Differences In Liver Function Research Articles

Management of the middle hepatic vein in right lobe living donor liver transplantation: A meta-analysis.

Living donor liver transplantation (LDLT) is a curative treatment for end stage liver disease. It is advantageous due to the shortage of deceased donors. However, in LDLT, whether the middle hepatic vein (MHV) should be preserved in donors remains controversial. We conducted searches in Pubmed, Embase, Cochrane Library, Web of Science, Ovid, and Google Scholar using the key words "living donor liver transplantation" and "middle hepatic vein". Due to ethical issues, there were no randomized control trails focusing on MHV in LDLT. The majority of reports were retrospective studies. We examined the reference lists to identify related investigations. Google Scholar was then used to obtain full texts. Nine observational studies were analyzed. There were no significant differences in liver function (WMD, -5.51; P=0.12) and complications (RR, 0.98; P=0.89) in donors with or without MHV. However, the liver function in recipients was greatly improved after LDLT with MHV (WMD, -78.32; P=0.01). No definite conclusion was obtained in terms of the liver regeneration indices between LDLT with or without MHV. It was conclude that grafts with MHV in LDLT favor recipient outcomes and do not harm the living donor if a careful preoperative evaluation is performed.

Therapeutic potential of umbilical cord mesenchymal stem cells in mice with acute hepatic failure.

Mesenchymal stem cells are probably one of the most promising alternatives for liver regeneration and repair. We present data supporting the ability of human umbilical cord mesenchymal stem cells (hUCMSCs) to generate hepatic elements and discuss the best transplantation pathway. AHF mice were given hUCMSCs through tail-vein injection or into the liver lobes. Blood serum and liver tissues were collected to analyze the improvement of liver function and histological repair 24 h after hUCMSC administration. Real-time polymerase chain reaction and immunohistochemistry were used to detect the expression of human hepatocyte-specific markers in liver tissues. The results showed significant statistical differences in liver function after transplantation (P<.05). Real-time PCR and immunochemistry results demonstrated that the expression of hepatocyte-specific markers such as CK18 and AFP were obviously increased in the treatment groups through both transplantation pathways. Our data indicate that hUCMSCs are one of the stem cell candidates for liver repair because hUCMSCs can be easily and readily isolated and differentiated into hepatocytes both in vitro and in vivo. Additionally, tail-vein injection of hUCMSCs has a similar therapeutic efficacy but is more convenient compared to liver lobe injection. Our findings highlight the potential therapeutic value of hUCMSCs and show that cell transplantation through a peripheral vein is a safe and effective way to treat AHF mice. Furthermore, this method might mediate repair in patients with liver damage or disease in future clinical therapy.

Therapeutic value of black seed oil in methotrexate hepatotoxicity in Egyptian children with acute lymphoblastic leukemia.

'Acute lymphoblastic leukemia is the most common childhood malignancy'. Adding methotrexate to treatment protocols increased survival rate in children with leukemia. Methotrexate efficacy is limited by its hepatotoxicity. To assess the therapeutic value of Black seed oil in 'methotrexate induced hepatotoxicity in Egyptian children with acute lymphoblastic leukemia'. This study was conducted on 40 children with acute lymphoblastic leukemia' including 20 patients under methotrexate therapy and Black seeds 80 mg/kg/day for one week after each methotrexate dose [Group II] and 20 patients under methotrexate therapy and placebo [Group III]. This study included also '20 healthy children of matched age and sex as a control group' [Group I]. All patients were subjected to complete blood picture, bone marrow aspiration and liver functions. No significant differences in liver functions between group II and III before therapy were observed. There were nonsignificant increase in total, direct and indirect serum bilirubin, serum ALT, AST, and alkaline phosphatase levels and prothrombin time in group II after methotrexate and Black seed oil therapy but there was significant increase in group III after treatment with methotrexate and placebo with 'significant differences between group II and III ' after therapy. There were significant differences in prognosis regarding remission, relapse, death and 'disease free survival but no significant difference in overall survival between group II and III'. Black cumin seeds decreased MTX hepatotoxicity and improved survival in children with ALL and can be recommended as adjuvant drug in patients with ALL under methotrexate therapy.

