Hepatobiliary Pancreat Dis Int

	2022 Vol. 21 No. 6
	Published: 2022-12-15


	Pages 511-618
	EDITORIAL META-ANALYSIS REVIEW ARTICLES ORIGINAL ARTICLES/Transplantation ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas LETTERS TO THE EDITOR THANKS GUIDELINES VIEWPOINTS

EDITORIAL

	511	Zeng J, Fan JG
		From NAFLD to MAFLD: Not just a change in the name
		The names of many diseases have changed over time, and the criteria of successfully changing the name of a disease should make sense, be easy to say and write, get quick endorsement by professional societies, and keep the same acronym. In general, a change in the name of a disease usually represents an improvement in the understanding of the disease, whether on clinical settings and natural history or pathophysiological aspects. The successful renamed liver diseases in history include from non-A non-B hepatitis, non-B non-C hepatitis, primary biliary cirrhosis to hepatitis C, hepatitis E and primary biliary cholangitis, respectively. Therefore, the rename of the disease that is finally used usually clearly indicates its main characteristics.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 511-513 . [Abstract] ( 89 ) [HTML 1KB] [PDF 0KB] ( 141 )

	514	Li CC, Yang HY, Mao YL
		Research progress and prospects of circulating tumor cells in hepatocellular carcinoma
		Hepatocellular carcinoma (HCC) is one of the most common cancers and is the second leading cause of cancer-related deaths worldwide [1,2]. The main therapies for HCC include surgical resection, local ablation, or liver transplantation, which are only applied to early-stage HCC. However, most patients at the time of initial HCC diagnosis have already progressed to an advanced stage, and survival can only be prolonged finitely via palliative therapies, such as transarterial chemoembolization, systemic therapy with tyrosine kinase inhibitors, and selective internal radiation therapy [3,4]. Moreover, as HCC has a high recurrence rate, the treatment efficacy is not satisfactory [5]. Currently, the diagnosis and monitoring of HCC primarily depend on serum biomarker detection, pathological examination, and imaging analysis. Common serum markers display poor diagnostic performance, and imaging and pathological examinations have limitations in diagnostic accuracy and sensitivity [6,7]. Therefore, we urgently require better approaches for the diagnosis and monitoring of HCC.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 514-515 . [Abstract] ( 89 ) [HTML 1KB] [PDF 0KB] ( 55 )

GUIDELINES

	516	Li JH, Xu X, Wang YF, Xie HY, Chen JY, Dong NG, Badiwala M, Xin LM, Ribeiro RVP, Yin H, Zhang H, Zhang JZ, Huo F, Yang JY, Yang HJ, Pan H, Li SG, Qiao YB, Luo J, Tang PF, Ye QF, Zheng SS
		Chinese expert consensus on organ protection of transplantation (2022 edition)
		Organ transplantation increases survival and improves quality of life to many patients with end-stage organ failure. Organ shortage is a worldwide problem that restricts organ transplantation [1]. Organ procurement and preservation as well as ischemia-reperfusion injury (IRI) after transplantation are the important factors affecting prognosis of recipients. Since the development of organ transplantation technology in the 20th century, organ protection technology has been a most promising concept in this field. Organ preservation solutions such as the Collins solution, University of Wisconsin (UW) solution, and histidinetryptophan- ketoglutarate (HTK) solution were developed sequentially [2], which developed rapidly in static cold storage (SCS) techniques. SCS remains the standard preservation technique for organ transplantation [2], but it invariably leads to a progressive decline in organ viability and function. It also precludes dynamic assessment of organ function to determine the adequacy for transplantation.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 516-526 . [Abstract] ( 81 ) [HTML 1KB] [PDF 0KB] ( 45 )

