C,73(23.93%)hepatitis B(HBV)and 33(10.82%)non-alcoholic fatty liver disease(NAFLD).56(18.36%)took statins,51(16.72%)aspirin and 50(16.39%)*** a median follow-up time of 59.90 months,34(11.15%)developed HCC-recurrence,48(15.74%)died,17(5.57%)from HCC-related ***,aspirin or metformin use was not associated with statistically significant differences in the composite endpoint of HCC-recurrence or all-cause mortality[hazard ratio(HR):1.16,95%CI:0.58-2.30;HR:1.21,95%CI:0.28-5.27;HR:0.61,95%CI:0.27-1.36],HCC-recurrence(HR:0.52,95%CI:0.20-1.35;HR:0.51,95%CI:0.14-1.93;HR 1.00,95%CI:0.37-2.72),or HCC-related mortality(HR:0.32,95%CI:0.033-3.09;HR:0.71,95%CI:0.14-3.73;HR:1.57,95%CI:0.61-4.04)*** dosing was not associated with statist-ically significant differences in HCC-related ***

关键词： Liver transplantation Hepatocellular carcinoma Transplant oncology Statins HMG-Co-A reductase Aspirin Metformin Mammalian target of rapamycin

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AIMS65: A promising upper gastrointestinal bleeding risk score but further validation required

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World Journal of Gastroenterology 2014年第39期20卷 14515-14516页

作者： Ray Boyapati avik majumdar Marcus Robertson Department of Gastroenterology and Liver Transplant Austin Hospital Heidelberg VIC 3084 Australia

A novel upper gastrointestinal bleeding risk stratification score(AIMS65) has recently been developed and validated. It has advantages over existing risk scores including being easy to remember and lack of subjectivity in calculation. We comment on a recent study that has cast doubt on the applicability of AIMS65 in the peptic ulcer disease population. Although promising, further studies are required to evaluate the validity of AIMS65 in various populations.

关键词： Gastrointestinal haemorrhage AIMS65 Endoscopy Prognosis Hemostasis Gastrointestinal bleeding

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Metabolic associated fatty liver disease:Addressing a new era in liver transplantation

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World Journal of Hepatology 2020年第12期12卷 1168-1181页

作者： Madeleine G Gill avik majumdar AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred HospitalSydney 2050New South WalesAustralia Central Clinical School The University of SydneySydney 2050New South WalesAustralia

Metabolic associated fatty liver disease(MAFLD),previously termed nonalcoholic fatty liver disease,is the leading global cause of liver disease and is fast becoming the most common indication for liver *** recent change in nomenclature to MAFLD refocuses the conceptualisation of this disease entity to its metabolic underpinnings and may help to spur a paradigm shift in the approach to its management,including in the setting of liver *** with MAFLD present significant challenges in the pre-,peri-and posttransplant settings,largely due to the presence of medical comorbidities that include obesity,metabolic syndrome and cardiovascular risk *** the community prevalence of MAFLD increases concurrently with the obesity epidemic,donor liver steatosis is also a current and future *** review outlines current epidemiology,nomenclature,management issues and outcomes of liver transplantation in patients with MAFLD.

关键词： Fatty liver Metabolic associated fatty liver disease Non-alcoholic fatty liver disease Liver transplantation Cirrhosis Metabolic syndrome

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Prevalence and outcomes of pancreatic cystic neoplasms in liver transplant recipients

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World Journal of Gastroenterology 2017年第48期23卷 8526-8532页

作者： Ken Liu Vikram Joshi Louise van Camp Qi-Wei Yang Judith E Baars Simone I Strasser Geoffrey W McCaughan avik majumdar Payal Saxena Arthur J Kaffes Sydney Medical School The University of Sydney AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Department of Radiology Royal Prince Alfred Hospital