Verification of inferior right hepatic vein-conserving segments 7 to 8 resection of the liver.

This study aims to investigate the safety of inferior right hepatic vein (IRHV)-conserving surgery by comparing the surgical data and postoperative complications between IRHV-conserving segments 7 to 8 (S7 to S8) resection and conventional right hemihepatectomy (RH). Five patients who underwent IRHV-conserving S7 to S8 segmentectomy between 2007 and 2011 (IRHV group) and 25 liver cancer patients who underwent RH without biliary tract reconstruction during the same period (RH group) were investigated. The surgical data, postoperative complications, and duration of hospital stay were compared. The IRHV and RH groups included 2 (40%) and 13 (52%) hepatocellular carcinoma patients, respectively. There were no significant differences in liver function before surgery between the groups. The presence of the IRHV did not adversely affect the processing of the short hepatic vein or frontal dissection of the inferior vena cava. The operative time was shorter (median, 366 minutes versus 501 minutes; P = 0.0001), the postoperative bilirubin level was lower (12 mg/dL versus 1.8 mg/dL; P = 0.037), and the duration of hospital stay was shorter (10 days versus 14 days; P = 0.002) in the IRHV group. No significant differences were noted in the intraoperative blood loss, postoperative transaminase levels, or the incidence of severe complications (Clavien grade IIIb or higher) between the groups. IRHV-conserving resection of the liver is a safe surgical procedure that is useful in preventing postoperative elevation of bilirubin level and in shortening the duration of hospital stay.

Clinical outcomes of the transplantation of stem cells from various human tissue sources in the management of liver cirrhosis: a systematic review and meta-analysis.

A systematic review and meta-analysis were performed to explore the clinical outcome of the transplantation of stem cells from various human tissue sources in cirrhotic patients. The relevant papers were searched via PubMed, EMBASE, and Cochrane Library databases. Changes in liver function before and after stem cell therapy were evaluated (self-control data). Difference in liver function and incidence of procedure-related complications, hepatocellular carcinoma (HCC), and death between patients undergoing stem cell therapy and conventional treatment were evaluated (case-control data). Of 786 papers initially identified, 31 were included. The sources of stem cell included bone marrow (n=26), umbilical cord (n=3), peripheral blood (n=1), and human fetal liver (n=1). No severe procedure-related complications were reported. According to the meta- analyses of self-control data, model for end-stage liver diseases (MELD) score was significantly reduced at the 3rd-4th and 6th months after stem cell therapy, but this reduction was not statistically significant at the 1st-2nd or 12th postoperative months. Child-Pugh score was also reduced after stem cell therapy, but the reduction was not statistically significant at all follow-up time points. According to the meta-analyses of case-control data, MELD and Child-Pugh scores were not significantly different between treatment and control groups at all follow-up time points. The incidence of HCC was not significantly different between treatment and control groups (odds ratio [OR] to=0.41, P=0.53). The mortality was not significantly different between the two groups (OR=0.48, P=0.20). Stem cell therapy could improve the liver function without any severe procedure-related complications. However, compared with conventional treatment, the benefit of stem cell therapy appeared to be not significant in improving the liver function and survival.

Evaluation of the effects of preconditioning regimens on hepatic veno-occlusive disease in mice after hematopoietic stem cell transplantation

Pre-conditioning regimens before hematopoietic stem cell transplantation (HSCT), such as total body irradiation (TBI) or busulfan/cyclophosphamide (BU/CY), are associated with hepatic veno-occlusive disease (HVOD). However, the mechanism of these regimens on hepatic veno-occlusive disease remains unclear. The aim of this study is to evaluate the effect of TBI or BU/CY on HVOD in mice after HSCT. Mice received TBI or BU/CY followed by HSCT. Analysis of liver pathology and function, and platelet aggregation were performed. Both these regimens caused damage to liver sinusoid endothelial cells, leading to loss of normal structural integrity of liver sinusoid, abnormal liver function, fibrin deposition, inflammatory cells infiltration and platelet aggregation. No differences of liver function in these regimens were observed. Increased hepatic lipid droplets, mitochondrial swelling and higher incidence of HVOD were observed in BU/CY. In conclusion, both TBI and BU/CY caused damage to liver sinusoid endothelial cells and occurrence of HVOD with higher incidence for BU/CY. Meanwhile, inflammation and platelet activation was also observed, suggesting targeting them maybe beneficial in the prophylaxis of HVOD.

