Hepatobiliary Pancreat Dis Int

	2023 Vol. 22 No. 1
	Published: 2023-02-15


	Pages 1-110
	REVIEW ARTICLES ORIGINAL ARTICLES/Transplantation ORIGINAL ARTICLES/Liver CLINICAL IMAGE LETTERS TO THE EDITOR VIEWPOINTS Special issue on frontiers in liver transplantation

Special issue on frontiers in liver transplantation

	1	Xu X
		State of the art and perspectives in liver transplantation
		Since the first liver transplantation (LT) was executed by Thomas E. Starzl in 1963, the past six decades have witnessed rapid progresses in LT, especially in the immunosuppressive agents, surgical techniques, and perioperative managements. LT has been well-recognized as the only curative intervention for end-stage liver diseases. In this special issue on frontiers in LT, authors from several international LT centers summarized the current state and progresses in LT, including selection criteria for LT candidates, and precise management in LT recipients with HCC.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 1-3 . [Abstract] ( 137 ) [HTML 1KB] [PDF 0KB] ( 129 )

	4	Fung J, DiSabato D, Liao CY, Ahmed O, Pillai A
		Perspective: Advances in liver transplantation for hepatocellular carcinoma – A prototype for transplant oncology ^Hot!
		In his 1969 book, Experience in Hepatic Transplantation , Thomas E Starzl wrote: “the unequivocal indication for the operation of liver replacement was originally considered to be primary hepatic malignancy which could not be treated with conventional techniques of subtotal liver resection” [1]. Thus, it was not surprising that many cases in the early reported series of orthotopic liver transplantation (OLT) were for malignant indications [2-4]. As these procedures were done during the developmental phase of OLT, characterized by a host of technical, immunological, infectious risk factors, along with the advanced cancer staging of these early cases, the overall outcomes were poor. In the 1983 NIH Consensus Development Conference on Liver Transplantation, the committee noted: “Primary hepatic malignancy confined to the liver but not amenable to resection may be an indication for transplantation. Results to date indicate a strong likelihood of recurrence of that malignancy” [5].
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 4-6 . [Abstract] ( 190 ) [HTML 1KB] [PDF 0KB] ( 127 )

	7	Jiang C, Sun XD, Qiu W, Chen YG, Sun DW, Lv GY
		Conversion therapy in liver transplantation for hepatocellular carcinoma: What’s new in the era of molecular and immune therapy? ^Hot!
		Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer globally, with limited therapies and unsatisfactory prognosis once in the advanced stages. With promising advances in locoregional and systematic treatments, fast development of targeted drugs, the success of immunotherapy, as well as the emergence of the therapeutic alliance, conversion therapy has recently become more well developed and an effective therapeutic strategy. This article aimed to review recent developments in conversion therapy in liver transplantation (LT) for HCC. Data sources: We searched for relevant publications on PubMed before September 2022, using the terms “HCC”, “liver transplantation”, “downstaging”, “bridging treatment”and “conversion therapy”. Results: Conversion therapy was frequently represented as a combination of multiple treatment modalities to downstage HCC and make patients eligible for LT. Although combining various local and systematic treatments in conversion therapy is still controversial, growing evidence has suggested that multimodal combined treatment strategies downstage HCC in a shorter time, which ultimately increases the opportunities for LT. Moreover, the recent breakthrough of immunotherapy and targeted therapy for HCC also benefit patients with advanced-stage tumors. Conclusions: In the era of targeted therapy and immunotherapy, applying the thinking of transplant oncology to benefit HCC patients receiving LT is a new topic that has shed light on advanced-stage patients. With the expansion of conversion therapy concepts, further investigation and research is required to realize the full potential of conversion treatment strategies, including accurately selecting candidates, determining the timing of surgery, improving the conversion rate, and guaranteeing the safety and long-term efficacy of treatment.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 7-13 . [Abstract] ( 160 ) [HTML 1KB] [PDF 0KB] ( 130 )

