Advanced Hepatic Alveolar Echinococcosis Research Articles

Application of hepatic lobe hyperplasia techniques in the treatment of advanced hepatic alveolar echinococcosis: a single-centre experience

BackgroundThis study was designed to investigate clinical efficiency and application indications of hepatic lobe hyperplasia techniques for advanced hepatic alveolar echinococcosis (AE) patients.MethodsA retrospective case series covering 19 advanced hepatic AE patients admitted to the First Affiliated Hospital of Xinjiang Medical University from September 2014 to December 2021 and undergoing hepatic lobe hyperplasia techniques due to insufficient remnant liver volume were analyzed. Changes of liver function, lesions volume, remnant liver volume, total liver volume before and after operation have been observed.ResultsAmong the patients, 15 underwent portal vein embolization (PVE). There was no statistical difference in total liver volume and lesions volume before and after PVE (P > 0.05). However, the remnant liver volume was significantly increased after PVE (P < 0.05). The median monthly increase rate in future liver remnant volume (FLRV) after PVE stood at 4.49% (IQR 3.55–7.06). Among the four patients undergoing two-stage hepatectomy (TSH), FLRV was larger than that before the first stage surgery, and the median monthly increase rate in FLRV after it stood at 3.34% (IQR 2.17–4.61). Despite no statistical difference in total bilirubin (TBil), albumin (Alb), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) in all patients with PVE, four patients who underwent TSH showed a decrease in ALT, AST and GGT. During the waiting process before the second stage operation, no serious complications occurred in all patients.ConclusionsFor patients suffering from advanced hepatic AE with insufficient FLRV, PVE and TSH are safe and feasible in promoting hepatic lobe hyperplasia.

Advances in the pharmacological treatment of hepatic alveolar echinococcosis: From laboratory to clinic.

Hepatic alveolar echinococcosis (HAE) is a zoonotic parasitic disease caused by the larvae of Echinococcus multilocularis. Because of its characteristics of diffuse infiltration and growth similar to tumors, the disability rate and mortality rate are high among patients. Although surgery (including hepatectomy, liver transplantation, and autologous liver transplantation) is the first choice for the treatment of hepatic alveolar echinococcosis in clinic, drug treatment still plays an important and irreplaceable role in patients with end-stage echinococcosis, including patients with multiple organ metastasis, patients with inferior vena cava invasion, or patients with surgical contraindications, etc. However, Albendazole is the only recommended clinical drug which could exhibit a parasitostatic rather than a parasitocidal effect. Novel drugs are needed but few investment was made in the field because the rarity of the cases. Drug repurposing might be a solution. In this review, FDA-approved drugs that have a potential curative effect on hepatic alveolar echinococcosis in animal models are summarized. Further, nano drug delivery systems boosting the therapeutic effect on hepatic alveolar echinococcosis are also reviewed. Taken together, these might contribute to the development of novel strategy for advanced hepatic alveolar echinococcosis.

Massive sympathetic nerve infiltration in advanced hepatic alveolar echinococcosis: a case report and review of the literature

BackgroundAlveolar echinococcosis is a zoonotic disease that mostly affects the liver, with vascular invasion and a protean clinical symptom. However, no reports of sympathetic nerve infiltration in hepatic alveolar echinococcosis have been reported. Here, we report a case of hepatic alveolar echinococcosis in a 33-year-old man. In this end-stage case, the lesion was heavily involved in the large vessels and biliary tract, and immunohistochemistry also incidentally revealed extensive nerve infiltration in the specimens after surgical treatment. Subsequently, neural classification was identified.Case presentationWe herein report a case of advanced hepatic alveolar echinococcosis with macrovascular invasion and sympathetic nerve infiltration. In this case, inferior vena cava (IVC), the portal vein and bile duct were infiltrated. Ultimately, according to our experience, ex vivo liver resection and autotransplantation (ELRA) was the optimal treatment way to perform for this unresectable patient. Samples were collected from normal liver tissue, junction tissue and the lesion. Hematoxylin–eosin (HE) staining was used to confirm the diagnosis. Neural infiltration was observed by immunohistochemical staining with protein gene product 9.5 (PGP9.5). Fluorescence colocalization was determined with PGP9.5 and tyrosine hydroxylase (TH). These results suggest that a large amount of sympathetic nerve infiltration occurred at the junction.ConclusionThis study suggests that advanced hepatic alveolar echinococcosis shows infiltrating growth, often invades the large vessels and biliary ducts, and may be accompanied by sympathetic nerve infiltration.

