BACKGROUND Coronavirus disease(COVID)is a new and highly contagious infectious disease caused by the coronavirus(COVID-19 or severe acute respiratory syndrome coronavirus 2).There is limited data regarding the inciden...BACKGROUND Coronavirus disease(COVID)is a new and highly contagious infectious disease caused by the coronavirus(COVID-19 or severe acute respiratory syndrome coronavirus 2).There is limited data regarding the incidence and management of COVID-19 in immunocompromised patients’post-transplantation.In the pre-COVID-19 era,these patients were already at an increased risk of developing opportunistic infections.These often manifested with atypical symptoms.CASE SUMMARY We report another case of uneventful COVID-19 pneumonia in a 58-year old male who was 18 mo’post liver transplantation.He received tacrolimus monotherapy since July 2019.The clinical manifestations included only epigastric pain radiating to the right hypochondrium,nausea and vomiting.He had no fevers,cough,shortness of breath,anosmia or dysgeusia even if the chest computed tomography scan revealed an extension of the multiple patchy ground-glass density shadows to the upper lobe of the left lung too.He was hospitalised and received a course of oral chloroquine(200 mg×3 per day)for a period of 10 d.Interestingly,the COVID 19 infection was uneventful though there were no modifications to his tacrolimus dosing.He was successfully discharged.We performed subsequent follow-up via telemedicine.CONCLUSION In light of the current pandemic,it is even more important to identify how the liver recipient’s patients present and are managed,especially for immunosuppression treatment.展开更多
Hepatocellular carcinoma(HCC)is an increasingly prevalent and deadly disease that is initiated by different etiological factors,such as alcohol-associated liver disease(ALD),metabolic dysfunction-associated steatohepa...Hepatocellular carcinoma(HCC)is an increasingly prevalent and deadly disease that is initiated by different etiological factors,such as alcohol-associated liver disease(ALD),metabolic dysfunction-associated steatohepatitis(MASH),viral hepatitis,and other hepatotoxic and hepatocarcinogenic agents.The tumor microenvironment(TME)of HCC is characterized by several different fibroblastic and immune cell types,all of which affect the initiation,progression and metastasis of this malignant cancer.This complex immune TME can be divided into an innate component that includes macrophages,neutrophils,dendritic cells,myeloid-derived suppressor cells,mucosal-associated invariant T cells,natural killer cells,natural killer T cells,and innate lymphoid cells,as well as an adaptive component that includes CD4+T cells,CD8+T cells,regulatory T cells,and B cells.In this review,we discuss the latest findings shedding light on the direct or indirect roles of these immune cells(and fibroblastic-like cells such as hepatic stellate cells)in the pathogenesis of HCC.Henceforth,further characterization of this heterogeneous TME is highly important for studying the progression of HCC and developing novel immunotherapeutic treatment options.In line with this,we also review novel groundbreaking experimental techniques and animal models aimed at specifically elucidating this complex TME and discuss emerging immune-based therapeutic strategies intended to treat HCC and predict the efficacy of these immunotherapies.展开更多
Importance:Liver transplantation(LT)is a life-saving therapy for patients with end-stage liver disease and with acute liver failure,and it is associated with excellent outcomes and survival rates at 1 and 5 years.The ...Importance:Liver transplantation(LT)is a life-saving therapy for patients with end-stage liver disease and with acute liver failure,and it is associated with excellent outcomes and survival rates at 1 and 5 years.The incidence of biliary complications(BCs)after LT is reported to range from 5%to 20%,most of them occurring in the first three months,although they can occur also several years after transplantation.Objective:The aim of this review is to summarize the available evidences on pathophysiology,risk factors,diagnosis and therapeutic management of BCs after LT.Evidence Review:a literature review was performed of papers on this topic focusing on risk factors,classifications,diagnosis and treatment Findings:Principal risk factors include surgical techniques and donor’s characteristics for biliary leakage and anastomotic biliary strictures and vascular alterations for non-anastomotic biliary strictures.MRCP is the gold standard both for intra-and extrahepatic BCs,while invasive cholangiography should be restricted for therapeutic uses or when MRCP is equivocal.About treatment,endoscopic techniques are the first line of treatment with success rates of 70-100%.The combined success rate of ERCP and PTBD overcome 90%of cases.Biliary leaks often resolve spontaneously,or with the positioning of a stent in ERCP for major bile leaks Conclusions and Relevance:BCs influence morbidity and mortality after LT,therefore further evidences are needed to identify novel possible risk factors,to understand if an immunological status that could lead to their development exists and to compare the effectiveness of innovative surgical and machine perfusion techniques.展开更多