META-ANALYSIS

	527	Kokkinakis S, Kritsotakis EI, Maliotis N, Karageorgiou I, Chrysos E, Lasithiotakis K
		Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis ^Hot!
		Background: In the past decades, the perioperative management of patients undergoing pancreaticoduodenectomy (PD) has undergone major changes worldwide. This review aimed to systematically determine the burden of complications of PD performed in the last 10 years. Data sources: A systematic review was conducted in PubMed for randomized controlled trials and observational studies reporting postoperative complications in at least 100 PDs from January 2010 to April 2020. Risk of bias was assessed using the Cochrane RoB2 tool for randomized studies and the methodological index for non-randomized studies (MINORS). Pooled complication rates were estimated using random-effects meta-analysis. Heterogeneity was investigated by subgroup analysis and meta-regression. Results: A total of 20 randomized and 49 observational studies reporting 63 229 PDs were reviewed. Mean MINORS score showed a high risk of bias in non-randomized studies, while one quarter of the randomized studies were assessed to have high risk of bias. Pooled incidences of 30-day mortality, overall complications and serious complications were 1.7% (95% CI: 0.9%–2.9%; I 2 = 95.4%), 54.7% (95% CI: 46.4%–62.8%; I 2 = 99.4%) and 25.5% (95% CI: 21.8%–29.4%; I 2 = 92.9%), respectively. Clinically-relevant postoperative pancreatic fistula risk was 14.3% (95% CI: 12.4%–16.3%; I 2 = 92.0%) and mean length of stay was 14.8 days (95% CI: 13.6–16.1; I 2 = 99.3%). Meta-regression partially attributed the observed heterogeneity to the country of origin of the study, the study design and the American Society of Anesthesiologists class. Conclusions: Pooled complication rates estimated in this study may be used to counsel patients scheduled to undergo a PD and to set benchmarks against which centers can audit their practice. However, cautious interpretation is necessary due to substantial heterogeneity.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 527-537 . [Abstract] ( 109 ) [HTML 1KB] [PDF 0KB] ( 57 )

REVIEW ARTICLES

	538	Han CZ, Wei Q, Yang MF, Zhuang L, Xu X
		The critical role of therapeutic plasma exchange in ABO-incompatible liver transplantation
		Background: The shortage of donor liver restricts liver transplantation (LT). Nowadays, donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver. Although it is now possible to perform ABO-incompatible (ABO-I) LT, antibody-mediated rejection (AMR) has been recognized as the primary cause of desperate outcomes after ABO-I LT. Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury. Therapeutic plasma exchange (TPE) can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity. Data sources: We searched PubMed and CNKI databases using search terms “therapeutic plasma exchange”, “ABO-incompatible liver transplantation”, “ABO-I LT”, “liver transplantation”, “LT”, “antibody-mediated rejection”, and “AMR”. Additional publications were identified by a manual search of references from key articles. The relevant publications published before September 30, 2020 were included in this review. Results: Different centers have made different attempts on whether to use TPE, when to use TPE and how often to use TPE. However, the control standard of lectin revision level is always controversial, the target titer varies significantly from center to center, and the standard target titer has not yet been established. TPE has several schemes to reduce antibody titers, but there is a lack of clinical trials that provide standardized procedures. Conclusions: TPE is essential for ABO-I LT. Hence, further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 538-542 . [Abstract] ( 82 ) [HTML 1KB] [PDF 0KB] ( 47 )

ORIGINAL ARTICLES/Transplantation

	543	Zhao JW, Shu X, Chen XX, Liu JX, Liu MQ, Ye J, Jiang HJ, Wang GS
		Prediction of early recurrence of hepatocellular carcinoma after liver transplantation based on computed tomography radiomics nomogram
		Background: Early recurrence results in poor prognosis of patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). This study aimed to explore the value of computed tomography (CT)-based radiomics nomogram in predicting early recurrence of patients with HCC after LT. Methods: A cohort of 151 patients with HCC who underwent LT between December 2013 and July 2019 were retrospectively enrolled. A total of 1218 features were extracted from enhanced CT images. The least absolute shrinkage and selection operator algorithm (LASSO) logistic regression was used for dimension reduction and radiomics signature building. The clinical model was constructed after the analysis of clinical factors, and the nomogram was constructed by introducing the radiomics signature into the clinical model. The predictive performance and clinical usefulness of the three models were evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA), respectively. Calibration curves were plotted to assess the calibration of the nomogram. Results: There were significant differences in radiomics signature among early recurrence patients and non-early recurrence patients in the training cohort (P < 0.001) and validation cohort (P < 0.001). The nomogram showed the best predictive performance, with the largest area under the ROC curve in the training (0.882) and validation (0.917) cohorts. Hosmer-Lemeshow testing confirmed that the nomogram showed good calibration in the training (P = 0.138) and validation (P = 0.396) cohorts. DCA showed if the threshold probability is within 0.06-1, the nomogram had better clinical usefulness than the clinical model. Conclusions: Our CT-based radiomics nomogram can preoperatively predict the risk of early recurrence in patients with HCC after LT.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 543-550 . [Abstract] ( 81 ) [HTML 1KB] [PDF 0KB] ( 59 )

