Epstein-Barr Virus–Related Post-Transplant Lymphoproliferative Disorders in Cystic Fibrosis Lung Transplant Recipients: A Case Series

Background

Solid organ transplantation is associated with a higher risk of Epstein-Barr virus (EBV)–related lymphoproliferative disease due to immunosuppressive regimen. Little evidence is currently available on post-transplant lymphoproliferative disorders (PTLDs) in the lung transplant (LuTx) setting, particularly in cystic fibrosis (CF) recipients.

Hepatocellular Carcinoma and Liver Transplantation: State of the Art

Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in chronic liver disease and cirrhosis. The incidence of HCC is growing worldwide.With respect to any other available treatment for liver cancer, liver transplantation (LT) has the highest potential to cure. LT allows for removal at once of both the tumor (“seed”) and the damaged-hepatic tissue (“soil”) where cancerogenesis and chronic liver disorders have progressed together. The Milan criteria (MC) have been applied worldwide to select patients with HCC for LT, yielding a 4-year survival rate of 75%. These criteria represent the benchmark for patient selection and are the basis for comparison with any other suggested criteria.However, MC are often considered to be too restrictive, and recent data show that between 25% and 50% of patients with HCC are currently transplanted beyond conventional indications. Consequently, any unrestricted expansion of selection criteria will increase the need for donor organs, lengthen waiting periods, increase drop-out rates, and impair outcomes on intention-to-treat analysis. Management of HCC recurrence after LT is challenging. There are a few reports available regarding the safety and efficacy of sorafenib for HCC recurrence after LT, but the data are heterogeneous. A multi-center prospective randomized controlled trial comparing placebo with sorafenib is advised. Alternatively, a meta-analysis of patient survival with sorafenib for HCC recurrence after LT could be helpful to characterize the therapeutic benefit and safety of sorafenib.Here, we review the use of LT for HCC, with particular emphasis on the selection criteria for transplantation in patients with HCC and management of HCC recurrence after LT.     

Patients with early recurrence of hepatocellular carcinoma have poor prognosis

BACKGROUND: Early recurrence(ER) after hepatic resection(HR) is a poor prognostic factor for patients with hepatocellular carcinoma(HCC). This study aimed to identify the clinicopathological features, outcomes, and risk factors for ER after HR for small HCC in order to clarify the reasons why ER is a worse recurrence pattern.METHODS: We retrospectively examined 130 patients who underwent HR for small HCC(≤30 mm). Recurrence was classified into ER(2 years) and late recurrence(LR)(≥2 years). The clinicopathological features, outcomes, and risk factors for ER were analyzed by multivariate analysis.RESULTS: ER was observed in 39 patients(30.0%). The survival rate of the ER group was significantly lower than that of the LR group(P0.005), and ER was an independent prognostic factor for poor survival(P=0.0001). The ER group had a significantly higher frequency(P=0.0039) and shorter interval(P=0.027) of development to carcinoma beyond the Milan criteria(DBMC) compared with the LR group, and ER was an independent risk factor for DBMC(P0.0001). Multi-nodularity, non-simple nodular type, and microvascular invasion were independent predictors for ER(P=0.012, 0.010, and 0.019, respectively).CONCLUSIONS: ER was a highly malignant recurrence pattern associated with DBMC and subsequent poor survival after HR for small HCC. Multi-nodularity, non-simple nodular type, and microvascular invasion predict ER, and taking these factors into consideration may be useful for the decision of the treatment strategy for small HCC after HR.