European Journal of Gastroenterology & Hepatology最新文献

{"title":"Reproductive and pregnancy control in Wilson disease patients in Spain.","authors":"Marta Romero-Gutiérrez, Pablo Alonso, Marina Berenguer, Antonio Olveira, María Luisa González-Diéguez, Paula Iruzubieta, Helena Masnou, Manuel Delgado, Manuel Hernández-Guerra, Sara Lorente, María Lázaro, José María Moreno-Planas, Concepción González, Paula Fernández-Álvarez, Francisca Cuenca, Judith Gómez, Luis García-Villareal, Olga Rodríguez, Zoe Mariño","doi":"10.1097/MEG.0000000000002831","DOIUrl":"10.1097/MEG.0000000000002831","url":null,"abstract":"<p><strong>Background and aim: </strong>Recommendations on pregnancy, lactation, and contraception in women with Wilson disease are briefly stated in international guidelines but are not entirely homogeneous. Data regarding the management of these special events among patients with Wilson disease in Spain are lacking. We used the Wilson Registry platform of the Spanish Association for the Study of the Liver to question patients on their reproductive and gestational lives.</p><p><strong>Methods: </strong>This was a multicentre ambispective study including adult women with Wilson disease in the Spanish Wilson Registry interviewed about their contraception, childbearing, pregnancy, and lactation experiences. Clinical and analytical data were extracted from the registry.</p><p><strong>Results: </strong>The study included 92 women from 17 centres in Spain. Most (63%) reported having a previous pregnancy history. The rate of spontaneous miscarriages was 21.6%, mainly occurring in the first trimester and up to one third among undiagnosed patients. Most pregnant women received chelator therapy during pregnancy, but dose reduction was recommended in less than 10%. After delivery, artificial lactation predominated (60.3%) and its use was mainly based on physician's recommendations (68%). Up to 40% of the women included reported some concerns about their reproductive lives, mainly related to the potential drug toxicity to their children. Most of the patients considered the information given by specialists to be sufficient.</p><p><strong>Conclusion: </strong>Gestational management among women with Wilson disease in Spain was found to be highly heterogeneous and frequently different from what is described in international guidelines. Education on rare liver diseases should be a priority for scientific societies in order to homogenize patient follow-up and recommendations.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and safety of atezolizumab plus bevacizumab in the treatment of hepatocellular carcinoma: treatment prognosis and comparison with tyrosine kinase inhibitors in a French multicenter matched real-life study.","authors":"Xavier Adhoute, Alexia Gonzalez, Thomas Levi-Strauss, Laurent Mineur, Guillaume Pénaranda, Floriane Sellier, Clémence Toullec, Olivia Pietri, Paul Castellani, Albert Tran, Hervé Perrier, Marc Bourliere, Rodolphe Anty","doi":"10.1097/MEG.0000000000002830","DOIUrl":"10.1097/MEG.0000000000002830","url":null,"abstract":"<p><strong>Background and aims: </strong>The combination of atezolizumab plus bevacizumab (Atz/Bev) has radically changed the treatment strategy for advanced hepatocellular carcinoma (HCC) but raises questions. Our objectives were to determine survival outcomes and safety in a real-life multicenter French cohort, to investigate the on-treatment prognostic value of the bioinflammatory RECA score, and to perform a matched comparison with patients who previously received tyrosine kinase inhibitors (TKIs).</p><p><strong>Methodology: </strong>A retrospective analysis of 109 consecutive patients enrolled from September 2020 to January 2023 and a post matched comparison with a TKI cohort ( n  = 79) by the propensity score matching method.</p><p><strong>Results: </strong>The Atz/Bev population was mainly nonviral disease patients (69%) with Child-Pugh grade A (90%), performance status 0/1 (90%), and Barcelona Clinic Liver Cancer stage B (38%) or stage C (62%) classification. After a median follow-up of 6.5 months (3.6-11.7), overall survival (OS) was 13.0 (5.1-28.7) months. OS was independently associated with metastasis, increased alkaline phosphatase, and serum bilirubin levels. Treatment-related adverse events were reported in 78% of patients, mostly grade 1 or 2. The RECA score clearly revealed two different prognosis groups after three cycles. No difference in OS was observed after matching between sequential treatment with TKIs and Atz/Bev.