ORIGINAL ARTICLES/Liver

	551	Chao JS, Zhu Q, Chen DS, Chen GM, Xie XQ, Liu AQ, Zhao SL, Sun HC
		Combined analysis of imaging tumor capsule with imaging tumor size guides the width of resection margin for solitary hepatocellular carcinoma ^Hot!
		Background: The optimal width of resection margin (RM) for hepatocellular carcinoma (HCC) remains controversial. This study aimed to investigate the value of imaging tumor capsule (ITC) and imaging tumor size (ITS) in guiding RM width for patients with HCC. Methods: Patients who underwent hepatectomy for HCC in our center were retrospectively reviewed. ITC (complete/incomplete) and ITS ( ≤3 cm/ > 3 cm) were assessed by preoperative magnetic resonance imaging (MRI). Using subgroup analyses based on ITC and ITS, the impact of RM width [narrow RM ( < 5 mm)/wide RM ( ≥5 mm)] on recurrence-free survival (RFS), overall survival (OS), and RM recurrence was analyzed. Results: A total of 247 patients with solitary HCC were included. ITC and ITS were independent predictors for RFS and OS in the entire cohort. In patients with ITS ≤3 cm, neither ITC nor RM width showed a significant impact on prognosis, and the incidence of RM recurrence was comparable between the narrow RM and wide RM groups (15.6% vs. 4.3%, P = 0.337). In patients with ITS > 3 cm and complete ITC, the narrow RM group exhibited comparable RFS, OS, and incidence of RM recurrence with the wide RM group ( P = 0.606, 0.916, and 0.649, respectively). However, in patients with ITS > 3 cm and incomplete ITC, the wide RM group showed better RFS and OS and a lower incidence of RM recurrence compared with the narrow RM group ( P = 0.037, 0.018, and 0.046, respectively). Conclusions: As MRI-based preoperative markers, conjoint analysis of ITC with ITS aids in determining RM width for solitary HCC patients. Narrow RM is applicable in patients with ITS ≤3 cm regardless of ITC status and in those with ITS > 3 cm and complete ITC. Wide RM is preferred in those with ITS > 3 cm and incomplete ITC.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 551-558 . [Abstract] ( 109 ) [HTML 1KB] [PDF 0KB] ( 55 )

	559	Guan MC, Ouyang W, Liu SY, Sun LY, Chen WY, Tong XM, Zhu H, Yang T
		Alpha-fetoprotein, protein induced by vitamin K absence or antagonist-II, lens culinaris agglutinin-reactive fraction of alpha-fetoprotein alone and in combination for early detection of hepatocellular carcinoma from nonalcoholic fatty liver disease: A multicenter analysis ^Hot!
		Background: Current surveillance strategies for hepatocellular carcinoma (HCC) among patients with nonalcoholic fatty liver disease (NAFLD) are insufficient. This study aimed to investigate the diagnostic performance of alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVKA-II), lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and their combinations in HCC underlying NAFLD patients. Methods: Serologic AFP, AFP-L3, and PIVKA-II levels in NAFLD patients with and without HCC were mea- sured. By receiver operating characteristic (ROC) analyses, the area under the curve (AUC), sensitivity, and specificity were obtained to evaluate the diagnostic accuracy of each biomarker and their combinations. Results: This study was conducted on 139 patients with NAFLD-HCC and 345 NAFLD controls. The elevation of these three biomarkers was observed in patients with NAFLD-HCC compared to those in NAFLD controls (all P < 0.001). When they were analyzed individually, PIVKA-II showed the best performance in diagnosing any-stage HCC with an AUC of 0.869, followed by AFP (0.763; vs. PIVKA-II, P < 0.001) and AFP-L3 (0.689; vs. PIVKA-II, P < 0.001). When they were analyzed in combination, AFP + PIVKA-II yielded the highest AUC (0.906), followed by AFP + PIVKA-II + AFP-L3 (0.904; vs. AFP + PIVKA-II, P = 0.086), PIVKA-II + AFP-L3 (0.881; vs. AFP + PIVKA-II, P < 0.001), and AFP + AFP-L3 (0.759; vs. AFP + PIVKA-II, P < 0.001). Similar findings were obtained in the subgroup with early-stage NAFLD-HCC, as well as the non-cirrhotic subgroup. Conclusions: These data validated the better diagnostic ability of PIVKA-II than AFP or AFP-L3 alone for diagnosing any-stage HCC among patients with NAFLD, and the combination of AFP + PIVKA-II signifi- cantly improved the diagnostic accuracy of NAFLD-HCC.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 559-568 . [Abstract] ( 106 ) [HTML 1KB] [PDF 0KB] ( 53 )

