Impact of Normothermic Machine Perfusion on Access to Liver Transplantation in Patients With Primary Hepatic Malignancies.

Background: Balancing the probability of transplant and waitlist dropout in patients with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) using MELD exception points has been an enduring challenge. The advent of normothermic machine perfusion (NMP) has the potential to increase access to transplantation in patients with primary hepatic malignancies.

Methods: Using the Scientific Registry of Transplant Recipients database, this study evaluated the impact of widespread availability of NMP on access to liver transplantation in transplant oncology.

Occult multifocal and incidental hepatocellular carcinoma: An analysis of long-term survival and risk factors at a single liver transplant center.

The clinical significance of occult HCC identified on explant pathology in liver transplantation (LT) remains unclear. Among recipients of LT, discordance between pre-LT radiographic assessment of HCC and explant tumor burden is common. Data regarding the association of incidental HCC (no pre-LT radiographic diagnosis) and occult multifocal hepatocellular carcinoma (omHCC, pre-LT radiology underestimates a number of explant tumors) with outcomes are scarce.

Extracellular vesicle digital scoring assay for assessment of treatment responses in hepatocellular carcinoma patients.

Background: There are no validated biomarkers for assessing hepatocellular carcinoma (HCC) treatment response (TR). Extracellular vesicles (EVs) are promising circulating biomarkers that may detect minimal residual disease in patients with treated HCC.

Methods: We developed the HCC EV TR Score using HCC EV Digital Scoring Assay involving click chemistry-mediated enrichment of HCC EVs, followed by absolute quantification of HCC EV-specific genes by RT-digital PCR.

Role of Liver Transplant in Primary and Secondary Liver Malignancies.

Hepatocellular carcinoma (HCC) and cholangiocarcinoma are the primary hepatic malignancies with established pathways to transplantation and model for end-stage liver disease (MELD) exception points. Other tumors managed with liver transplantation (LT) include hepatic epithelioid hemangioendothelioma and fibrolamellar HCC. LT for metastatic neuroendocrine tumor has been established with patient selection criteria and a path to MELD exception points.

Noninvasive prognostication of hepatocellular carcinoma based on cell-free DNA methylation.

Background: The current noninvasive prognostic evaluation methods for hepatocellular carcinoma (HCC), which are largely reliant on radiographic imaging features and serum biomarkers such as alpha-fetoprotein (AFP), have limited effectiveness in discriminating patient outcomes. Identification of new prognostic biomarkers is a critical unmet need to improve treatment decision-making. Epigenetic changes in cell-free DNA (cfDNA) have shown promise in early cancer diagnosis and prognosis.

Combining Ultrasound Imaging and Molecular Testing in a Multimodal Deep Learning Model for Risk Stratification of Indeterminate Thyroid Nodules.

Indeterminate cytology (Bethesda III and IV) represents 15-30% of biopsied thyroid nodules and require additional diagnostic testing. Molecular testing (MT) is a commonly used diagnostic tool that evaluatesmalignancy risk through next generation sequencing of fine needle aspiration (FNA) samples. While MT achieves high sensitivity (97-100%) in ruling out malignancy, its specificity and positive predictive value (PPV) remain relatively low.

Center-level variations are associated with disparate waitlist mortality and probability of liver transplant in MELD 35 and greater patients.

Liver transplant (LT) centers may have variations in their approach to high-acuity (MELD ≥35) candidates for listing and transplantation. We investigated center-specific differences in waitlist outcomes, probability of LT, and post-LT survival in MELD ≥35 patients. Adult candidates of LT (MELD ≥35) were identified from the Scientific Registry of Transplant Recipients between January 1, 2010, and April 1, 2022.

Treating rare tumors with liver transplantation.

Purpose Of Review: The success of liver transplantation (LT) in treating unresectable hepatocellular carcinoma (HCC) has resulted in interest in LT for other oncologic conditions. Here, we discuss the role of LT for rare oncologic indications including metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs), hepatic epitheliod hemangioendothelioma (HEHE), fibrolamellar hepatocellular carcinoma (FLC), and hepatic angiosarcoma (HAS).

Recent Findings: Conditions reviewed have been documented indications for LT in the available literature.

Society for Cardiovascular Angiography and Interventions Shock Classification to Stratify Outcomes of Extracorporeal Membrane Oxygenation.

We applied the Society for Cardiovascular Angiography and Interventions (SCAI) schema to cardiogenic shock (CS) patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to assess performance in this high acuity group of patients. Records of adult patients receiving VA-ECMO for CS at our institution from 01/2015 to 12/2019 were reviewed. Post-cardiotomy and noncardiogenic shock patients were excluded.

