Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC ... more Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC is an aggressive disease with high fatality as reflected by the close numbers of annual deaths per year from HCC and annual incidence worldwide. In the United States, HCC incidence has increased substantially during the past two decades and is projected to continue to rise. Surgical resection remains the best treatment option for anatomically resectable tumors in patients with well-preserved liver function. For patients who are not resection candidates, liver transplantation offers treatment not only for HCC, but also for the cirrhotic liver. Liver transplantation for HCC is a rapidly evolving field. The results have dramatically improved with implementation of surveillance, careful selection of patients for transplantation, and pre-transplant tumor ablation. New promising tumor biomarkers, therapies for hepatitis C virus, molecular targeted therapies for HCC, and immunosuppression will ensure even better outcomes moving forward. This review discusses how liver transplant for HCC has changed over the many years, is currently improving, and how future research will shape better results.
Hepatocellular carcinoma (HCC) represents one of the most common neoplasmsworldwide. Liver trasnp... more Hepatocellular carcinoma (HCC) represents one of the most common neoplasmsworldwide. Liver trasnplantation (LT) is the treatment of choice forselected group of patients with HCC.LT is actually a consolidated therapeutic option for HCC because it cures bothtumor and underlying cirrhosis.In 1996, the publication of a pivotal prospective study on less than 50 patients,transplanted for HCC under predefined criteria (single HCC ≤ 5 cm or 3 HCC≤ 3 cm each), the so called "Milan criteria", showed a 4-year survival of 75%.However, the indication of LT for HCC treatment has evolved over recentyears. The possibility of an extension of Milan criteria as indication for LT is alreadya debated issue. Living donor LT (LDLT) is an alternative option if waiting list is long and offersthe possibility of a LT after a short time.In this review, the current indications and results of liver transplantion for HCChave been dsicusssed.
Over the past decade, ERCP has become the preferred method of treatment for biliary strictures in... more Over the past decade, ERCP has become the preferred method of treatment for biliary strictures in patients after orthotopic liver transplantation (OLT). Although data strongly support ERCP for treating anastomotic strictures, the little information available for the role of ERCP in the treatment of nonanastomotic strictures (NAS) has been unpromising. We investigated the efficacy and safety of using balloon dilation and multiple biliary stents to treat NAS. A retrospective study. A tertiary-care medical center. Fifteen patients who were diagnosed with post-OLT NAS between January 2003 and June 2007. ERCP with balloon dilation and multiple stenting. Resolution, complication, and recurrence rates. Eleven of the 15 patients completed endoscopic treatment, of whom 9 had cholangiographic improvement, biochemical normalization, and cholestatic symptom relief (treatment success), and 1 required retransplantation (treatment failure). None of the 9 successfully treated patients experienced NAS recurrence in a mean follow-up of 17 months. Of the remaining 4 patients, 1 died of nonbiliary causes and 3 were still undergoing treatment with stents in place, of whom 2 have near-normalized total serum bilirubin and were cholestatic symptom free. A retrospective study, small sample size, single endoscopist. Endoscopic treatment of NAS with balloon dilation and multiple stents appears to be safe and effective, and it may reduce the need for retransplantation because of NAS. Larger studies are still required to confirm its utility as a mainstay for treating NAS and to determine what factors are associated with endoscopic treatment success.
Association of Surgeons and SRS, May 1999, Brighton Association of Surgeons of Great Britain and ... more Association of Surgeons and SRS, May 1999, Brighton Association of Surgeons of Great Britain and Ireland, June 1999, Southport
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC ... more Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC is an aggressive disease with high fatality as reflected by the close numbers of annual deaths per year from HCC and annual incidence worldwide. In the United States, HCC incidence has increased substantially during the past two decades and is projected to continue to rise. Surgical resection remains the best treatment option for anatomically resectable tumors in patients with well-preserved liver function. For patients who are not resection candidates, liver transplantation offers treatment not only for HCC, but also for the cirrhotic liver. Liver transplantation for HCC is a rapidly evolving field. The results have dramatically improved with implementation of surveillance, careful selection of patients for transplantation, and pre-transplant tumor ablation. New promising tumor biomarkers, therapies for hepatitis C virus, molecular targeted therapies for HCC, and immunosuppression will ...
Hepatocellular carcinoma (HCC) is no longer a disease of the Eastern hemisphere. HCC incidence ha... more Hepatocellular carcinoma (HCC) is no longer a disease of the Eastern hemisphere. HCC incidence has tripled in the United States in the past two decades. It is the fastest rising cause of cancer mortality in the U.S. and in parts of Western Europe. In the past the HCC epidemic was fueled by the Hepatitis B virus (HBV) seen mainly in Asia via horizontal transmission. In this decade, we are experiencing a rising tide due to the maturation of the Hepatitis C epidemic related to contaminated blood products and, more importantly, intravenous drug experimentation. As the obesity epidemic sweeps across the west the incidence of nonalcoholic fatty liver disease (NAFLD) and its inflammatory component nonalcoholic steatohepatitis (NASH) are becoming the harbinger of HCC yet to come. Worldwide, the incidence of HCC equals the mortality. Five year survival is at best 12%. These grim statistics underscore the need for earlier detection through screening resulting in initiation of early treatment ...
