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Clinical significance of surgical resection for hepatocellular carcinoma with portal vein invasion:a nationwide cohort study

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 814-823,I0006-I0008页

作者： Hye-Sung Jo Pyoung-Jae Park Young-Dong Yu Yoo Jin Choi Se Hyeon Yu Dong-Sik Kim Korean Liver Cancer Association Division of HBP Surgery and Liver transplantation Department of SurgeryKorea University College of MedicineSeoulRepublic of Korea Division of transplantation and Vascular Surgery Department of SurgeryKorea University Guro HospitalKorea University College of MedicineSeoulRepublic of Korea

Background:Hepatocellular carcinoma(HCC)with portal vein invasion(PVI)is considered an advanced stage with a poor *** current guidelines recommend systemic treatment for HCC with PVI,surgical resection could produce acceptable outcomes in selected *** study aimed to identify the clinical significance of surgical resection for HCC with PVI patients using a large-scale nationwide ***:This retrospective,multicenter,observational cohort analyzed data from the Korean Primary Liver Cancer Registry.A total of 16,781 patients who were newly diagnosed with HCC between 2008 and 2018 were enrolled in this *** with worse Child-Turcotte-Pugh scores(≥7)or performance status(≥2)were *** them,998 patients who received treatment for HCC with PVI were included in the analysis and were divided into two groups:resection group of 151(15.1%)and palliative group of 847(84.9%)who received transarterial and systemic therapy according to the treatment *** matching the number and size of the tumors and model for end-stage liver disease(MELD)score between the groups,the final study cohort for analysis comprised 151(26.6%)patients in the resection group and 417(73.4%)in the palliative *** primary endpoints were overall survival(OS)and cancer-specific survival(CSS).Results:The number and maximum size of HCC did not differ between the resection and palliative groups after matching[1(range,1-5)vs.1(range,1-6),P=0.11 and 5.5(range,1.2-20.6)vs.6.0(range,1.0-20.5)cm,P=0.24,respectively].Tumor markers,including alpha-fetoprotein(AFP)and protein induced by vitamin K absence or antagonist-II(PIVKA-II),also did not differ between the groups(P=0.29 and P=0.36,respectively).The 5-year OS and CSS rates of the resection and palliative groups were 44.8%and 17.4%(P<0.001)and 47.7%and 18.6%(P<0.001),*** analysis showed that palliative treatment intent was the most significant risk factor for OS and CSS[odds ratio(OR

关键词： Hepatocellular carcinoma(HCC) portal vein invasion(PVI) overall survival(OS) cancer-specific survival(CSS) surgical resection

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The link between intracellular calcium signaling and exosomal PD-L1 in cancer progression and immunotherapy

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Genes & Diseases 2024年第1期11卷 321-334页

作者： Md Rakibul Alam Md Mizanur Rahman Zhiguo Li department of Toxicology and Cancer Biology College of MedicineUniversity of KentuckyLexingtonKY 40506USA department of medicine(nephrology) Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlberta T6E2H7Canada

Exosomes are small membrane vesicles containing microRNA,RNA,DNA fragments,and proteins that are transferred from donor cells to recipient *** cells release exo-somes to reprogram the factors associated with the tumor microenvironment(TME)causing tu-mor metastasis and immune *** evidence revealed that cancer cell-derived exosomes carry immune inhibitory molecule program death ligand 1(PD-L1)that binds with re-ceptor program death protein 1(PD-1)and promote tumor progression by escaping immune ***,some FDA-approved monoclonal antibodies are clinicallyused for cancer treatment by blocking PD-1/PD-L1 *** notable treatment outcomes,some pa-tients show poor drug *** PD-L1 plays a vital role in lowering the treatment response,showing resistance to PD-1/PD-L1 blockage therapy through recapitulating the ef-fect of cell surface *** enhance therapeutic response,inhibition of exosomal PD-L1 is *** signaling is the central regulator of tumorigenesis and can regulate exosome biogenesis and secretion by modulating Rab GTPase family and membrane fusion ***-mune checkpoints are also connected with calcium signaling and calcium channel blockers like amlodipine,nifedipine,lercanidipine,diltiazem,and verapamil were also reported to suppress cellular PD-L1 ***,to enhance the PD-1/PD-L1 blockage therapy response,the reduction of exosomal PD-L1 secretion from cancer cells is in our therapeutic *** this review,we proposed a therapeutic strategy by targeting calcium signaling to inhibit the expression of PD-L1-containing exosome levels that could reduce the anti-PD-1/PD-L1 therapy resistance and increase the patient's drug response rate.