Dexamethasone in outcome of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Acute-on-chronic liver failure (ACLF) caused by hepatitis B virus (HBV) is a severe disease with high mortality. Immune injury plays an important role during the early stage of the disease. Our research aimed to investigate the safety and efficacy of dexamethasone therapy for patients with HBV-related ACLF. A total of 134 inpatients with HBV-induced ACLF were enrolled from January 2009 to December 2012. All the patients received the standard medicine treatment (SMT), among whom 31 cases underwent additional dexamethasone injection for three times (dexamethasone treatment [DMT] Group). A total of 35 patients (SMT Group) matched for baseline characters served as controls. Both the groups were followed up for 12 weeks. The survival rates, liver functions, and complications were recorded. The 12-week cumulative survival rates were 45.7% (16/35)and 48.4% (15/31) for SMT Group and DMT Group, respectively, and no significant differences were found (P = 0.959). There were no dramatic differences in liver function and model for end-stage liver disease (MELD) score at 1, 2, 4, 8, and 12 weeks between two groups. There were no significant differences in the incidence of complications (i.e. infection, gastrointestinal bleeding, encephalopathy, hepatorenal syndrome, and ascites) from 1 to 12 weeks between Group SMT and Group DMT. More than 40 ages, MELD score more than 28 and encephalopathy were independent risk factors for the mortality of patients. Dexamethasone cannot improve liver functions and 12-week survival rates of patients with HBV-related ACLF. Age, MELD score, and encephalopathy are independent risk factors.

Interest of a new biodegradable stent coated with paclitaxel on anastomotic wound healing after biliary reconstruction

Benign biliary stricture of anastomotic stoma is frequent after biliary reconstruction. To prevent such a complication, a new paclitaxel-coated poly-L-lactide acid (PLLA) biodegradable biopolymer stent was designed. This original device was intended both to exert adequate mechanical support properties and to allow controlled drug delivery from the coating, with the goal of favoring wound healing after biliary reconstruction. PLLA stents coated with three different paclitaxel concentrations were implanted in the biliary anastomosis of mongrel dogs (defining groups B, C, and D, respectively). Dogs without stent placement were included in control group A. Liver function tests and residual dosage of paclitaxel from each stent were measured. Histological data and α-smooth muscle actin immunohistochemical staining of biliary-enteric anastomosis were examined. There were no significant differences in liver function among the four groups and no bile leakage was observed. The paclitaxel-coated stents could slowly release paclitaxel for 9 weeks. In groups C and D, histological examinations showed less granulation tissue and glandular hyperplasia in biliary-enteric anastomosis than in control groups A and B. Submucosal collagen deposition was reduced and α-smooth muscle actin-positive cells decreased significantly, indicating the inhibition of myofibroblast proliferation in groups C and D. PLLA-paclitaxel-coated stents reduced the proliferation of granulation tissue and glandular hyperplasia, and inhibited the myofibroblast proliferation and extracellular matrix overdeposition during the healing process of biliary-enteric anastomotic stoma. This original device may offer a new way for the prevention of benign biliary structure.

The effect of 5 intravenous lipid emulsions on plasma phytosterols in preterm infants receiving parenteral nutrition: a randomized clinical trial