</p><p><strong>Conclusion: </strong>This real-life study highlights the importance of liver function when using Atz/Bev combination and the necessity of identifying predictive markers of response to HCC therapies. Our findings suggest a change in practices, with a marked proportion of intermediate stages, and support the on-treatment prognostic value of an inflammatory score.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capturing the incidence of patient agitation amongst conscious sedation ERCPs and the impact on therapeutic outcomes.","authors":"Eoin Keating, Gayle Bennett, Harvey Martir, Barry Kelleher, Stephen Stewart, Navneet Ramlaul, Michael McKenny, Jan Leyden","doi":"10.1097/MEG.0000000000002878","DOIUrl":"https://doi.org/10.1097/MEG.0000000000002878","url":null,"abstract":"<p><strong>Background: </strong>Completing advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation is challenging. International recommendations favor enhanced sedation (e.g. propofol) for ERCP. Conscious sedation can result in sedation-related failure (SRF) and agitation for some patients, limiting therapeutic efficacy.</p><p><strong>Aim: </strong>The aim of this study is to establish the risk of SRF and the impact on therapeutic success under conscious sedation practice in a single tertiary referral center.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained ERCP database, analyzing sedation, procedural success, and complications.</p><p><strong>Results: </strong>Over 19 months, 807 conscious sedation ERCPs were recorded. Median midazolam dose was 5 mg (range 1-14 mg) and median fentanyl dose was 75 µg (0-200 µg). Sedation reversal was required in 0.1% of cases (1/807). Overall ductal cannulation rate was 92%. Severe agitation was recorded in 11% (86/807) of conscious sedation ERCP reports with SRF present in 3% (22/807). Patient agitation resulted in significantly lower cannulation (81% vs 92%, P = 0.002) and successful clearance rates (49% vs 85%, P = 0.002) versus non-agitated cases. Complication and pancreatitis rates were unaffected. Highest rates of SRF and agitation were identified in female patients, patients aged <50 years old, and post-operative biliary leak indications.</p><p><strong>Conclusion: </strong>Over 10% of conscious sedation ERCPs are compromised by sedation issues, resulting in procedure abandonment or significantly diminished therapeutic success. General anesthetic ERCP is beneficial in facilitating biliary access, removing the risk of agitation and providing stability to aid cannulation. Female patients, patients aged <50 years, and post-operative biliary leak ERCPs appear as the priority cases for enhanced sedation support.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of complications after thermal ablation for hepatocellular carcinoma: the role of assessment of liver background.","authors":"Yuhua Xie, Jing Liu, Yifan Shi, Xiaoyan Xie, Jie Yu, Ming Xu, Xiaohua Xie, Guangliang Huang, Bowen Zhuang, Mingsen Bi, Dongjie Qu, Fangying Fan, Minghua Ying, Qingqing Sun, Manxia Lin, Ping Liang","doi":"10.1097/MEG.0000000000002879","DOIUrl":"https://doi.org/10.1097/MEG.0000000000002879","url":null,"abstract":"<p><strong>Objective: </strong>To use an elastography technology and other clinical and radiological data for assessment of liver background and analyze risk factors of complications after thermal ablation in patients with hepatocellular carcinoma.</p><p><strong>Methods: </strong>Demographics, laboratory analyses, and radiological characteristics were collected from all patients. Main elastography-related indicators included F index (fibrosis index), A index (inflammation index), ATT (attenuation coefficient), E (kPa), AREA (area of blue parts), and CORR (correlation). All complications after thermal ablation were collected. Univariate analysis was performed to detect significant variables, which subsequently entered a stepwise logistic regression analysis (conditional forward selection) to identify independent variables.</p><p><strong>Results: </strong>A total of 218 patients from October 2020 to June 2023 with 291 thermal ablation sessions were enrolled. 