Nonalcoholic fatty liver disease activity score and Brunt's pathologic criteria for the diagnosis of nonalcoholic steatohepatitis: What do they mean and do they agree?
✍ Scribed by Stefano Ballestri; Amedeo Lonardo; Paola Loria
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 352 KB
- Volume
- 53
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
We read with interest the article by Vibert et al. 1 recently published in HEPATOLOGY. The authors described their single-center experience with liver transplantation for hepatocellular carcinoma (HCC) in human immunodeficiency virus (HIV)-positive patients (21 cases) and compared those patients to HIV-negative patients (61 cases) who were also affected by HCC. Because of the higher dropout rate among the HIV-positive patients (23.8% versus 11.4%), HIV infection impaired the results of liver transplantation for HCC on an intent-to-treat basis but had no significant impact on overall survival and recurrence-free survival after liver transplantation. In our center from 2005 to 2010, we performed transplantation for 13 HIV-positive patients affected by HCC. The characteristics of this cohort are reported in Table . Unlike Vibert et al.'s patients, none of our patients were dropped from the waiting list. None experienced HCC recurrence, although three patients were outside the Milan criteria at listing (23%); only one of those patients (7.7%) had microvascular invasion. Seventy-seven percent had grade 2 and 23% had grade 3 HCC according to Edmondson-Steiner. 2 The mean number and total diameter of the HCC nodules were 2 6 1 and 46 6 29 mm, respectively, upon pathological analysis. Before transplantation, all patients were treated with transarterial chemoembolization or combined transarterial chemoembolization and radio frequency ablation; the mean necrosis value was 67% 6 39% for the HCC nodules upon pathological analysis. Finally, the 1-, 3-, and 5-year patient and graft survival rates were 84.6%, 84.6%, and 70.5% and 84.6%, 84.6%, and 84.6%, respectively, with a median follow-up of 35 months (range ¼ 2-73 months). In conclusion, our experience seems to be comparable to the experience reported by Vibert et al. except for the absence of HCC recurrence, which was present in 23.8% of the patients investigated in the French cohort.