Hepatobiliary Pancreat Dis Int

	2020 Vol. 19 No. 1
	Published: 2020-02-15


	Pages 1-100
	EDITORIAL ORIGINAL ARTICLES/Transplantation ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas LETTERS TO THE EDITOR VIEWPOINTS

EDITORIAL

	1	Sugawara Y
		Living-donor liver transplantation for patients with hepatocellular carcinoma in Japan: Current situations and challenge
		Liver transplantation has now been a standard therapy for patients with hepatocellular carcinoma (HCC) in the early stage [1] . Liver transplantation is an ideal treatment for HCC which can treat both the tumors and the underlying damaged liver and thus, has higher chance of cure than the other treatments for HCC.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 1-2 . [Abstract] ( 98 ) [HTML 1KB] [PDF 0KB] ( 186 )

ORIGINAL ARTICLES/Transplantation

	3	Qin T, Gu XQ, Jeong SS, Song YY, Liu JC, Zheng JX, Xue F, Xia Q
		Impact of EBV infection and immune function assay for lymphoproliferative disorder in pediatric patients after liver transplantation: A single-center experience ^Hot!
		Background: Post-transplant lymphoproliferative disorder (PTLD) is a lethal complication after pediatric liver transplantation, but information regarding risk factors for the development of PTLD remains unclear. This study was to identify characteristics and risk factors of PTLD. Methods: A total of 705 pediatric patients who underwent liver transplantation between January 2017 and October 2018 were studied. Impact of clinical characteristics and Epstein-Barr virus (EBV) infection on the development of PTLD was evaluated. In addition, ImmuKnow assay was adopted in partial patients to analyze the immune status. Results: Twenty-five (3.5%) patients suffered from PLTD with a median time of 6 months (3–14 months) after transplantation. Extremely high tacrolimus (TAC) level was found in 2 fatal cases at PTLD onset. EBV infection was found in 468 (66.4%) patients. A higher peak EBV DNA loads ( > 9590 copies/mL) within 3 months was a significant indicator for the onset of PTLD. In addition, the ImmuKnow assay demonstrated that overall immune response was significantly lower in patients with EBV infection and PTLD ( P < 0.0001). The cumulative incidence of PTLD was also higher in patients with lower ATP value ( ≤187 ng/mL, P < 0.05). Conclusions: A careful monitoring of EBV DNA loads and tacrolimus concentration might be supportive in prevention of PTLD in pediatric patients after liver transplantation. In addition, application of the ImmuKnow assay may provide guidance in reducing immunosuppressive agents in treatment of PTLD.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 3-11 . [Abstract] ( 103 ) [HTML 1KB] [PDF 0KB] ( 174 )

	12	Kong HY, Zhao X, Wang KR
		Intraoperative management and early post-operative outcomes of patients with coronary artery disease who underwent orthotopic liver transplantation ^Hot!
		Background: Coronary artery disease (CAD) is frequently observed in aging end-stage liver disease (ESLD) patients who require orthotopic liver transplantation (OLT). This situation is challenging for both the patients and the medical staff. Methods: We retrospectively studied the case records of 26 ESLD patients with CAD who underwent OLT with total clamping of the inferior vena cava between 2014 and 2018. We analyzed the details of the pre-operative evaluation, intraoperative anesthetic management and post-operative prognosis of these patients. Results: All patients tolerated the anhepatic stage well. Post-reperfusion syndrome (PRS) was observed in 13 patients (50%) and 2 of them were severe but corrected well. ST-segment depression was frequently observed during the anhepatic stage and reperfusion stage. No mortality due to cardiac-related events occurred among the patients during hospitalization. OLT with the modified piggyback technique could successfully be performed in ESLD patients with mild and moderate CAD. Conclusions: A thorough evaluation and optimization of recipients, strict monitoring and optimized man- agement of circulation, knowledge of the complicated changes during OLT procedures, and strategies to ameliorate post-reperfusion syndrome favorite the outcomes.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 12-16 . [Abstract] ( 105 ) [HTML 1KB] [PDF 0KB] ( 186 )