115 patients (52.8%) developed complications. Fifteen patients (6.9%) developed major complications. Minor complications included postoperative pain (20.6%), fever (19.3%), effusion (22.5%), and hyperammonemia (1.8%). AREA (P = 0.034), tumor size (P = 0.005), and abnormal aspartate aminotransferase (AST) (P = 0.018) were independent predictors for complications. F index (P = 0.021), tumor size (P < 0.001), and abnormal AST (P = 0.047) were independent predictors for effusion. The results of univariate analysis of infection showed that tumor size, CORR, ATT, diabetes, Child-Turcotte-Pugh grade, abnormal AST, total protein, and albumin were significant (all P < 0.05).</p><p><strong>Conclusion: </strong>Several radiological and combinational elastography indicators related to liver fibrosis, steatosis, or inflammation were significantly correlated with the occurrence of complications. Clinical assessment of the liver background should not be neglected in the management of postablation complications.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between gut microbiota and pancreatitis: a bidirectional Mendelian randomization.","authors":"Boyuan Nan, Luyuan Jin, Tianze Wang, Chao Long, Hao Zhao, Chunhui Wang, Wei Zhang","doi":"10.1097/MEG.0000000000002861","DOIUrl":"https://doi.org/10.1097/MEG.0000000000002861","url":null,"abstract":"<p><strong>Objective: </strong>The causative role of gut microbiota in pancreatitis remains unknown. This study aimed to investigate potential causal associations between gut microbiota and pancreatitis, using bidirectional Mendelian randomization (MR) analysis.</p><p><strong>Methods: </strong>We analyzed genome-wide association study (GWAS) summary statistics for gut microbiota (211 taxa from gut microbiota, n = 18 340) and two types of pancreatitis, namely acute pancreatitis (AP, 5509 cases and 301 383 controls) and chronic pancreatitis (CP, 3002 cases and 301 383 controls). A reverse MR analysis was also performed to assess the possibility of reverse causation.</p><p><strong>Results: </strong>Nine features (one family + eight genera) showed a causal association with AP. According to inverse-variance weighted (IVW) estimates, phylum Firmicutes (P = 4.10 × 10-2), genus Erysipelatoclostridium (P = 4.80 × 10-2), genus Flavonifractor (P = 4.10 × 10-2), genus Methanobrevibacter (P = 3.40 × 10-2), and genus Prevotella9 (P = 4.60 × 10-2) were found to have a protective effect on AP. Additionally, genus Eubacteriumeligensgroup (P = 4.10 × 10-2), genus Eubacteriumfissicatenagroup (P = 4.00 × 10-3), genus Coprococcus3 (P = 4.10 × 10-2), and genus Haemophilus (P = 4.60 × 10-2) exhibited a positive correlation with AP. Four features (two families + two genera) were causally associated with CP. IVW results also confirmed that family Clostridiaceae1 (P = 3.30 × 10-2), genus LachnospiraceaeFCS020group (P = 4.60 × 10-2), and genus Prevotella9 (P = 1.90 × 10-2) were protective factors for CP, whereas the presence of family Victivallaceae (P = 2.60 × 10-2) correlated with CP risk. No causal effects of pancreatitis (AP or CP) on these gut microbiota taxa were found in the reverse MR analysis.</p><p><strong>Conclusion: </strong>This study confirms a potential causal relationship between gut microbiota and pancreatitis, highlighting the gut microbiota-pancreas axis in the pathogenesis of pancreatitis.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nonlinear relationship between dietary inflammatory index and stroke among US adults with metabolic dysfunction-associated steatotic liver disease.","authors":"Renwei Guo, Juan Du","doi":"10.1097/MEG.0000000000002876","DOIUrl":"https://doi.org/10.1097/MEG.0000000000002876","url":null,"abstract":"<p><strong>Background: </strong>Some studies have found that high dietary inflammatory index (DII) increases stroke risk, but previous studies have mostly been conducted in the general population, and the exact relationship between DII and stroke in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not clear.</p><p><strong>Methods: </strong>This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2009-2016) to investigate the association between the DII and stroke. DII was computed according to established methods. Participants were categorized into tertiles of DII (Q1-Q3). Multivariate weighted logistic regression analysis, smooth curve fitting, and subgroup analysis were employed to explore this relationship. Subgroup analyses were conducted based on demographic and clinical variables.