Pretransplant Functional Status Predicts Postoperative Morbidity and Mortality after Liver Transplantation in Patients with Cirrhosis.

Background/Aims: This study aimed to investigate whether pretransplant frailty can predict postoperative morbidity and mortality after liver transplantation (LT) in patients with cirrhosis. Methods: We retrospectively reviewed 242 patients who underwent LT between 2018 and 2020 at a tertiary hospital in Korea. Results: Among them, 189 patients (78.1%) received LT from a living donor. Physical frailty at baseline was assessed by the Short Physical Performance Battery (SPPB), by which patients were categorized into two groups: frail (SPPB <10) and non-frail (SPPB ≥10). Among the whole cohort (age, 55.0±9.2 years; male, 165 [68.2%]), 182 patients were classified as non-frail and 60 patients were classified as frail. Posttransplant survival was shorter in the frail group than the non-frail group (9.3 months vs 11.6 months). Postoperative intensive care unit stay was longer in the frail group than in the non-frail group (median, 6 days vs 4 days), and the 30-day complication rate was higher in the frail group than in the non-frail group (78.3% vs 59.3%). Frailty was an independent risk factor for posttransplant mortality (adjusted hazard ratio, 2.38; 95% confidence interval, 1.02 to 5.57). In subgroup analysis, frail patients showed lower posttransplant survival regardless of history of hepatocellular carcinoma and donor type. Conclusions: Assessment of pretransplant frailty, as measured by SPPB, provides important prognostic information for clinical outcomes in cirrhotic patients undergoing LT.

Clinicopathologic characteristics and long-term prognosis of scirrhous hepatocellular carcinoma.

BACKGROUND: Clinicopathologic features and long-term outcomes in patients with scirrhous hepatocellular carcinoma (S-HCC) are not fully defined. METHODS: We compared data of 37 patients with S-HCC and 604 with usual HCC (U-HCC) undergoing surgery. RESULTS: The S-HCC group showed less HBV infection (78.4 vs. 92.0%, P = 0.02), low serum AFP level (2320 ± 6356 vs. 3297 ± 18690 ng/ml, P < 0.0001), less delayed washout during CT (72.7 vs. 90.7%, P = 0.004), and low usefulness of clinical diagnostic criteria (32.4 vs. 57.5%, P = 0.003), compared to the U-HCC group. More portal vein invasion (18.9 vs. 4.1%, P = 0.03) and less liver cirrhosis (35.1 vs. 65.1%, P = 0.001) and fibrous capsule (40.5 vs. 81.6%, P < 0.001) were noted in the S-HCC group than the U-HCC group. Long-term survival rates were similar between the S-HCC and U-HCC groups, even with subgroup analysis according to Child-Pugh score and modified UICC stage. CONCLUSION: The S-HCC group showed distinct patient and tumor characteristics but similar long-term outcome.

Salvage treatment with hypofractionated radiotherapy in patients with recurrent small hepatocellular carcinoma.

PURPOSE: To investigate the rates of tumor response and local control in patients with recurrent small hepatocellular carcinoma (HCC) treated with hypofractionated radiotherapy (RT) as a salvage treatment and to evaluate treatment-related toxicities. METHODS AND MATERIALS: Between 2006 and 2009, a total of 20 patients with recurrent small HCC were treated with hypofractionated RT after the failure of previous treatment. The eligibility criteria for hypofractionated RT were as follows: 1) HCC less than 5 cm, 2) HCC not adjacent to critical organs, 3) HCC without portal vein tumor thrombosis, and 4) less than 15% of normal liver volume that would be irradiated with 50% of prescribed dose. The RT dose was 50 Gy in 10 fractions. The tumor response was determined by CT scans performed 3 months after the end of RT. RESULTS: The median follow-up period after RT was 22 months. The overall survival rates at 1 and 2 years were 100% and 87.9%, respectively. Complete response (CR) was achieved in seven of 20 lesions (35%) evaluated by CT scans performed 3 months after the end of RT. In-field local control was achieved in 85% of patients. Fourteen patients (70%) developed intra-hepatic metastases. Six patients developed grade 1 nausea or anorexia during RT, and two patients had progression of ascites after RT. There was no grade 3 or greater treatment-related toxicities. CONCLUSIONS: The current study showed a favorable outcome with respect to hypofractionated RT for small HCC. Partial liver irradiation with 50 Gy in 10 fractions is considered tolerable without severe complications.