ORIGINAL ARTICLES/Liver

	17	Smolka V, Tkachyk O, Ehrmann J, Karaskova E, Zapalka M, Volejnikova J
		Acute onset of autoimmune hepatitis in children and adolescents
		Background: Autoimmune hepatitis (AIH) is a rare progressive liver disease, which manifests as acute hepatitis in 40%-50% of pediatric cases. This refers predominantly to spontaneous exacerbations of previ- ously unrecognized subclinical AIH with laboratory and histological signs of chronic hepatitis, or to acute exacerbations of known chronic disease. Only a few of these patients fulfill criteria for acute liver failure (ALF). Methods: Forty children diagnosed with AIH in our center between 2000 and 2018 were included in this study. All of them fulfilled revised diagnostic criteria of the International Autoimmune Hepatitis Group (IAIHG) for probable or confirmed AIH, and other etiologies of liver diseases were excluded. Patients were divided into two groups: acute AIH (A-AIH) or chronic AIH (C-AIH). Results: Acute onset of AIH occurred in 19/40 children (48%). Six of them fulfilled the criteria of ALF with coagulopathy and encephalopathy. Five of 6 children with ALF suffered from exacerbation of previ- ously undiagnosed chronic AIH, among which 4 children were histologically confirmed as micronodular cirrhosis. The remaining one patient had fulminant AIH with centrilobular necrosis, but no histological signs of previous chronic liver damage. We observed significantly lower levels of albumin, higher levels of aminotransferases, bilirubin, INR, IgG, higher IAIHG score and more severe histological findings in A- AIH than in C-AIH. No differences in patient age and presence of autoantibodies were observed between A-AIH and C-AIH. All children, including those with ALF and cirrhosis, were treated with corticosteroids, and are alive and achieved AIH remission. Liver transplant was not indicated in any patient. Conclusion: Rapid and accurate diagnosis of A-AIH may be difficult. However, timely start of immunosup- pressive therapy improves prognosis and decreases number of indicated liver transplantations in children with AIH.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 17-21 . [Abstract] ( 105 ) [HTML 1KB] [PDF 0KB] ( 171 )

	22	Lashen SA, Elshafei MM, Hablass FH, Alsayed EA, Hassan AA
		Liver stiffness as a predictor of hepatocellular carcinoma behavior in patients with hepatitis C related liver cirrhosis
		Background: Risk stratification and prognostication of hepatocellular carcinoma (HCC) help to improve patient outcome. Herein we investigated the role of liver stiffness measurement (LSM) in the prediction of HCC behavior. Methods: Totally 121 naïve patients with HCC were included. HCC radiological evaluation and staging were done. LSM was measured using virtual touch quantification. Patients were divided into early to intermediate HCC (BCLC-0, A and B) and late HCC (BCLCC and D). HCC was treated according to the BCLC stage. HCC recurrence-free interval was estimated. Results: The mean LSM inside the tumor was significantly lower than the peri-tumoral area and the cirrhotic non-cancerous liver parts ( P < 0.001). In late HCCs stage, the mean LSM inside the tumor and in the peri-tumoral tissue was lower than the corresponding values in the early to intermediate HCCs stage ( P < 0.001). LSM inside the tumor and in the peri-tumoral tissue negatively correlated with serum AFP, tumor vascular invasion, and stage ( P < 0.05). The recurrence-free interval was directly correlated to LSM inside the tumor and inversely to LSM in cirrhotic non tumorous liver part. Kaplan-Meier analysis showed that the recurrence-free interval was significantly longer in patients with LSM inside the tumor of ≥1.25 m/s compared to those with LSM inside the tumor of < 1.25 m/s. Conclusions: LSM can serve as a potential non-invasive predictor for HCC clinical behavior and the recurrence-free interval following loco-regional treatments.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 22-28 . [Abstract] ( 98 ) [HTML 1KB] [PDF 0KB] ( 160 )

