Background/Aim: Although definition of transcatheter arterial chemo-emblization (TACE) refractory in hepatocellular carcinoma (HCC) has been proposed, a criterion for switching TACE to next therapy has not been established clinically. We estimate tumor marker score, which has been proposed for predicting prognosis of HCC treated with TACE.

Method: From 2000 to 2015, 183 naïve intermediate-stage HCC patients with Child-Pugh A were enrolled. AFP (≥100 ng/mL; HR 1.515; P=0.033), AFP-L3 (≥10%; HR 1.510; P=0.039), and PIVKA-II (≥100 mAU/mL; HR 1.676; P=0.009) for the score were significant prognostic factors by Cox-hazard multivariate analysis. Median survival time (MST) of patients with score 2 or more were shorter than the others (19.4 vs. 48.8 months, P<0.001). MST after twice TACE was shorter in patients, who showed PR or SD by imaging evaluation, with score 2 or more than the others (14.0 vs. 43.0 months, P<0.001).

Conclusion: In patients with score 2 or more, next therapy should be considered even if therapeutic response is thought to be PR or SD after twice TACE.

A 25-year-old male was admitted to our hospital to undergo detailed evaluation of liver disease and abdominal hemodynamics because of suspicious abnormality of inferior vena cava (IVC) on computed tomography. Doppler ultrasonography showed tortuous-shaped vessel at the hepatic tract of IVC with continuous blood flow. Furthermore, he was accompanied with splenorenal shunt showing bidirectional flow or hepatopetal direction and cystic dilatation at the left renal vein. These findings were confirmed by angiogram, which also revealed continuation of IVC with azygos vein. There were no abnormal findings on liver biopsy sample and hepatic venous pressure gradient (0.74 mmHg), however he was accompanied with splenomegaly probably due to the increased inflow to portal system. Although congenital anomalies of the IVC are increasingly recognized even in asymptomatic condition with frequent use of radiological imaging, this is a very rare case of infrahepatic incomplete interruption of IVC with both azygos and portal continuation.

An 83-year-old man with chronic hepatitis C and hypertension attended clinics from 2008. He was diagnosed with hepatocellular carcinoma in 2013 and received three courses of transcatheter arterial chemoembolization (TACE). He subsequently received a fourth TACE with cisplatin (CDDP) in 2016.

Acute liver and kidney injury, anemia, and thrombocytopenia developed the day after TACE. We diagnosed disseminated intravascular coagulation (DIC) and administered Nafamostat, methylprednisolone, and a blood transfusion. Laboratory data did not improve with schizocytes observed in a peripheral blood smear, leading to a diagnosis of secondary thrombotic microangiopathy (TMA) and DIC. Following plasma exchanges, transaminase and LDH improved markedly, while anemia, thrombocytopenia, and renal dysfunction improved slowly. Hemoglobin and platelets became stable after nine plasma exchanges. We suspect the patient had secondary TMA resulting from CDDP. To our knowledge there is limited information on this association and we therefore report this rare case of secondary TMA resulting from CDDP.

In this study, we aimed to clarify the efficacy and safety of denosumab for osteoporosis in patients with autoimmune liver diseases. We administered 60 mg denosumab subcutaneously every 6 month in seven patients with autoimmune hepatitis (AIH)- or primary biliary cholangitis (PBC)-related osteoporosis, whose bone mineral density (BMD) was less than 70% of the young adult mean. The BMD significantly increased in 12 months after the beginning of denosumab treatment compared with the baseline. The serum level of TRACP-5b, a bone resorption marker, significantly reduced, besides serum ALP and ALP3 levels significantly reduced in 6 and 12 months. Denosumab-related adverse effects including hypocalcemia and renal dysfunction were not observed.

These results suggest that denosumab could be a good option to treat osteoporosis in patients with autoimmune liver diseases and warrant further prospective study.

Hepatitis B surface antigen (HBsAg) levels in sixteen patients who underwent switching of previous nucleos(t)ide analogues (NAs) to Tenofovir (TDF) were evaluated. Patients were classified into Adefovir (ADF)-pretreated group and Entecavir (ETV)-pretreated group. HBsAg levels were significantly decreased throughout the course, especially after administration of TDF in all patients. In ADF-pretreated group, no significant difference of HBsAg levels was observed before and after administration of TDF. On the other hand, HBsAg levels after administration of TDF were significant decreased, while no significant difference was observed before administration of TDF in ETV-pretreated group. As conclusion, it is suspected that administration of TDF may have some effect on control of HBsAg levels.