Simultaneous splenectomy (SSPX) in adult living donor liver transplantation (ALDLT) has definitely beneficial roles such as portal flow modulation in small‐for‐size graft and correction of hypersplenism‐related pancytopenia, and so on, but disastrous complications after SSPX often occur. For the first time, we devised unique and innovative splenic devascularization (SDV) procedure to alleviated untoward effects of SSPX but to maintain its benefits for the indicated patients. From April 2013 to December 2014, 520 recipients underwent ALDLT, and the SSPX and SDV were simultaneously performed in 62 (11.9%) and 61 (11.7%) patients respectively. The most common indication was hypersplenism‐related pancytopenia (n=101), small‐for‐size graft (n=14), HCV (n=7), and splenic artery aneurysm (n=1). Postoperative small‐for‐size graft syndrome (SFSS) was absent in both SSPX and SDV, and preoperative pancytopenia was improved in both groups since postoperative 1 week, although SSPX was more substantial than SDV. Preoperative splenic volume (706.2 ± 282.9 mL) after SDV significantly decreased to 425.5 ± 204.4 mL on 1 month, respectively. In contrast to SDV, SSPX resulted in longer operation time and higher incidence of postoperative complications including mortality. In conclusion, SDV can replace SSPX during ALDLT without hampering its beneficial roles seriously, but get rid of splenectomy‐related lethal complication.

Hea-Seon Ha, Jung-Ja Hong, In-Ok Kim, Sae-Rom Lee, Ah-Young Lee, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Chul-Soo Ahn, Deok-Bog Moon, Ki-Hun Kim, Sung-Gyu Lee, Shin Hwang. Korean J Transplant 2019;33:112-7. https://doi.org/10.4285/jkstn.2019.33.4.112

Hepatic steatosis (HS) beyond a certain degree can jeopardize living donor (LD) safety, particularly in right lobe (RL) donors, making it a major obstacle for donor pool expansion in adult‐to‐adult living donor liver transplantation (ALDLT). From July 2004 to June 2016, 58 LDs donated their RLs despite having moderate HS (30%‐50% steatosis) determined by intraoperative biopsy at a single center. We performed greedy matching to compare the outcomes of the donors and recipients of this group with those of LDs with no HS. The mean left lobe (LL) HS value in the 58 cases was 20.9±12.4%, which was significantly lower than the mean RL HS value (38.8±6.7%, P<0.001). The mean ratio of the remnant LL to the total liver volume was 37.8±2.2. No differences were observed in the postoperative liver function and donor and recipient morbidity and mortality rates. The liver regeneration rates in recipients and donors at 1 month, 6 months, and 1 year postoperatively did not differ significantly. The patient and graft survival rates of the recipients showed no differences. Use of well‐selected RL grafts with moderate steatosis does not impair graft function, recipient outcomes, or donor safety.

Liver cancer exhibits the fourth most common cause of cancer‑associated mortality worldwide. Due to the rapid growth, solid tumors undergo severe hypoxia and produce high levels of extracellular adenosine to maintain homeostasis. A previous study indicated that the hypoxic condition in liver cancer increased hepatic adenosine, which is known to facilitate cancer survival and proliferation. Extracellular adenosine has been revealed to regulate pathological and physiological processes in cells and tissues. However, its pathophysiological role in liver cancer remains undetermined. Emerging evidence has indicated that the adenosine A2B receptor promotes the progression of liver cancer. Therefore, it was hypothesized that HIF‑1α is a transcriptional regulator of A2B in human liver cancer. The current study determined A2B expression of a number of liver cancer cell lines and performed functional studies of HIF‑1α as a master transcriptional regulator of hepatic A2B signaling during hypoxic conditions. The current study aimed to identify the promoter region of A2B, which has a hypoxia response element, by performing luciferase assays. The present study demonstrated that reduced HIF‑1α expression is associated with low expression of A2B, and HIF‑1α overexpression is associated with A2B induction. Furthermore, the siRNA‑mediated downregulation of A2B inhibited the growth and proliferation of HepG2, which is a liver cancer cell line. The relationship between HIF‑1α and A2B expression was also identified in human liver cancer specimens. In conclusion, the current study indicated that A2B is induced by the HIF‑1α transcriptional regulator during hypoxia, and it may be a potential pharmacologic and therapeutic target for the treatment of patients with liver cancer.

Minjae Kim, Shin Hwang, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Ki-Hun Kim, Jung-Man Namgoong, Woo-Hyoung Kang, Young-In Yoon, Hwui-Dong Cho, Byeong-Gon Na, Sang Hoon Kim, Sung-Gyu Lee. Korean J Transplant 2022;36:45-53. https://doi.org/10.4285/kjt.21.0031

Park GC, et al. Ann Surg Treat Res. 2020 May;98(5):235-246. https://doi.org/10.4174/astr.2020.98.5.235