	569	Li JP, Zhao S, Jiang HJ, Jiang H, Zhang LH, Shi ZX, Fan TT, Wang S
		Quantitative dual-energy computed tomography texture analysis predicts the response of primary small hepatocellular carcinoma to radiofrequency ablation
		Background: Radiofrequency ablation (RFA) is one of the effective therapeutic modalities in patients with hepatocellular carcinoma (HCC). However, there is no proper method to evaluate the HCC response to RFA. This study aimed to establish and validate a clinical prediction model based on dual-energy computed tomography (DECT) quantitative-imaging parameters, clinical variables, and CT texture parameters. Methods: We enrolled 63 patients with small HCC. Two to four weeks after RFA, we performed DECT scanning to obtain DECT-quantitative parameters and to record the patients’ clinical baseline variables. DECT images were manually segmented, and 56 CT texture features were extracted. We used LASSO algorithm for feature selection and data dimensionality reduction; logistic regression analysis was used to build a clinical model with clinical variables and DECT-quantitative parameters; we then added texture features to build a clinical-texture model based on clinical model. Results: A total of six optimal CT texture analysis (CTTA) features were selected, which were statistically different between patients with or without tumor progression ( P < 0.05). When clinical vari- ables and DECT-quantitative parameters were included, the clinical models showed that albumin-bilirubin grade (ALBI) [odds ratio (OR) = 2.77, 95% confidence interval (CI): 1.35-6.65, P = 0.010], λAP (40-100 keV) (OR = 3.21, 95% CI: 3.16-5.65, P = 0.045) and IC AP (OR = 1.25, 95% CI: 1.01-1.62, P = 0.028) were asso- ciated with tumor progression, while the clinical-texture models showed that ALBI (OR = 2.40, 95% CI: 1.19-5.68, P = 0.024), λAP (40-100 keV) (OR = 1.43, 95% CI: 1.10-2.07, P = 0.019), and CTTA-score (OR = 2.98, 95% CI: 1.68-6.66, P = 0.001) were independent risk factors for tumor progression. The clinical model, clinical-texture model, and CTTA-score all performed well in predicting tumor progression within 12 months after RFA (AUC = 0.917, 0.962, and 0.906, respectively), and the C-indexes of the clinical and clinical-texture models were 0.917 and 0.957, respectively. Conclusions: DECT-quantitative parameters, CTTA, and clinical variables were helpful in predicting HCC progression after RFA. The constructed clinical prediction model can provide early warning of potential tumor progression risk for patients after RFA.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 569-576 . [Abstract] ( 88 ) [HTML 1KB] [PDF 0KB] ( 61 )

