Publications by authors named "Gonzalo Sapisochin"

Introduction: Patients with advanced hepatocellular carcinoma (HCC) and macrovascular invasion (MVI) are recommended to receive systemic therapy according to guidelines. Stereotactic body radiotherapy (SBRT) and surgery are increasingly used in this patient population. This study compares outcomes from these local treatments.

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Liver transplantation (LT) has been accepted as a cornerstone of care in hepatocellular carcinoma (HCC) for almost three decades. In recent years, its role has been evolving to include patients with disease burden beyond the widely used Milan criteria. The integration of dynamic biomarkers such as alpha-fetoprotein together with downstaging approaches and tumor evolution after enlistment has allowed the selection of patients most likely to benefit, resulting in 5-year survival rates greater that 70%.

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Background: Solitary hepatocellular carcinoma measuring ≤3 cm represents approximately 30% of hepatocellular carcinoma cases, yet treatment guidelines lack robust evidence. This study compares oncologic outcomes after ablation, liver resection, and liver transplantation for solitary, small hepatocellular carcinoma.

Methods: We systematically searched databases up to 7 February 2022, for studies including adults with solitary hepatocellular carcinoma ≤3 cm treated by any ablation, liver resection, or liver transplantation.

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Background: Hepatocellular carcinoma (HCC) recurs after liver transplantation (LT) in ~17% of patients. We aimed to retrospectively compare the outcomes of patients treated with different tyrosine kinase inhibitors (TKIs) for recurrent HCC post-LT.

Methods: Patients with recurrent HCC post-LT between 2006 and 2019 were included.

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Background And Aims: Liver transplant (LT) for transplant oncology (TO) indications is being slowly adopted worldwide and has been recommended to be incorporated cautiously due to concerns about mid-long-term survival and its impact on the waiting list.

Approach And Results: We conducted 4 systematic reviews of all series on TO indications (intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma [phCC]) and liver metastases from neuroendocrine tumors (NETs) and colorectal cancer (CRLM) and compared them using patient-level meta-analyses to data obtained from the United Network for Organ Sharing (UNOS) database considering conventional daily-practice indications. Secondary analyses were done for specific selection criteria (Mayo-like protocols for phCC, SECA-2 for CRLM, and Milan criteria for NET).

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Posttransplant HCC recurrence significantly impacts survival, yet its management is challenging due to limited evidence. With recent advancements in HCC treatment, updated data on managing recurrent diseases are needed. In this retrospective study across 6 centers (2000-2022), we employed Cox proportional-hazards regression and log-rank tests to assess survival differences.

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This study aims to identify and categorize nonmedical barriers encountered by recipients, donors, and health care providers in the context of living donor liver transplantation (LDLT). Liver transplantation is vital for individuals with liver failure, yet high mortality rates on the transplant waitlist persist. LDLT was introduced to address deceased donor organ shortages; however, its adoption varies widely across regions, prompting the need to explore barriers hindering its implementation.

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Article Synopsis
  • Liver transplantation is the main treatment for severe liver diseases and certain cancers, but there is limited information on managing tumors that appear after the transplant.
  • A study of 54 patients who underwent liver surgery after transplantation found that most had hepatocellular carcinoma (HCC) and many did not receive additional therapies before or after surgery.
  • The results indicate that liver resection is generally safe after transplantation, with survival rates comparable to those in patients without a transplant, and should be considered for well-selected patients.
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Article Synopsis
  • Living donor liver transplantation (LDLT) significantly improves survival rates for liver disease patients and decreases wait times for transplants.
  • A study of 7,257 LDLT recipients showed a median overall survival of 17 years, with various factors influencing mortality rates identified over time.
  • The findings suggest that LDLT is a safe and effective procedure, and survival rates have improved even as patient risk factors have increased, indicating room for further advancements in the field.
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  • Tranexamic acid is known to reduce bleeding and blood transfusions in various surgeries, but its effectiveness for patients undergoing liver resection due to cancer is uncertain.
  • A multicenter randomized clinical trial involving 1384 patients was conducted to see if tranexamic acid decreases the need for red blood cell transfusions within 7 days after liver surgery.
  • The results showed no significant difference in transfusion rates or blood loss between the tranexamic acid group and the placebo group, and those who received tranexamic acid experienced more complications.
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Objective: Assess the impact of having a living donor on waitlist outcomes and overall survival through an intention-to-treat analysis.

Background: Living-donor liver transplantation (LDLT) offers an alternative to deceased donation in the face of organ shortage. An as-treated analysis revealed that undergoing LDLT, compared to staying on the waiting list, is associated with improved survival, even at Model for End-stage Liver Disease-sodium (MELD-Na) score of 11.

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Introduction: Pancreas organ shortages and long recipient waitlist times are critical components that limit recipients from receiving a pancreas transplant. Over the last decade, our center has been using donation after cardiac death (DCD) donors as an adjunct to donation after brain death (DBD) donors to expand the organ pool. The aim of this study was to compare recipient and graft survival between DCD and DBD recipients.

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Background & Aims: Metabolic syndrome (MS) is a growing epidemic and a risk factor for the development of hepatocellular carcinoma (HCC). This study investigated the long-term outcomes of liver resection (LR) for HCC in patients with MS. Rates, timing, patterns, and treatment of recurrences were investigated, and cancer-specific survivals were assessed.

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This review provides an in-depth exploration of portal hypertension (PH) and its implications in various surgical procedures. The prevalence of clinically significant PH is 50% to 60% in compensated cirrhosis and 100% in decompensated cirrhosis. The feasibility and safety of hepatic and nonhepatic surgical procedures in patients with PH has been shown.

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Article Synopsis
  • The study aimed to establish a common language regarding extreme liver surgery to facilitate better comparison of surgical outcomes across different centers.
  • A Delphi methodology was used, gathering opinions from 38 expert surgeons, who largely agreed on key definitions related to total vascular occlusion and surgical approaches, achieving consensus on various topics.
  • Ultimately, 75% agreed on a definition for extreme liver surgery, highlighting the importance of a unified approach in managing patients with complex liver diseases.
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Living liver donation (LLD) has been suggested as a potential solution to reduce the waitlist mortality for liver transplantation (LT) recipients by facilitating living donor liver transplantation (LDLT). Ensuring both donor and recipient safety is a critical aspect of LDLT. An accurate understanding of the complexity and extend of safety outcomes of the donor is imperative to maintain the high-quality standard this medical program requires.

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Background: Metastasis or recurrence of pancreatic neuroendocrine tumors (pNETs) after pancreatectomy is an important source of postsurgical morbidity. This study aimed to define disease-free survival (DFS) in this population.

Methods: Patients who underwent pancreatectomy for pNETs between January 2005 and January 2022 were included.

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