Elevated plasma phytosterol concentrations are an untoward effect of parenteral nutrition (PN) with vegetable oil-based lipid emulsions (LEs). Phytosterols are elevated in neonatal cholestasis, but the relation remains controversial. The objective was to study the effect of 5 LEs on plasma phytosterols in preterm infants. One hundred forty-four consecutive admitted preterm infants (birth weight: 500-1249 g) were studied. Patients were randomly assigned to receive 1 of 5 different LEs: S [100% soybean oil (SO)], MS [50% medium-chain triglycerides (MCTs) and 50% SO], MSF (50% MCTs, 40% SO, and 10% fish oil (FO)], OS (80% olive oil and 20% SO), or MOSF (30% MCTs, 25% olive oil, 30% SO, and 15% FO). Phytosterols in the LEs and in plasma (on postnatal day 7 and day 14) were measured by gas chromatography-mass spectrometry. Patients in the S group had significantly higher total phytosterol intakes than did the other study groups. On PN days 7 and 14, plasma phytosterol concentrations were highest in the S group and lowest in the MOSF group. Despite similar β-sitosterol intakes between the MS and MSF groups, plasma concentrations were significantly lower in the MSF than in the MS group. Only 3 patients (2.1%) developed cholestasis: 1 in the MS, 1 in the MSF, and 1 in the MOSF group. No cases of cholestasis were observed in the S and OS groups. In uncomplicated preterm infants receiving routine PN, we found a correlation between phytosterol intake and plasma phytosterol concentrations; however, cholestasis was rare and no difference in liver function at 6 wk was observed.

Comparison of α2-Macroglobulin Synthesis by Juvenile vs. Mature Rats after Identical Inflammatory Stimulation

Synthesis of α2-macoglobulin (α2M) by 3-week-old juvenile rats was compared to that of mature 7- and 11-week-old rats. Serum concentrations of α2M, interleukin (IL)-6- and cytokine-induced neutrophil chemoattractant (CINC)-1 were measured by enzyme-linked immunosorbent assay. The area under the concentration vs. time curve (AUC) for α2M was significantly different among the three groups. The synthesis of α2M increased in an age-dependent manner. No significant difference was observed for the AUC of IL-6, but that of CINC-1 in 3-week-old rats was significantly lower than that in 7- or 11-week-old rats. These results suggest that synthesis of α2M was increased in mature compared to juvenile rats, possibly due to differences in liver function. The maximum concentration of CINC-1 in 3-week-old rats was observed 6 h after turpentine oil injection. The serum concentrations of IL-6 and CINC-1 increased more quickly in juvenile rats than in mature rats after inflammatory stimulation.

Age- and sex-dependent DNA hypomethylation controlled by growth hormone in mouse liver

In mammals, differences in liver function and aging have been observed between sexes; however, the epigenetic mechanisms underlying such differences remain largely unexplored. In this study, we investigated sex- and age-dependent DNA methylation status in the mouse liver. We analyzed 90 known sex-differentially expressed genes, and identified sex-dependent methylation in Zfp809, Hsd3b5, Treh, Cxcl11, Cyp17a1, and Nnmt genes. After 4 weeks of age, we noted the gradual establishment of sex-dependent hypomethylation in each of these genes in either males or females. The exposure of male mice to female-like growth hormone (GH) profile repressed male-predominant hypomethylation and promoted female-predominant hypomethylation. The occurrence of age-dependent hypomethylation, including at loci for which we also observed sex-dependent changes in DNA methylation, was accompanied by the downregulation of DNMT3A/B. In addition, we found that age-dependent hypomethylation was promoted through liver regeneration induced by partial hepatectomy, suggesting that DNMT activities were not enough to retain methylation levels. In conclusion, our results demonstrate that sex-dependent GH profiles influence the age-progressive hypomethylation under decreased DNMT3A/B levels in certain regions of the genome.

Sex-dependent hepatic transcripts and metabolites in the development of glucose intolerance and insulin resistance in Zucker diabetic fatty rats

Male Zucker diabetic fatty (mZDF) rats spontaneously develop type 2 diabetes, whereas females only become diabetic when fed a diabetogenic high-fat diet (high-fat-fed female ZDF rat, HF-fZDF). The aim of this study was to investigate if differences in liver functions could provide clues to this sex difference. Non-diabetic obese fZDF rats were compared with either mZDF or HF-fZDF regarding hepatic molecular profiles, to single out those components that might be protective in the females. High-fat feeding in fZDF led to enhanced weight gain, increased blood glucose and insulin levels, reduced insulin sensitivity and a trend towards reduced glucose tolerance, indicative of a prediabetic state. mZDF rats were diabetic, with low levels of insulin, high levels of glucose, reduced insulin sensitivity and impaired glucose tolerance. Transcript profiling and capillary electrophoresis time-of-flight mass spectrometry were used to indentify hepatic transcripts and metabolites that might be related to this. Many diet-induced alterations in transcript and metabolite levels in female rats were towards a 'male-like' phenotype, including reduced lipogenesis, increased fatty acid (FA) oxidation and increased oxidative stress responses. Alterations detected at the level of hepatic metabolites, indicated lower capacity for glutathione (GSH) production in male rats, and higher GSH turnover in females. Taken together, this could be interpreted as if anabolic pathways involving lipogenesis and lipid output might limit the degree of FA oxidation and oxidative stress in female rats. Together with a greater capacity to produce GSH, these hepatic sex differences might contribute to the sex-different development of diabetes in ZDF rats.