ORIGINAL ARTICLES/Biliary

	577	Chen S, Li MQ, Duan WJ, Li BE, Li SX, Lv TT, Ma L, Jia JD
		Concomitant extrahepatic autoimmune diseases do not compromise the long-term outcomes of primary biliary cholangitis ^Hot!
		Background: Primary biliary cholangitis (PBC) patients often have concomitant extrahepatic autoimmune (EHA) diseases including Sjogren’s syndrome (SS), systemic sclerosis (SSc), rheumatoid arthritis (RA), and autoimmune thyroid disease. The present study aimed to describe the prevalence of EHA diseases in PBC and explore the impact of EHA diseases on the long-term outcomes of PBC in Chinese patients. Methods: Medical records of PBC patients diagnosed in our institute were retrospectively reviewed. Patients were followed up by a standardized telephone interview. The endpoints were defined as liver-related death and/or liver transplantation. Results: Totally 247 of the 985 (25.1%) PBC patients enrolled in the study had at least one concomitant EHA disease. Sjogren’s syndrome ( n = 140, 14.2%) was the most frequent one, followed by rheumatoid arthritis (RA) ( n = 56, 5.7%) and Hashimoto’s thyroiditis ( n = 45, 4.6%). Patients with EHA diseases were more common in females ( P < 0.001) and in those with a family history of autoimmune disease ( P = 0.017). Overall, no differences were found between PBC patients with and without EHA diseases in terms of biochemical response rates to ursodeoxycholic acid, the incidence of hepatic events, or transplant-free survival. RA and EHA ≥2 were protective factors for hepatic events in univariate Cox analysis, but the results became insignificant in multivariate analysis. Conclusions: Concomitant EHA diseases were common in PBC patients but did not compromise the long- term outcomes of PBC.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 577-582 . [Abstract] ( 144 ) [HTML 1KB] [PDF 0KB] ( 57 )

ORIGINAL ARTICLES/Pancreas

	583	Spanehl L, Revskij D, Bannert K, Ehlers L, Jaster R
		YAP activates pancreatic stellate cells and enhances pancreatic fibrosis
		Background: Pancreatic stellate cells (PSCs) foster the progression of pancreatic adenocarcinoma and chronic pancreatitis (CP) by producing a dense fibrotic stroma. However, the incomplete knowledge of PSCs biology hampers the exploration of antifibrotic therapies. Here, we explored the role of the Hippo pathway in the context of PSCs activation and experimental CP. Methods: CP model was created in rats with the tail vein injection of dibutyltin dichloride (DBTC). The expression of Yes-associated protein (YAP) in CP tissue was assessed. Primary and immortalized rats PSCs were treated with the YAP-inhibitor verteporfin. Furthermore, YAP siRNA was employed. Subsequently, DNA synthesis, cell survival, levels of α-smooth muscle actin ( α-SMA) protein, presence of lipid droplets and PSCs gene expression were evaluated. Upstream regulators of YAP signaling were studied by reporter gene assays. Results: In DBTC-induced CP, pronounced expression of YAP in areas of tubular structures and periductal fibrosis was observed. Verteporfin diminished DNA replication in PSCs in a dose-dependent fashion. Knockdown of YAP reduced cell proliferation. Primary cultures of PSCs were characterized by a decrease of lipid droplets and increased synthesis of α-SMA protein. Both processes were not affected by verteporfin. At the non-cytotoxic concentration of 100 nmol/L, verteporfin significantly reduced mRNA levels of transforming growth factor- β1 ( Tgf- β1 ) and Ccn family member 1 ( Ccn1 ). YAP signaling was activated by TGF- β1, but repressed by interferon- γ. Conclusions: Activated YAP enhanced PSCs proliferation. The antifibrotic potential of Hippo pathway inhibitors warrants further investigation.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 583-589 . [Abstract] ( 96 ) [HTML 1KB] [PDF 0KB] ( 52 )

VIEWPOINTS

	590	Vijay A, Jeon H
		Liver transplantation for patients with intrahepatic cholangiocarcinoma
		Cholangiocarcinoma (CCA) constitutes a group of heterogeneous malignant tumors emerging in the biliary tree [1]. Based on their anatomical distribution, CCA is classified into perihilar cholangiocarcinoma (pCCA), distal cholangiocarcinoma (dCCA) and intrahepatic cholangiocarcinoma (iCCA) and they account for 60%-70%, 20%-30% and 5%-10% of CCA, respectively. The past decade has seen a 2-fold increase in annual percentage change in incidence of iCCA in USA when compared to the prior three decades [2].
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 590-593 . [Abstract] ( 87 ) [HTML 1KB] [PDF 0KB] ( 52 )