	14	Fan GH, Zhang CZ, Gao FQ, Wei XY, Ling SB, Wang K, Wang JG, Zheng SS, Nikfarjam M, Xu X
		A mixed blessing for liver transplantation patients -- Rapamycin ^Hot!
		Background: Liver transplantation (LT) is an effective treatment option for end-stage liver disease. Mammalian target of rapamycin (mTOR) inhibitors, such as rapamycin, are widely used post LT. Data sources: In this review, we focused on the anti-cancer activities and metabolic side effects of rapamycin after LT. The literature available on PubMed for the period of January 1999-September 2022 was reviewed. The key words were rapamycin, sirolimus, liver transplantation, hepatocellular carcinoma, diabetes, and lipid metabolism disorder. Results: Rapamycin has shown excellent effects and is safer than other immunosuppressive regimens. It has exhibited excellent anti-cancer activity and has the potential in preventing hepatocellular carcinoma (HCC) recurrence post LT. Rapamycin is closely related to two long-term complications after LT, diabetes and lipid metabolism disorders. Conclusions: Rapamycin prevents HCC recurrence post LT in some patients, but it also induces metabolic disorders. Reasonable use of rapamycin benefits the liver recipients.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 14-21 . [Abstract] ( 170 ) [HTML 1KB] [PDF 0KB] ( 129 )

	22	Li ZW, Wang L
		The role of liver sinusoidal endothelial cells in liver remodeling after injury
		Liver transplantation is the optimal treatment for patients with end-stage liver disease, metabolic liver diseases, and hepatic malignancies that are not amenable to resection. Hepatic ischemia-reperfusion injury (IRI) is the main problem in liver transplantation and liver resection, leading to parenchymal cell injury and organ dysfunction. The damage of liver sinusoidal endothelial cells (LSECs) is a critical event in IRI. LSECs work as an important regulating factor of liver regeneration after partial hepatectomy. This review primarily describes the mechanisms of LSECs injury in IRI and explores the roles of LSECs in liver regeneration, and briefly introduces the protective strategies targeting LSECs damaged in IRI.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 22-27 . [Abstract] ( 147 ) [HTML 1KB] [PDF 0KB] ( 127 )

	28	Pan B, Liu W, Ou YJ, Zhang YQ, Jiang D, Li YC, Chen ZY, Zhang LD, Zhang CC
		Gastroduodenal artery disconnection during liver transplantation decreases non-anastomotic stricture incidence ^Hot!
		Background: The hepatic artery is the only blood source nourishing the biliary duct and associated with biliary complication after liver transplantation (LT). Gastroduodenal artery (GDA) disconnection increased proper hepatic artery flow. Whether this procedure attenuates biliary non-anastomotic stricture (NAS) is not clear. Methods: A total of 241 patients with LT were retrospectively analyzed. The patients were divided into the GDA disconnection (GDA-) and GDA preservation (GDA + ) groups. Propensity score matching (PSM) was administrated to reduce bias. Logistic regression was conducted to analyze risk factors for biliary NAS before and after PSM. Postoperative complications were compared. Kaplan-Meier survival analysis and log-rank tests were performed to compare overall survival. Results: In all, 99 patients (41.1%) underwent GDA disconnection, and 49 (20.3%) developed NAS. Multi- variate logistic regression revealed that GDA preservation (OR = 2.24, 95% CI: 1.11-4.53; P = 0.025) and model for end-stage liver disease (MELD) score > 15 (OR = 2.14, 95% CI: 1.12-4.11; P = 0.022) were risk factors for biliary NAS. PSM provided 66 pairs using 1:2 matching method, including 66 GDA discon- nection and 99 GDA preservation patients. Multivariate logistic regression after PSM also showed that GDA preservation (OR = 3.15, 95% CI: 1.26-7.89; P = 0.014) and MELD score > 15 (OR = 2.41, 95% CI: 1.08-5.36; P = 0.031) were risk factors for NAS. When comparing complications between the two groups, GDA preservation was associated with a higher incidence of biliary NAS before and after PSM ( P = 0.031 and 0.017, respectively). In contrast, other complications including early allograft dysfunction ( P = 0.620), small-for-size graft syndrome ( P = 0.441), abdominal hemorrhage ( P = 1.000), major com- plications (Clavien-Dindo grade ≥3, P = 0.318), and overall survival ( P = 0.088) were not significantly different between the two groups. Conclusions: GDA disconnection during LT ameliorates biliary NAS incidence and may be recommended for application in clinical practice.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 28-33 . [Abstract] ( 192 ) [HTML 1KB] [PDF 0KB] ( 209 )

