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1
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Evaluation of safety parameters and changes in serum concentration in liver transplant recipients treated with doxorubicin during the anhepatic period. Cancer Chemother Pharmacol 2013; 72:1325-33. [PMID: 24121480 DOI: 10.1007/s00280-013-2311-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/25/2013] [Indexed: 12/22/2022]
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2
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Dimitroulopoulos D, Xinopoulos D, Tsamakidis K, Zisimopoulos A, Andriotis E, Panagiotakos D, Fotopoulou A, Chrysohoou C, Bazinis A, Daskalopoulou D, Paraskevas E. Long acting octreotide in the treatment of advanced hepatocellular cancer and overexpression of somatostatin receptors: randomized placebo-controlled trial. World J Gastroenterol 2007. [PMID: 17589893 DOI: 10.3748/wjg.v13.i13.3164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC). METHODS A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with 111Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5 mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30 mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner. RESULTS Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49+/-6 wk) as compared to the control group (28+/-1 wk) and to the SSTR negative group (28+/-2 wk), LR=20.39, df=2, P<0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the first year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group, respectively. CONCLUSION The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.
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Affiliation(s)
- D Dimitroulopoulos
- Liver Cancer Unit, Agios Savvas Cancer Hospital, 35 Parnassou str., GR-152 34 Halandri-Athens, and Laboratory of Biostatistics, Department of Nursing, University of Athens, Greece.
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3
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Dimitroulopoulos D, Xinopoulos D, Tsamakidis K, Zisimopoulos A, Andriotis E, Panagiotakos D, Fotopoulou A, Chrysohoou C, Bazinis A, Daskalopoulou D, Paraskevas E. Long acting octreotide in the treatment of advanced hepatocellular cancer and overexpression of somatostatin receptors: Randomized placebo-controlled trial. World J Gastroenterol 2007; 13:3164-70. [PMID: 17589893 PMCID: PMC4436600 DOI: 10.3748/wjg.v13.i23.3164] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC).
METHODS: A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with 111Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner.
RESULTS: Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49 ± 6 wk) as compared to the control group (28 ± 1 wk) and to the SSTR negative group (28 ± 2 wk), LR = 20.39, df = 2, P < 0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the first year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group respectively.
CONCLUSION: The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.
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Affiliation(s)
- D Dimitroulopoulos
- Liver Cancer Unit, Agios Savvas Cancer Hospital, 35 Parnassou str., GR-152 34 Halandri-Athens, and Laboratory of Biostatistics, Department of Nursing, University of Athens, Greece.
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4
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Abstract
Currently, the primary use of liver transplantation in the setting of malignancy is in patients with hepatocellular carcinoma, with generally accepted criteria for transplantation consisting of the presence of one nodule less than 5 cm or two of three nodules each less than 3 cm in the absence of detectable vascular invasion. In some patients and settings, surgical resection before transplantation is an emerging, promising option. There is no clear beneficial role of transplantation in patients with resectable or unresectable cholangiocarcinoma, except in selected patients with unresectable disease that is associated with primary sclerosing cholangitis. While good survival results have been achieved with transplantation in patients with epithelioid hemangioendothelioma of the liver, the long-term survival of some patients without any radical treatment leaves the benefit of transplantation unclear. Transplantation would appear to benefit some patients with unresectable liver metastases from neuroendocrine tumors; those who present with non-neuroendocrine liver metastases are not considered candidates for transplantation.
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Affiliation(s)
- Jacques Belghiti
- Department of Digestive Surgery and Transplantation, Hospital Beaujon, Clichy, France
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5
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Fuster J, Charco R, Llovet JM, Bruix J, García-Valdecasas JC. Liver transplantation in hepatocellular carcinoma. Transpl Int 2005; 18:278-82. [PMID: 15730486 DOI: 10.1111/j.1432-2277.2004.00046.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Liver transplantation is one option of surgical treatment for cirrhotic patients with hepatocellular carcinoma, it not only treats the malignancy but also the underlying disease. After an initial period of disappointing results, mainly due to lack of adequate selection, survival nowadays is similar to that obtained by cirrhotic patients without tumor. Currently the scarcity of donors is the main limitation in the treatment of this type of patients. Increased time on the waiting list does compromise the results if they are analyzed in an intention-to-treat basis. Adjuvant therapy on the waiting list (ethanol injection, chemoembolization, surgery, etc.) or the use of marginal grafts in order to increase the donor pool may be some alternatives to overcome this deficit. The development of adult living donor liver transplantation has proved to be a good alternative in this type of patients even if they do not fulfill the conventional criteria.
