Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Liver transplantation is the most effective radical treatment for hepatocellular carcinoma (HCC), especially for patients with HCC complicated by cirrhosis. Since most patients are in an advanced stage of unresectable state when they are present, the preoperative downstaging treatment for liver transplantation in HCC is of great significance for increasing the opportunity for surgery, reducing the dropout rate from the liver transplant waiting list, and thereby lowering the postoperative recurrence rate. Currently, immune checkpoint inhibitor (ICI)-based combination immunotherapy and targeted therapy is the most effective treatment for preoperative downstaging in liver transplantation for HCC. However, the immunoenhancing effects of ICI may increase the risk of post-transplant rejection. Therefore, it is necessary to find a "critical point" that allows ICI to effectively inhibit tumor growth during preoperative downstaging treatment without causing severe rejection after transplantation. This article reviews the latest advances in preoperative ICI treatment protocols, efficacy assessment, indications, contraindications, drug discontinuation timing, and principles of prevention and treatment of rejection in liver transplantation for HCC.

Objective To explore the application effect of personalized osteotomy guide plate in high tibial osteotomy for patients with knee osteoarthritis(KOA).Methods A total of 99 patients with KOA who underwent open wedge high tibial osteotomy(OWHTO)in our hospital from January 2022 to January 2023 were selected and randomly divided into a study group(50 cases)and a control group(49 cases)using a random number table method.The control group received traditional medial OWHTO treatment,and the study group received a combination of medial OWHTO and personalized osteotomy guide plate treatment.The indexes of operation and postoperative rehabilitation,serum inflammatory stress factor[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),cortisol(Cor),adrenocorticotropin(ACTH)],anatomical structure of knee joint[tibial plateau posterior Angle(PTSA),proximal medial tibial Angle(MPT A),hip knee ankle Angle(HKA)],knee function,ACL shape and function,postoperative complications were compared between the two groups.Results The amount of bleeding,the number of intraoperative fluoroscopy,and the postoperative drainage volume in the study group were(138.69±24.03)ml,(4.83±1.07)times,and(228.95±38.72)ml,respectively,which were all less than those in the control group(154.28±27.16)ml,(7.15±1.14)times,and(271.61±42.19)ml.In the study group,the operation time,incision length,and hospitalization time were(40.96±7.28)min,(8.96±0.85)cm,and(10.73±2.05)d,respectively,which were all shorter than those in the control group[(52.31±10.12)min,(9.51±1.03)cm,and(12.16±2.37)d],with statistically significant differences(P＜0.05).The levels of serum CRP,TNF-α,Cor,and ACTH in the study group on the 3rd day after the operation were(31.36±4.68)mg/L,(26.71±3.84)ng/ml,(241.28±27.45)ng/ml,and(18.65±3.01)pmol/L,respectively,which were lower than those in the control group[(35.07±5.16)mg/L,(30.29±4.15)ng/ml,(279.65±30.12)ng/ml,and(21.73±3.28)pmol/L,respectively],and the differences were statistically significant(P＜0.05).The Hospital for Special Surgery(HSS)knee score and Knee Society Score(KSS)of the study group at 12 months after surgery were(81.24±6.85)points and(78.26±6.14)points,respectively,which were higher than those of the control group[(78.08±6.42)points and(75.53±5.82)points,respectively],with statistically significant differences(P＜0.05);at the 12th month after surgery,the width of the ACL body in the study group was(5.68±0.71)mm,which was greater than that in the control group[(5.12±0.64)mm].The amount of anterior tibial displacement was(5.81±0.43)mm,which was smaller than that in the control group(6.19±0.41)mm,and the differences were statistically significant(P＜0.05);the incidence of postoperative complications in the study group was 4.00％,which was lower than that in the control group(18.37％),and the difference was statistically significant(P＜0.05).Conclusion The combined treatment of medial OWHTO and personalized osteotomy guide plate can reduce surgical trauma in patients with KOA,lower the incidence of complications,facilitate patient recovery,while maintaining the morphology and function of the ACL,and improving prognosis.