	29	Noh OK, Kim SS, Yang MJ, Lim SG, Hwang JC, Cho HJ, Cheong JY, Cho SW
		Treatment and prognosis of hepatic epithelioid hemangioendothelioma based on SEER data analysis from 1973 to 2014
		Background: Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular origin with an unknown etiology, a low incidence, and a variable natural course. We evaluated the management and prognosis of HEH from the Surveillance, Epidemiology and End Results (SEER) program and changes in treatment modalities of HEH over 30 years. Methods: From 1973 to 2014 in the SEER database, we selected patients diagnosed with HEH. We analyzed the clinical characteristics, patterns of management, and clinical outcomes of patients with HEH. Results: We identified 79 patients with HEH (median age: 54.0 years; male to female ratio: 1:2.6). The initial extent of disease was local in 22 (27.8%) patients, regional metastasis in 22 (27.8%), distant metas- tasis in 31 (39.2%) and unknown in 4 (5.1%). The median size of primary tumor was 3.85 cm (interquartile range, 2.50–7.93 cm). Among 74 patients with available management data, the most common management was no treatment (29/74, 39.2%), followed by chemotherapy only (22/74, 29.7%), liver resection-based (13/74, 17.6%), and transplantation-based therapy (6/74, 8.1%). The 5-year cancer-specific survival rate was 57.8%. Patients who underwent surgical treatment had significantly higher survival than those who underwent non-surgical treatment (5-year survival; 88% vs. 49%, P = 0.019). Multivariate analysis revealed that surgical therapy was the only independent prognostic factor for survival (hazard ratio: 0.20, P = 0.040). Conclusions: Resection or liver transplantation is worth considering for treatment of patients with HEH.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 29-35 . [Abstract] ( 116 ) [HTML 1KB] [PDF 0KB] ( 159 )

ORIGINAL ARTICLES/Biliary

	36	Gonzalez-Urquijo M, Rodarte-Shade M, Lozano-Balderas G, Gil-Galindo G
		Cholecystoenteric fistula with and without gallstone ileus: A case series
		Background: A cholecystoenteric fistula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. Methods: From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder dis- ease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. Results: Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal fistula, four patients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33–86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60–240 min), and the median operative blood loss was 50 mL (range 10–600 mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. Conclusions: There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon’s expertise and the patient’s condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 36-40 . [Abstract] ( 103 ) [HTML 1KB] [PDF 0KB] ( 149 )

	41	Han HS, Kim MJ, Han JH, Yun J, Kim HK, Yang Y, Kim KB, Park SM
		Bile-derived circulating extracellular miR-30d-5p and miR-92a-3p as potential biomarkers for cholangiocarcinoma ^Hot!
		Background: Cholangiocarcinoma (CCA) is from cholangiocytes, and therefore bile is a potentially rich source of biomarkers for CCA. The aim of the study was to identify and validate microRNAs (miRNAs) in bile samples that are differentially expressed between benign biliary disease (BBD) and CCA. Methods: Bile samples from 106 patients with obstructive biliary disease were allocated consecutively to a discovery set (10 patients with BBD and 11 with CCA) and then a validation set (48 patients with BBD and 37 with CCA). An miRNA microarray platform was used to screen 1209 miRNAs in the discovery set. Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to validate the profiling results in the discovery and validation sets. In addition, the levels of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were determined from patient serum samples. Results: Microarray profiling showed that miR-30d-5p and miR-92a-3p were significantly upregulated in bile from the CCA group compared with those from the BBD group. qRT-PCR results indicated that the expression levels of miR-30d-5p and of miR-92a-3p were significantly upregulated in the CCA group compared to the BBD group, validating the miRNA microarray results. Pathway analysis suggested that putative target genes of miR-30d-5p and of miR-92a-3p were involved in CCA-associated signalling pathways, such as Hippo, Wnt, p53, MAPK, and EGFR. Receiver operating curve analysis revealed that the areas under the curve for bile miR-30d-5p, miR-92a-3p, serum CA19-9, and CEA were 0.730, 0.652, 0.675, and 0.603, respectively, and bile miR-30d-5p showed the best diagnostic performance with a sensitivity of 81.1% and a specificity of 60.5%. Conclusions: The levels of extracellular miR-30d-5p and miR-92a-3p in bile were significantly higher in patients with CCA than those in patients with BBD. Bile-derived circulating extracellular miR-30d-5p and miR-92a-3p are potential biomarkers for discriminating CCA from BBD.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 41-50 . [Abstract] ( 94 ) [HTML 1KB] [PDF 0KB] ( 167 )