</p><p><strong>Results: </strong>A total of 2426 individuals were enrolled in our study. The overall prevalence of stroke in the study population was 4.66%. The smooth curve fitting analysis indicated a J-shaped relationship between DII and stroke among individuals with MASLD. In multivariate weighted logistic regression analysis, the odds ratio (OR) of DII is 1.17 (95% CI: 1.03-1.38) for stroke, with a turning point of 1.89. After the turning point, the OR (95% CI) was 1.22 (1.08-2.56). In subgroup analysis, DII still increased the risk of stroke independently.</p><p><strong>Conclusion: </strong>Our study highlighted a J-shaped association between DII and stroke in adults with MASLD from USA.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in nutritional therapy practices: results of a survey on nutritional management of severe inflammatory bowel disease.","authors":"Katja Anneli Selin, Sara Andersson, Katarina Bilén, Hans Strid, Jan Björk, Mattias Soop, Francesca Bresso, Charlotte R H Hedin","doi":"10.1097/MEG.0000000000002872","DOIUrl":"https://doi.org/10.1097/MEG.0000000000002872","url":null,"abstract":"<p><strong>Objectives: </strong>The optimal nutritional management during a severe flare of inflammatory bowel disease is uncertain. The goal of this study was to describe variations in nutritional practices between different countries, professions and types of hospitals, as well as between ulcerative colitis (UC) and Crohn's disease (CD).</p><p><strong>Methods: </strong>In this cross-sectional study, a novel questionnaire was distributed in the ECCO Congress 2022 and via ECCO country representatives.</p><p><strong>Results: </strong>The survey was completed by 313 participants. In total, 68% of the respondents were physicians. No specific nutritional screening tool was used by 45% of respondents. Almost a quarter of respondents reported less than 25% of patients being assessed by a dietitian in the first 3 days of a flare. The most common form of nutritional therapy was oral nutritional supplements (ONS) with easy-to-digest food. Total parenteral nutrition (TPN) was used by 10% of respondents for UC patients and 7% for CD. Energy intake, stool frequency and inflammatory biomarkers were the most common factors in determining when to change nutritional therapy. There were significant differences between different countries and health care professions for all the outcomes (P < 0.05). Nutritional management did not generally vary according to hospital type (university vs. general). During the first 3 days of a flare, a diet consisting exclusively of ONS was significantly more frequently used for CD than UC (P = 0.018). Otherwise, similar nutritional therapy strategies were reported for CD and UC, including using TPN to a similar extent.</p><p><strong>Conclusion: </strong>There is significant variation in nutritional management practices. Country is the main determinant of differences in practice.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the landscape of metabolic-associated steatotic liver disease treatment: aspirin as a potential game changer.","authors":"Saransh Narang, Yash Vardhan Trivedi, Anniesha Bista Chhetri, Fnu Anamika, Priyanshi Shah, Rohit Jain","doi":"10.1097/MEG.0000000000002877","DOIUrl":"https://doi.org/10.1097/MEG.0000000000002877","url":null,"abstract":"<p><p>Metabolic-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease in Western countries, with rapidly increasing prevalence worldwide, estimated at around 40% due to modernization and urbanization. MASLD is defined as hepatic steatosis and identified through histology, imaging, blood markers, and in the absence of other secondary causes of hepatic fat accumulation, such as significant alcohol consumption, use of steatogenic medication, or hereditary disorders. The current management strategies addressing MASLD involve lifestyle modifications and treating coexisting conditions such as obesity, hyperlipidemia, insulin resistance, and type 2 diabetes. Several studies demonstrate that antiplatelet drugs, including acetylsalicylic acid, have beneficial effects on hepatocytes by decreasing hepatic inflammation, oxidative stress, and insulin resistance and may prevent hepatic fibrosis progression in MASLD. This review article discusses the impact of aspirin on steatosis and triglyceride accumulation in the hepatocytes.