Solid Organ Transplantation From SARS-CoV-2-infected Donors to Uninfected Recipients: A Single-center Experience.

BACKGROUND: The risk of donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in solid organ (heart, lung, liver, kidney, pancreas, and intestine) transplant recipients is poorly understood. Since hematogenous transmission of SARS-CoV-2 has not been documented to date, nonlung solid organs might be suitable for transplantation since they likely portend a low risk of viral transmission. METHODS: Abdominal solid organs from SARS-CoV-2-infected donors were transplanted into uninfected recipients. RESULTS: Between April 18, 2021, and October 30, 2021, we performed transplants of 2 livers, 1 simultaneous liver and kidney, 1 kidney, and 1 simultaneous kidney and pancreas from SARS-CoV-2-infected donors into 5 uninfected recipients. None of the recipients developed SARS-CoV-2 infection or coronavirus disease 2019, and when tested, allograft biopsies showed no evidence of SARS-CoV-2 RNA. CONCLUSIONS: Transplanting nonlung organs from SARS-CoV-2-infected donors into uninfected recipients demonstrated no evidence of virus transmission.

Liver Transplant in a Polymerase Chain Reaction-Positive COVID-19 Recipient: A Case Report.

The severe acute respiratory syndrome coronavirus 2 coronavirus disease 2019 (COVID-19) global pandemic has ushered in an era of hesitation in performing transplants in affected patients. This stems from the paucity of data regarding the testing modalities, long-term implications, and uncertain prognosis in this group of patients. Current guidance from the Centers for Disease Control recommends assessing symptoms rather than polymerase chain reaction (PCR) positivity. In light of these recommendations, we describe a case of an orthotopic liver transplant in a patient infected with COVID-19 with persistent PCR positivity for 40 days before retransplant. The patient's perioperative and postoperative course was uncomplicated. Our experience leads us to advocate for liver transplants in patients who are PCR positive for COVID-19 after careful individualized and multidisciplinary evaluation regarding their liver disease and COVID-19 symptomatology.

Identification of Novel and Noninvasive Biomarkers of Acute Cellular Rejection After Liver Transplantation by Protein Microarray.

BACKGROUND: Acute cellular rejection (ACR) is one of the main factors in transplanted organ failure in liver transplantation. A precise marker for diagnosing or predicting rejection is not currently available; therefore, invasive liver biopsy is standard procedure. To develop a noninvasive method for precise diagnosis of ACR, we evaluated autoantibodies from patient sera as potential biomarkers using protein microarrays (seromics). METHODS: Sera from hepatitis C virus-positive ACR patients were compared to three hepatitis C virus cirrhosis control groups and healthy volunteers. The control groups consisted of 2 no-ACR groups obtained on postoperative day 28 and 1 year after transplantation and a preoperative group obtained 1 day before transplantation. For validation, we evaluated whether the candidate antibodies can distinguish ACR from other types of liver dysfunction after liver transplantation using enzyme-linked immunosorbent assay. RESULTS: Seromic analysis by weighted average difference (WAD) ranking and Mann-Whitney U test revealed a significant increase of 57 autoantibodies in the sera of ACR patients with liver dysfunction. Among the 57 candidates, autoantibodies to charged multivesicular body protein 2B, potassium channel tetramerization domain containing 14, voltage gated subfamily A regulatory beta subunit 3, and triosephosphate isomerase 1 were regarded as potential biomarkers of ACR after liver transplantation. Using 20 ACR patients with variable backgrounds for validation, the autoantibodies to charged multivesicular body protein 2B and triosephosphate isomerase 1 were significantly increased in ACR patients compared to other control groups. CONCLUSIONS: A panel of autoantibodies identified by seromics as potential noninvasive biomarkers was clinically useful for diagnosing ACR after liver transplantation.

[An Elderly Colon Cancer Patient with Multiple Liver Metastases Who Was Successfully Treated Using mFOLFOX6 and sLV5FU2 Chemotherapy - A Case Report].

Curative treatment for unresectable colon cancer is difficult, and therefore, chemotherapy is often administered in an attempt to improve the prognosis. However, the safety andfeasibility of chemotherapy for elderly patients over 80-years-old have not yet been clarified. We report an elderly colon cancer patient with multiple liver metastases who was successfully treatedwith mFOLFOX6 andsLV5 FU2 chemotherapy. The patient was an 83-year-old-man who was referredto our hospital. After performing sigmoidectomy, we administered mFOLFOX6 chemotherapy. After 5 courses, the regimen was changed to sLV5FU2 owing to grade 3 neuropathy. Liver metastases disappearedanda complete response was obtained1 year after chemotherapy administration. Twenty-four courses of sLV5FU2 chemotherapy had been safely performed. Although grade 1 neutropenia developed, no other adverse event was observed. Currently, the patient is alive without recurrence. Chemotherapy for elderly patients is both feasible and safe.

[A Case of Liver Metastasis of Ampullary Carcinoma That Developed Postoperatively That Was Effectively Treated with Gemcitabine plus Cisplatin].

A 75-year-oldman presenting with obstructive jaundice was referredto our hospital. Basedon a diagnosis of carcinoma of the ampulla of Vater, we performed pancreatoduodenectomy. Postoperative histopathological examination revealed a welldifferentiated papillotubular adenocarcinoma, T3, N0, M0, Stage III . Six months after surgery, an isolatedliver metastasis in S6 was identifiedon CT scan andMRI; therefore, we administeredgemcitabine plus cisplatin chemotherapy. After 6 courses of this regimen, a clinical complete response(CR)was obtained. After 12 courses, the clinical CR continued; however, grade 3 lower-extremity peripheral neuropathy appeared. Therefore, gemcitabine monotherapy was administered as second line chemotherapy. However, multiple liver metastases appearedandthe patient passedaway owing to exacerbation of the disease 2 years after initiating chemotherapy. Although recurrent ampullary carcinoma is difficult to treat, our patient had a long-term survival. Here we report the details of our case and review the relevant literature.

