John Fung

Transarterial Radioembolization (TARE) is an emerging therapy for the management of hepatocellular carcinoma (HCC). Radioactive Y90 can be loaded onto glass or resin microparticles for intra-arterial selective internal radiation therapy. TARE is a multistage procedure requiring a mapping procedure and a treatment procedure. The mapping procedure informs operators on vascular anatomy as well as potential arteriovenous shunting. Based on the device desired, goal of treatment, vascularity of the tumor and shunting, dosage can be computed for treatment day. Overall, TARE is generally a well-tolerated procedure with promising clinical outcomes with HCC for the purposes of curative therapy, downstaging, and palliation.

The concept of machine perfusion of human liver allografts dates back to the early work of Starzl and colleagues, 1 describing the development of an in situ oxygenated extracorporeal membrane oxygenation circuit for abdominal organ perfusion and an extracorporeal oxygenated, hypothermic dual portal venous and hepatic artery machine perfusion for the assessment of allograft function. 2 Since then, the advances in perfusion technology and development of optimized perfusion solutions have brought ex vivo machine perfusion into practical clinical use. The development of machine perfusion as a mode of preservation has proceeded along 3 pathways:(1) in situ normothermic regional perfusion (NRP);(2) ex vivo hypothermic machine perfusion; and (3) ex vivo normothermic machine perfusion (NMP), with respective increasing complexity in the technologies used. Ex vivo machine perfusion requires that the …

Metabolites produced by the intestinal microbiome modulate mucosal immune defenses and optimize epithelial barrier function. Intestinal dysbiosis, including loss of intestinal microbiome diversity and expansion of antibiotic-resistant pathobionts, is accompanied by changes in fecal metabolite concentrations and increased incidence of systemic infection. Laboratory tests that quantify intestinal dysbiosis, however, have yet to be incorporated into clinical practice. We quantified fecal metabolites in 107 patients undergoing liver transplantation (LT) and correlated these with fecal microbiome compositions, pathobiont expansion, and postoperative infections. Consistent with experimental studies implicating microbiome-derived metabolites with host-mediated antimicrobial defenses, reduced fecal concentrations of short- and branched-chain fatty acids, secondary bile acids, and tryptophan metabolites correlate with …

Conclusions:HMP-O 2 demonstrates safety and noninferior efficacy for liver graft preservation in comparison to SCS. Early allograft failure by L-GrAFT 7 was lower in HMP-O 2, suggesting improved early clinical function. Recipients of HMP-O 2 livers also demonstrated a lower incidence of primary nonfunction and biliary strictures, although this difference did not reach significance.

PurposeTo assess the safety and effectiveness of using modified radiation lobectomy (mRL) to treat primary hepatic tumors located in the right hepatic lobe (segments V-VIII) and determine future liver remnant (FLR) hypertrophy.MethodsA retrospective review was performed at a single institution to include 19 consecutive patients (7 Female, 12 Male) who underwent single-session mRL for right sided primary hepatic tumors: 15 received segmentectomy plus lobectomy (segmental dose >190 Gy and lobar dose >80 Gy); 4 were treated with the double-segmental approach (dominant segments >190 Gy and non-dominant segments > 80 Gy). Treated tumors included 13 hepatocellular carcinoma (HCC), 4 cholangiocarcinoma (CCA), and 2 mixed-type HCC-CCA with a median dominant tumor size of 5.3 cm (Interquartile range [IQR]: 3.7-7.3cm). FLR of the left hepatic lobe was measured at baseline, T1 (4-8 weeks …

The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term allograft health, including noninvasive and tissue monitoring, immunosuppression optimization, and long-term structural changes. Potential revision of the rejection classification scheme to better accommodate and communicate late T cell-mediated rejection patterns and related structural changes, such as nodular regenerative hyperplasia, were discussed. Improved stratification of long-term maintenance immunosuppression to match the heterogeneity of patient settings will be central to improving long-term patient survival. Such personalized therapeutics are in turn contingent on a better understanding and monitoring of allograft status within a rational …

Abstract No. 360 Safety of Transarterial Radioembolization Plus Adjuvant Systemic Capecitabine for Treatment of Unresectable Biliary Tract Cancer

Background:Open Access Systematic ReviewComparing High-and Low-Model for End-Stage Liver Disease Living-Donor Liver Transplantation to Determine Clinical Efficacy: A Systematic Review and Meta-Analysis (CHALICE Study)