AIM To determine the prevalence,characteristics and clinical course of pancreatic cystic neoplasms(PCNs) in liver transplantation(LT) *** We retrospectively studied consecutive patients who underwent LT between January 1998 to April 2016. Clinical and laboratory data were obtained from patient medical records. Imaging findings on computed tomography and magnetic resonance cholangiopancreatography were reviewed by two *** During the study period,872 patients underwent cadaveric LT. Pancreatic cysts were identified in 53/872(6.1%) and 31/53(58.5%) were PCNs [28 intraductal papillary mucinous neoplasm(IPMN),2 mucinous cystic neoplasm(MCN),1 serous cystadenoma]. Patients with PCNs exhibited less male predominance(55% vs 73%,P = 0.03) compared to patients without pancreatic cysts. Thirteen patients(42%) were diagnosed with PCN pre-LT while 18 patients(58%) developed PCN post-LT. The median size of PCNs was 13 mm [interquartile range(IQR) 10-20 mm]. All IPMNs were side-branch type. Most PCNs were found in the head and body of pancreas(37% each),followed by the tail(25%). Five patients underwent further evaluation with endoscopic ultrasound. Progress imaging was performed on 81% of patients. PCNs remained stable in size and number in all but 2 patients. During a median follow up of 39 mo(IQR 26-58 mo),the 2(6%) patients with MCN underwent pancreatectomy. No PCN patient developed pancreatic adenocarcinoma,while 5 died from illnesses unrelated to the PCN. Among patients without PCN,1/841(0.1%) developed pancreatic *** The prevalence of PCNs in LT recipients was similar to the general population(3.6%,31/872). Side-branch IPMNs do not appear to have accelerated malignant potential in post-LT patients,indicating the current surveillance guidelines are applicable to this group.

关键词： Pancreatic cystic neoplasm Intraductal papillary mucinous neoplasm Mucinous cystic neoplasm Liver transplantation Pancreatic adenocarcinoma Immunosuppression

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Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma:A systematic review and meta-analysis

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World Journal of Meta-Analysis 2022年第4期10卷 220-237页

作者： Myo Jin Tang Guy D Eslick John S Lubel Ammar Majeed avik majumdar William Kemp Stuart K Roberts Department of Gastroenterology Alfred HospitalMelbourne 3004VictoriaAustralia Monash Medical School Monash UniversityMelbourne 3004VictoriaAustralia Department of Statistics Clued Pty LtdSydney 2006New South WalesAustrali Central Clinical School Monash UniversityMelbourne 3004VictoriaAustralia Department of Gastroenterology Austin HospitalHeidelberg 3084VictoriaAustralia Department of Medicine Austin CampusUniversity of MedicineMelbourne 3084VictoriaAustralia

BACKGROUND Studies to date comparing outcomes of microwave ablation(MWA)with radiofrequency ablation(RFA)on patients with hepatocellular carcinoma have yielded conflicting results,with no clear superiority of one technique over the *** aim of this systematic review and meta-analysis was to compare the efficacy and safety of MWA with *** To perform a systematic review and meta-analysis comparing the efficacy and safety of MWA with *** A systematic literature search was performed using Ovid Medline,Embase,PubMed,Reference Citation Analysis,Cochrane Central and Cochrane Systematic Review databases,and Web of *** and full manuscripts were screened for inclusion utilising predefined inclusion and exclusion criteria comparing outcomes of MWA and RFA.A random-effects model was used for each ***-regression analysis was performed to adjust for the difference in follow-up period between the *** outcome measures included complete ablation(CA)rate,local recurrence rate(LRR),survival[local recurrence-free survival(LRFS),overall survival(OS)]and adverse *** A total of 42 published studies[34 cohort and 8 randomised controlled trials(RCT)]with 6719 patients fulfilled the selection *** was no significant difference in tumour size between the treatment *** rates between MWA and RFA groups were similar in prospective cohort studies[odds ratio(OR)0.95,95%confidence interval(CI)0.28–3.23]and RCTs(OR 1.18,95%CI 0.64–2.18).However,retrospective studies reported higher rates with MWA(OR 1.29,95%CI 1.06–1.57).Retrospective cohort studies reported higher OS(OR 1.54,95%CI 1.15–2.05 and lower LRR(OR 0.67,95%CI 0.51–0.87).No difference in terms of LRFS or 30-d mortality was observed between both *** had an increased rate of adverse respiratory events when compared to RFA(OR 1.99,95%CI 1.07–3.71,P=0.03).CONCLUSION MWA achieves similar CA rates and as good or better longer-term outcomes in relation to LRR and O

关键词： Microwave ablation Radiofrequency ablation Hepatocellular carcinoma Survival Recurrence Meta-analysis

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