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1.
Clin Mol Hepatol ; 27(4): 564-574, 2021 10.
Article in English | MEDLINE | ID: covidwho-1551487

ABSTRACT

BACKGROUND/AIMS: In July 2017, the Emprint™ next-generation microwave ablation system using thermosphere technology (Covidien, Boulder, CO, USA) was approved for use in Japan. This system can produce a predictable spherical ablation zone at higher temperatures than radiofrequency ablation (RFA). The aim of the present study was to elucidate whether this new microwave thermosphere ablation (MTA) could safely improve outcome compared to RFA, which is the standard of care for small hepatocellular carcinoma (HCC). METHODS: This retrospective study analyzed 513 patients with 630 HCCs (≤3 cm) who were performed by percutaneous RFA (174 patients, 214 HCCs) or MTA (339 patients, 416 HCCs) between January 2016 and March 2020. RESULTS: Median ablation time was significantly shorter for MTA (240 seconds) than for RFA (721 seconds; P<0.001). A significant difference in 3-year local tumor progression rate was evident between the RFA group (22%) and MTA group (8%; P<0.001). Multivariable analysis revealed ablation procedure and tumor diameter as independent factors contributing to local tumor progression (MTA; P<0.001; hazard ratio, 0.565; 95% confidence interval, 0.437-0.731). In patients with primary HCC, a significant difference in overall survival was evident (RFA vs. MTA, 3-year, 77% vs. 95%, P=0.029). Ablation procedure and Child-Pugh score were independent factors contributing to survival. The total complication rate was significantly lower for MTA (8%) than for RFA (14%, P<0.05), particularly for bile duct injury (3% vs. 9%, respectively; P<0.05). CONCLUSION: Next-generation MTA for small HCC could provide safer, more curative treatment in a shorter ablation time than RFA.


Subject(s)
Carcinoma, Hepatocellular , Catheter Ablation , Liver Neoplasms , Radiofrequency Ablation , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/surgery , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/surgery , Microwaves , Radiofrequency Ablation/adverse effects , Retrospective Studies , Treatment Outcome
2.
Clin Mol Hepatol ; 27(4): 564-574, 2021 10.
Article in English | MEDLINE | ID: covidwho-1456286

ABSTRACT

BACKGROUND/AIMS: In July 2017, the Emprint™ next-generation microwave ablation system using thermosphere technology (Covidien, Boulder, CO, USA) was approved for use in Japan. This system can produce a predictable spherical ablation zone at higher temperatures than radiofrequency ablation (RFA). The aim of the present study was to elucidate whether this new microwave thermosphere ablation (MTA) could safely improve outcome compared to RFA, which is the standard of care for small hepatocellular carcinoma (HCC). METHODS: This retrospective study analyzed 513 patients with 630 HCCs (≤3 cm) who were performed by percutaneous RFA (174 patients, 214 HCCs) or MTA (339 patients, 416 HCCs) between January 2016 and March 2020. RESULTS: Median ablation time was significantly shorter for MTA (240 seconds) than for RFA (721 seconds; P<0.001). A significant difference in 3-year local tumor progression rate was evident between the RFA group (22%) and MTA group (8%; P<0.001). Multivariable analysis revealed ablation procedure and tumor diameter as independent factors contributing to local tumor progression (MTA; P<0.001; hazard ratio, 0.565; 95% confidence interval, 0.437-0.731). In patients with primary HCC, a significant difference in overall survival was evident (RFA vs. MTA, 3-year, 77% vs. 95%, P=0.029). Ablation procedure and Child-Pugh score were independent factors contributing to survival. The total complication rate was significantly lower for MTA (8%) than for RFA (14%, P<0.05), particularly for bile duct injury (3% vs. 9%, respectively; P<0.05). CONCLUSION: Next-generation MTA for small HCC could provide safer, more curative treatment in a shorter ablation time than RFA.