关键词： Calcium signaling CD8^(+)T cells Exosomal PD-L1 Exosomes biogenesis Immunosuppression Immunotherapy

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Beyond the Rex: an innovative meso-intrahepatic portal vein bypass for late-onset extrahepatic portal vein occlusion after living donor liver transplantation

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Hepatobiliary Surgery and Nutrition 2024年第4期13卷 662-668页

作者： Chee-Chien Yong Hsu-Ting Yen Yu-Fan Cheng Leona Bettina Dungca Raymond Joseph De Vera Itsuko Chih-Yi Chen Chao-Long Chen department of Surgery Liver Transplantation CenterKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiung department of Cardiovascular Surgery Liver Transplantation CenterKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiung department of Diagnostic Radiology Liver Transplantation CenterKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiung

The Meso-Rex bypass(MRB)is recognized as an effective treatment for portal hypertension secondary to extrahepatic portal vein occlusion(EHPVO)both in the pediatric and adult population,within or outside the context of liver *** is the preferred surgical treatment in most centers because not only does it addresses the portal hypertension,but also restores physiologic portal hepatopetal ***,the Rex recess,the landmark for this technique,may not be safely accessible in some *** present a 22-year-old male who underwent living donor liver transplant(LDLT)for neonatal *** presented with variceal bleeding due to EHPVO at 13 years after *** endoscopic,radiologic,and surgical interventions were employed to address the recurrent gastrointestinal bleeding,but results have been *** performed a meso-intrahepatic portal vein bypass(MIPVB),an innovative alternative to the MRB,for this patient with extensive post-operative adhesions,perihilar collaterals,and cavernous *** creation in patients where the Rex recess is inaccessible is technically *** with a multidisciplinary team approach,meticulous preoperative planning,and close follow-up,the authors have demonstrated that it is a safe and feasible option for patients with late-onset EHPVO after liver transplantation.

关键词： Meso-Rex bypass(MRB) portal vein occlusion liver transplantation(LT)

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Pleural empyema with endobronchial mass due to Rhodococcus equi infection after renal transplantation: A case report and review of literature

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World Journal of Clinical Cases 2024年第1期12卷 224-231页

作者： Guo-Fu Liang Sheng Chao Zhou Sun Ke-Jing Zhu Qian Chen Lei Jia Yu-Lin Niu department of Organ transplantation School of Clinical MedicineGuizhou Medical UniversityGuiyang 550025Guizhou ProvinceChina department of Organ transplantation The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550000Guizhou ProvinceChina

BACKGROUND Kidney transplantation is the best option for patients with end-stage renal ***,the need for lifelong immunosuppression results in renal transplant recipients being susceptible to various *** equi(***)is a rare opportunistic pathogen in humans,and there are limited reports of infection with *** in post-renal transplant recipients and no uniform standard of *** article reports on the diagnosis and treatment of a renal transplant recipient infected with *** 21 mo postoperatively and summarizes the charac-teristics of infection with *** after renal transplantation,along with a detailed review of the ***,we present the case of a 25-year-old man who was infected with *** 21 mo after renal *** the clinical features at the time of presentation were not specific,chest computed tomography(CT)showed a large volume of pus in the right thoracic cavity and right middle lung atelectasis,and fiberoptic bronchoscopy showed an endobronchial mass in the right middle and lower lobe *** culture and metagenomic next-generation sequen-cing sequencing of the pus were suggestive of *** *** immunosup-pressive drugs were immediately suspended and intravenous vancomycin and azithromycin were administered,along with adequate drainage of the *** endobronchial mass was then *** the patient’s clinical symptoms and chest CT presentation resolved,he was switched to intravenous ciprofloxacin and azithromycin,followed by oral ciprofloxacin and *** patient was re-hospitalized 2 wk after discharge for recurrence of *** *** recovered after another round of adequate abscess drainage and intravenous ciprofloxacin and *** Infection with *** in renal transplant recipients is rare and complex,and the clinical presentation lacks *** antibiotic therapy is required,and adequate abscess drainage and s

关键词： Kidney transplantation Rhodococcus equi Pleural empyema Pulmonary atelectasis Immunosuppression Case report

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Efficacy and safety of Yiqi Peiyuan granules for improving the short-term prognosis of patients with acute kidney injury:A multicenter,double-blind,placebo-controlled,randomized trial

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Journal of Integrative medicine 2024年第3期22卷 279-285页

作者： Jia-jia Wu Tian-yi Zhang Ying-hui Qi Min-yan Zhu Yan Fang Chao-jun Qi Li-ou Cao Ji-fang Lu Bo-han Lu Lu-min Tang Jian-xiao Shen Shan Mou department of nephrology Molecular Cell Lab for Kidney DiseaseShanghai Peritoneal Dialysis Research CenterUremia Diagnosis and Treatment CenterRenji Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghai 200127China department of nephrology Shanghai Pudong New Area Punan HospitalShanghai 200125China department of nephrology Ningbo Hangzhou Bay HospitalNingbo 315336Zhejiang ProvinceChina

