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Open Access Original Article Issue
Influence of sex on outcomes of liver transplantation for hepatocellular carcinoma: a multicenter cohort study in China
Cancer Biology & Medicine 2024, 21 (4): 347-362
Published: 28 February 2024
Downloads:0
Objective

Sex-specific differences are observed in various liver diseases, but the influence of sex on the outcomes of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains to be determined. This study is the first Chinese nationwide investigation of the role of sex in post-LT outcomes in patients with HCC.

Methods

Data for recipients with HCC registered in the China Liver Transplant Registry between January 2015 and December 2020 were analyzed. The associations between donor, recipient, or donor-recipient transplant patterns by sex and the post-LT outcomes were studied with propensity score matching (PSM). The survival associated with different sex-based donor-recipient transplant patterns was further studied.

Results

Among 3,769 patients enrolled in this study, the 1-, 3-, and 5-year overall survival (OS) rates of patients with HCC after LT were 96.1%, 86.4%, and 78.5%, respectively, in female recipients, and 95.8%, 79.0%, and 70.7%, respectively, in male recipients after PSM (P = 0.009). However, the OS was comparable between recipients with female donors and male donors. Multivariate analysis indicated that male recipient sex was a risk factor for post-LT survival (HR = 1.381, P = 0.046). Among the donor-recipient transplant patterns, the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival (P < 0.05).

Conclusions

Our findings highlighted that the post-LT outcomes of female recipients were significantly superior to those of male recipients, and the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival. Livers from male donors may provide the most benefit to female recipients. Our results indicate that sex should be considered as a critical factor in organ allocation.

Open Access Review Article Issue
FGF21-mediated autophagy: Remodeling the homeostasis in response to stress in liver diseases
Genes & Diseases 2024, 11 (3): 101027
Published: 13 July 2023
Downloads:2

Liver diseases are worldwide problems closely associated with various stresses, such as endoplasmic reticulum stress. The exact interplay between stress and liver diseases remains unclear. Autophagy plays an essential role in maintaining homeostasis, and recent studies indicate tight crosstalk between stress and autophagy in liver diseases. Once the balance between damage and autophagy is broken, autophagy can no longer resist injury or maintain homeostasis. In recent years, FGF21 (fibroblast growth factor 21)-induced autophagy has attracted much attention. FGF21 is regarded as a stress hormone and can be up-regulated by an abundance of signaling pathways in response to stress. Also, increased FGF21 activates autophagy by a complicated signaling network in which mTOR plays a pivotal role. This review summarizes the mechanism of FGF21-mediated autophagy and its derived application in the defense of stress in liver diseases and offers a glimpse into its promising prospect in future clinical practice.

Open Access Review Issue
Visual analysis of mesenchymal stem cell research in liver disease based on bibliometrics
iLIVER 2022, 1 (4): 283-291
Published: 23 November 2022
Downloads:8

The research of mesenchymal stem cells (MSCs) in the field of liver diseases has received more and more attention. This paper introduces the current situation, hot spots, and development trends in this field. Comprehensive searches were conducted using Web of Science Core Collection from January 1, 2000 to December 13, 2021 with the following keywords: TS(topic) = (liver*OR hepatic*OR hepatocyte) AND TS(topic) = (Mesenchymal stem cell*). VOSviewer (version 1.6.16) and CiteSpace V are used as bibliometric tools to analyze and visualize the knowledge graph. A total of 4452 papers were included in this study, and the number of research papers on MSCs in the field of liver diseases increased from January 2000 to December 2020. Eighty-four countries and regions have published articles on research in this field, among which China and the United States are the main two countries of publication. Based on the keyword burst detection, we find that the research in this field has shifted from basic research to clinical application, from medical research to interdisciplinary research. Tissue engineering and regenerative medicine are the frontier fields of MSCs research in liver diseases. Multicountry, multi-author cooperation, and multi-disciplinary intersection are the research trends in this field. Exocrine body, obesity, and tissue engineering are the hotspots in this field.

Open Access Review Issue
Advanced therapies for congenital biliary tract malformation: From bench to bedside
iLIVER 2022, 1 (3): 159-168
Published: 30 August 2022
Downloads:7

Congenital biliary tract malformations are a series of rare but extremely serious diseases that mainly include biliary atresia and biliary hypoplasia (referred to as Alagille syndrome). The rapid progression of biliary atresia and Alagille syndrome results in jaundice, cholestatic liver disease, cirrhosis, and even liver failure. In most cases, supportive or clinically specific therapies cannot achieve satisfactory outcomes. Therefore, liver transplantation (especially living donor liver transplantation) may be required. As many studies have elucidated the role of genetic factors and the molecular mechanism of congenital biliary tract malformations, experimental therapies such as organoid transplantation, cell therapy, and immunotherapy have been proved to be feasible. These advanced methods have shown outstanding advantages, particularly in patients with end-stage biliary tract malformations, surgery failure, and other problems that cannot be solved by conventional therapies. This review article discusses the potential pathogenesis of and promising therapeutic strategies for biliary tract malformations.

Open Access Review Issue
Applications of neural networks in liver transplantation
iLIVER 2022, 1 (2): 101-110
Published: 09 August 2022
Downloads:8

The use of neural networks (NNs) as a cutting-edge technique in the medical field has drawn considerable attention. NN models "learn" from a large amount of data and then find corresponding clinical patterns that are challenging for clinicians to recognize. In this study, we focus on liver transplantation (LT), which is an effective treatment for end-stage liver diseases. The management before and after LT produces a massive quantity of medical data, which can be fully processed by NNs. We describe recent progress in the clinical application of NNs to LT in five respects: pre-transplantation evaluation of the donor and recipient, recipient outcome prediction, allocation system development, operation monitoring, and post-transplantation complication prediction. This review provides clinicians and researchers with a description of forefront applications of NNs in the field of LT and discusses prospects and pitfalls.

Open Access Review Issue
Aspirin in hepatocellular carcinoma: Is it an out-of-date or promising treatment?
iLIVER 2022, 1 (1): 55-64
Published: 28 March 2022
Downloads:36

Hepatocellular carcinoma (HCC) is one of the most aggressive human malignancies with a dismal survival rate. Few strategies can effectively prevent the occurrence of HCC. Although immunotherapy has significantly improved HCC-related survival in recent years, this systemic therapy is very expensive and lays a heavy burden on most HCC patients. Aspirin, which is currently one of the most widely used medications in analgesic and cardiovascular diseases, is reported to have anti-tumor effects on HCC. Most importantly, long-term administration of low-dose aspirin does not significantly increase the risk of gastrointestinal bleeding. Owing to its cost-effectiveness and wide use, aspirin can be easily applied as an HCC treatment and is affordable for a wide range of patients. Therefore, deeper understanding and more attention are needed to extend the frontline of aspirin's preventive and therapeutic potential into cancer research and management. In this review, we discuss the preventive effect of aspirin on HCC in the context of different etiological factors, including hepatitis B or hepatitis C virus infection, non-alcoholic fatty liver disease, and alcohol-associated liver disease. The therapeutic role of aspirin in resectable or unresectable HCC management is also discussed. Furthermore, the mechanisms underlying the anti-cancer effects of aspirin on HCC are fully reviewed and discussed in the following two aspects: the effect of aspirin on multi-oncogenic signaling pathways in HCC (e.g., AMPK, Wnt/β-catenin, NF-κB) and aspirin-mediated immunometabolic responses in liver diseases. These findings indicate aspirin is a promising agent for populations at risk and HCC patients to prevent or treat HCC.

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