Subject(s)
Carcinoma, Hepatocellular , Catheter Ablation , Liver Neoplasms , Radiofrequency Ablation , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/surgery , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/surgery , Microwaves , Radiofrequency Ablation/adverse effects , Retrospective Studies , Treatment Outcome
4.
Clin Transplant ; 35(4): e14246, 2021 04.
Article in English | MEDLINE | ID: covidwho-1069387

ABSTRACT

Adverse clinical outcomes related to SARS-CoV-2 infection among liver transplant (LTx) recipients remain undefined. We performed a meta-analysis to determine the pooled prevalence of outcomes among hospitalized LTx recipients with COVID-19. A database search of literature published between December 1, 2019, and November 20, 2020, was performed per PRISMA guidelines. Twelve studies comprising 517 hospitalized LTx recipients with COVID-19 were analyzed. Common presenting symptoms were fever (71%), cough (62%), dyspnea (48%), and diarrhea (28%). Approximately 77% (95% CI, 61%-93%) of LTx recipients had a history of liver cirrhosis. The most prevalent comorbidities were hypertension (55%), diabetes (45%), and cardiac disease (21%). In-hospital mortality was 20% (95% CI, 13%-28%) and rose to 41% (95% CI, 19%-63%) (P < 0.00) with ICU admission. Additional subgroup analysis demonstrated a higher mortality risk in the elderly (>60-65 years) (OR 4.26; 95% CI, 2.14-8.49). There was no correlation in respect to sex or time since transplant. In summary, LTx recipients with COVID-19 had a high prevalence of dyspnea and gastrointestinal symptoms. In-hospital mortality was comparable to non-transplant populations with similar comorbidities but appeared to be less than what is reported elsewhere for cirrhotic patients (26%-40%). Importantly, the observed high case fatality in the elderly could be due to age-associated comorbidities.


Subject(s)
COVID-19/epidemiology , Liver Transplantation , Transplant Recipients , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/surgery , Female , Hospitalization , Humans , Liver Neoplasms/surgery , Male , Middle Aged
6.
J Laparoendosc Adv Surg Tech A ; 31(3): 266-272, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-720927

ABSTRACT

Background: COVID-19 pandemic rendered the surgical approach as well as the surgical indication very complex due to the outstanding consumption of public health system' resources, especially in the intensive care subdivision. A multidisciplinary team-based strategy is necessary to adapt guidelines and medical practices to the actual situation. The aim of this study is to evaluate the changes in the therapeutic algorithm in a small group of patients with hepatocellular carcinoma (HCC) enlisted for surgery during the COVID-19 outbreak. Materials and Methods: A multidisciplinary strategy has been adopted to allocate HCC patients to a treatment that permitted to reduce the risk of complications and the hospital stay, thus preventing contamination by the virus. Nasopharyngeal swab and a chest radiograph were performed in all patients within 48 hours before the surgical procedure: in the suspected cases with negative COVID tests, we prudently postponed surgery and repeated the diagnostic tests after 15 days. Results: During the emergency state, 11 HCC patients were treated (8 laparoscopic ablations and 3 hepatic resections). We reported only 1 postoperative complication (hemothorax) and 1 death during the follow-up for COVID pneumonia. Comparing our performances with those in the same time frame in the past 4 years, we treated a similar number of HCC patients, obtaining a decrease in operative timing (P = .0409) and hospital stay (P = .0412) (Fig. 2b) with similar rates of immediate postoperative complications, without ICU admissions. Conclusions: An adapted algorithm for the treatment of HCC to COVID outbreak permitted to manage safely these patients by identifying those most at risk of evolution of the neoplastic disease.


Subject(s)
COVID-19/epidemiology , Carcinoma, Hepatocellular/surgery , Disease Management , Guideline Adherence , Hepatectomy/methods , Laparoscopy/methods , Liver Neoplasms/surgery , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/epidemiology , Comorbidity , Female , Humans , Length of Stay , Liver Neoplasms/epidemiology , Male , Middle Aged , Operative Time , Pandemics , SARS-CoV-2
7.
Am J Transplant ; 20(7): 1916-1921, 2020 07.
Article in English | MEDLINE | ID: covidwho-210165

