HCC recurrence in HCV-infected patients after liver transplantation: SiLVER Study reveals benefits of sirolimus in combination with CNIs - a post-hoc analysis

Factors affecting outcomes in liver transplant (LTx) recipients with hepatocellular carcinoma (HCC) and hepatitis C viral (HCV) infection include the choice of immunosuppression. Here, we analyzed the HCV+ subgroup of patients from the randomized controlled, international SiLVER Study. We performed a post hoc analysis of 166 HCV+ SiLVER Study patients regarding HCC outcome after LTx. Control patients (group A: n = 88) received mTOR inhibitor (mTORi)-free, calcineurin inhibitor (CNI)-based versus sirolimus-based immunosuppression (group B: n = 78). We found no significant difference regarding HCV-RNA titers between group A and B. Since no effect in group B could be due to variable sirolimus dosing, we split group B into patients receiving sirolimus-based immunosuppression + CNIs for >50% (B1; n = 44) or <50% (B2; n = 34) of the time. While there remained no difference in HCV-RNA titer between groups, HCC recurrence-free survival in group B1 (81.8%) was markedly better versus both group A (62.7%; P = 0.0136) and group B2 (64.7%; P = 0.0326); Interestingly, further subgroup analysis revealed an increase (P = 0.0012) in liver enzyme values in group B2. Taken together, in HCV-infected patients with HCC and LTx, mTORi immunosuppression + CNIs yields excellent outcomes. Unexpectedly, higher levels of liver inflammation and poorer outcomes occur with mTORi monotherapy in the HCV+ subgroup

Phoswich scintillator for proton and gamma radiation of high energy

We present here a Phoswich scintillator design to achieve both high resolution gamma ray detection, and good efficiency for high energy protons. There are recent developments of new high resolution scintillator materials. Especially the LaBr3(Ce) and LaCl3(Ce) crystals have very good energy resolution in the order of 3% for 662 keV gamma radiation. In addition, these materials exhibit a very good light output (63 and 32 photons/keV respectively). A demonstrator detector in the form of an Al cylinder of 24 mm diameter and a total length of 80 mm with 2 mm wall thickness, containing a LaBr3(Ce) crystal of 20 mm diameter and 30 mm length directly coupled to a LaCl3(Ce) crystal of 50 mm length, and closed with a glass window of 5 mm, was delivered by Saint Gobain. To the glass window a Hamamatsu R5380 Photomultiplier tube (PMT) was coupled using silicon optical grease. \ua9 2011 American Institute of Physics