	34	Liu P, Wang X, Liu H, Wang SX, Xu QG, Wang L, Xu X, Cai JZ
		Sirolimus improves the prognosis of liver recipients with hepatocellular carcinoma: A single-center experience
		Background: Tumor recurrence after liver transplantation (LT) for selective patients diagnosed with hepatocellular carcinoma (HCC) in the setting of cirrhosis is the greatest challenge effecting the prognosis of these patients. The aim of this study was to evaluate the efficacy of sirolimus on the prognosis for these recipients. Methods: The data from 193 consecutive HCC patients who had undergone LT from January 2015 to December 2019 were retrospectively analyzed. These patients were divided into the sirolimus group [patients took sirolimus combined with calcineurin inhibitors (CNIs) (n = 125)] and non-sirolimus group [patients took CNI-based therapy without sirolimus (n = 68)]. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. The prognostic factors and independent risk factors for RFS and OS were further evaluated. Results: Non-sirolimus was an independent risk factor for RFS (HR = 2.990; 95% CI: 1.050-8.470; P = 0.040) and OS (HR = 3.100; 95% CI: 1.190-8.0 0 0; P = 0.020). A higher proportion of patients beyond Hangzhou criteria was divided into the sirolimus group (69.6% vs. 80.9%, P = 0.030). Compared with the non-sirolimus group, the sirolimus group had significantly better RFS ( P < 0.001) and OS ( P < 0.001). Further subgroup analysis showed similar results. Conclusions: This study demonstrated that sirolimus significantly decreased HCC recurrence and pro- longed RFS and OS in LT patients with different stage of HCC.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 34-40 . [Abstract] ( 135 ) [HTML 1KB] [PDF 0KB] ( 127 )

	41	Yao J, Lei YG, Yi HM, Yang Y
		Clinical strategies to improve the survival rate of liver recipients with acute-on-chronic liver failure
		There are currently more than 100 million patients with liver disease in China, and 300000 patients are estimated to be diagnosed with end-stage liver diseases each year. Since Dr. Starzl, a professor from the University of Pittsburgh, completed the first liver transplant in 1963, liver transplantation has been recognized as the only effective treatment for patients with end-stage liver disease. Liver transplantation has progressed rapidly in China recently in terms of surgical techniques and perioperative management. China now is the second largest liver transplantation country in the world, with 5000-6000 liver transplantations each year. It has been reported that 24423 adult patients underwent liver transplantation in China between 2015 and 2020 [1]. However, according to the database of China Liver Transplant Registry (CLTR) in 2020, the 1- and 5-year survival rates were 84% and 71%, and were 93.6% and 81.2% in the USA in the same time period in the United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) [2,3]. Therefore, there is still a room to improve in China.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 41-44 . [Abstract] ( 151 ) [HTML 1KB] [PDF 0KB] ( 123 )