The experimental study of magnetic resonance diffusion-weighted imaging to the treatment of acute hepatic injury with allogeneic MBMCs transplantation into liver

To investigate the therapeutic effect of mononuclear bone marrow cells (MBMCs) transplantation to rabbit liver with acute hepatic injury (AHI) and the feasibility that evaluated the functional recovery of acute hepatic injury model with MR-DWI. 10 healthy rabbits were chosen to be normal control group which was only carried out MR-DWI scan of normal liver. 42 model rabbits of acute liver injury were randomly selected and divided into 2 groups:transplanted group (n = 21) and control group(n = 21). Each rabbit of the transplanted group was infused 5 ml MBMCs suspension (about containing 2 × 10⁷ MBMCs) into its liver at multiple sites. All manipulations to each rabbit in the control group were as same as those in the transplanted group except that 5 ml of D-Hanks solution was injected instead of MBMCs suspension.7 model rabbits respectively chosen from the transplanted group and the control group were carried out MR-DWI scan and calculated the mean ADC value of the injury liver and then were killed on day 7, day 14 and day 28 of AHI establishment after transplantation. Other comparative assays were performed including: functional assay of liver, pathological examination of liver sections. Before MBMCs transplantation, the difference of liver function was not significant between the transplanted group and the control group. But after MBMCs transplantation, the liver functions of the transplanted group were significantly better than those of the control group at all time points tested (P < 0.05). On day 7 of AHI establishment after MBMCs transplantation, the mean ADC values of the transplanted group and the control group were significant lower than those of the normal control group (P < 0.05). The mean ADC values of the transplanted group and the control group increased to the mean ADC values of the normal control group over time. At the same time point, the mean ADC values of the transplanted group were significantly higher than those of the control group. In the transplanted group, the difference of average ADC values between any two time points were significantly (P < 0.05). In the control group, the mean ADC values on day 7 were lower than those on day 14 and day 28 (P < 0.05), the mean ADC values on day 14 were lower than those on day 28 (P = 0.417). The correlation between the average ADC value and the ALT or AST was negative (P < 0.05), the correlation between the average ADC value and the ALB was positive (P < 0.05). Along with the increase of the average ADC value, the liver function of the AHI model rabbit gradually got better. Transplantation of MBMCs promoted the recovery of liver function of AHI model rabbit. The recovery of the injury liver could be detected with observing dynamic change of its mean ADC value.

Liver Function Tests Profile in Cancer Patients on Cytotoxic Chemotherapy: A preliminary report

To assess liver function in Nigerian cancer patients undergoing cytotoxic chemotherapy, with a view to contributing to the existing literature and possibly making recommendations for better management of the affected patients in Nigerian hospitals. Serum levels of total bilirubin (TB), alanine amino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), total protein (TP), albumin (ALB) and De Ritis ratio (AST/ALT) were determined in 50 cancer patients both before and after chemotherapy and 50 age- and sex-matched control individuals. The data obtained were analysed using Microsoft Office Excel 2003. Two-tailed student's t- test for matched samples and Pearson's linear correlation statistical methods were employed for the analyses. The levels of serum ALT, AST, ALP and TB, ALB, TP and AST/ALT were significantly higher in cancer patients than in controls both before and after chemotherapy, with more pronounced elevations after chemotherapy. There were positive and significant correlations between cycles of chemotherapy and the serum liver function tests. The findings from the present study conclude that there is slight difference when compared to controls in liver function test profile in cancer patients even before commencement of chemotherapy with a worsening of the profile of patients after chemotherapy. This difference in liver function also increases with the cycles of chemotherapy.