ORIGINAL ARTICLES/Pancreas

	51	Zhang XY, Zhang XZ, Lu FY, Zhang Q, Chen W, Ma T, Bai XL, Liang TB
		Factors associated with failure of enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy
		Background: The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care program aimed at reducing surgical stress response and accelerating recovery. However, a small proportion of patients fail to benefit from the ERAS program following pancreaticoduodenectomy. This study aimed to identify the risk factors associated with failure of ERAS program in pancreaticoduodenectomy. Methods: Between May 2014 and December 2017, 176 patients were managed with ERAS program following pancreaticoduodenectomy. ERAS failure was indicated by prolonged hospital stay, unplanned readmission or unplanned reoperation. Demographics, postoperative recovery and compliance were compared of those ERAS failure groups to the ERAS success group. Results: ERAS failure occurred in 59 patients, 33 of whom had prolonged hospital stay, 18 were readmitted to hospital within 30 days after discharge, and 8 accepted reoperation. Preoperative American Society of Anesthesiologists (ASA) score of ≥III (OR = 2.736; 95% CI: 1.276–6.939; P = 0.028) and albumin (ALB) level of < 35 g/L (OR = 3.589; 95% CI: 1.403–9.181; P = 0.008) were independent risk factors associated with prolonged hospital stay. Elderly patients ( > 70 years) were on a high risk of unplanned reoperation (62.5% vs. 23.1%, P = 0.026). Patients with prolonged hospital stay and unplanned reoperation had delayed intake and increased intolerance of oral foods. Prolonged stay patients got offbed later than ERAS success patients did (65 h vs. 46 h, P = 0.012). Unplanned reoperation patients tended to experience severer pain than ERAS success patients did (3 score vs. 2 score, P = 0.035). Conclusions: Patients with high ASA score, low ALB level or age > 70 years were at high risk of ERAS failure in pancreaticoduodenectomy. These preoperative demographic and clinical characteristics are important determinants to obtain successful postoperative recovery in ERAS program.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 51-57 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 186 )

	58	Rodriguez-Lopez M, Tejero-Pintor FJ, Bailon-Cuadrado M, Barrera-Rebollo A, Perez-Saborido B, Pacheco-Sanchez D
		Impaired immune reaction and increased lactate and C-reactive protein for early prediction of severe morbidity and pancreatic fistula after pancreatoduodenectomy ^Hot!
		Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during first and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lac- tate were compared between individuals presenting Clavien ≥III morbidity, pancreatic fistula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching significance were further analyzed in order to calculate a predictive score. Results: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 ( P = 0.04). Patients with PF presented higher CRP on POD2 ( P = 0.001), higher lactate on POD1 ( P = 0.007) and POD2 ( P = 0.008), and lower lymphocytes on POD1 ( P = 0.007) and POD2 ( P = 0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 ( P = 0.048, P = 0.038), lower lymphocytes on POD1 ( P = 0.001) and POD2 ( P = 0.003), and higher CRP on POD2 ( P = 0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was defined according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased ( P < 0.001). Receiver operating characteristic curves and Hosmer–Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 58-67 . [Abstract] ( 98 ) [HTML 1KB] [PDF 0KB] ( 191 )