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil count predicts the complete response after transarterial chemoembolization related to favorable outcome in hepatocellular carcinoma.","authors":"Young Mi Hong","doi":"10.1097/MEG.0000000000002873","DOIUrl":"https://doi.org/10.1097/MEG.0000000000002873","url":null,"abstract":"<p><strong>Background: </strong>Systemic inflammatory markers have emerged as novel prognostic biomarkers associated with prognosis for tumors. This study aims to investigate the predictive value of systemic inflammatory markers for complete response (CR) in patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE).</p><p><strong>Methods: </strong>This retrospective study enrolled 575 HCC patients undergoing TACE. Survival outcomes were evaluated based on tumor response, and the analysis was conducted using a Kaplan-Meier curve. Predictive factors for achieving a CR after the initial TACE were analyzed by univariate and multivariate analyses in a Cox regression model.</p><p><strong>Results: </strong>After the initial TACE, 246 of 575 (42.8%) patients achieved a CR. During a median of 60 months follow-up, the CR group had better overall survival than non-CR group (median: 82.3 vs. 51.6 months, P < 0.001). Pre-TACE neutrophil count was associated with tumor response (P = 0.06). Multivariate analysis showed that hepatitis B virus infection [hazard ratio (HR) = 0.585, 95% confidence interval (CI) = 0.360-0.952, P = 0.031] and pre-TACE neutrophil count (HR = 2.854, 95% CI = 1.115-7.307, P = 0.029) were independent predictive factors for CR after the initial TACE. Additionally, a high pre-TACE neutrophil count was associated with male gender (P < 0.001), large tumor size (P < 0.001), advanced Barcelona Clinic Liver Cancer stage (P = 0.003), and high protein induced by vitamin K absence or antagonist-II level (P < 0.001).</p><p><strong>Conclusion: </strong>Patients who achieved CR after the initial TACE showed a favorable prognosis. Pre-TACE neutrophil count was found to be an independent predictor of CR. These findings offer valuable insights for identifying patients who would derive the greatest benefit from TACE and for distinguishing those who may require alternative treatment approaches for HCC.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of hepatocellular carcinoma downstaging through hepatic transarterial chemoembolization in liver transplantation.","authors":"Beatriz G de Morais, Alex F Horbe, Gabriela Perdomo Coral, Raquel de F Jotz, Priscila C Fontana, Angelo A Mattos","doi":"10.1097/MEG.0000000000002869","DOIUrl":"https://doi.org/10.1097/MEG.0000000000002869","url":null,"abstract":"<p><strong>Introduction and aim: </strong>Liver transplantation plays an important role in treating hepatocellular carcinoma (HCC). However, diagnosis often occurs when the tumor size exceeds Milan criteria. In this context, locoregional treatments are frequently indicated. The aim of this study is to evaluate cirrhotic patients with HCC undergoing transarterial chemoembolization (TACE) for downstaging.</p><p><strong>Methods: </strong>This retrospective study assessed medical records of patients aged 18 years or older, diagnosed with HCC, who underwent TACE with the aim of downstaging. In the survival analysis, the Kaplan-Meier method was used. P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>One hundred and twenty-three patients were evaluated, of which 44.7% underwent liver transplantation after downstaging. Mortality in these patients was 32.7% and the probability of survival at 1, 2, and 5 years after liver transplantation was, respectively, 80%, 70.8%, and 57%. When comparing with the unsuccessful group, there was a significant difference regarding number of nodules, size of the largest nodule, and response by Modified Response Evaluation Criteria in Solid Tumor. The characteristics of the group undergoing TACE for downstaging and the group undergoing TACE as a bridge to transplantation were also compared, and patients were selected through the propensity score. A more significant number of nodules was observed in patients who underwent downstaging (P = 0.014) and they exceeded Milan criteria in the explanted liver more frequently (P = 0.007). Survival in the downstaging group and in the bridge group was not different (P = 0.342).</p><p><strong>Conclusion: </strong>Liver transplantation in patients with HCC after successful downstaging proved to be effective, as patients had adequate survival.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}