Journal of Liver: Disease & Transplantation (JLDT) is a peer-reviewedonline journal and aims to publish the most complete and reliable source of information on the discoveries and current developments in the mode of original articles, review articles, case reports, short communications, etc. in all areas of liverstudiesand making them available to researchers worldwide.
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Early Changes in Smallfor- Flow Syndrome: An Experimental Model
The aim of the present study is to present an experimental model of the early changes in hemodynamic and histological values after hyperextended hepatectomy. Intraoperative findings are important, because early control of damage could prevent the development of small-for-flow syndrome. Sequential liver segmentectomy was performed under general anesthesia in 11 minipigs until 80% of the parenchyma was resected. After each resection, histological samples of remnant parenchyma were taken and values recorded for portal flow, portal pressure, arterial hepatic flow, suprahepatic vein pressure, arterial pressure, and cardiac frequency. This hyperextended hepatectomy model reproduces the changes observed in small-for-flow syndrome. The hemodynamic and histological changes observed are immediate; therefore, they should be prevented during surgery by modulating pressure and portal flow. Intraoperative measurement of pressure and portal flow should be part of the therapeutic and diagnostic algorithms of patients who undergo major hepatic resection.
Analysis of Methylation and Expression Profiles of CPT1-A and APOE Genes in Patients with NAFLD
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal hepatic steatosis in the absence of alcohol abuse worldwide. The aim of this study was to investigate the effect of promoter methylation of carnitine palmitoyltransferase I (CPT1) and apolipoprotein E (APOE) genes on the risk of non-alcoholic fatty liver disease (NAFLD). Methods: The promoter methylation of APOE and CPT-1A were
analyzed using a methylation-specific polymerase chain reaction (MS-PCR) in blood samples taken from 80 NAFLD individuals and 100 healthy controls. The expression levels of APOE and CPT- 1A were also assessed in 10 blood mRNA samples from NAFLD patients. These cases were compared to the blood samplesof healthy controls (n=10) with real-time quantitative reverse transcriptase PCR. Results: The percentage of methylation for CPT-1A gene was significant between normal individuals and patients. The APOE gene methylation was not significant between cases and controls. A statistically significant relationship was found for methylation of CPT-1A between cases and controls (p<0.001). The relative expression of CPT-1A and APOE mRNA in NAFLD blood was no significantly different in comparison of blood samples between healthy controls and cases. The present outcomes indicate that the methylation status of the CPT-1A gene has a significant function in the process of NAFLD and suggest further study with a large sample size for this reason.
Cumulative Radiation Exposure in Liver Transplant Candidates and Patients Transplanted with Hepatocellular Carcinoma
Liver transplant candidates and recipients undergo regular imaging for hepatocellular carcinoma (HCC) screening and surveillance. Excessive radiation exposure is associated with risks of malignancy and infection. Longitudinal studies on the amount and impact of radiation exposure in patients with liver disease are lackiing.Using baseline values, the mean radiation exposure for non-transplant patients being screened for HCC using ultrasounds every 6 months, alternating between ultrasound and CT every 6 months, or CT every 6 months was 10, 27 and 35 mSv, respectively. For transplant candidates undergoing surveillance for recurrent HCC, the mean radiation exposure was 36 mSv and 15 mSv from abdominal and chest CT scans, respectively. In recipients transplanted for HCC, the mean cumulative radiation exposure 5 years after liver transplantation was 144 mSv. Conclusion: Longitudinal studies are needed to assess the safety and long term impact of radiation exposure. Patients transplanted with HCC represent a particularly high risk group for potential complications.
A New Pig Model of Auxiliary Partial Liver Transplantation Based on Anastomosis with
Intrahepatic Inferior Vena Cava of Recipient
Auxiliary partial orthotopic liver transplantation (APOLT) is a feasible approach to treat patients with fulminant hepatic failure and metabolic liver diseases. It is still necessary to establish a simple and reliable APOLT model using large animals for deep research.Ten healthy male or female domestic pigs, weighing 20- 35 kg, were randomly selected to be either donor group (n=8) or recipient group (n=8). The right liver of donor was used as a graft. After the left lobe of recipient was resected, the anterior wall of the distal intrahepatic inferior vena cava was properly dissected. Endto- side anastomosis was performed between graft suprahepatic inferior vena cava and host distal intrahepatic inferior vena cava. End-to-side anastomosis was performed between the donor and recipient portal veins. After the spleen of recipient was resected, end-to-end anastomosis was made between graft hepatic artery and host splenic artery, and a cannula was inserted into host splenicvein for postoperative portal phlebography. The common bile duct of donor was intubated for external drainage.
Sorafenib and Mammalian Target of Rapamycin Inhibitors after Liver Transplantation: A
Single-Center Experience and Review of the Literature
Hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is observed in 10-15% of the patients and generally has a dismal prognosis. Little is known about the safety and efficacy of a therapeutic regimen including sorafenib and mammalian target of rapamycin inhibitors (mTORi) in this setting. The medical charts of the recipients of a LT presenting HCC recurrence and treated with sorafenib either alone
or in combination with mTORi were retrospectively reviewed.
Aflatoxins, Hepatitis and Hepatocellular Carcinoma: A Special Focus on Turkey’s Current Status
Mycotoxins are food contaminants produced as secondary metabolites by different kinds of fungi. The major groups of mycotoxins are aflatoxins (AFs), ochratoxins, patulin and fusarium toxins. Aflatoxin B1 (AFB1) is classified as carcinogenic to humans (Group I) by The International Agency for Research on Cancer. The principle target organ of AFB1 is liver. AFB1 causes hotspot mutation of p53 gene at third base of codon 249, and takes the form of G…>T transversions. Besides, both hepatits B virus (HBV) and hepatits C virus (HCV) infections were suggested to be responsible HCC. HCC is the most frequent primary liver cancer and the most severe complication of chronic liver disease. The annual number of new cases worldwide represents more than 5% of human cancers and is the third leading cause of cancer-related deaths. One or more causative agents can be identified in most HCC cases. AFB1 exposure with viral hepatitis is suggested to lead to HCC. This review will focus on AFB1, viral hepatitis, their synergistic and additive effects and the measures that should be taken to prevent HCC stemming from AFB1 exposure with viral hepatitis.
Diagnostic Imaging of Patients with Pancreato-Biliary Diseases: Comparison between Ultrasound, Computed Tomography and Magnetic Resonance
The aim of this study was to directly compare the results of MR cholangio-pancreatography (MRCP) with those of ultrasound (US) and multi-slice computed tomography (MSCT) in patients with pancreatico-biliary diseases. A total of 110 patients (62 M, 48 F), ranging in age from 22 to 89 years, was studied before surgery (n=99) or after cholecystectomy (n=11) for lithiasis. MRCP was performed in all patients while US was acquired in 55 patients and MSCT was performed in 76 patients. Histology (n=34), biopsy (n=38), endoscopic retrograde cholangio-pancreatography (ERCP) (n=28) and/or clinical-imaging follow-up (n=10) data were considered as standard of reference. Patient population was divided in three groups; Group 1 (n=55) consisted of a comparison between MRCP and US in biliary tract diseases; Group 2 (n=37) consisted of a comparison between MRCP and MSCT in biliary tract diseases; Group 3 (n=40) consisted of a comparison between MRCP and MSCT in pancreatic masses. A regional imaging qualitative evaluation of biliary and pancreatic duct system (gallbladder and cystic duct, intra- and extra-hepatic ducts, main pancreatic duct) was performed.