Study on the Effect of Quasi-Radical Lesion Resection on the Quality of Life of Patients With Advanced Hepatic Alveolar Echinococcosis

ObjectiveTo retrospectively analyze the effects of radical lesion resection and quasi radical lesion resection on the quality of life of patients with advanced hepatic alveolar echinococcosis.MethodsThrough the existing HIS system of Qinghai Provincial People's Hospital, 104 patients with hepatic alveolar echinococcosis who underwent surgical treatment in our hospital from January 2012 to December 2017 and completed the quality of life questionnaire were selected as the research objects. The above cases were divided into radical group (n = 51) and quasi-radical group (n = 53) according to different surgical methods (degree of radical cure). The quality of life of patients with hydatidosis was measured by interview or telephone follow-up. The preoperative indexes, intraoperative conditions and postoperative recovery indicators of the two groups were observed, such as Child-Puhg grade, PNM classification, scope of hepatectomy, intraoperative bleeding, Clavien grade, incidence of complications, 5-year recurrence rate and total score of quality of life and so on.ResultsThere was no significant difference between the two groups in general data such as age, gender, hydatid size, Child-Puhg grade and preoperative liver function (P > 0.05). However, there was a statistically significant difference in PNM classification between the two groups (P < 0.05). There were significant differences in intraoperative bleeding, postoperative liver function recovery, Clavien grade of complication severity and 5-year recurrence rate between the two groups (P < 0.05). There was no significant difference in postoperative quality of life between the two groups (P > 0.05).ConclusionFor patients with advanced hepatic alveolar echinococcosis whose objective cannot be achieved by conventional hepatectomy, quasi-radical resection of the lesion can not only reduce the risk and difficulty of surgery, but also the quality of life of the patients may be as good as that of radical resection.

Application of ex vivo liver resection and autotransplantation in treating Budd-Chiari syndrome secondary to end-stage hepatic alveolar echinococcosis: A case series.

Background:Secondary Budd-Chiari syndrome (BCS) occurs due to a blockage in the liver caused by invasion or compression by a large lesion. Conventional treatments for BCS do not solve practical problems, wherease liver transplantation has been only applied as a last-resort therapy and as the only opportunity for a radical cure. We explored the feasibility of applying ex vivo liver resection and autotransplantation (ELRA) for the new indications of treating patients with end-stage hepatic alveolar echinococcosis (HAE). Our center has firstly proposed the idea and successfully treated the 49 patients with HAE. This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE.Methods:According to the degree of lesion invasion and surgical options, 11 patients were divided into 4 types. These 11 patients had large lesions that invaded the second and third hilum of the caudate lobe and involved the confluence of the hepatic vein and the inferior vena cava, suprahepatic vena cava, or at least 2 hepatic veins and led to secondary BCS. The aim of the present work was to report 11 patients with life-threatening diseases who underwent ELRA (ex vivo liver resection and autotransplantation) for secondary BCS, to propose a classification system for secondary BCS, and to suggest that secondary BCS is an indication for ELRA.Results:Eleven patients successfully underwent ELRA without intraoperative mortality. The median autograft weight was 690 g (440–950 g); operative time was 12.5 hours (9.4–16.5 hours); Postoperative hospital stay was 15 days (7–21 days). Clavien-Dindo grade IIIa or higher postoperative complications occurred in only 5 patients.Conclusions:This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE, not only provides new ideas for alternative treatments of secondary BCS, but also provides a classification system for secondary BCS. This article describes the technical process of outflow tract reconstruction and the experience for expanding the indications for ELRA. Our study demonstrated that ELRA is well feasible for treatment of BCS secondary to advanced HAE.

Postoperative complications of ex vivo liver resection combined with autologous liver transplantation in treatment of advanced hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies

Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People's Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. Results All 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (18.18%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.