Objective To explore the predictive value of preoperative prognostic nutritional index(PNI)for postoperative out-comes of patients with hepatocellular carcinoma(HCC)undergoing transarterial chemoembolization(TACE).Methods The clinical datas of 142 HCC patients treated with TACE as initial treatment were retrospectively collected.According to the cut-off value deter-mined by the receiver operating characteristic(ROC)curve,the preoperative systemic immune-inflammation index(SII),PNI,aspar-tate aminotransferase-neutrophil ratio(ANRI),aspartate aminotransferase-lymphocyte ratio(ALRI)and aspartate aminotransferase-platelet ratio(APRI)were divided into high group and low group,and their effects of TACE on postoperative outcome were ana-lyzed.Results Preoperative PNI was negatively correlated with liver function 1 week after TACE.Preoperative PNI and tumor size were independent risk factors for overall survival(OS).The PNI≥42.35 group was better than PNI<42.35 group(OS 28 months vs 10 months),the tumor size<5 cm was better than tumor size≥5 cm(OS 37 months vs 11 months),and the differences were statistically significant(P<0.05).PNI was an independent risk factor for progression-free survival(PFS).The PNI≥42.35 group was better than PNI<42.35 group(PFS 6 months vs 3 months),and the difference was statistically significant(P<0.05).Conclusion Preop-erative PNI has a certain prognostic value in HCC patients,and the OS and PFS of HCC patients with PNI<42.35 group after TACE are shorter.

Pathologically,hepatocellular carcinoma(HCC)is prone to invade the portal vein and form portal vein tumor thrombus(PVTT).Although great advances in the treatment of HCC have been achieved in recent years,HCC patients with PVTT still have limited therapeutic options and poor prognosis.Hepatic arterial infusion chemotherapy(HAIC)is a therapeutic approach that combines local therapy with systemic antitumor effects,and a lot of studies have shown that HAIC carries certain survival benefit to patients with advanced HCC complicated by PVTT,and it is considered to be an effective local therapy for advanced HCC,especially for patients with type Vp3-4 HCC.Systemic therapy is the main treatment for advanced HCC,but the diversity of HAIC combined with targeted and immunotherapy may become a more effective treatment option for HCC with severe PVTT,and it is possible to achieve a tumor-free state through translational therapy,allowing patients with advanced HCC to survive for a longer time.This article aims to summarize the research progress in HAIC for advanced HCC complicated by PVTT.

The shortage of donor organs is the primary factor limiting the availability of liver transplantation (LT) and is a leading cause of death among patients on the waiting list. The reuse of liver allografts, while rare, represents a significant and unconventional donor resource, offering a promising strategy to expand the donor pool. This approach has been documented in international literature, demonstrating favorable surgical outcomes and long-term follow-up results. Here, we report the first case of liver allograft reuse in the Liver Transplantation Center, Department of General Surgery, Huashan Hospital, Fudan University. In this case, the first recipient underwent orthotopic LT for acute liver failure and hepatic encephalopathy. However, their condition deteriorated on the seventh postoperative day, culminating in brain death. Following evaluation and maintenance, the liver allograft was successfully re-transplanted into a second recipient, who had undergone LT six days earlier but experienced acute hepatic artery embolism leading to rapid liver function deterioration. The second recipient's liver function recovered smoothly after surgery, and they were discharged on the 28th postoperative day. This case highlights the significant value of liver allograft reuse in expanding the donor pool and providing life-saving options for critically ill patients requiring urgent LT.

Objective To explore the application effect of personalized osteotomy guide plate in high tibial osteotomy for patients with knee osteoarthritis(KOA).Methods A total of 99 patients with KOA who underwent open wedge high tibial osteotomy(OWHTO)in our hospital from January 2022 to January 2023 were selected and randomly divided into a study group(50 cases)and a control group(49 cases)using a random number table method.The control group received traditional medial OWHTO treatment,and the study group received a combination of medial OWHTO and personalized osteotomy guide plate treatment.The indexes of operation and postoperative rehabilitation,serum inflammatory stress factor[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),cortisol(Cor),adrenocorticotropin(ACTH)],anatomical structure of knee joint[tibial plateau posterior Angle(PTSA),proximal medial tibial Angle(MPT A),hip knee ankle Angle(HKA)],knee function,ACL shape and function,postoperative complications were compared between the two groups.Results The amount of bleeding,the number of intraoperative fluoroscopy,and the postoperative drainage volume in the study group were(138.69±24.03)ml,(4.83±1.07)times,and(228.95±38.72)ml,respectively,which were all less than those in the control group(154.28±27.16)ml,(7.15±1.14)times,and(271.61±42.19)ml.In the study group,the operation time,incision length,and hospitalization time were(40.96±7.28)min,(8.96±0.85)cm,and(10.73±2.05)d,respectively,which were all shorter than those in the control group[(52.31±10.12)min,(9.51±1.03)cm,and(12.16±2.37)d],with statistically significant differences(P＜0.05).The levels of serum CRP,TNF-α,Cor,and ACTH in the study group on the 3rd day after the operation were(31.36±4.68)mg/L,(26.71±3.84)ng/ml,(241.28±27.45)ng/ml,and(18.65±3.01)pmol/L,respectively,which were lower than those in the control group[(35.07±5.16)mg/L,(30.29±4.15)ng/ml,(279.65±30.12)ng/ml,and(21.73±3.28)pmol/L,respectively],and the differences were statistically significant(P＜0.05).The Hospital for Special Surgery(HSS)knee score and Knee Society Score(KSS)of the study group at 12 months after surgery were(81.24±6.85)points and(78.26±6.14)points,respectively,which were higher than those of the control group[(78.08±6.42)points and(75.53±5.82)points,respectively],with statistically significant differences(P＜0.05);at the 12th month after surgery,the width of the ACL body in the study group was(5.68±0.71)mm,which was greater than that in the control group[(5.12±0.64)mm].The amount of anterior tibial displacement was(5.81±0.43)mm,which was smaller than that in the control group(6.19±0.41)mm,and the differences were statistically significant(P＜0.05);the incidence of postoperative complications in the study group was 4.00％,which was lower than that in the control group(18.37％),and the difference was statistically significant(P＜0.05).Conclusion The combined treatment of medial OWHTO and personalized osteotomy guide plate can reduce surgical trauma in patients with KOA,lower the incidence of complications,facilitate patient recovery,while maintaining the morphology and function of the ACL,and improving prognosis.