	68	Gambitta P, Maffioli A, Spiropoulos J, Armellino A, Vertemati M, Aseni P
		Endoscopic ultrasound-guided drainage of pancreatic fluid collections: The impact of evolving experience and new technologies in diagnosis and treatment over the last two decades
		Background: Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pancreatic fluid collections (PFCs) due to the better experience and significant progress using newer stents and access devices during last decade. This study aimed to evaluate the role of the evolving experience and possible influence of new technological devices on the outcome of patients evaluated for PFCs and submitted to EUS-guided drainage during two different periods: the early period at the beginning of experience when a standardized technique was used and the late period when the increased experience of the operator, combined with different stents quality were introduced in the management of PFCs. Methods: We retrospectively analyzed the clinical data of a cohort of 91 consecutive patients, who underwent EUS-guided drainage of symptomatic PFCs from October 2001 to September 2017. Demographic, therapeutic results, complications, and outcomes were compared between early years’ group (2001–2008) and late years’ group (2009–2017). Results: Endoscopic treatment was successfully achieved in 55.6% (20/36) of patients in the early years’ group, and in 96.4% (53/55) in the late years’ group. Eighteen patients (12 in early years’ and 6 in the late year’s group) required additional open surgery. Procedural complications were observed in 5 patients, 4 in early years’ and 1 in late years’ group. Mortality was registered in two patients (2.2%), one for each group. Conclusions: During our long-term survey using EUS-guided endoscopic drainage of PFCs, significantly better outcomes in term of improved success rate and decrease complications rate were observed during the late period.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 68-73 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 156 )

	74	Facciorusso A, Buccino VR, Del Prete V, Antonino M, Contaldo A, Muscatiello N
		Statins decrease the risk of acute pancreatitis after endoscopic ultrasound fine-needle aspiration of pancreatic cysts
		Background: Basic and clinical studies suggest that statins may prevent and even ameliorate acute pancreatitis. The present study was to evaluate whether statin decreases the risk of acute pancreatitis in patients undergoing endoscopic ultrasound-guided fine-needle aspiration of pancreatic cysts. Methods: Out of 456 patients with pancreatic cysts referred to our center between 2006 and 2018, 365 were finally included in analyses: 86 were treated with statins and 279 were not at the time of endoscopic ultrasound fine-needle aspiration. We compared the acute pancreatitis incidence between the two groups, and we also compared other complications such as bleeding and infections. Results: Median age was 64 years [interquartile range (IQR) 62–69] and median cyst size was 24 mm (IQR, 21–29). The most frequent histology was intraductal papillary mucinous neoplasm (45.3% and 42.3% in the two groups, respectively; P = 0.98). All 13 patients experiencing post-endoscopic ultrasound acute pancreatitis were from the control group (4.7%), of which 3 were classified as severe pancreatitis. None of statin users developed post-procedural acute pancreatitis (odds ratio: 0.15; 95% confidence interval: 0.03–0.98; P = 0.03). No difference was registered with regard to severe pancreatitis and other complications. Conclusions: Statins exert a beneficial role in preventing acute pancreatitis in patients with pancreatic cysts undergoing endoscopic ultrasound-guided fine-needle aspiration. If confirmed in prospective trials, our findings may pave the way to an extensive use of statins as prophylactic agents in pancreatic inter- ventional endoscopy.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 74-79 . [Abstract] ( 84 ) [HTML 1KB] [PDF 0KB] ( 166 )

