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Kumar P, Krishna P, Nidoni R, Adarsh CK, Arun MG, Shetty A, Mathangi J, Sandhya, Gopasetty M, Venugopal B. Atezolizumab plus bevacizumab as a downstaging therapy for liver transplantation in hepatocellular carcinoma with portal vein thrombosis: The first report. Am J Transplant 2024:S1600-6135(24)00072-8. [PMID: 38219868 DOI: 10.1016/j.ajt.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
Atezolizumab plus bevacizumab is the preferred first-line treatment regimen for patients with advanced hepatocellular carcinoma. Limited data have shown promising results with the use of immune checkpoint inhibitors like nivolumab to downstage these patients for liver transplantation (LT). Here, we describe the first case of successful downstaging with atezolizumab plus bevacizumab in a patient with multifocal hepatocellular carcinoma and main portal vein tumoral thrombosis, followed by ABO-incompatible live donor LT. This illustrated case highlights that atezolizumab plus bevacizumab therapy may be a potential bridging tool for curative LT.
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Affiliation(s)
- Pramod Kumar
- Department of Hepatology, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India.
| | - Pradeep Krishna
- Department of HPB and Liver Transplantation Surgery, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
| | - Ravindra Nidoni
- Department of HPB and Liver Transplantation Surgery, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
| | - C K Adarsh
- Department of Gastroenterology, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
| | - M G Arun
- Department of Liver transplantation anesthesia, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
| | - Aashish Shetty
- Department of Liver transplantation anesthesia, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
| | - J Mathangi
- Department of Radiation Oncology, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
| | - Sandhya
- Department of Pathology, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
| | - Mahesh Gopasetty
- Department of HPB and Liver Transplantation Surgery, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
| | - B Venugopal
- Department of HPB and Liver Transplantation Surgery, BGS Gleneagles Global Hospital, Bengaluru, Karnataka, India
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Das S, Swain SK, Addala PK, Balasubramaniam R, Gopakumar CV, Zirpe D, Renganathan K, Kollu H, Patel D, Vibhute BB, Rao PS, Krishnan E, Gopasetty M, Khakhar AK, Vaidya A, Ramamurthy A. Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time. Prog Transplant 2016; 26:340-347. [PMID: 27543202 DOI: 10.1177/1526924816663516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nations with emerging deceased-donor liver transplantation programs, such as India, face problems associated with poor donor maintenance. Cold ischemic time (CIT) is typically maintained short by matching donor organ recovery and recipient hepatectomy to achieve maximum favorable outcome. We analyzed different extended criteria donor factors including donor acidosis, which may act as a surrogate marker of poor donor maintenance, to quantify the risk of primary nonfunction (PNF) or initial poor function (IPF). METHODS A single-center retrospective outcome analysis of prospectively collected data of patients undergoing deceased-donor liver transplantation over 2 years to determine the impact of different extended criteria donor factors on IPF and PNF. RESULTS From March 2013 to February 2015, a total of 84 patients underwent deceased-donor liver transplantation. None developed PNF. Thirteen (15.5%) patients developed IPF. Graft macrosteatosis and donor acidosis were only related to IPF ( P = .002 and P = .032, respectively). Cold ischemic time was maintained short (81 cases ≤8 hours, maximum 11 hours) in all cases. CONCLUSION Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.
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Affiliation(s)
- Somak Das
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Sudeepta Kumar Swain
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Pavan Kumar Addala
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | | | - C V Gopakumar
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Dinesh Zirpe
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | | | - Harsha Kollu
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Darshan Patel
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Bipin B Vibhute
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Prashantha S Rao
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Elankumaran Krishnan
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Mahesh Gopasetty
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Anand K Khakhar
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
| | - Anil Vaidya
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India.,3 Oxford Division of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Anand Ramamurthy
- 1 Gastrointestinal Surgery and Liver Transplantation, Apollo Hospital, Chennai, India
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Mathivanan K, Gopasetty M, Vibhute B, Varma MC, Ramamurthy A, Khakhar A. Simultaneous kidney–pancreas transplant for type Ⅱ diabetes mellitus with end-stage renal disease. Indian Journal of Transplantation 2014. [DOI: 10.1016/j.ijt.2014.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gopasetty M, Mazariegos G, Abu-Elmagd K, R. SI. Small Bowel Transplantation without Simultaneous Liver Graft Shows Increased Susceptibility to Chronic Rejection in Children. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rodrigues G, Kannaiyan L, Gopasetty M, Rao S, Shenoy R. Colonic pseudo-obstruction due to herpes zoster. Indian J Gastroenterol 2002; 21:203-4. [PMID: 12416757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Visceral motor complications are uncommon manifestations of herpes zoster (varicella zoster). We report a 59-year-old man who developed acute colonic pseudo-obstruction, which followed the appearance of dermatomal herpes zoster.
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Affiliation(s)
- Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College and Hospital, Manipal, Karnataka.
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