Objective To explore the predictive value of preoperative prognostic nutritional index(PNI)for postoperative out-comes of patients with hepatocellular carcinoma(HCC)undergoing transarterial chemoembolization(TACE).Methods The clinical datas of 142 HCC patients treated with TACE as initial treatment were retrospectively collected.According to the cut-off value deter-mined by the receiver operating characteristic(ROC)curve,the preoperative systemic immune-inflammation index(SII),PNI,aspar-tate aminotransferase-neutrophil ratio(ANRI),aspartate aminotransferase-lymphocyte ratio(ALRI)and aspartate aminotransferase-platelet ratio(APRI)were divided into high group and low group,and their effects of TACE on postoperative outcome were ana-lyzed.Results Preoperative PNI was negatively correlated with liver function 1 week after TACE.Preoperative PNI and tumor size were independent risk factors for overall survival(OS).The PNI≥42.35 group was better than PNI<42.35 group(OS 28 months vs 10 months),the tumor size<5 cm was better than tumor size≥5 cm(OS 37 months vs 11 months),and the differences were statistically significant(P<0.05).PNI was an independent risk factor for progression-free survival(PFS).The PNI≥42.35 group was better than PNI<42.35 group(PFS 6 months vs 3 months),and the difference was statistically significant(P<0.05).Conclusion Preop-erative PNI has a certain prognostic value in HCC patients,and the OS and PFS of HCC patients with PNI<42.35 group after TACE are shorter.

The shortage of donor organs is the primary factor limiting the availability of liver transplantation (LT) and is a leading cause of death among patients on the waiting list. The reuse of liver allografts, while rare, represents a significant and unconventional donor resource, offering a promising strategy to expand the donor pool. This approach has been documented in international literature, demonstrating favorable surgical outcomes and long-term follow-up results. Here, we report the first case of liver allograft reuse in the Liver Transplantation Center, Department of General Surgery, Huashan Hospital, Fudan University. In this case, the first recipient underwent orthotopic LT for acute liver failure and hepatic encephalopathy. However, their condition deteriorated on the seventh postoperative day, culminating in brain death. Following evaluation and maintenance, the liver allograft was successfully re-transplanted into a second recipient, who had undergone LT six days earlier but experienced acute hepatic artery embolism leading to rapid liver function deterioration. The second recipient's liver function recovered smoothly after surgery, and they were discharged on the 28th postoperative day. This case highlights the significant value of liver allograft reuse in expanding the donor pool and providing life-saving options for critically ill patients requiring urgent LT.

Inherited metabolic liver disease (IMLD) is a category of liver metabolic diseases caused by genetic disorders. The pathogenesis of IMLD is complex, which primarily comprises the accumulation of harmful metabolic substrates or products caused by specific enzyme defects and energy defects or abnormal deposition caused by abnormal metabolism of glucose, fat and other substances. In recent years, liver transplantation has played an increasingly critical role in the treatment of IMLD with the development of liver transplantation. At present, IMLD has become the second most important indication after biliary atresia in pediatric liver transplantation. Currently, IMLD patients receiving liver transplantation can be divided into two categories: the first category is IMLD complicated with liver disease; Category 2 patients have a normal liver structure but are deficient in related metabolic enzymes. It can not only replace the liver with abnormal structure and function, but also provide normal enzymes required for patients' metabolism, which may improve their quality of life and even save their lives. In this article, common feasible liver transplantation for IMLD, clinical prognosis and surgical procedures of liver transplantation for IMLD were reviewed, aiming to provide reference for liver transplantation for IMLD.