REVIEW ARTICLES

	45	Zhu SF, Yuan W, Du YL, Wang BL
		Research progress of lncRNA and miRNA in hepatic ischemia-reperfusion injury ^Hot!
		Background: Hepatic ischemia-reperfusion injury (HIRI) is a common complication of liver surgeries, such as hepatectomy and liver transplantation. In recent years, several non-coding RNAs (ncRNAs) including long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) have been identified as factors involved in the pathological progression of HIRI. In this review, we summarized the latest research on lncRNAs, miRNAs and the lncRNA-miRNA regulatory networks in HIRI. Data sources: The PubMed and Web of Science databases were searched for articles published up to December 2021 using the following keywords: “hepatic ischemia-reperfusion injury”, “lncRNA”, “long non- coding RNA”, “miRNA”and “microRNA”. The bibliography of the selected articles was manually screened to identify additional studies. Results: The mechanism of HIRI is complex, and involves multiple lncRNAs and miRNAs. The roles of lncRNAs such as AK139328, CCAT1, MALAT1, TUG1 and NEAT1 have been established in HIRI. In addition, numerous miRNAs are associated with apoptosis, autophagy, oxidative stress and cellular inflammation that accompany HIRI pathogenesis. Based on the literature, we conclude that four lncRNA-miRNA regulatory networks mediate the pathological progression of HIRI. Furthermore, the expression levels of some lncRNAs and miRNAs undergo significant changes during the progression of HIRI, and thus are potential prognostic markers and therapeutic targets. Conclusions: Complex lncRNA-miRNA-mRNA networks regulate HIRI progression through mutual activation and antagonism. It is necessary to screen for more HIRI-associated lncRNAs and miRNAs in order to identify novel therapeutic targets.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 45-53 . [Abstract] ( 156 ) [HTML 1KB] [PDF 0KB] ( 157 )

	54	Zou YW, Ren ZG, Sun Y, Liu ZG, Hu XB, Wang HY, Yu ZJ
		The latest research progress on minimally invasive treatments for hepatocellular carcinoma ^Hot!
		Background: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death world- wide. Due to the high prevalence of hepatitis B virus (HBV) infection in China, the incidence of HCC in China is high, and liver cirrhosis caused by chronic hepatitis also brings great challenges to treatment. This paper reviewed the latest research progress on minimally invasive treatments for HCC, including percutaneous thermal ablation and new nonthermal ablation techniques, and introduced the principles, advantages, and clinical applications of various therapeutic methods in detail. Data sources: The data of treatments for HCC were systematically collected from the PubMed, ScienceDirect, American Chemical Society and Web of Science databases published in English, using “minimally invasive”and “hepatocellular carcinoma”or “liver cancer”as the keywords. Results: Percutaneous thermal ablation is still a first-line strategy for the minimally invasive treatment of HCC. The effect of microwave ablation (MWA) on downgrading treatment before liver transplantation is better than that of radiofrequency ablation (RFA), while RFA is more widely used in the clinical practice. High-intensity focused ultrasound (HIFU) is mainly used for the palliative treatment of advanced liver cancer. Electrochemotherapy (ECT) delivers chemotherapeutic drugs to the target cells while reducing the blood supply around HCC. Irreversible electroporation (IRE) uses a microsecond-pulsed electric field that induces apoptosis and necrosis and triggers a systemic immune response. The nanosecond pulsed electric field (nsPEF) has achieved a good response in the ablation of mice with HCC, but it has not been reported in China for the treatment of human HCC. Conclusions: A variety of minimally invasive treatments provide a sufficient survival advantage for HCC patients. Nonthermal ablation will lead to a new wave with its unique advantage of antitumor recurrence and metastasis.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 54-63 . [Abstract] ( 172 ) [HTML 1KB] [PDF 0KB] ( 141 )

