Medical epidemiology of patients surviving ten years after liver transplantation.

The transition into extended long-term follow-up after liver transplantation raises a new series of issues with respect to continuing care of this population. A retrospective study was performed, analyzing patients who underwent orthotopic liver transplant (OLT) and survived ≥10 yr at a single institution. Long-term comorbidities such as diabetes mellitus (DM), hypertension (HTN), chronic kidney disease (CKD), coronary artery disease (CAD), and obesity were identified and standardized prevalence ratios ([SPR]) utilized to compare with the general US population. There was an increased prevalence of HTN ([SPR] = 2.25 ± 0.61), DM ([SPR] = 2.67 ± 0.72), and CKD ([SPR] = 15.3 ± 4.04) but not CAD or obesity. In multivariate analysis, non-viral etiology of end-stage liver disease was associated with CKD (OR 3.42 CI 1.11-10.53), and an initial glomerular filtration rate (GFR) <60 mL/min per 1.73 m(2) (CKD stages III-V) was associated with HTN (OR 4.62 CI 1.14-18.73) after OLT. Creatinine ≥ 1.5 mg/dL at 10 yr was associated with an initial GFR <60 mL/min per 1.73 m(2) (p = 0.000) and CAD after OLT (p = 0.012). Patients, 10 yr after OLT, have a significantly higher prevalence of HTN, DM, and CKD than the general population, which is not confounded by obesity. Increased vigilance and proactive management are required to further improve long-term outcomes.

Laparoscopic-assisted microwave ablation for hepatocellular carcinoma: safety and efficacy in comparison with radiofrequency ablation.

BACKGROUND: Thermal ablation techniques are increasingly important in the search for improved locoregional therapy of hepatocellular carcinoma (HCC) in patients with cirrhosis. This study reports the largest US series using laparoscopic-assisted microwave ablation (Lap-MWA) with a 915-MHz generator for HCC and compares it with a contemporary laparoscopic-assisted radiofrequency ablation (Lap-RFA) experience. METHODS: Thirty-five patients with HCC underwent laparoscopic-assisted ablation utilizing either MWA or RFA. Medical records, radiographic imaging, and histology were reviewed and outcomes analyzed. RESULTS: Twenty-two patients underwent Lap-RFA (27 tumors) and 13 received Lap-MWA (15 tumors). Average ablation volumes were similar for Lap-RFA and Lap-MWA at 23.43 and 28.99 cm(3), respectively (=0.69). Average operative times for Lap-RFA were 149 ± 35 min versus 112 ± 40 min with Lap-RFA (P = 0.004). Mean follow-up was 19 months in the Lap-RFA group: 50% alive without evidence of disease, 9% alive with disease, 36% deceased and 5% lost to follow-up. Mean follow-up in the Lap-MWA group was 7 months: 54% alive without evidence of disease, 31% alive with disease and 15% deceased. CONCLUSION: Lap-MWA is a safe and efficacious locoregional therapy for HCC which achieves outcomes comparable to Lap-RFA. Shorter operative times were realized with this modality and complete coagulative necrosis was confirmed histologically on explanted livers.