	594	He JJ, Geng L, Wang ZY, Zheng SS
		Enhanced recovery after surgery in perioperative period of liver transplantation
		End-stage liver disease (ESLD) usually causes multi-organ dysfunction which increases the risk for perioperative complications and mortality [1]. Liver transplantation is the only curative therapy for ESLD. However, liver transplantation is a major and challenging surgery with a great level of complexity as a result of the interaction between donor and recipient factors. Consequently, this procedure brings a high risk of complications that significantly affect 1-year mortality and graft loss [2]. In addition, immunosuppressant applications are required postoperatively. These factors make perioperative care of patients with liver disease complicated, and the risk of poor patient prognosis increases accordingly. Optimized perioperative management strategies benefit the patient rehabilitation and prolong survival. Enhanced recovery after surgery (ERAS) is a multimodal and evidence-based program of care to minimize the surgical stress, reduce perioperative morbidity and hospital stay [3] . ERAS strategies have been widely used in many fields for nearly 20 years, including colorectal, urological, orthopedics and other surgeries. However, as hepatic surgery differs significantly from colorectal or urological surgery in terms of underlying disease, comorbidities, metabolic stress response and organ-specific complications, the content of ERAS program for liver transplantation is specific. Although studies verified that ERAS is safe and effective in liver transplantation [4,5], it has not yet been widely accepted. This study summarized ERAS strategies of perioperative liver transplantation based on evidence-based medicine, and evaluated the effectiveness on clinical application.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 594-596 . [Abstract] ( 103 ) [HTML 1KB] [PDF 0KB] ( 48 )

	597	Jin WM, Song SY, Xu XF, Wen CP, Hu CF
		Role of gut microbiota in primary biliary cholangitis
		Primary biliary cholangitis (PBC, formerly known as primary biliary cirrhosis) is a chronic female-predominant inflammatory and cholestatic liver disease with a prolonged course and poor prognosis [1]. It is characterized by anti-mitochondrial autoantibody (AMA), immunoglobulin M and lymphocyte infiltration in the portal area of liver tissue. A recent systemic review has shown a steady rise both in incidence and prevalence of PBC, with 5.31/100000 persons and 40.2/100000 persons, respectively [2]. It can cause fatigue, pruritus and is associated with a high risk of cirrhosis and liver failure if left untreated [3]. The pathogenesis of PBC may be related to genetic, environmental, immune factors and individual susceptibility, but the specific etiology is not clear. Several previous studies [4,5] have found that gut microbiota plays an important role in a variety of liver diseases, including PBC. The bidirectional crosstalk between liver and microbiome appears to be crucial in maintaining health and could be therapeutically targeted, such as by fecal microbiota transplantation.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 597-599 . [Abstract] ( 104 ) [HTML 1KB] [PDF 0KB] ( 57 )

	600	Hori T, Yasukawa D
		Technical aspects in pancreaticoduodenectomy and therapeutic strategies for pancreatic cancer: History, current status, and future perspectives
		The incidence of pancreatic cancer (PC) has increased, and invasive ductal adenocarcinoma is the most common among PC patients [1]. Even in patients who receive radical treatments, namely chemotherapy and surgery, the five-year survival is only 2%-9% [1]. Currently, many physicians recognize that further developments in multidisciplinary therapy are crucial to overcome PC [1].
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 600-602 . [Abstract] ( 107 ) [HTML 1KB] [PDF 0KB] ( 47 )

	603	Huang LP, Jin SF, Jiang RL
		Nutritional management of severe acute pancreatitis
		Severe acute pancreatitis (SAP) is a common clinical emergency and critical illness. The increases of hyperlipidemic pancreatitis and alcoholic pancreatitis result in the increase of SAP. The SAP mortality is as high as 30% [1]. During the resuscitation and treatment of SAP, the metabolism changes require nutritional support. The individual metabolic status need personalized nutrition approach.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 603-604 . [Abstract] ( 102 ) [HTML 1KB] [PDF 0KB] ( 53 )

LETTERS TO THE EDITOR

	605	Tian QJ, Xie M, Wang JT, Wang Y, Zhang B, Cai JZ, Qi XL, Rao W
		Safety and immunogenicity of COVID-19 vaccination among liver transplant recipients in China
		During the ongoing coronavirus disease 2019 (COVID-19) pandemic globally, patients with chronic liver diseases (CLD), particularly cirrhosis, hepatobiliary malignancies, candidates for liver transplantation (LT), and immunosuppressed LT recipients appear to be at increased risk of infections, which leads to an increase in mortality [1–6]. Apart from physical distancing, quarantine and isolation, vaccination is crucial for the restraining of the epidemic and the protection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and aggravation of COVID-19 [7,8]. A recent prospective, multicenter, open-label study in China has demonstrated the safety of inactivated whole-virion SARS-CoV-2 vaccines in patients with CLD; however, these patients had decreased response (76.7%-78.9%) to SARS-CoV-2 vaccines compared with healthy subjects (90.3%), which might be associated with the impairment in immunity in the population with CLD [9]. This raises the concern in the safety and immunogenicity of COVID-19 vaccination among LT recipients in China since this population may have more suppressed immunity [8,10,11]. Herein, we preliminary investigated the influence of COVID-19 vaccination on general safety, graft function, host immunogenicity of vaccination among LT recipients in a large transplantation center in China.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 605-608 . [Abstract] ( 76 ) [HTML 1KB] [PDF 0KB] ( 63 )