ORIGINAL ARTICLES/Transplantation

	64	Zhu CX, Yang L, Zhao H, Zhang Y, Tu S, Guo J, Yan D, Hu CX, Lu HF, Xu KJ, Huang JR, Li LJ
		Impact of cirrhosis-related complications on posttransplant survival in patients with acute-on-chronic liver failure
		Background: Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome defined as acute decom- pensation in patients with chronic liver disease. Liver transplantation (LT) is the most effective treatment. We aimed to assess the impact of cirrhosis-related complications pre-LT on the posttransplant prognosis of patients with ACLF. Methods: This was an observational cohort study conducted between January 2018 and December 2020. Clinical characteristics, cirrhosis-related complications at LT and patient survival post-LT were collected. All liver recipients with ACLF were followed for 1 year post-LT. Results: A total of 212 LT recipients with ACLF were enrolled, including 75 (35.4%) patients with ACLF-1, 64 (30.2%) with ACLF-2, and 73 (34.4%) with ACLF-3. The median waiting time for LT was 11 (4-24) days. The most prevalent cirrhosis-related complication was ascites (78.8%), followed by hepatic encephalopathy (57.1%), bacterial infections (48.1%), hepatorenal syndrome (22.2%) and gastrointestinal bleeding (11.3%). Survival analyses showed that patients with complications at LT had a significantly lower survival probability at both 3 months and 1 year after LT than those without complications (all P < 0.05). A simplified model was developed by assigning one point to each complication: transplantation for ACLF with cirrhosis-related complication (TACC) model. Risk stratification of TACC model identified 3 strata ( ≥4, =3, and ≤2) with high, median andlow riskofdeath afterLT (P<0.001). Moreover, the TACC model showed a comparable ability for predicting the outcome post-LT to the other four prognostic models (chronic liver failure-consortium ACLF score, Chinese Group on the Study of Severe Hepatitis B-ACLF score, model for end-stage liver disease score and Child-Turcotte-Pugh score). Conclusions: The presence of cirrhosis-related complications pre-LT increases the risk of death post-LT in patients with ACLF. The TACC model based on the number of cirrhosis-related complications pre-LT could stratify posttransplant survival, which might help to determine transplant timing for ACLF.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 64-71 . [Abstract] ( 143 ) [HTML 1KB] [PDF 0KB] ( 123 )

ORIGINAL ARTICLES/Liver

	72	Ding DY, Liu L, Li HL, Gan XJ, Ding WB, Gu FM, Sun DP, Li W, Pan ZY, Yuan SX, Zhou WP
		Development of preoperative prognostic models including radiological features for survival of singular nodular HCC patients
		Background: Early singular nodular hepatocellular carcinoma (HCC) is an ideal surgical indication in clinical practice. However, almost half of the patients have tumor recurrence, and there is no reliable prog- nostic prediction tool. Besides, it is unclear whether preoperative neoadjuvant therapy is necessary for patients with early singular nodular HCC and which patient needs it. It is critical to identify the pa- tients with high risk of recurrence and to treat these patients preoperatively with neoadjuvant therapy and thus, to improve the outcomes of these patients. The present study aimed to develop two prognostic models to preoperatively predict the recurrence-free survival (RFS) and overall survival (OS) in patients with singular nodular HCC by integrating the clinical data and radiological features. Methods: We retrospective recruited 211 patients with singular nodular HCC from December 2009 to January 2019 at Eastern Hepatobiliary Surgery Hospital (EHBH). They all met the surgical indications and underwent radical resection. We randomly divided the patients into the training cohort ( n = 132) and the validation cohort ( n = 79). We established and validated multivariate Cox proportional hazard models by the preoperative clinicopathologic factors and radiological features for association with RFS and OS. By analyzing the receiver operating characteristic (ROC) curve, the discrimination accuracy of the models was compared with that of the traditional predictive models. Results: Our RFS model was based on HBV-DNA score, cirrhosis, tumor diameter and tumor capsule in imaging. RFS nomogram had fine calibration and discrimination capabilities, with a C-index of 0.74 (95% CI: 0.68-0.80). The OS nomogram, based on cirrhosis, tumor diameter and tumor capsule in imaging, had fine calibration and discrimination capabilities, with a C-index of 0.81 (95% CI: 0.74-0.87). The area under the receiver operating characteristic curve (AUC) of our model was larger than that of traditional liver cancer staging system, Korea model and Nomograms in Hepatectomy Patients with Hepatitis B Virus- Related Hepatocellular Carcinoma, indicating better discrimination capability. According to the models, we fitted the linear prediction equations. These results were validated in the validation cohort. Conclusions: Compared with previous radiography model, the new-developed predictive model was concise and applicable to predict the postoperative survival of patients with singular nodular HCC. Our models may preoperatively identify patients with high risk of recurrence. These patients may benefit from neoadjuvant therapy which may improve the patients’ outcomes.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 72-80 . [Abstract] ( 159 ) [HTML 1KB] [PDF 0KB] ( 173 )