文摘BACKGROUND Coronavirus disease(COVID)is a new and highly contagious infectious disease caused by the coronavirus(COVID-19 or severe acute respiratory syndrome coronavirus 2).There is limited data regarding the incidence and management of COVID-19 in immunocompromised patients’post-transplantation.In the pre-COVID-19 era,these patients were already at an increased risk of developing opportunistic infections.These often manifested with atypical symptoms.CASE SUMMARY We report another case of uneventful COVID-19 pneumonia in a 58-year old male who was 18 mo’post liver transplantation.He received tacrolimus monotherapy since July 2019.The clinical manifestations included only epigastric pain radiating to the right hypochondrium,nausea and vomiting.He had no fevers,cough,shortness of breath,anosmia or dysgeusia even if the chest computed tomography scan revealed an extension of the multiple patchy ground-glass density shadows to the upper lobe of the left lung too.He was hospitalised and received a course of oral chloroquine(200 mg×3 per day)for a period of 10 d.Interestingly,the COVID 19 infection was uneventful though there were no modifications to his tacrolimus dosing.He was successfully discharged.We performed subsequent follow-up via telemedicine.CONCLUSION In light of the current pandemic,it is even more important to identify how the liver recipient’s patients present and are managed,especially for immunosuppression treatment.
基金supported by the intramural program of the NIAAA(Bin Gao)the Institut Universitaire de France(IUF)(Fouad Lafdil)Xin Wei Wang was supported by the intramural program of the NCIl,NIH
文摘Hepatocellular carcinoma(HCC)is an increasingly prevalent and deadly disease that is initiated by different etiological factors,such as alcohol-associated liver disease(ALD),metabolic dysfunction-associated steatohepatitis(MASH),viral hepatitis,and other hepatotoxic and hepatocarcinogenic agents.The tumor microenvironment(TME)of HCC is characterized by several different fibroblastic and immune cell types,all of which affect the initiation,progression and metastasis of this malignant cancer.This complex immune TME can be divided into an innate component that includes macrophages,neutrophils,dendritic cells,myeloid-derived suppressor cells,mucosal-associated invariant T cells,natural killer cells,natural killer T cells,and innate lymphoid cells,as well as an adaptive component that includes CD4+T cells,CD8+T cells,regulatory T cells,and B cells.In this review,we discuss the latest findings shedding light on the direct or indirect roles of these immune cells(and fibroblastic-like cells such as hepatic stellate cells)in the pathogenesis of HCC.Henceforth,further characterization of this heterogeneous TME is highly important for studying the progression of HCC and developing novel immunotherapeutic treatment options.In line with this,we also review novel groundbreaking experimental techniques and animal models aimed at specifically elucidating this complex TME and discuss emerging immune-based therapeutic strategies intended to treat HCC and predict the efficacy of these immunotherapies.
文摘Importance:Liver transplantation(LT)is a life-saving therapy for patients with end-stage liver disease and with acute liver failure,and it is associated with excellent outcomes and survival rates at 1 and 5 years.The incidence of biliary complications(BCs)after LT is reported to range from 5%to 20%,most of them occurring in the first three months,although they can occur also several years after transplantation.Objective:The aim of this review is to summarize the available evidences on pathophysiology,risk factors,diagnosis and therapeutic management of BCs after LT.Evidence Review:a literature review was performed of papers on this topic focusing on risk factors,classifications,diagnosis and treatment Findings:Principal risk factors include surgical techniques and donor’s characteristics for biliary leakage and anastomotic biliary strictures and vascular alterations for non-anastomotic biliary strictures.MRCP is the gold standard both for intra-and extrahepatic BCs,while invasive cholangiography should be restricted for therapeutic uses or when MRCP is equivocal.About treatment,endoscopic techniques are the first line of treatment with success rates of 70-100%.The combined success rate of ERCP and PTBD overcome 90%of cases.Biliary leaks often resolve spontaneously,or with the positioning of a stent in ERCP for major bile leaks Conclusions and Relevance:BCs influence morbidity and mortality after LT,therefore further evidences are needed to identify novel possible risk factors,to understand if an immunological status that could lead to their development exists and to compare the effectiveness of innovative surgical and machine perfusion techniques.