Background:Yiqi Peiyuan(YQPY)prescription,a composite prescription of traditional Chinese medicine,has been used to prevent or delay the continued deterioration of renal function after acute kidney injury(AKI)in some institutions and has shown considerable ***:This is the first randomized controlled trial to assess efficacy and safety of YQPY for improving short-term prognosis in adult patients with ***,setting,participants and interventions:This is a prospective,double-blind,multicenter,randomized,and placebo-controlled clinical trial.A total of 144 enrolled participants were randomly allocated to two groups according to a randomization ***,caregivers and investigators assessing the outcomes were blinded to group *** in the YQPY group received 36 g YQPY granules twice a day for 28 *** in the placebo group received a placebo in the same dose as the YQPY *** outcome measures:The primary outcome was the change in the estimated glomerular filtration rate(eGFR)between baseline and after 4 and 24 weeks of *** secondary outcomes were the change of serum creatinine(Scr)level between baseline and after treatment,and the incidence of endpoint events,defined as eGFR increasing by more than 25%above baseline,eGFR>75 mL/min per1.73 m2or the composite endpoint,which was defined as the sum of patients meeting either of the above ***:Data from a total of 114 patients(59 in the YQPY group and 55 in the control group)were *** mean changes in eGFR and Scr in weeks 4 and 24 had no difference between the two *** further subgroup analysis(22 in the YQPY group and 31 in the control group),the mean change in eGFR after treatment for 4 weeks was 27.39 mL/min per 1.73 m2in the YQPY group and 5.78 mL/min per1.73 m2in the placebo group,and the mean difference between groups was 21.61 mL/min per 1.73 m2(P<0.001).Thirteen(59.1%)patients in the YQPY group and 5(16.1%)in the placebo g

关键词： Chinese herbal medicine Randomized controlled trial Acute kidney injury Renal function

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Update on the reciprocal interference between immunosuppressive therapy and gut microbiota after kidney transplantation

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World Journal of transplantation 2024年第1期14卷 72-83页

作者： Maurizio Salvadori Giuseppina Rosso department of Renal transplantation Careggi University HospitalFlorence 50139TuscanyItaly Division of nephrology San Giovanni di Dio HospitalFlorence 50143ToscanaItaly

Gut microbiota is often modified after kidney *** principally happens in the first period after *** and,most of all,immunosuppressive drugs are the main *** relationship between immunosuppressive drugs and the gut microbiota is *** one side immunosuppressive drugs modify the gut microbiota,often generating dysbiosis;from the other side microbiota may interfere with the immunosuppressant pharmacokinetics,producing products more or less active with respect to the original *** phenomena have influence over the graft outcomes and clinical consequences as rejections,infections,diarrhea may be caused by the dysbiotic ***,calcineurin inhibitors such as tacrolimus and cyclosporine,mycophenolate mofetil and mTOR inhibitors are the immunosuppressive drugs whose effect on the gut microbiota is better *** contrast is well known how the gut microbiota may interfere with glucocorticoids,which may be transformed into *** may be transformed by microbiota into a product called M1 that is 15-fold less active with respect to *** pro-drug mycophenolate mofetil is normally transformed in mycophenolic acid that according the presence or not of microbes producing the enzyme glucuronidase,may be transformed into the inactive product.

关键词： Immunosuppressive therapy Kidney transplantation Gut microbiota Dysbiosis Pathobionts Graft outcomes

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Clinical feasibility of modified extended left hemihepatectomy in advanced perihilar cholangiocarcinoma

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Hepatobiliary Surgery and Nutrition 2024年第1期13卷 165-167页

作者： Hye-Sung Jo Dong-Sik Kim Division of HBP Surgery and Liver transplantation Department of SurgeryKorea University College of MedicineSeoulRepublic of Korea

Curative resection is undoubtedly the most important prognostic factor in perihilar cholangiocarcinoma(1).The current consensus of surgical resection of perihilar cholangiocarcinoma consists of hemihepatectomy,including caudate lobectomy and aggressive lymphadenectomy,depending on the extent of bile duct *** decisions on whether to resect the right or left liver and whether to perform an extended hepatectomy or trisectionectomy are all aimed at obtaining negative radial and longitudinal margins(2,3).

