Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Patients with hepatocellular carcinoma that die during the first year of liver transplantation have high blood sFasL concentrations
Leonardo Lorente, Sergio T Rodriguez, Pablo Sanz, Agustín F González-Rivero, Antonia Pérez-Cejas, Javier Padilla, Dácil Díaz, Antonio González, María M Martín, Alejandro Jiménez, Purificación Cerro, Julián Portero, Manuel A Barrera
Leonardo Lorente, Intensive Care Unit, Hospital Universitario de Canarias, La Laguna 38320, Spain
Sergio T Rodriguez, María M Martín, Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Santa Cruz Tenerife 38010, Spain
Pablo Sanz, Javier Padilla, Manuel A Barrera, Department of Surgery, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz Tenerife 38010, Spain
Agustín F González-Rivero, Antonia Pérez-Cejas, Department of Laboratory, Hospital Universitario de Canarias, La Laguna 38320, Spain
Dácil Díaz, Antonio González, Department of Digestive, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz Tenerife 38010, Spain
Alejandro Jiménez, Research Unit, Hospital Universitario de Canarias, La Laguna 38320, Spain
Purificación Cerro, Transplant Unit, Hospital Universitario Nuestra Señora Candelaria, Santa Cruz Tenerife 38010, Spain
Julián Portero, Department of Radiology, Hospital Universitario Nuestra Señora Candelaria, Santa Cruz Tenerife 38010, Spain
Author contributions: Lorente L was responsible of conceive, design and coordinate the study, made substantial contributions to acquisition of data, analysis and interpretation of data, and drafted the manuscript; Rodriguez ST, Sanz P, Padilla J, Díaz D, González A, Martín MM, Cerro P, Portero J and Barrera MA have made substantial contributions to acquisition of data and provided useful suggestions; González-Rivero AF and Pérez-Cejas A participated in blood determination levels; Jiménez A have made substantial contributions to analysis and interpretation of data; All authors read critically and approved the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Institutional review board statement: The Institutional Board of the Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife, Spain) approved the study protocol.
Informed consent statement: The informed consent to participate in the study was signed by the patient or a family member.
Conflict-of-interest statement: There are no conflicts of interest to declare.
Data sharing statement: The datasets generated during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Leonardo Lorente, MD, PhD, Attending Doctor, Medical Assistant, Intensive Care Unit, Hospital Universitario de Canarias, Ofra, La Laguna 38320, Spain.
lorentemartin@msn.com
Received: December 13, 2022
Peer-review started: December 13, 2022
First decision: January 19, 2023
Revised: January 20, 2023
Accepted: February 21, 2023
Article in press: February 21, 2023
Published online: March 16, 2023
Processing time: 83 Days and 21.9 Hours
BACKGROUND
Fas ligand (FasL) is one ligand that activates extrinsic apoptosis pathway. High expression in lymphocytes of FasL have been found in patients with acute rejection of liver transplantation (LT). No high blood concentrations of soluble FasL (sFasL) have been found in patients with acute LT rejection; however, the samples size of those studies was small.
AIM
To determine whether patients with hepatocellular carcinoma (HCC) that dead during the first year of LT have higher blood sFasL concentrations previously to LT that those who that remain alive in a study of higher sample size.
METHODS
Patients underwent LT due to HCC were included in this retrospective study. Serum sFasL levels prior to LT were measured and one-year LT mortality was registered.
RESULTS
Non-surviving patients (n = 14) showed higher serum sFasL levels [477 (269-496) vs 85 (44-382) pg/mL; P < 0.001] than surviving patients (n = 113). Serum sFasL levels (pg/mL) were associated with mortality (OR = 1.006; 95%CI = 1.003-1.010; P = 0.001) independently of age of LT donor in the logistic regression analysis.
CONCLUSION
We report for the first time that HCC patients who die within the first year of HT have higher blood sFasL concentrations prior to HT than those who remain alive.
Core Tip: Fas ligand (FasL) is one of the main ligands that activate apoptosis via the extrinsic pathway. Elevated blood concentrations of soluble FasL (sFasL) have not been found in patients with acute liver transplant (LT) rejection; however, the sample sizes of those studies were small. We found in this retrospective study of 127 patients with hepatocellular carcinoma underwent to LT that patients that die during the first year of LT have higher blood sFasL concentrations previously to LT than those who that remain alive. The beneficial results of blockade of the Fas system in animal models could motivate its investigation in these patients.