VIEWPOINTS

	80	Ravindranath A, Sen Sarma M, Yachha SK
		Bile acid synthetic defects: Simplified approach in a nutshell
		Bile acid synthetic defects (BASD) constitute a rare group of disorders with manifestations in children as well as adults. Diagnosing the individual BASD mandates a lucid understanding of the bile acid synthetic pathway. However, the synthesis pathway is complex, consisting of numerous enzymes and intermediate products that are volatile in the physician’s memory. Despite paucity of literature, a simplified approach to the BASD is presented in this paper.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 80-84 . [Abstract] ( 117 ) [HTML 1KB] [PDF 0KB] ( 181 )

	85	Sowier A, Pyda P, Sowier S, Kapturzak J, Rybak A, Bialecki J
		Postoperative negative-pressure drainage through a PEG tube can prevent pancreatic fistula after pancreatoduodenectomy
		Postoperative pancreatic fistula (POPF) is a well-known complication after pancreatoduodenectomy [1] . It is difficult to prevent due to a number of factors. The very placement and tightening of sutures in pancreatic tissue is challenging. Perfusion of the anastomosis edges is unpredictable. Another risk factor is the large amounts of fluids (comprising gastric and intestinal secretions, bile, and pancreatic juice) collected in the intestine near the pancreatic anastomosis, which increase the pressure in the first loop of the anastomosed intestine, and may ultimately rupture the pancreatoenteric anastomosis. Effective peristalsis, required to pass these fluids to subsequent sections of the intestine, takes time to return after such an extensive procedure. Increased pressure in the intestinal loop may also contribute to ischemia, by increasing the tension of the intestinal wall, constricting or even blocking its blood vessels. All these are aggravated by the chemical effects of intestinal contents. Any surgical errors may add the risk of POPF. The most significant risk factors include pancreatic duct size smaller than 3 mm; soft pancreatic parenchyma, ampullary, duodenal, cystic, or islet cell pathology; and massive intraoperative blood loss. Based on these factors a fistula risk score was devised to assess the probability of POPF formation after pancreatoduodenectomy [2] .
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 85-87 . [Abstract] ( 106 ) [HTML 1KB] [PDF 0KB] ( 166 )

LETTERS TO THE EDITOR

	88	Lai Q, Ruberto F, Melandro F, Larghi Laureiro Z, Rossi M, Mennini G
		Hypothermic oxygenated perfusion for a steatotic liver graft
		Donor steatosis represents a well-known risk factor for primary non-function, early allograft dysfunction, and biliary complications after liver transplantation (LT) [1,2] . Recently, machine perfusion (MP) technology has been implemented in the clinical practice, with the primary intent to assess the graft quality and to optimize the organ selection process [3] . A limited number of articles has been published specifically investigated the role of MP in steatotic livers [4–10] , with few of them looking at the role of hypothermic MP.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 88-90 . [Abstract] ( 95 ) [HTML 1KB] [PDF 0KB] ( 133 )

	91	Zhuang L, Mou HB, Yu LF, Zhu HK, Yang Z, Liao Q, Zheng SS
		Immune checkpoint inhibitor for hepatocellular carcinoma recurrence after liver transplantation
		Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancers with the highest incidence in China (more than 50% of all cases worldwide) [1] . Liver transplantation (LT) is regarded as an optimal therapy for selected HCC patients. The Milan criteria are the benchmark for candidate selection that ensure excellent prognosis for patients with HCC [2] . The Hangzhou criteria expand 51.5% more of Milan criteria for LT candidates with comparable posttransplant survivals [3] . However, LT recipients fulfilling Milan criteria or Hangzhou criteria are at the risk of up to 13%−18% HCC recurrence rate within five years [4] . Only 25%−50% of recurrent HCC patients post-LT are eligible for surgical treatment which have consistently presented favored survival benefit than systemic therapy [5] . Therefore, it worth exploring alternative treatments such as chemotherapy, targeted therapy and recently developed immune checkpoint inhibitor (ICI) treatment. Through blocking programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) signaling pathway and restoring T cell activities, ICIs are promising in the treatment of many types of cancers [6] . Despite the eager demand for effective HCC treatment options, the present opinion considers immunosuppression a contraindication for ICIs in LT recipients, whom otherwise would be exposed to great risk of organ rejection. Here, we report a case of the longest survival benefit achieved by using ICIs in an immunosuppressed LT recipient with recurrent HCC.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 91-93 . [Abstract] ( 92 ) [HTML 1KB] [PDF 0KB] ( 141 )