ABSTRACT

Over 1 000 000 cases of coronavirus disease 2019 (COVID-19) have been confirmed since the worldwide outbreak began. Not enough data on infected solid organ transplant (SOT) recipients are available, especially data about the management of immunosuppressants. We report two cases of COVID-19 in two transplant recipients, with different treatments and prognoses. The first patient received liver transplantation due to hepatitis B virus-related hepatocellular carcinoma and was confirmed to have COVID-19 9 days later. Following a treatment regimen consisting of discontinued immunosuppressant use and low-dose methylprednisolone-based therapy, the patient developed acute rejection but eventually recovered. The other patient had undergone a renal transplant from a living-related donor 17 years ago, and was admitted to the hospital because of persistent fever. This patient was also diagnosed with COVID-19. His treatment regimen consisted of reduced immunosuppressant use. No signs of rejection were observed during the regimen. In the end, the patient successfully recovered from COVID-19. These effectively treated cases can provide a basis for immunosuppressant management of COVID-19-positive SOT recipients.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Immunosuppressive Agents/therapeutic use , Organ Transplantation , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Transplant Recipients , Adult , Betacoronavirus , COVID-19 , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Hepatitis B/complications , Hepatitis B/surgery , Hepatitis B virus , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Liver Neoplasms/complications , Liver Neoplasms/surgery , Liver Transplantation , Male , Methylprednisolone/administration & dosage , Middle Aged , Pandemics , Prognosis , SARS-CoV-2 , Treatment Outcome
8.
Am J Transplant ; 20(8): 2254-2259, 2020 08.
Article in English | MEDLINE | ID: covidwho-155106

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) is a highly infectious and rapidly spreading disease. There are limited published data on the epidemiology and outcomes of COVID-19 infection among organ transplant recipients. After initial flulike symptoms, progression to an inflammatory phase may occur, characterized by cytokine release rapidly leading to respiratory and multiorgan failure. We report the clinical course and management of a liver transplant recipient on hemodialysis, who presented with COVID-19 pneumonia, and despite completing a 5-day course of hydroxychloroquine, later developed marked inflammatory manifestations with rapid improvement after administration of off-label, single-dose tocilizumab. We also highlight the role of lung ultrasonography in early diagnosis of the inflammatory phase of COVID-19. Future investigation of the effects of immunomodulators among transplant recipients with COVID-19 infection will be important.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Coronavirus Infections/complications , Liver Transplantation , Pneumonia, Viral/complications , Renal Dialysis , Transplant Recipients , COVID-19 , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Coronavirus Infections/drug therapy , Hepatitis C/complications , Hepatitis C/surgery , Humans , Hydroxychloroquine/therapeutic use , Inflammation , Liver Cirrhosis/complications , Liver Cirrhosis/surgery , Liver Neoplasms/complications , Liver Neoplasms/surgery , Male , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Reoperation , Treatment Outcome
9.
Am J Transplant ; 20(7): 1907-1910, 2020 07.
Article in English | MEDLINE | ID: covidwho-47494

ABSTRACT

Liver injury is common in patients with COVID-19, but little is known about its clinical presentation and severity in the context of liver transplant. We describe a case of COVID-19 in a patient who underwent transplant 3 years ago for hepatocellular carcinoma. The patient came to clinic with symptoms of respiratory disease; pharyngeal swabs for severe acute respiratory syndrome coronavirus 2 were positive. His disease progressed rapidly from mild to critical illness and was complicated by several nosocomial infections and multiorgan failure. Despite multiple invasive procedures and rescue therapies, he died from the disease. The management of COVID-19 in the posttransplant setting presents complex challenges, emphasizing the importance of strict prevention strategies.


Subject(s)
Carcinoma, Hepatocellular/complications , Coronavirus Infections/complications , End Stage Liver Disease/complications , Hepatitis B/complications , Liver Neoplasms/complications , Liver Transplantation , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Carcinoma, Hepatocellular/surgery , Coronavirus Infections/therapy , Cross Infection/complications , End Stage Liver Disease/surgery , Fatal Outcome , Hepatitis B/surgery , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Liver Neoplasms/surgery , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Postoperative Complications , Radiography, Thoracic , SARS-CoV-2 , Tomography, X-Ray Computed , Transplant Recipients , Treatment Outcome
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