CLINICAL IMAGE

	81	Mayer P, Felli E, Enescu I, Habersetzer F, Tripon S
		Upper gastrointestinal bleeding due to left side portal hypertension after pancreatic surgery
		Left-side portal hypertension (LSPH) is a rare cause of intraabdominal venous hypertension. In most of cases, LSPH is due to pancreatic diseases, especially chronic pancreatitis, but it is also described in other abdominal diseases (i.e., retroperitoneal fibrosis or perineal abscess) after abdominal surgery (i.e., pancreatic surgery, liver transplantation) or endovascular procedures [1–4]. Notably, LSPH was described for the first time by Greenwald and Wasch in 1939 [5]. Unlike generalized portal hypertension frequently observed in chronic liver disease, patients with LSPH have normal liver function. However, they can develop esophageal and/or gastric varices [1,2,6]. The incidence of LSPH remains unknown but it seems gradually increased in recent years especially due to higher sensitivity of current imaging techniques and increased knowledge in pancreatic disorders. Most of the time LSPH is an asymptomatic condition, but in some case, it can present with chronic abdominal pain or upper gastrointestinal variceal bleeding (UGIVB).
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 81-84 . [Abstract] ( 116 ) [HTML 1KB] [PDF 0KB] ( 120 )

VIEWPOINTS

	85	Stavrou GA, Kardassis D, Blatt LA, Gharbi A, Donati M
		Modified ALPPS as an individual rescue treatment strategy for resection of Klatskin tumors
		Surgery for Klatskin tumors is a complex procedure often requiring extended hepatectomy combined with vascular and bile duct reconstruction in the setting of cholestasis, cholangitis, impaired liver regeneration and small future liver remnant (FLR) usually measured on computed tomography (CT) volumetry in a standardized (sFLR) fashion. Major morbidity is as high as 70%, and published literature estimates mortality around 15% [1]. Careful strategic planning and modulation of the FLR are factors improving outcomes.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 85-87 . [Abstract] ( 132 ) [HTML 1KB] [PDF 0KB] ( 149 )

LETTERS TO THE EDITOR

	88	Abdel-Rahman O
		Outcomes of liver transplantation as an oncologic surgery for different primary liver cancers: A real-world, population-based study
		Although liver transplantation is likely used to treat individuals with end-stage liver disease because of non-neoplastic reasons, the adoption of liver transplantation in the management of primary liver cancer has been expanding in the past decades [1–3]. Prior population-based studies for liver transplantation, in the cancer sphere, focused on delineating the outcomes of patients with hepatocellular carcinoma (HCC) treated with transplantation versus other locoregional treatments [4–6]. However, little is known about the outcomes of patients with non-HCC primary liver cancers treated with liver transplantation. Understanding the outcomes of liver transplantation in different patient populations can have important implications for treatment decision-making for individual patients, but also for general policies underlying the transplant waitlist management and prioritization of listed patients. This study aimed to evaluate the outcomes of patients with different primary liver cancers treated with liver transplantation as an oncologic surgery.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 88-91 . [Abstract] ( 112 ) [HTML 1KB] [PDF 0KB] ( 140 )