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC ... more Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC is an aggressive disease with high fatality as reflected by the close numbers of annual deaths per year from HCC and annual incidence worldwide. In the United States, HCC incidence has increased substantially during the past two decades and is projected to continue to rise. Surgical resection remains the best treatment option for anatomically resectable tumors in patients with well-preserved liver function. For patients who are not resection candidates, liver transplantation offers treatment not only for HCC, but also for the cirrhotic liver. Liver transplantation for HCC is a rapidly evolving field. The results have dramatically improved with implementation of surveillance, careful selection of patients for transplantation, and pre-transplant tumor ablation. New promising tumor biomarkers, therapies for hepatitis C virus, molecular targeted therapies for HCC, and immunosuppression will ensure even better outcomes moving forward. This review discusses how liver transplant for HCC has changed over the many years, is currently improving, and how future research will shape better results.
Hepatocellular carcinoma (HCC) represents one of the most common neoplasmsworldwide. Liver trasnp... more Hepatocellular carcinoma (HCC) represents one of the most common neoplasmsworldwide. Liver trasnplantation (LT) is the treatment of choice forselected group of patients with HCC.LT is actually a consolidated therapeutic option for HCC because it cures bothtumor and underlying cirrhosis.In 1996, the publication of a pivotal prospective study on less than 50 patients,transplanted for HCC under predefined criteria (single HCC ≤ 5 cm or 3 HCC≤ 3 cm each), the so called "Milan criteria", showed a 4-year survival of 75%.However, the indication of LT for HCC treatment has evolved over recentyears. The possibility of an extension of Milan criteria as indication for LT is alreadya debated issue. Living donor LT (LDLT) is an alternative option if waiting list is long and offersthe possibility of a LT after a short time.In this review, the current indications and results of liver transplantion for HCChave been dsicusssed.
Over the past decade, ERCP has become the preferred method of treatment for biliary strictures in... more Over the past decade, ERCP has become the preferred method of treatment for biliary strictures in patients after orthotopic liver transplantation (OLT). Although data strongly support ERCP for treating anastomotic strictures, the little information available for the role of ERCP in the treatment of nonanastomotic strictures (NAS) has been unpromising. We investigated the efficacy and safety of using balloon dilation and multiple biliary stents to treat NAS. A retrospective study. A tertiary-care medical center. Fifteen patients who were diagnosed with post-OLT NAS between January 2003 and June 2007. ERCP with balloon dilation and multiple stenting. Resolution, complication, and recurrence rates. Eleven of the 15 patients completed endoscopic treatment, of whom 9 had cholangiographic improvement, biochemical normalization, and cholestatic symptom relief (treatment success), and 1 required retransplantation (treatment failure). None of the 9 successfully treated patients experienced NAS recurrence in a mean follow-up of 17 months. Of the remaining 4 patients, 1 died of nonbiliary causes and 3 were still undergoing treatment with stents in place, of whom 2 have near-normalized total serum bilirubin and were cholestatic symptom free. A retrospective study, small sample size, single endoscopist. Endoscopic treatment of NAS with balloon dilation and multiple stents appears to be safe and effective, and it may reduce the need for retransplantation because of NAS. Larger studies are still required to confirm its utility as a mainstay for treating NAS and to determine what factors are associated with endoscopic treatment success.
Association of Surgeons and SRS, May 1999, Brighton Association of Surgeons of Great Britain and ... more Association of Surgeons and SRS, May 1999, Brighton Association of Surgeons of Great Britain and Ireland, June 1999, Southport
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC ... more Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC is an aggressive disease with high fatality as reflected by the close numbers of annual deaths per year from HCC and annual incidence worldwide. In the United States, HCC incidence has increased substantially during the past two decades and is projected to continue to rise. Surgical resection remains the best treatment option for anatomically resectable tumors in patients with well-preserved liver function. For patients who are not resection candidates, liver transplantation offers treatment not only for HCC, but also for the cirrhotic liver. Liver transplantation for HCC is a rapidly evolving field. The results have dramatically improved with implementation of surveillance, careful selection of patients for transplantation, and pre-transplant tumor ablation. New promising tumor biomarkers, therapies for hepatitis C virus, molecular targeted therapies for HCC, and immunosuppression will ...
Hepatocellular carcinoma (HCC) is no longer a disease of the Eastern hemisphere. HCC incidence ha... more Hepatocellular carcinoma (HCC) is no longer a disease of the Eastern hemisphere. HCC incidence has tripled in the United States in the past two decades. It is the fastest rising cause of cancer mortality in the U.S. and in parts of Western Europe. In the past the HCC epidemic was fueled by the Hepatitis B virus (HBV) seen mainly in Asia via horizontal transmission. In this decade, we are experiencing a rising tide due to the maturation of the Hepatitis C epidemic related to contaminated blood products and, more importantly, intravenous drug experimentation. As the obesity epidemic sweeps across the west the incidence of nonalcoholic fatty liver disease (NAFLD) and its inflammatory component nonalcoholic steatohepatitis (NASH) are becoming the harbinger of HCC yet to come. Worldwide, the incidence of HCC equals the mortality. Five year survival is at best 12%. These grim statistics underscore the need for earlier detection through screening resulting in initiation of early treatment ...
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