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Affiliation(s)
- Josep Fuster
- Barcelona-Clinic Liver Cancer (BCLC) Group, Department of Surgery, Digestive Disease Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Villaroel 170, 08036 Barcelona, Catalonia, Spain
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6
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Friedewald SM, Molmenti EP, DeJong MR, Hamper UM. Vascular and nonvascular complications of liver transplants: sonographic evaluation and correlation with other imaging modalities and findings at surgery and pathology. Ultrasound Q 2003; 19:71-85; quiz 108-10. [PMID: 12973092 DOI: 10.1097/00013644-200306000-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Liver transplantation is performed in adults and children to treat patients with irreversible liver damage when medical or other surgical treatment has failed. The most common indications for transplantation are cirrhosis secondary to fulminant acute hepatitis or chronic active hepatitis, sclerosing cholangitis, primary biliary cirrhosis, Budd-Chiari syndrome, inborn errors of metabolism, and unresectable but local hepatocellular carcinoma. This article reviews the sonographic findings in the preoperative evaluation of liver transplant recipients, briefly describes the surgical technique, and demonstrates normal postoperative findings in liver transplant recipients as well as complications associated with liver transplantation.
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Affiliation(s)
- Sarah M Friedewald
- Women's Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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7
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Mela M, Mancuso A, Burroughs AK. Review article: hepatocellular carcinoma: indications for liver transplantation. Aliment Pharmacol Ther 2003; 17 Suppl 2:130-7. [PMID: 12786624 DOI: 10.1046/j.1365-2036.17.s2.16.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The role of liver transplantation for hepatocellular carcinoma has evolved over the years and currently is one of the curative therapies for small tumours. The survival rates are similar with those for nonmalignant liver disease after transplantation. The treatment of small tumours eligible for both resection and transplantation depends on the experience of the transplant centre and the waiting time for a liver graft. With waiting times for liver transplant becoming gradually longer, prioritization of the tumour patients has been suggested. Adjuvant therapies may delay the tumour progression while patients wait for a transplant. The living donor and the domino liver transplantation are useful alternatives given the shortage of organs but the experience is still limited in the Western world and the selection for the domino livers is fairly restricted.
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Affiliation(s)
- M Mela
- Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, London, UK
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8
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Mauro MA. Oncologic Interventions. J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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9
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Liu LU, Schiano TD, Min AD, Kim-Schluger L, Schwartz ME, Emre S, Fishbein TM, Bodenheimer HC, Miller CM. Syngeneic living-donor liver transplantation without the use of immunosuppression. Gastroenterology 2002; 123:1341-5. [PMID: 12360494 DOI: 10.1053/gast.2002.36012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Transplantation between monozygotic twins has been successfully performed using the kidney, small intestine, and pancreas. Identical HLA matching has enabled these individuals to be transplanted without the need for immunosuppressive medication. Liver transplantation without immunosuppression would lessen the risk of recurrent viral hepatitis and eliminate much of the morbidity associated with long-term use of immunosuppressive medication. Living-donor liver transplantation (LDLT) has been performed with increasing success in recent years without an opportunity arising to use a monozygotic twin as a donor. We report 2 cases of LDLT between identical twins wherein perfect haploidentity has allowed these recipients to be transplanted without the need for immunosuppression. Although HLA matched genotypically, there may be differences in anatomy between donor and recipient. Mild liver chemistry test abnormalities may occur after transplant despite the absence of immunosuppression.
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Affiliation(s)
- Lawrence U Liu
- The Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, New York 10029, USA
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10
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Hassoun Z, Gores GJ, Rosen CB. Preliminary experience with liver transplantation in selected patients with unresectable hilar cholangiocarcinoma. Surg Oncol Clin N Am 2002; 11:909-21. [PMID: 12607579 DOI: 10.1016/s1055-3207(02)00036-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Previous experience with OLT for hilar CCA has been discouraging, and survival was dismal. This study demonstrates that carefully selected patients with unresectable hilar CCA can achieve long-term survival after OLT. The survival rate obtained with this protocol (5-year actuarial survival of 87%) is comparable with the overall survival rate of liver-transplant recipients at the authors' institution. In comparison, the best survival rate after OLT for hilar CCA reported in the literature is 64.8% at 5 years in a subset of nine patients with negative lymph nodes. In the absence of a control group, it is difficult to assess with certainty the role of a combination of chemotherapy and radiotherapy, but in some patients it seems to prevent or slow progression of the disease while waiting for an available organ. Treatment-related morbidity, although significant, is not prohibitive. Nevertheless, a considerable proportion of treated patients ultimately was found to have advanced disease precluding transplantation. This finding confirms the importance of the staging laparotomy as an essential component of the protocol.