Safety and efficacy of reduced-volume hepatectomy for advanced hepatic alveolar echinococcosis

Objective To evaluate the efficacy and safety of reduced volume hepatectomy in treatment of advanced hepatic alveolar echinococcosis. Methods The clinical data of 90 patients with advanced hepatic alveolar echinococcosis treated at the Qinghai Provincial People's Hospital from January 2017 to January 2019 were retrospectively analyzed. There were 41 males and 49 females, with an average age of 32 (range 11 to 58) years. The locations of the lesions, operations, complications and follow-up were analyzed. Results 90 patients were treated with reduced volume focal hepatectomy, 38 with radical resection and 52 with quasi radical resection. The operation time was (361±22) min. The hospital stay was (22±2) day, and the blood loss was (781±37) ml. Red blood cells were transfused in 19 patients and plasma in 39 patients. Pringle’s maneuver was used in 12 patients, regional hepatic blood flow occlusion in 42 patients, and Glisson sheath occlusion in 26 patients. The total bilirubin, alanine aminotransferase and aspartate aminotransferase returned to normal in 3 to 14 days after operation. There were 12 patients who developed bile leakage, 41 pleural effusion and 26 effusion in the operation sites. A total of ninety patients were followed up for 2 to 24 months. There was no recurrence of echinococcosis after radical resection and no enlargement of residual lesions after quasi-radical resection. Conclusion Reduced-volume hepatectomy reduced the risk and difficulty of operation. The follow-up results were good. This approach provides a feasible scheme for treatment of advanced hepatic alveolar echinococcosis. Key words: Echinococcosis, hepatic; Treatment outcome; Reduced-volume focal hepatectomy; Safety

Clinical characteristics of 175 cases with advanced hepatic alveolar echinococcosis

To investigate the clinical characteristics of patients with advanced hepatic alveolar echinococcosis, so as to provide more evidence for the diagnosis and treatment of advanced hepatic alveolar echinococcosis. The clinical records of 175 cases with hepatic alveolar echinococcosis admitted to the Affiliated Hospital of Qinghai University from 2012 to 2017 were retrospectively reviewed. Among the 175 cases with hepatic alveolar echinococcosis, the male to female ratio was 1∶1.6, and the mean age was (38.6 ± 12.9) years (range, 11 to 69 years). 93.7% of the patients (164 cases) were Tibetan, and 79.4% (139 cases) were from Guoluo Prefecture. 73.7% (129 cases) were herdsmen, and 58.3% (102 cases) were illiterate. The major clinical symptoms included upper abdominal pain, yellowing of skin and mucosa, and scleral icterus. 69.1% of the lesions were located in bilateral livers, and 63.4% of the cases have 2 and more lesions. 53.7% of the cases have their inferior vena cava involved by the lesions. In addition, the most affected neighboring organ was diaphragmatic muscle (21.7%), and lung was the most affected distant metastatic site (40.6%). Advanced hepatic alveolar echinococcosis is highly prevalent in Guoluo Prefecture, Qinghai Province. Screening of this disease is required in this region and rational treatment scheme should be developed.

Magnetic resonance imaging evaluation of characteristics of vascular invasion in intermediate and advanced hepatic alveolar echinococcosis.

The objective of the present study was to provide a basis for the personalized treatment of intermediate and advanced hepatic alveolar echinococcosis (HAE) by elucidating the characteristics of vascular invasion and lesion growth. A total of 160 patients with intermediate and advanced HAE who were subjected to plain as well as contrast-enhanced 3.0-T magnetic resonance imaging prior to surgery were analyzed. Pathological and intra-operative observations of the subjects were also considered. The size and location of HAE lesions, vascular invasion characteristics and growth patterns were assessed. A total of 78 patients (48.75%) had lesions involving the S5-8 segment/partial right liver lobe, 21 (13.13%) had involvement in the S2-4 segment/partial left liver lobe and 61 (38.13%) had lesions that transcended the left and right liver lobes. Pathological examination revealed that the vascular invasion rates of the hepatic portal veins, intrahepatic veins (left, central and right vein, and inferior vena cava) and hepatic arteries were 51.88, 43.28 and 26.87%, respectively. Liver hilum invasion was observed in 128 patients (80.00%), 71 of which (44.38%) presented with invasion of the primary porta hepatis, 11 (6.88%) with invasion of the secondary porta hepatis and 46 (28.75%) with invasion of the primary as well as the secondary porta hepatis. In conclusion, the growth pattern of intermediate and advanced HAE is determined by the site, blood supply and activity of the lesion. The current study demonstrated that lesions tend to invade the intrahepatic venous system and porta hepatis, and to target veins rather than arteries.

Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis

Radical resection is the best treatment for patients with advanced hepatic alveolar echinococcosis (AE). Liver transplantation is considered for selected advanced cases; however, a shortage of organ donors and the risk of postoperative recurrence are major challenges. The aim of this study was to assess the clinical outcomes of ex vivo liver resection and autotransplantation for end-stage AE. In this prospective study, 69 consecutive patients with end-stage hepatic AE were treated with ex vivo resection and liver autotransplantation between January 2010 and February 2017. The feasibility, safety and long-term clinical outcome of this technique were assessed. Ex vivo extended hepatectomy with autotransplantation was successful in all patients without intraoperative mortality. The median weight of the graft and AE lesion were 850 (370-1,600) g and 1,650 (375-5,000) g, respectively. The median duration of the operation and anhepatic phase were 15.9 (8-24) h and 360 (104-879) min, respectively. Six patients did not need any blood transfusion. Complications higher than IIIa according to Clavien classification were observed in 10 patients. The 30-day-mortality and overall mortality (>90 days) were 7.24% (5/69) and 11.5% (8/69), respectively. The mean hospital stay was 34.5 (12-128) days. Patients were followed-up systematically for a median of 22.5 months (14-89) without recurrence. This is the largest series assessing ex vivo liver resection and autotransplantation in end-stage hepatic AE. This technique could be an effective alternative to liver transplantation in patients with end-stage hepatic AE, with the advantage that it does not require an organ nor immunosuppressive agents. Ex vivo liver resection and autotransplantation were performed in a large series of patients with end-stage hepatic alveolar echinococcosis. The results showed that this surgical option was feasible, with acceptable postoperative mortality, but 100% disease-free survival in survivors. Careful patient selection, as well as precise assessment for size and quality of the remnant liver are key to successful surgery.

TRANSPLANTATION TECHNOLOGIES FOR SURGICAL TREATMENT OF THE LOCALLY ADVANCED HEPATIC ALVEOCOCCOSIS WITH INVASION INTO GREAT VESSELS

Aim. To study the opportunities, immediate and long-term results of surgical treatment of locally advanced hepatic alveococcosis with invasion into great vessels. Material and Methods. The study included 63 patients. There were 19 liver transplantations, 12 normothermal liver autotransplantations (ante situm), 1 hypothermic liver autotransplantation (ex situ ex vivo) and 31 extended liver resections with resection and repair of great vessels. Results. Overall morbidity after liver transplantation was 31.6%, after normothermic liver autotransplantations — 38.5%, after extended liver resections with resection and repair of great vessels — 25.8%. Mortality after liver transplantation was 5.3% (1 patient). There was no in-hospital mortality after liver autotransplantations and after extended liver resections with resection and repair of great vessels. Maximal follow-up after liver transplantation was 54 months, after liver autotransplantations — 38 months, after extended liver resections with resection and repair of great vessels — 40 months. Long-term mortality was absent. Median survival was 21 months. Conclusion. Transplantation techniques in liver surgery can be recognized as an important and new surgical strategy in the treatment of unresectable hepatic alveolar echinococcosis. Excellent immediate and long-term results of radical surgery for locally advanced hepatic alveolar echinococcosis using transplantation technologies emphasize justification to concentrate these patients in highly specialized centers.

The clinical practice of improvement the "Volume and Quality" of functional liver in autologous liver transplantation for the patients with alveolar echinococcosis

Objective: To investigate the clinical significance of accurate assessment of "volume and quality" of functional liver in Autologous liver transplantation (ALT) in the treatment of the advanced hepatic alveolar echinococcosis (HAE). Methods: The clinical data of 12 patients with advanced HAE who underwent ALT at the First Affiliated Hospital of Xinjiang Medical University from May 2015 to July 2016 were retrospectively analyzed. Results: The preoperative hepatic functions of 12 patients were 8 Child-Pugh Grade A, 1 Grade B, and 3 Grade C. Three of the patients had moderate or severe jaundice. Three of the patients calculated functional liver graft volume (GV) and standard liver volume (SLV) ratio (GV/SLV) were <30%. After the protection of liver function, anti-infection, percutaneous transhepatic cholangiography drainage (PTCD), selective portal vein embolization (PVE), and staging liver resection, liver function Child-Pugh grade of 11 patients was raised to A grade, and the other patient was B grade, meanwhile the bilirubin was reduced to 2 times the normal value. The GV/SLV ratios of 3 patients with low GV/SLV ratio had reached 44.4%, 47.2% and 56.2% respectively. In this study, the GV/SLV ratios of the 12 patients were between 73.2% and 40.8% with an average of 55.6%. Operation time was 11.5-20.5 h, with an average of 12.3 h. Anhepatic phase time was 193-375 min with median 253.5 min. The red blood cell suspension was 0-6 U during the operation. The average hospitalization was 10-42 d, with the average 22.7 d. Total hospital costs were 121 600-434 800 Yuan, with the median cost of 174 400 Yuan. One patient died of septic shock a week after surgery. Conclusion: (1)ALT may provide feasibility for the advanced HAE. (2)Accurate assessment of functional liver "volume and quality" appeared as the key points to the ALT. (3)Precise surgery and individualized treatment could improve and protect the functional liver "volume and quality" .

