BACKGROUND Liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established worldwide.The cornerstone of this treatment lies in the various criteria formulated by expert con...BACKGROUND Liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established worldwide.The cornerstone of this treatment lies in the various criteria formulated by expert consensus and experience.The variations among the criteria are staggering,and the short-and long-term outcomes are controversial.AIM To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the future.METHODS We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were received.The centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was noted.RESULTS Of the 23 centers,35%were high volume center(>500 Liver transplants)while 52%were high-volume centers that performed more than 50 transplants/year.Approximately 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the patients.Barring a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC lesion.Positron-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied indications.The alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the criteria.The criteria for successful downstaging varied,but most centers conformed to the UCSF o展开更多
Background and Aims:Hepatocellularcarcinoma(HCC)isthe sixth most commonly occurring cancer worldwide.Knowledge and adherence to HCC surveillance guidelines has been associated with earlier detection.We sought to evalu...Background and Aims:Hepatocellularcarcinoma(HCC)isthe sixth most commonly occurring cancer worldwide.Knowledge and adherence to HCC surveillance guidelines has been associated with earlier detection.We sought to evaluate characteristics and outcomes following HCC diagnosis in patients screened for HCC in a large academic liver center versus patients diagnosed and referred from the community.Methods:We reviewed the records of patients diagnosed with HCC in the liver center of an academic institution from January 1999 till December 2013.Patients were classified into two groups:patients followed in our hepatology clinic and patients with HCC recently referred to our center.Univariate analysis was performed using chi-squared test and multivariate analysis was performed using SPSS 22.0.Results:The records of 410 patients were reviewed,and included 77.3%of patients referred from the community and 22.7%of patients followed in our clinic.In the clinic group,75.6%were identified with one nodule at initial diagnosis,compared to 65.6%in the referral group.Patients in the referral group were more likely to present with tumors≥5 cm at diagnosis,with 28.7%compared to 5.4%in the clinic group(P<0.0001).Patients referred from the community were also less likely to undergo transplant,with 32.2%as compared to 48.4%of the clinic group(P<0.004).Conclusion:Patients with chronic liver disease managed in an academic liver center present in the early stage of HCC diagnosis and are more likely to meet the Milan criteria and undergo transplant.Early referral to a specialized transplant center,if feasible,where a multidisciplinary approach is utilized might be essential in the management of chronic liver disease.展开更多
Cancer after transplantation is the third cause of death and one of the more relevant comorbidities. Aim of this review is to verify the role of different pathogenetic mechanisms in cancer development in transplant pa...Cancer after transplantation is the third cause of death and one of the more relevant comorbidities. Aim of this review is to verify the role of different pathogenetic mechanisms in cancer development in transplant patients and in general population as well. In particular has been outlined the different role exerted by two different families of drug as calcineurin inhibitor and mammalian target of rapamycin(m TOR) inhibitor. The role of m TOR pathways in cell homeostasis is complex but enough clear. As a consequence the m TOR pathway deregulation is involved in the genesis of several cancers. Hence the relevant role of m TOR inhibitors. The authors review the complex mechanism of action of m TOR inhibitors, not only for what concerns the immune system but also other cells as endothelial, smooth muscle and epithelial cells. The mechanism of action is still now not completely defined and understood. It implies the inhibition of m TOR pathway at different levels, but mainly at level of the phosphorylation of several intracellular kinases that contribute to activate m TOR complex. Many prospective and retrospective studies in transplant patients document the antineoplastic role of m TOR inhibition. More recently m TOR inhibitors proven to be effective in the treatment of some cancers also in general population. Kidney cancers, neuroendocrine tumors and liver cancers seem to be the most sensitive to these drugs. Best results are obtained with a combination treatment, targeting the m TOR pathway at different levels.展开更多
文摘BACKGROUND Liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established worldwide.The cornerstone of this treatment lies in the various criteria formulated by expert consensus and experience.The variations among the criteria are staggering,and the short-and long-term outcomes are controversial.AIM To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the future.METHODS We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were received.The centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was noted.RESULTS Of the 23 centers,35%were high volume center(>500 Liver transplants)while 52%were high-volume centers that performed more than 50 transplants/year.Approximately 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the patients.Barring a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC lesion.Positron-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied indications.The alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the criteria.The criteria for successful downstaging varied,but most centers conformed to the UCSF o
文摘Background and Aims:Hepatocellularcarcinoma(HCC)isthe sixth most commonly occurring cancer worldwide.Knowledge and adherence to HCC surveillance guidelines has been associated with earlier detection.We sought to evaluate characteristics and outcomes following HCC diagnosis in patients screened for HCC in a large academic liver center versus patients diagnosed and referred from the community.Methods:We reviewed the records of patients diagnosed with HCC in the liver center of an academic institution from January 1999 till December 2013.Patients were classified into two groups:patients followed in our hepatology clinic and patients with HCC recently referred to our center.Univariate analysis was performed using chi-squared test and multivariate analysis was performed using SPSS 22.0.Results:The records of 410 patients were reviewed,and included 77.3%of patients referred from the community and 22.7%of patients followed in our clinic.In the clinic group,75.6%were identified with one nodule at initial diagnosis,compared to 65.6%in the referral group.Patients in the referral group were more likely to present with tumors≥5 cm at diagnosis,with 28.7%compared to 5.4%in the clinic group(P<0.0001).Patients referred from the community were also less likely to undergo transplant,with 32.2%as compared to 48.4%of the clinic group(P<0.004).Conclusion:Patients with chronic liver disease managed in an academic liver center present in the early stage of HCC diagnosis and are more likely to meet the Milan criteria and undergo transplant.Early referral to a specialized transplant center,if feasible,where a multidisciplinary approach is utilized might be essential in the management of chronic liver disease.
文摘Cancer after transplantation is the third cause of death and one of the more relevant comorbidities. Aim of this review is to verify the role of different pathogenetic mechanisms in cancer development in transplant patients and in general population as well. In particular has been outlined the different role exerted by two different families of drug as calcineurin inhibitor and mammalian target of rapamycin(m TOR) inhibitor. The role of m TOR pathways in cell homeostasis is complex but enough clear. As a consequence the m TOR pathway deregulation is involved in the genesis of several cancers. Hence the relevant role of m TOR inhibitors. The authors review the complex mechanism of action of m TOR inhibitors, not only for what concerns the immune system but also other cells as endothelial, smooth muscle and epithelial cells. The mechanism of action is still now not completely defined and understood. It implies the inhibition of m TOR pathway at different levels, but mainly at level of the phosphorylation of several intracellular kinases that contribute to activate m TOR complex. Many prospective and retrospective studies in transplant patients document the antineoplastic role of m TOR inhibition. More recently m TOR inhibitors proven to be effective in the treatment of some cancers also in general population. Kidney cancers, neuroendocrine tumors and liver cancers seem to be the most sensitive to these drugs. Best results are obtained with a combination treatment, targeting the m TOR pathway at different levels.