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Affiliation(s)
- Ziad Hassoun
- Division of Gastroenterology and Hepatology, Mayo Medical School, Clinic, and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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11
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McCaughan GW, Koorey DJ, Strasser SI. Hepatocellular carcinoma: current approaches to diagnosis and management. Intern Med J 2002; 32:394-400. [PMID: 12162396 DOI: 10.1046/j.1445-5994.2002.00227.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Hepatocellular carcinoma, frequently associated with chronic viral hepatitis, is the fourth most common cancer worldwide. The incidence in Western countries is rising rapidly. Recent developments in diagnostic imaging allow for identification of small lesions amenable to curative therapy. Effective therapy of advanced hepatocellular carcinoma remains a major clinical problem.
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Affiliation(s)
- G W McCaughan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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12
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Hess D, Humar A, Sielaff TD. Living related liver transplantation for recurrent hepatocellular carcinoma in a normal liver. Clin Transplant 2002; 16:240-2. [PMID: 12010151 DOI: 10.1034/j.1399-0012.2002.01135.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The role of liver transplantation for hepatocellular carcinoma (HCC) is evolving. In patients with advanced liver disease and early stage HCC, transplantation offers the best hope for cure. A living donor offers the optimal approach to a timely transplant, before disease progression obviates the potential benefit. But extending the indications beyond those designated by the United Network for Organ Sharing (UNOS) for liver transplantation for HCC is controversial [Hepatology 2001: 33: 1073; Liver Transplant 2000: 6: S1]. Cadaver split techniques and use of living donors are potentially compelling ways to test the limitations of liver transplantation for HCC, without notably reducing the cadaver organ pool. Herein, we report a rare case of a patient who developed a well-differentiated HCC in a normal liver. After resection of the index lesion and, later, of a remote recurrent lesion, a living donor liver transplant was offered. The natural history of this lesion and the management of transplantation in this setting are discussed.
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Affiliation(s)
- Donavon Hess
- Department of Surgery, University of Minnesota, Minneapolis 55455, USA
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13
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Liver transplantation for hepatocellular carcinoma. Curr Opin Organ Transplant 2002. [DOI: 10.1097/00075200-200206000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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15
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Affiliation(s)
- Jordi Bruix
- Barcelona Clínic Liver Cancer (BCLC) Group, Liver Unit, Digestive Disease Institute, Hospital Clínic i Provincial, Villaroel 170, 08036 Barcelona, Catalonia, Spain.
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16
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Sandhu J. Percutaneous Hepatic Oncologic Interventions. J Vasc Interv Radiol 2002. [DOI: 10.1016/s1051-0443(02)70043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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17
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Abstract
There are three levels of cells in the hepatic lineage that respond to injury or carcinogenesis: the mature hepatocyte, the ductular "bipolar" progenitor cell, and a putative periductular stem cell. Hepatocytes are numerous, and respond rapidly to liver cell loss by one or two cell cycles but can only produce other hepatocytes. The ductular progenitor cells are less numerous, may proliferate for more cycles than hepatocytes, and are generally considered "bipolar," i.e., they can give rise to biliary cells or hepatocytes. Periductular stem cells are rare in the liver, have a very long proliferation potential, and may be multipotent. Extrahepatic (bone marrow) origin of the periductular stem cells is supported by recent data showing that hepatocytes may express genetic markers of donor hematopoietic cells after bone marrow transplantation. These different regenerative cells with variations in potential for proliferation and differentiation may provide different sources of cells for liver transplantation: hepatocytes for treatment of acute liver damage, liver progenitor cell lines for liver-directed gene therapy, and bone marrow-derived cells for chronic long-term liver replacement. A limiting factor in the success of liver cell transplantation is the condition of the hepatic microenvironment in which the cells must proliferate and set up housekeeping.
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Affiliation(s)
- S Sell
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York 12208-3479, USA.
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18
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Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodés J. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001; 35:421-30. [PMID: 11592607 DOI: 10.1016/s0168-8278(01)00130-1] [Citation(s) in RCA: 3233] [Impact Index Per Article: 134.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- J Bruix
- Liver Unit, Digestive Disease Institute, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain.
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