Good outcome following liver transplantation using pericardial-peritoneum window for hepato-atrial anastomosis to overcome advanced hepatic alveolar echinococcosis and secondary Budd-Chiari Syndrome - a case report

BackgroundThis report presents a case of a 57- year old female with advanced Hepatic Alveolar Echinococcosis causing a secondary Budd-Chiari Syndrome due to infiltration of the suprahepatic inferior vena cava treated successfully by liver transplantation.Case presentationA temporary veno-venous bypass was introduced, but a typical end to end cavo-caval anastomosis wasn’t possible in this case. In order to access a disease free part of the inferior vena cava, an oval window of the diaphragm was excised, providing communication between the peritoneum and pericardium. A vascular clamp was placed onto the right atrium which allowed for an atrial-caval anastomosis. The remainder of hepatectomy was performed in a conventional manner. In the post-operative period and during the 18 month follow-up there were no complications. The patient remains in good general condition with optimal graft function.ConclusionsA hepato-atrial anastomosis with a pericardial-peritoneum window during liver transplantation is feasible and extends the curability potential for patients with advanced Hepatic Alveolar Echinococcosis considered for liver transplantation.

Management of Advanced Hepatic Alveolar Echinococcosis: Report of 42 Cases.

Radical resection is the first choice for hepatic alveolar echinococcosis (HAE). However, many patients with advanced HAE have no chance to be treated with curative resection owing to the long clinical latency. This study aimed to evaluate the necessity of aggressive operations, like palliative resection and orthotopic liver transplantation (OLT), in the management of advanced HAE. A retrospective study analyzed 42 patients with advanced HAE treated with palliative resection (N = 15), palliative nonresective procedures (N = 13), OLT (N = 3), or albendazole therapy alone (N = 11). The patients' condition before treatments was comparable among all the four groups. The overall 1-year, 3-year, and 5-year survival rates of the 42 cases were 81.0%, 45.2%, and 23.8%, respectively. No event occurred to end the follow-up during the 5-year observation period except death. The survival time (median ± standard error) of the palliative resection group (3.6 ± 1.4 years) was longer than that of the palliative nonresective procedures group (1.5 ± 0.2) and the albendazole therapy-alone group (1.0 ± 0.4). The 5-year survival rates after palliative resection and liver transplantation were 40.0% and 66.7%, compared with only 7.7% and 9.1% after palliative nonresective procedures or albendazole therapy alone. Therefore, we concluded that aggressive treatment with a multimodality strategy could contribute to prolonged survival in patients with advanced HAE. Moreover, the prognosis of the patients who received albendazole therapy alone or palliative nonresective procedures is poor.

Diagnosis and treatment of hepatic alveolar echinococcosis after liver transplantation

As a treatment method for advanced hepatic alveolar echinococcosis (AE),liver transplantation has been gradually performed.One patient with hepatic AE recurrence after liver transplantation was admitted to the Fourth Hospital of PLA in November 2012.The patients received liver transplantation in 2006 for the treatment of hepatic AE.Recurrent lesions were found in the head of the pancreas and the right lung.The patient was also associated with liver dysfunction.Liver function was improved obviously after liver-protective treatment,and continuous albendazole treatment was giving to the patient.Based on a full discussion of the patient,we thought that hepatic AE patients who met the following conditions could receive liver transplantation:(1) Severe hepatic insufficiency.(2) Inability to receive radical liver resection.(3) Absence of extra-hepatic metastasis of AE.Albendazole should be administered for at least 2 years after liver transplantation,and the patient should be monitored for a minimum of 10 years for the prevention of possible recurrence of AE. Key words: Hepatic alveolar echinococcosis ; Liver transplantation ; Recurrence ; Diagnosis ; Treatment

Pediatric alveolar echinococcosis invading the diaphragm and spreading to the chest and abdominal wall

Hepatic alveolar echinococcosis (AE) is an endemic disease in certain parts of the world and relatively rare in children. This report describes a 9-year-old girl with hepatic AE invading the diaphragm and directly spreading to the chest and abdominal wall. She was treated by surgical extirpation and albendazole therapy. In advanced hepatic AE, combined therapy of surgical and medical intervention is thought to improve the prognosis.