关键词： Treatment outcome hepatectomy perihilar cholangiocarcinoma

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Cardiac evaluation of renal transplant candidates with heart failure

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World Journal of transplantation 2024年第4期14卷 44-49页

作者： Amer Ashaab Belal Alfonso Hernandez Santos Jr Amir Kazory department of medicine Division of NephrologyUniversity of Florida College of MedicineGainesvilleFL 32610United States Division of nephrology Hypertension and Renal TransplantationUniversity of FloridaGainesvilleFL 32608United States

Patients with advanced kidney disease are at elevated risk of developing heart failure and appropriate risk stratification is important to permit them to receive kidney *** American Heart Association and American College of Cardiology joint statement provides guidance on risk stratification for the major cause of heart failure for these patients in its recommendations for coronary heart *** we provide an overview of the available literature on risk strati-fication for nonischemic heart failure and functional heart disease states such as pulmonary *** of these options for optimizing these patients be-fore transplant include optimizing their volume status,often with more agg-ressive *** transplantation remains the treatment of choice for patients with advanced kidney disease and cardiac disease,the correction of the azotemic substances with kidney transplantation has been associated with imp-roved survival than remaining on dialysis *** findings in the studies reviewed here are expected to help clinicians refine current strategies for evalua-ting potential kidney transplant recipients.

关键词： Kidney transplantation Preoperative evaluation Clinical practice guidelines Heart failure Pulmonary hypertension

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A single center analysis of long-term outcomes and survival related risk factors in liver retransplantation

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 425-443,I0011页

作者： Zhihao Li Yi Ping Sng Chao-Long Chen Chih-Che Lin Shih-Ho Wang Chee-Chien Yong Liver transplantation Center and department of Surgery Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung

Background:Liver retransplant is the only option to save a patient with liver graft ***,it is controversial due to its poor survival outcome compared to primary *** deceased organ donation in Taiwan leads to high waitlist ***,living-donor grafts offer a valuable alternative for *** study aims to analyze the single center’s outcome in living donor liver retransplantation(re-LDLT)and deceased donor liver retransplantation(re-DDLT)as well as the survival related confounding risk ***:This is a single center retrospective study including 32 adults who underwent liver retransplantation(re-LT)from June 2002 to April *** cohort was divided into a re-LDLT and a re-DDLT group and survival outcomes were *** outcomes over different periods,the effect of timing on survival,and multivariate analysis for risk factors were also demonstrated Results:Of the 32 retransplantations,the re-LDLT group(n=11)received grafts from younger donors(31.3 vs.43.75 years,P=0.016),with lower graft weights(688 vs.1,457.2 g,Ptransplantation after 2010 was *** analysis showed that the timing of retransplantation(early ***)did not affect patient *** analysis revealed that prolonged warm ischemia time(WIT)and intraoperative blood transfusion were related to poor long-term ***:Retransplantation with living donor graft demonstrated good long-term outcomes with acceptable complications to both recipient and *** may serve as a choice in areas lacking deceased *** timing of retransplantation did not affect the long-term *** effort should be made to reduce WIT and massive blood transfusion as they contributed to poor survi

关键词： Retransplantation living donor liver retransplantation(re-LDLT) deceased donor liver retransplantation(re-DDLT) timing of retransplantation long-term outcome

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Impact of bisphosphonate treatment on bone mineral density after kidney transplant

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World Journal of transplantation 2024年第3期14卷 102-109页

作者： Georgia Andriana Georgopoulou Marios Papasotiriou Theodoros Ntrinias Eirini Savvidaki Dimitrios S Goumenos Evangelos Papachristou department of nephrology and Kidney transplantation University Hospital of PatrasPatras 26504Greece

BACKGROUND Mineral bone disease is associated with chronic kidney disease and persists after kidney *** treatment contributes to the patho-genesis of this *** treatments have shown positive but inde-finite *** To evaluate the effectiveness and safety of bisphosphonate treatment on post kidney transplantation bone mineral density(BMD).METHODS We included kidney transplant recipients(KTRs)whose BMD was measured after the operation but before the initiation of treatment and their BMD was measured at least one year *** also evaluated the BMD of KTRs using two valid mea-surements after transplantation who received no treatment(control group).RESULTS Out of 254 KTRs,62(39 men)were included in the *** were initiated in 35 KTRs in total(20 men),1.1±2.4 years after operation and for a period of 3.9±2.3 years while 27(19 men)received no *** improved significantly in KTRs who received bisphosphonate treatments(from-2.29±1.07 to-1.66±1.09,P<0.0001).The control group showed a non-significant decrease in BMD after 4.2±1.4 years of follow-up after *** function was not affected by bisphosphonate *** KTRs with established osteoporosis,active treatment had a similar and significant effect on those with osteopenia or normal bone *** In this retrospective study of KTRs receiving bisphosphonate treatment,we showed that active treatment is effective in preventing bone loss irrespective of baseline BMD.

关键词： Mineral and bone disorders Chronic kidney disease Kidney transplant recipients Bisphosphonates Bone mineral density

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