	92	Pei JH, Shen CH, Li RD, Tao YF, Lu L, Wang ZX
		Successful adult-to-pediatric liver transplantation of discarded partial liver allograft with benign caudate lobe tumor
		Pediatric liver transplantation is the only treatment option for end-stage liver disease in children, and the 5-year and 20-year survival rates after living donor liver transplantation (LDLT) can reach 91.5% and 84.2% [1]. Many Asian countries, including China, have begun to develop LDLT and achieved good progress. However, the shortage of donor livers in children remains a serious problem. Parents with hepatitis B virus, fatty liver, or blood type incompatibility, and those with strong ethical objections are not suitable donors, and many children have to wait for a suitable liver source. We recently have used five split discarded left lateral lobe as donor liver from living patients with caudate lobe benign tumors and have achieved good results. Here, we share our experiences of using discarded liver grafts as donor liver in pediatric liver transplantation. Both the hepatectomy and “discarded” graft procurement surgery were approved by the Medical Affairs Department and the Ethics Committee of the Huashan Hospital of Fudan University.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 92-95 . [Abstract] ( 134 ) [HTML 1KB] [PDF 0KB] ( 132 )

	96	Wang ZT, Chen JY
		Bilateral lung transplantation, a new option for pulmonary metastasis from hepatocellular carcinoma?
		The lung is the most frequent site of extrahepatic hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). Pulmonary metastasis from hepatocellular carcinoma (PM-HCC) carries a poor prognosis as the patient could finally die of pulmonary failure secondary to the tumor despite maintaining ideal liver function.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 96-98 . [Abstract] ( 118 ) [HTML 1KB] [PDF 0KB] ( 149 )

	99	Ma XQ, Yang SS, Wang HQ, Wu J, Yu CB
		Predictive value of lipocalin 2 and cystatin C for acute kidney injury in patients with cirrhosis
		Acute kidney injury (AKI) is a common complication in patients with liver cirrhosis and with a high mortality [1]; early diagnosis and treatment improve survival. Lipocalin 2 (NGAL) and cystatin C have been identified as early biomarkers of AKI. However, controversy remains regarding the utility of NGAL and cystatin C for the early diagnosis of AKI in patients with liver cirrhosis. This study aimed to evaluate the performance of NGAL and cystatin C in diagnosing AKI in patients with liver cirrhosis and predicting their clinical outcomes.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 99-103 . [Abstract] ( 101 ) [HTML 1KB] [PDF 0KB] ( 136 )

	104	Albuquerque APB, Fernandes AR, Duarte ALBP, de Ataide Mariz H, Junior JGCA, Mattos LA, da Rocha Pitta MG, Rego MJBM
		ANA-HEp2 pattern evaluation in pancreatic cancer: What can the autoantibodies tell us?
		Pancreatic neoplasms are mainly diagnosed by imaging methods and confirmed by biopsies [1]. Imaging techniques and the tumor markers carbohydrate antigen 19-9 (CA19-9) or carcinoembryonic antigen (CEA) used for follow-up, are expensive and of low sensitivity and specificity [2].
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 104-106 . [Abstract] ( 106 ) [HTML 1KB] [PDF 0KB] ( 222 )

	107	Wu CX, Xiao LB, Luo ZF, Shi SH
		Diagnostic approaches for pancreatic tuberculosis
		Pancreatic tuberculosis refers to tuberculosis of pancreas and peripancreatic lymph nodes due to both conditions having similar clinical manifestations and therapeutic regimens [1,2]. It is a rare entity worldwide, which is often shown as mass and treated by the unnecessary surgery due to misdiagnosis as pancreatic malignancy [1,2]. In most patients, abdominal tuberculosis is often independent of pulmonary tuberculosis, with an incidence of coexisting disease ranging from 5% to 36% and abdominal tuberculosis constituting about 11% of extra-pulmonary tuberculosis [2,3]. Pancreatic tuberculosis is part of abdominal tuberculosis, which can involve the gastrointestinal tract, peritoneum, lymph nodes and solid viscera, and has been troubling surgeons because of its variable signs and symptoms [3]. Here, we presented a pancreatic tuberculosis case with a resolution of obstructive jaundice before antitubercular therapy, then made a literature review on its diagnostic approaches.
		Hepatobiliary Pancreat Dis Int. 2023; 22(1): 107-110 . [Abstract] ( 113 ) [HTML 1KB] [PDF 0KB] ( 213 )

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