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Hepatitis B virus (HBV) reinfection and recurrence of hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT) are associated with increased graft failure and reduced patient survival. We evaluated the effects of both HCC recurrence and HBV reinfection on the long-term survival of these patients after OLT. One hundred seventy-five patients underwent OLT for HBV-related liver diseases and were the subjects of this retrospective study. We assessed risk factors for HBV reinfection, HCC recurrence, and survival post-OLT using univariate and multivariate analyses. During a mean follow-up of 43.0 Ϯ 42.0 months, 88 of 175 (50.3%) patients transplanted for HBV-related liver disease had HCC prior to OLT. Thirteen (14.8%) of these patients had HCC recurrence after OLT. The mean time for recurrence of HCC was 26.1 Ϯ 31.9 months. Twelve of 175 (6.9%) patients developed HBV reinfection after liver transplantation. The mean time for HBV reinfection was 28.7 Ϯ 26.4 months. Ten of these 12 (83.3%) patients had HCC prior to OLT, and 5 (50%) developed recurrence of HCC. On multivariate analyses, pre-OLT HCC and recurrence of HCC post-OLT were significantly associated with HBV reinfection after transplantation (P ϭ 0.031 and P Ͻ 0.001, respectively). HCC recurrence after OLT was associated with lymphovascular invasion (P Ͻ 0.001) and post-OLT chemotherapy (P Յ 0.001). The 3-and 5-year survival rates were significantly decreased in patients with HBV reinfection (P ϭ 0.007) and in patients with HCC recurrence after OLT (P ϭ 0.03). In conclusion, pre-OLT HCC and HCC recurrence after transplantation were associated with HBV reinfection and with decreased patient survival. Hepatitis B immunoglobulin and antiviral therapy was only partially effective in preventing HBV reinfection in patients with HCC recurrence. Liver Transpl 15:1525-1534, 2009. © 2009 AASLD. Received February 11, 2009 accepted July 14, 2009. Hepatitis B virus (HBV) is the principal cause of cirrhosis and hepatocellular carcinoma (HCC) worldwide and is responsible for at least 500,000 deaths per year. 1Prior to the availability of immunoprophylaxis and antiviral agents, the outcome of liver transplantation for hepatitis B-related liver disease was poor, and this often led to HBV reinfection rates greater than 80% and mortality rates of 50% at 2 years.2 Prophylactic use of hepatitis B immunoglobulin (HBIG) along with the nucleoside analogue lamivudine has markedly decreased the reinfection rate of HBV by suppressing HBV replication through their synergistic effect. However, despite reports demonstrating the reduced risk of hepatitis B reinfection and improved survival of patients treated with dual prophylaxis after orthotopic liver transplantation (OLT) for HBV, approximately 10% of transplanted patients develop HBV reinfection.4 Factors associated with HBV reinfection include a high pre-OLT HBV DNA level, 5 hepatitis B e antigen positivity, 4 immunosuppression from steroids and from sys-

Background:We aimed to systematically determine the impact of tumor burden on the 68 Ga-prostate-specific membrane antigen-11 ( 68 Ga-PSMA) PET biodistribution by the use of quantitative measurements.Methods: This international multicenter retrospective analysis included 406 men with prostate cancer who received 68 Ga-PSMA PET/CT. Of these, 356 had positive findings and were stratified by quintiles into very low (Q1, ≤25 ml), low (Q2, 25-189 ml), moderate (Q3, 189-532 ml), high (Q4, 532-1355 ml) and very high (Q5, ≥1355 ml) total PSMApositive tumor volume (PSMA-VOL). PSMA-VOL was obtained by semi-automatic segmentation of total tumor lesions using qPSMA software. Fifty prostate cancer patients with no PSMA-positive lesions (negative scan) served as control group. Normal organs, which included salivary glands, liver, spleen and kidneys, were semi-automatically segmented using 68 Ga-PSMA PET images and average SUV (SUVmean) was obtained.Correlations of PSMA-VOL as continuous and as categorical variable by quintiles with SUVmean of normal organ were evaluated. Results:The median PSMA-VOL was 302 ml (interquartile range [IQR], 47-1076). The median (IQR) SUVmean of salivary glands, kidneys, liver and spleen was 10.

The prevalence of hepatitis B virus (HBV) infection is reportedly high in Vietnamese Americans (VAs), but most previous studies did not assess full HBV serology, and not the prevalence of HBV and hepatitis C virus (HCV) infection simultaneously. The aim of the study is to assess the prevalence of different HBV serologies and HCV infection in VAs. This study was based on the data collected by testing for Hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibody (HBcAb IgG), anti-HBs antibody (HBsAb), and anti-HCV antibody (anti-HCV) in a series of community screening in VAs in Orange County, California. In 1,405 VA participants, the mean age was 51 (17-87) years, 45.1% were males; 68.2%, married; 97.2%, born in Vietnam. Most of the participants were non-US born with their primary language being non-English and with limited access to health care. Of the 1,405 cases, 124 (8.8%) were confirmed HBV infection by HBsAg+; 81 (5.8%), HCV infection by anti-HCV+; including four (0.3%) with HBV/HCV coinfection. Twelve percent of the participants with confirmed HBV infection thought they were previously tested negative, while 29.7% of the participants with confirmed HCV infection thought they were previously tested negative. In this cohort, 15.4% were HBsAg-/HBsAb-/HBcAb IgG-, i.e. being susceptible to HBV infection. In HCV infected participants, 65.4% were born between 1945 and 1965. This large serial survey and screening in the Vietnamese American community confirmed the rates of HBV and HCV infection to be as high as 8.8% and 5.8%, respectively. We have also identified factors related to HBV and HCV infection in this high-risk population.