Scoring system in intermediate-stage HCC treated with TACE.

PURPOSE: To identify predictors of overall survival (OS) in naïve intermediate-stage HCC patients undergoing transarterial chemoembolization (TACE) and to suggest an objective point score for patients’ stratification. MATERIALS AND METHODS: We retrospectively reviewed clinical and demographic data of 149 patients (125 males; mean age 65 years) with naïve intermediate-stage HCC treated with TACE between 2006 and 2011. Tumor response at 1 month was defined according to mRECIST. Stepwise Cox regression model was used to identify predictors of OS and develop an objective point score. RESULTS: Median OS was 22.7 months. At multivariate analysis, negative independent prognostic factors for OS were age >65 years (HR 1.80; P=.0048), ascites (HR 2.36; P=.0041) and progressive disease after TACE (HR 4.68; P0 (15.3 months, group C). When considering pre and post-procedural variables, group post-A had median OS of 40.2 months, significantly longer than groups post-B (scores 0-1, median OS 21.1 months) and post-C (score ≥2, median OS of 8.3 months). CONCLUSIONS: Combining pre- and post-TACE parameters, our scoring system enables a simple stratification of intermediate-stage HCC patients

Weight gain and de novo metabolic disorders after liver transplantation

The development of nutritional and metabolic abnormalities represents an important burden in patients after liver transplantation (LT). Our study aimed at evaluating the incidence, time of onset, and risk factors for nutritional and metabolic abnormalities in patients after LT. The study was a single-center retrospective study. Consecutive patients undergoing elective LT from 2000 to 2016 were enrolled. The presence of at least two among arterial hypertension (AH), diabetes mellitus (DM), dyslipidemia, and obesity (BMI ≥ 30 Kg/m2) was utilized to define patients with the metabolic disorder (MD). Three hundred and fifteen patients were enrolled; the median age was 56 years (68% males). Non-alcoholic steatohepatitis (NASH) was the origin of liver disease in 10% of patients. During follow-up, 39% of patients developed AH, 18% DM, and 17% dyslipidemia. Metabolic disorders were observed in 32% of patients. The NASH etiology (OR: 6.2; CI 95% 0.5-3; p = 0.003) and a longer follow-up (OR: 1.2; CI 95% 0.004-0.02; p = 0.002) were associated with de novo MD. In conclusion, nutritional and metabolic disorders are a frequent complication after LT, being present in up to one-third of patients. The NASH etiology and a longer distance from LT are associated with de novo MD after LT

The Effect of 12 Weeks of β-Hydroxy-β-Methyl-Butyrate Supplementation after Liver Transplantation: A Pilot Randomized Controlled Study

Sarcopenia is a frequent complication in liver transplant (LT) recipients. β-hydroxy-β-methyl-butyrate (HMB) has the potential to increase muscle-performance and tropism. Our study aims at evaluating the effect on muscle mass and functioning, and the safety of 12 weeks of HMB supplementation in patients after LT. This is a pilot, randomized study. Male patients undergoing LT were randomly assigned to the HMB or control group. A diet interview, anthropometry and body composition by dual energy X-ray absorptiometry (DEXA) were performed at enrollment (T0), after 12 weeks (T1) and after 12 months (T12). Twenty-two liver transplant male patients were enrolled in the study: 12 in the HMB group and 10 as the control group. At enrollment, demographic, clinical and nutritional data were similar. According to the appendicular skeletal muscle index, sarcopenia was present in 50% of patients. The appendix skeletal muscle mass index (ASMI) showed a significant increase at T1 and T12 in HMB patients, but not in controls. The mid-arm muscle-circumference and hand grip strength also increased at T1 and T12 versus T0 only in the HMB group. No side effects were reported in either group. The study showed a positive effect of HMB in the recovery of muscle mass and strength after LT. HMB supplement in patients after LT was safe and well tolerated

Inter and intra-observer variation in ultrasonographic detection of gallstones: The multicenter Italian study on epidemiology of Cholelithiasis (M.I.COL.)

Abstract Inter and intra-observer agreement in classifying the presence of gallstones by ultrasonographic images according to established criteria was studied. A film recording of 50 routine ultrasonographic examinations of the gallbladder was read by each of the 46 observers who participated in the Multicenter Italian Study on Epidemiology of Cholelithiasis (M.I.COL.). The overall Kappa score for inter-observer agreement was 0.649, while intra-observer agreement was "good" or "excellent" (Kappa scores greater than 0.60) in 75% of the observers. No statistical difference for inter-observer agreement between "novices" and "expert" echographers was found in the overall Kappa statistic or in category-specific Kappa scores (gallstone, no gallstone, doubtful and inconclusive examinations) The present study suggests that the development of explicit criteria by a group of trained echographers does not eliminate inter- and intra-observer disagreement in categorizing subjects for gallbladder stones

Graft macrosteatosis and time of T-tube removal as risk factors for biliary strictures after liver transplantation

Biliary strictures (BS) remain a significant problem following liver transplantation (LT), representing an important cause of morbidity. The purpose of this follow-up study was to evaluate the incidence and risk factors associated with BS after LT. From 2001 to 2009, 244 consecutive patients underwent LT at our center. Multiple donor and recipient variables were collected for each patient. Exclusion criteria were hepaticojejunostomy, living-donor LT, and follow-up less than threemonths. We reviewed 177 patients, all of whom underwent an end-to-end choledochocholedochostomy and T-tube placement. BS occurred in 23% of patients. Multivariate analysis revealed that graft macrovesicular steatosis >25% (p=0.05, OR 3.38) and time of T-tube removal less than six months (p=0.02, OR 2.53) were independent risk factors for BS. Biliary strictures did not affect patient and graft survival. Donor macrovesicular steatosis represents a risk factor for BS, contributing to liver damage through a reduction in hepatic blood flow. Time of T-tube removal seems to play a role in the development of BS, although it is unclear whether it represents the cause or the consequence of the development of BS