	609	Huang JY, Huang ZL, Yang Z, Zheng XP
		Contrast-enhanced ultrasound predicts microvascular invasion in patients with hepatocellular carcinoma
		The presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is an important indicator for HCC recurrence and poor prognosis [1]. Determining the preoperative MVI status is helpful for guiding clinical treatment and improving prognosis. Currently, MVI diagnosis is achieved primarily by postoperative histopathology, which makes it difficult to provide a definite diagnosis before surgery. However, significant advancements in imaging technology have begun to allow clinicians to make a diagnosis of HCC MVI prior to surgery. In this study, we used contrastenhanced ultrasound (CEUS) to observe the characteristics of HCC enhancement patterns and quantitatively analyze the changes in HCC blood perfusion parameters to explore the value of CEUS in evaluating HCC MVI.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 609-613 . [Abstract] ( 79 ) [HTML 1KB] [PDF 0KB] ( 43 )

	614	Gastaca M, Gomez J, Terreros I
		Endovascular treatment for early hepatic artery occlusion after liver transplantation: Angioplasty or stent
		We read with great interest the recent article by Zhu et al. [1]. In the study, the authors analyzed the outcomes of 26 patients diagnosed with hepatic artery occlusion (HAO) and treated with an endovascular approach (EVT) within the first 30 days after orthotopic liver transplantation (LT). The median interval from LT to EVT was 7 days, most patients were treated with angioplasty and only two (7.7%) needed stent placement. The authors should be congratulated as they achieved a 100% of success rate with an 80.8% of 1-year survival rate.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 614-615 . [Abstract] ( 79 ) [HTML 1KB] [PDF 0KB] ( 50 )

	616	Zhu HK, Cao GH, Zheng SS
		Reply to: Endovascular treatment for early hepatic artery occlusion after liver transplantation: Angioplasty or stent
		We thank Dr. Gastaca et al. for the interest toward our article and the thoughtful comments. We are willing to further discuss the topic of endovascular treatment (EVT) after liver transplantation (LT). Congratulation to their successful experience of EVT. As Dr. Gastaca emphasized, most of the transplant centers, even important centers, are hesitant to perform EVT early after LT [1–3]. Their team demonstrated successful experience of EVT treating hepatic artery thrombosis and stenosis during very early period with high patency rates and absence of major complications [4] . We strongly agree with Dr. Gastaca’s attitude and admire the novel approach.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 616-616 . [Abstract] ( 83 ) [HTML 1KB] [PDF 0KB] ( 54 )

	617	Angeles-Mar HJ, Garcia-Campa M, Elizondo-Omana RE, Guzman-Lopez S, Martinez-Garza JH, Quiroga-Garza A
		Letter to the Editor concerning: Gallbladder perforation: A single-center experience in north India and a step-up approach for management
		We sincerely applaud the work done by Gupta et al., in which they analyzed a single-center experience regarding gallbladder perforation (GBP) management [1]. Currently, there is a lack of cohort studies to adequately describe the approach strategies and management for this pathology, with international guidelines making ambiguous recommendations [2,3]. Their study stratified GBP types and provided details regarding clinical presentation, comorbidities, preoperative diagnosis, etiology, imaging techniques, and surgical approach. The study reported a high conversion rate when a laparoscopic approach was attempted for cholecystectomy.
		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 617-618 . [Abstract] ( 74 ) [HTML 1KB] [PDF 0KB] ( 56 )

THANKS

	619
		Thanks

		Hepatobiliary Pancreat Dis Int. 2022; 21(6): 619-A9-10 . [Abstract] ( 80 ) [HTML 1KB] [PDF 48KB] ( 533 )

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