Role of left atrial appendage occlusion in patients with HeartMate 3.

Objectives: Left atrial appendage occlusion (LAAO) at the time of implantation may reduce thromboembolic events (TEs) during continuous-flow left ventricular assist device support. The HeartMate 3 (HM3) reduces TEs overall, but the efficacy of LAAO in HM3 is unknown.

Methods: Adults receiving first HM3 implantation from November 2014 through December 2019 at a single, large medical centre were retrospectively reviewed.

Development of De Novo Aortic Insufficiency in Patients With HeartMate 3.

Background: De novo aortic insufficiency (AI) is a common adverse event after continuous-flow left ventricular assist device (LVAD) placement and is associated with morbidity and mortality. This study aims to compare the development of de novo AI between HeartMate 3 (Abbott) and HeartMate II LVAD recipients.

Methods: A retrospective review was conducted of clinical characteristics and serial echocardiograms (1 month, 6 months, and 1 year postimplantation) of HeartMate 3 patients implanted between November 2014 and March 2019 and of HeartMate II patients implanted between April 2004 and December 2015 at Columbia University Irving Medical Center.

Clinical efficacy of direct or indirect left ventricular unloading during venoarterial extracorporeal membrane oxygenation for primary cardiogenic shock.

Objective: Left ventricular (LV) distention is a feared complication in patients receiving venoarterial (VA) extracorporeal membrane oxygenation (ECMO). LV unloading can be achieved indirectly with intra-aortic balloon pump (IABP) or directly with an Impella device (Abiomed, Danvers, Mass). We sought to assess the clinical and hemodynamic effects of IABP and Impella devices on patients supported with VA ECMO.

A Standardized Approach Improves Outcomes of Extracorporeal Membrane Oxygenation for Postcardiotomy Shock.

Postcardiotomy shock (PCS) has historically been associated with substantial morbidity and mortality. Mortality at discharge is reportedly more than 60%. We investigated the outcomes of our standardized approach to veno-arterial extracorporeal membrane oxygenation (ECMO) management for PCS.

National outcomes of bridge to multiorgan cardiac transplantation using mechanical circulatory support.

Background: Little is known regarding the profile of patients with multiorgan failure listed for simultaneous cardiac transplantation and secondary organ. In addition, few studies have reported how these patients are bridged with mechanical circulatory support (MCS). In this study, we examined national data of patients listed for multiorgan transplantation and their outcomes after bridging with or without MCS.

Bleeding and Thrombotic Events During Extracorporeal Membrane Oxygenation for Postcardiotomy Shock.

Background: Anticoagulation therapy management during venoarterial extracorporeal membrane oxygenation (ECMO) is particularly difficult in postcardiotomy shock patients given a significant bleeding risk. We sought to determine the effect of anticoagulation treatment on bleeding and thrombosis risk for postcardiotomy shock patients on ECMO.

Methods: We retrospectively reviewed patients who received ECMO for postcardiotomy shock from July 2007 through July 2019.

Serial assessment of HeartMate 3 pump position and inflow angle and effects on adverse events.

Objectives: This study analyses the position of the HeartMate 3 left ventricular assist device on serial radiographs to assess positional change and possible correlation with adverse events.

Methods: We retrospectively analysed 59 left ventricular assist device recipients who had serial chest radiographs at 1 month, 6 months and 12 months post-implantation between November 2014 and June 2018. We measured pump angle, pump-spine distance and pump-diaphragm depth and investigated their relationship to a composite outcome of heart failure readmission, low flow alarms, stroke or inflow/outflow occlusion requiring surgical repositioning through recurrent event survival modelling.

Prosthetic valve thrombosis during extracorporeal life support for postcardiotomy shock.

Postcardiotomy shock is a complication after open-heart surgery that may be alleviated with extracorporeal life support (ECLS). Postcardiotomy shock patients on ECLS with prosthetic valves are at a high risk of valve thrombosis. We retrospectively reviewed patients supported with ECLS after the development of postcardiotomy shock at our centre, 90 of which had prosthetic valves.

Use Side Branch of the Aortic Graft to Facilitate Coronary Reconstruction During Complex Aortic Surgery.

The interposition graft could be used for difficult coronary reconstruction during aortic root replacement. We introduced a new technique that utilizes side branch of an aortic graft to facilitate coronary reconstruction. The present study describes this technique and its outcomes.