	94	Alexandrescu ST, Zlate AC, Grigorie RT, Ionescu M, Popescu I
		Deliberate external pancreatic fistula after pancreaticoduodenectomy performed in the setting of acute pancreatitis, and its internalization through fistula-jejunostomy
		Many patients with tumors of the pancreatic head or of the ampulla of Vater require endoscopic manipulation of the duodenal papilla in order to achieve tumor biopsy or for common bile duct stenting. These interventional endoscopy approaches may lead to acute pancreatitis. The iatrogenic acute pancreatitis will influence the surgical strategy in patients scheduled for pancreaticoduodenectomy (PD). Due to the small number of cases, the surgical strategy in patients who require PD in the context of acute pancreatitis has not been standardized. The most meaningful strategy is to postpone the operation until clinic, enzymatic and radiologic remission of the pancreatitis is achieved. Even when these criteria are fulfilled, sometimes, during laparotomy one can observe the persistence of steatonecrosis (small foci of necrosis of the fatty tissue around the pancreas) and edema of the pancreas. In such instances, because of the pancreatic stump pancreatitis, the risk of pancreato-jejunal/gastric (PJA/PGA) anastomosis postoperative leak is extremely high [1] . Therefore, avoidance of the pancreatic anastomosis during PD and the performance of an external drainage of the pancreatic stump may represent an option, assuming the formation of a deliberate external pancreatic fistula. Afterwards, the internalization of the fistula can be performed during a second operation, usually by a pancreato-jejunostomy (“two stage” PD) [2] .
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 94-96 . [Abstract] ( 102 ) [HTML 1KB] [PDF 0KB] ( 174 )

	97	Takayashiki T, Yoshitomi H, Furukawa K, Kuboki S, Miyazaki M, Ohtsuka M
		Clinicopathological features and prognosis of surgical resected cases of biliary cancer with pancreaticobiliary maljunction
		Pancreaticobiliary maljunction (PBM) is a congenital anomaly in which the pancreatic and bile ducts join anatomically outside of the duodenal wall away from the Oddi’s sphincter. This condition causes the reflux of pancreatic juice into the bile duct under high pressure, resulting in various pathologic changes. The features of PBM patients are common bile duct dilatation, long common channel, and high amylase levels in bile juice. Among them, one of the most significant problems is the development of biliary cancer, including extrahepatic bile duct and gallbladder cancers [1] . A nationwide survey in Japan reported biliary cancer in 21.6% of adult patients with PBM concomitant with congenital biliary dilatation, 32.1% and 62.3% extrahepatic bile duct and gallbladder cancers, respectively [2] . The problems of PBM were previously considered to be relatively specific in Asia because the number of Asian patients with PBM is greater than that of Western patients. However, a recent French multicenter study reported that the therapeutic implications and guidelines of the Japanese PBM study group were applicable to the European population [3] , suggesting that the high risk of biliary cancer in patients with PBM is an important issue in not only Asia but also Western countries.
		Hepatobiliary Pancreat Dis Int. 2020; 19(1): 97-100 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 154 )

Forgot your password?

Enter your e-mail address to receive an e-mail with your account information.

Submission Guidance

Top cited articles

- Most Cited Hepatobiliary & Pancreatic Diseases International Articles

- Most Downloaded Hepatobiliary & Pancreatic Diseases International Articles

more>>

Top downloaded articles

more>>

Services

Web feed

hbpdint@126.com

hbpdje@zju.edu.cn

Copyright © Official Publication of First Affiliated Hospital
Official Publication of First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
浙ICP备05050873号-1