Time of Dropout From the Liver Transplant List in Patients With Hepatocellular Carcinoma: Clinical Behavior According to Tumor Characteristics and Severity of Liver Disease.

BACKGROUND: Prolonged time on the waiting list affects post-transplant survival of patients with hepatocellular carcinoma (HCC). However, it is not yet known which patients will be at higher risk for early dropout from the list. We investigate specific risk factors for early waiting list dropout in patients with HCC. METHODS: This was a single-center, intention-to-treat analysis of adults with HCC, within the Milan criteria, from July 2006 through September 2013. Patients were divided into groups according to waiting list time. The main end point was dropout from the list. RESULTS: The dropout rates of the study cohort at 3, 6, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Patients who dropped out from the list tended to be older, with blood types A and O, and with higher Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. They also had larger nodules, responded poorly to trans-arterial chemo-embolization (TACE), and had a higher alpha-fetoprotein. Those with blood types B and AB appeared to be protected for dropout (odds ratio [OR] = 0.21, P = .02). Patients who responded to TACE were also protected (OR = 0.22, P < .001). When we looked into time to dropout, the only baseline characteristic that stood out was a higher MELD score (13 for those dropping out up to 90 days vs 10 for those dropping out after 180 days, P = .0025). CONCLUSIONS: We conclude that patients who drop out early from the list are primarily driven by the severity of liver disease. Patients who had progressive HCC had a high tumor load and poor response to loco-regional therapies, dropping out from the list after 180 days of inclusion.

Akaline, saline and mixed saline-alkaline stresses induce physiological and morpho-anatomical changes in Lotus tenuis shoots.

Saline, alkaline and mixed saline-alkaline conditions frequently co-occur in soil. In this work, we compared these plant stress sources on the legume Lotus tenuis, regarding their effects on shoot growth and leaf and stem anatomy. In addition, we aimed to gain insight on the plant physiological status of stressed plants. We performed pot experiments with four treatments: control without salt (pH = 5.8; EC = 1.2 dS·m(-1)) and three stress conditions, saline (100 mM NaCl, pH = 5.8; EC = 11.0 dS·m(-1)), alkaline (10 mM NaHCO3, pH = 8.0, EC = 1.9 dS·m(-1)) and mixed salt-alkaline (10 mM NaHCO3 + 100 mM NaCl, pH = 8.0, EC = 11.0 dS·m(-1)). Neutral and alkaline salts produced a similar level of growth inhibition on L. tenuis shoots, whereas their mixture exacerbated their detrimental effects. Our results showed that none of the analysed morpho-anatomical parameters categorically differentiated one stress from the other. However, NaCl- and NaHCO3 -derived stress could be discriminated to different extents and/or directions of changes in some of the anatomical traits. For example, alkalinity led to increased stomatal opening, unlike NaCl-treated plants, where a reduction in stomatal aperture was observed. Similarly, plants from the mixed saline-alkaline treatment characteristically lacked palisade mesophyll in their leaves. The stem cross-section and vessel areas, as well as the number of vascular bundles in the sectioned stem were reduced in all treatments. A rise in the number of vessel elements in the xylem was recorded in NaCl-treated plants, but not in those treated exclusively with NaHCO3.