[A case of hepatic resection of liver metastasis 8 years after resection of an adenoid cystic carcinoma of the parotid gland].

We performed surgical resection for a case of hepatic metastasis of an adenoid cystic carcinoma of the parotid gland. A 53-year-old woman underwent parotidectomy for primary adenoid cystic carcinoma in 2004. In 2005, she underwent resection of a local recurrence. However, in 2012, 8 years after primary tumor resection, abdominal ultrasonography revealed a hepatic tumor in the lateral segment, for which we performed laparoscopic partial hepatectomy. The hepatic tumor was histologically diagnosed as a hepatic metastasis of the adenoid cystic carcinoma of the parotid gland. At 8 postoperative months, no further recurrence was observed.

[A case report of total remnant pancreatectomy for ductal carcinoma after distal pancreatectomy for invasive intraductal papillary mucinous carcinoma].

Recently, the number of case reports detailing cancer recurrence in the pancreatic remnants, following surgical resection of intraductal papillary-mucinous carcinoma (IPMC) of the pancreas has increased. We report the case of a 74-year-old woman who underwent pancreatic resection twice in a 3-year period for primary IPMC and remnant pancreatic ductal carcinoma. We first performed distal pancreatectomy for branched IPMC in the pancreatic tail. Histopathological examination revealed invasive IPMC and the negative margin of the pancreatic duct. The expression of tumor markers gradually increased in the 2 years and 4 months after the initial surgery, and a tumor was detected in the remnant pancreas. We performed total remnant pancreatectomy. The recurrent tumor consisted of moderately differentiated adenocarcinoma. Currently, the patient is alive without recurrence for a year since the second resection. This experience suggests that careful surveillance is necessary for IPMC.

[A case report of primary adenocarcinoma of small intestine].

This is an account of a case of primary adenocarcinoma of the small intestine with peritoneal dissemination successfully treated with chemotherapy. A 64-year-old woman was admitted with a complaint of severe abdominal distension. Abdominal computerized tomography revealed a bowel obstruction with tumor and the remarkable small bowel dilation of oral side of tumor. The tumor was found at surgery to be at the ileum 15 cm proximal from the ileocecal region. Peritoneal dissemination was recognized around the ileocecal region, so ileum partial resection was performed for the primary cancer lesion and dissemination region. Pathological diagnosis of the resected specimen was adenocarcinoma with lymph nodes metastasis. The peritoneal dissemination consisted of metastatic adenocarcinoma from small intestine. After an operation, internal use of S-1 was performed as adjuvant chemotherapy. But a recurrent lesion at the ovarium was detected 6 months after surgery. The patient was subsequently treated with resection of the ovarium. For lung metastasis, the combination chemotherapy with mFOLFOX6 + bevacizumab was administered. Primary small intestinal adenocarcinoma is a rare disease, and it is often diagnosed as advanced cancer because of few characteristic symptoms. So carcinoma of the small intestine usually has a poor prognosis.

[A case of advanced gastric cancer with liver metastases resected successfully after S-1 monotherapy and S-1/CDDP combination chemotherapy].

The patient was a 75-year-old man, who was diagnosed with type 3 gastric cancer with solitary liver metastasis whose diameter was 12 mm. Distal gastrectomy with D2 lymph node dissection was performed in June 2008. S-1 monotherapy (120 mg/day, day 1-28/42 days) for liver metastasis started as the first-line chemotherapy. After 3 courses, the diameter of liver metastasis enlarged to 22 mm. Moreover, S-1 and CDDP combined chemotherapy (S-1: 120 mg/day, day 1-21/ 35 days, CDDP: 60 mg/m2, day 8/35 days) was performed as the second-line chemotherapy, nevertheless the diameter of liver metastasis enlarged to 26 mm. No distant metastasis without solitary liver tumor was observed for 6 months after gastric resection, so a partial hepatic resection was performed in February 2009. Five months after the operation, the patient is doing well and shows no signs of recurrence of the cancer. A combination gastrectomy with D2 lymphadenectomy and postoperative chemotherapy was considered to be a radical treatment for H1, Stage IV gastric cancer.

[Two cases of venous thrombosis occurred during systemic chemotherapy for colorectal cancer].

We reported two cases of venous thrombosis occurred during systemic chemotherapy for colorectal cancer. Case 1: A 68-year-old male, who had been operated for rectal cancer received systemic chemotherapy with liver and lung metastases. Three months after the chemotherapy, the chest CT showed venous thrombosis. Case 2: A 53-year-old female, who had been operated for rectal cancer received systemic chemotherapy with lung metastases. Ten months after the chemotherapy, the contrastradiogram from catheter showed venous thrombosis. Venous thrombosis should be considered when CV ports were placed especially with systemic chemotherapy for colorectal cancer.

[A case of successful treatment using octreotide acetate for occlusive ileus in terminal stage cancer].

We report a 35-year-old female bearing ovarian cancer who was suffering from intestinal obstruction due to multiple recurrences. The treatment of 300 microg/day of octreotide acetate was started. The symptom of obstruction, such as vomiting and nausea, caused by intestinal obstruction was suddenly controlled and the quality of life was improved. Octreotide acetate can be applied for the management of intestinal obstruction caused by metastases at the terminal stage of cancer.