The application of ω-3 fish oil fatty emulsion in the early stage of liver transplantation

Objective To evaluate the effect of omega-3 fatty emulsion on liver function, immune function and inflammatory reaction following liver transplantation. Methods Sixty-four patients who had undergone liver transplantation from January 2008 to December 2009 were equally divided into therapeutic group and control group (n = 32). After liver transplantation, the control group was treated routinely, on the basis of conventional therapy, and the patients in the therapeutic group were added with ω-3 fish oil fatty emulsion. At the 10th day, the liver function, levels of cytokines [tumor necrosis factor (TNF), interleukin ( IL)-1]and incidence of rejection and infection were compared. Results There were no significant differences in liver function, the incidence of rejection ( 12. 5% vs. 9.4% ) and infection ( 18.8% vs.25.0% ) between the two groups. The mortality was 0 in therapeutic group and 6. 25% in control group. The levels of TNF-α and IL-1 level in therapeutic group were significantly lower than in control group ( P <0. 05 ) , also lower than those before operation (P < 0. 05 ). Conclusion It is effective and safe to use ω-3 fish oil fatty emulsion in the early stage of liver transplantation. Without interfering with the immune suppression, It reduces the release of inflammatory mediators and improves the prognosis of severe infection. Key words: Liver transplantation; ω-3 fish oil fatty emulsion; TNF-α; IL-1

Favorable clinical outcome using a covered stent following transjugular intrahepatic portosystemic shunt in patients with portal hypertension

To compare retrospectively the clinical outcomes in patients treated with transjugular intrahepatic portosystemic shunt (TIPS) using the novel polytetrafluoroethylene-covered stents (Fluency) and bare stents. Sixty consecutive patients with portal hypertension treated with TIPS from April 2007 to April 2009 were included. TIPS creation was performed with Fluency stent grafts in 30 patients (group A) and with bare stents in 30 patients (group B). Liver function, TIPS patency and clinical outcomes were evaluated every 3 months after procedures. During hospitalization, there were no cases of hepatic encephalopathy (HE) and recurrence of variceal bleedings. Acute shunt occlusion was found in one patient in each group. Follow-ups were performed in group A with average time of 6.16 +/- 3.89 months and in group B with 8.34 +/- 4.42 months. The rates of recurrent bleeding, shunt occlusion, HE and mortality were 0.03, 0.0, 16.7 and 0% in group A, and 20.0, 30.0, 20.0 and 13.3% in group B, respectively. There was no difference of HE between group A and group B. The decrease of portal pressure and portosystemic pressure gradient, and the increase of portal flow were 34.1 and 23.3%, 60.0 and 52.8%, and 189.5 and 111.1% in group A and B, respectively. There were no differences of liver function between group A and B. The Fluency stent graft is relatively safe and effective in TIPS creation, with a high patency rate compared with bare stents.

The retrospective study of transjugular intrahepatic portosystemic shunt with covered or uncovered stents in patients with portal hypertension

To retrospectively compare the clinical outcome in patients with portal hypertension treated with transjugular intrahepatic portosystemic shunt (TIPS) using Fluency stent-graft (PTFE-covered stents) or bare stents. Approval of study and treatment protocol and waiver of informed consent for the retrospective study were obtained from institutional review board. Informed consent was obtained from each patient before procedure. Sixty consecutive patients with portal hypertension treated with TIPS from April 2007 to April 2009 were included. TIPS creation was performed with Fluency stent-graft in 30 patients (group A) and with bare stents in 30 patients (group B). Liver function, TIPS patency and clinical outcome were evaluated every 3 months. During hospitalization, there was no hepatic encephalopathy and recurrency of variceal bleeding.Acute shunt occlusion was observed in one patient with group A and another patient with group B.Follow-up was performed with average time of (6.2 +/- 3.9) months in group A and (8.3 +/- 4.4) months in group B. The rates of recurrent bleeding, acute shunt occlusion, hepatic encephalopathy and death were 3.3% and 20.0%, 0 and 30.0%, 16.7% and 20.0%, 0 and 13.3% in group A and B. The rates of recurrent bleeding, acute shunt occlusion and death in group A was lower than those in group B. There was no difference of hepatic encephalopathy between group A and B. The decrease of portal pressure and portosystemic pressure gradient, and the increase of portal flow and shunt flow in group A were higher than those in group B. There were no difference of liver function, ammonia and MELD between group A and B. Fluency stent-graft is safe and effective in TIPS creation, with high patency rate. Covered-stent can improve the clinical outcome of portal hypertension.

Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma: A cohort study

To prospectively evaluate the short and long term clinical impact of selective transarterial chemoembolization (TACE) on liver function in patients with hepatocellular carcinoma (HCC). To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine-aminotransferase (ALT), prothrombin time (PT) and bilirubin. According to Cancer Liver Italian Program (CLIP) and Barcelona Clinic Liver Cancer (BCLC) staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed "on demand". Liver function tests were checked in all patients every four months. After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 +/- 1.12 to 6.11 +/- 1.57 at discharge time (P < 0.0001), decreasing after four months to 5.81 +/- 0.73 (not significant). ALT, PT and bilirubin significantly (P < 0.0001) increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 +/- 6.3 mo (median: 16 mo). Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. Selective TACE may produce significant, but transitory increases in ALT values, with no major impact on liver function and Child-Pugh score. Preservation of liver function is achievable also in patients previously treated with other therapeutic modalities and in patients undergoing multiple TACE cycles. Liver function can remain stable in the long-term, with optimal medium term survival. This result can be achieved through rigorous patient selection on the basis of tumour characteristics and clinical conditions.

Effect of graft steatosis on liver function and organ survival after liver transplantation

BackgroundIt was the aim to determine the effect of graft steatosis on intraoperative organ blood flow, postoperative liver function, and organ survival. MethodsA total of 225 consecutive liver transplants were reviewed. Liver blood flow, hepatic function (AST, ALT, prothrombin time), and organ survival were determined. Donor liver grafts were categorized into 2 subgroups: mild (<30%) (n = 175) and moderate to severe (≥30%) (n = 50) macrovesicular steatosis. ResultsModerate to severe steatosis was associated with significantly increased AST and ALT levels and significantly diminished prothrombin time on the first and second postoperative day. By day 7 differences in liver function were no longer evident. Organ blood flow was not affected by steatosis. After adjustment for potential confounders, organ survival did not depend on the degree of donor steatosis (5-year-survival rates: 68% and 58% with steatosis <30%, or ≥ 30%, respectively) (hazard ratio .754, confidence interval .458–1.242, P = .268). ConclusionSteatotic livers can be transplanted safely with good results for long-term organ survival if other contraindications are absent.

Effect of fire smoke on some biochemical parameters in firefighters of Saudi Arabia

BackgroundFirefighters who are facing fires, are frequently exposed to hazardous materials including carbon monoxide, hydrogen cyanide, hydrogen chloride, benzene, sulphur dioxide, etc. This study aimed to evaluate some relevant serum biochemical and blood hematological changes in activity involved firefighters in comparison to normal subjects.Subjects and MethodsTwo groups of male firefighters volunteered to participate in the study. The first included 28 firefighters from Jeddah, while the second included 21 firefighters from Yanbu, with overall age ranged 20–48 years. An additional group of 23 male non-firefighters volunteered from both cities as normal control subjects, of age range 20–43 years. Blood samples were collected from all volunteer subjects and investigated for some relevant serum biochemical and blood hematological changes.ResultsThe results obtained showed that, there were statistically significant differences in liver function, kidney function, serum lipid profile, cortisol, creatine kinase, lactate dehydrogenase, iron and its biologically active derivatives, and blood picture in firefighters as compared with the normal control group. These results indicate that, fire smoke mainly affects serum biochemical and blood hematological parameters. Such results might point out to the need for more health protective and prophylactic measures to avoid such hazardous health effects that might endanger firefighters under their highly drastic working conditions.ConclusionBesides using of personal protective equipments for firefighters to protect them against exposure to toxic materials of fire smoke, it is recommended that, firefighters must be under continuous medical follow up through a standard timetabled medical laboratory investigations to allow for early detection of any serum biochemical or blood hematological changes that might happen during their active service life and to allow for early treatment whenever necessary.