Hepatitis B virus (HBV)-host junction sequences (HBV-JSs) has been detected in the urine of patients with HBV infection. This study evaluated HBV-JSs as a marker of minimum residual disease (MRD) and tumor recurrence after treatment in HBV-hepatocellular carcinoma (HCC) patients. Archived serial urine DNA from two HBV–HCC with recurrence as confirmed by MRI and four HBV-related cirrhosis (LC) patients were used. Urinary HBV-JSs were identified by an HBV-targeted NGS assay. Quantitative junction-specific PCR assays were developed to investigate dynamic changes of the most abundant urinary HBV-JS. Abundant urinary HBV-JSs were identified in two cases of tumor recurrence. In case 1, a 78-year-old female with HBV- HCC underwent a follow-up MRI following microwave ablation. While MRI results were variable, the unique HBV-JS DNA, HBV-Chr17, steadily increased from initial diagnosis to HCC recurrence. In case 2, a 74-year-old male with HBV–HCC contained two HBV-JS DNA, HBV-Chr11 and HBV-TERT, that steadily increased after initial HCC diagnosis till recurrence. One LC examined had HBV-TERT DNA detected, but transiently in 3.5 years during HCC surveillance. HBV-JS DNA was persistently elevated prior to the diagnosis of recurrent HCC, suggesting the potential of urinary HBV-JS DNA to detect MRD and HCC recurrence after treatment.

Wilson disease is an autosomal recessive disorder of abnormal copper metabolism that is prevalent in the younger population, rarely presenting in patients older than 40 years. Clinical presentation may be variable, and diagnosis is often aided by clinical and biochemical tests. We report the case of a 72-year-old woman who presented with acute liver failure initially of unclear etiology. Our patient was initially managed for presumed drug-induced liver injury but ultimately diagnosed with Wilson disease on the basis of clinical presentation, laboratory testing, liver biopsy, quantitative hepatic copper, and abnormal genetic testing.

Background: Hepatocellular carcinoma (HCC) is a major cause of mortality in the United States, but it can be cured with orthotopic liver transplant (OLT) in selected patients. Despite curative intent, post-OLT recurrence can occur in up to 15% of patients. The need for a program of post-OLT surveillance is widely accepted but the specifics of an optimal program have not been established. There is interest in identifying lower-risk cohorts of patients in whom an abbreviated strategy of surveillance may prove adequate, utilizing tools such as the RETREAT score. Unique challenges are posed in the post-transplant population regarding safety and tolerability of systemic therapy for HCC recurrence, suggesting early detection is beneficial. Methods: This was a single-center retrospective analysis of characteristics and outcomes for all patients undergoing transplant at our center between 1 January 2012 and 31 December 2024. Diagnosis of HCC was determined by histological confirmation or Liver Imaging and Reporting Data System (LI-RADS) 5 findings on contrast-enhanced cross-sectional imaging. RETREAT scores were calculated for all patients. Results: During the study period, 923 transplants were performed, of which 329 (35.6%) were for HCC. Post-OLT recurrence occurred in 36 (10.9%) of these. Recurrence was associated with the presence of any viable tumor on explant surgical pathology, the presence of a viable tumor beyond Milan Criteria, the presence of microvascular invasion, a larger diameter of viable tumor on explant, and a higher RETREAT score. Although higher RETREAT scores were associated with post-OLT recurrence, one-third of patients who experienced post-OLT recurrence had RETREAT scores of 0 or 1. RETREAT scores did not correlate with the time interval between transplant and HCC recurrence. Systemic therapy proved challenging, with 10/25 patients receiving systemic therapy for post-OLT recurrence having to stop or alter regimens due to the severity of adverse effects. Conclusions: The rates of post-transplant recurrence and the experience of patients managed with systemic therapy for post-OLT recurrence in our experience were in line with previously published data. Due to the overall low RETREAT scores, the sensitivity of the RETREAT score in identifying patients at risk for post-OLT recurrence was limited, and the low RETREAT score had very limited incremental negative predictive value for identifying a low-risk population. This suggested that a broad screening strategy for post-OLT recurrence may be better than a personalized strategy in which patients with low RETREAT scores receive abbreviated surveillance.