PNF is characterized clinically by graft function insufficient to sustain life leading to death or re-transplantation in the first week post-operatively. The etiology of PNF is poorly understood but has been associated with prolonged ischemia times as well as several donor factors. “
“See article in J. Gastroenterol. Hepatol. 2011; 26: LY294002 cost 1612–1618. Based on the results from the Sorafenib Hepatocellular carcinoma Assessment Randomized Protocol (SHARP) trial and Asia-Pacific

trial, sorafenib, an oral multikinase inhibitor, was globally approved for the treatment of unresectable, advanced hepatocellular carcinoma (HCC).1,2 In the design of both studies, inclusion criteria were advanced stage (vascular invasion or distant metastasis) of HCC and good hepatic reserve function (Child–Pugh A). That is, due to the peculiar characteristic of HCC that malignancy is mostly accompanied by the preneoplastic condition of cirrhosis, which itself affects overall survival,

patients with Child–Pugh A were selected in those trials. Thus, the clinical utility of sorafenib in patients with Child–Pugh B or C remains unknown. In addition, the positioning of sorafenib is still not concrete in nations where the cost of this drug is higher compared to other treatment modalities.3,4 For buy EMD 1214063 instance, in Korea, reimbursement from the national insurance system is largely restricted. Though the government commenced reimbursement of it from January 2011, the indications are just advanced HCC if patients were not eligible for or had disease progression MCE after surgical or locoregional therapy (transarterial chemoembolization, ethanol injection, or radiofrequency ablation) with all of the following

conditions; (i) Tumor Node Metastasis (TNM) stage III or IV, (ii) Child–Pugh class A, (iii) Eastern Cooperative Oncology Group (ECOG) performance status, 0–2. Rather similar restrictions apply to reimbursement for sorafenib in Australia. Even with this indication, reimbursement in Korea is only partial, with patient copayment being 50%, and the period of reimbursement is only one year. In the USA, the Food and Drug Administration (FDA) authorized the use of sorafenib for patients with “unresectable HCC”, while in Europe, the indication is even extended as sorafenib is indicated for just “HCC”.5 Limited reimbursement policies and high cost of sorafenib in Asia-Pacific countries can lead to physicians treating patients with advanced HCC with other modalities, even though sorafenib is the only drug to show survival benefit in randomized, controlled trials. Under the aforementioned design of clinical trial and reimbursement environment, many physicians want to know the efficacy and safety of sorafenib in real clinical practice, especially in Barcelona Clinic Liver Cancer-C (BCLC-C) stage. In this issue of the Journal, Kim et al.