Patients In Child-Pugh Research Articles

Correlation Between Portal Venous Dimensions And Liver Stiffness In Patients Of Child Pugh A Cirrhosis

BACKGROUND: Liver cirrhosis is an end-stage liver disease characterized by pathologic fibrosis and regenerative nodules with resultant liver dysfunction. The diagnostic hallmark of portal hypertension is slow flow velocities in addition to the increased caliber of the mean portal vein. That is, the diagnosis of portal hypertension requires the measurement of mean portal velocity and portal diameter, and the correlation between cirrhosis and mean portal velocity and port diameter is the correlation between liver cirrhosis and its complications.OBJECTIVE: To analyze the correlation between portal vein dimensions and liver stiffness in patients of Child-Pugh A cirrhosis.METHOD: This study was a cross-sectional study on 30 subjects with Child-Pugh A liver cirrhosis. The subjects of this research are patients who come to the Radiology Department of the Dr. Kariadi Hospital in Semarang for point shear wave elastography and abdominal ultrasound examination from January to December 2022. Spearman test correlation was used for the analysis.RESULT: Spearman test showed no correlation between liver stiffness and portal vein diameter (p=0.250, r= -0.217), liver stiffness and mean portal vein velocity (p=0.883, r= -0.028), and portal vein diameter with mean venous velocity in Child-Pugh A liver cirrhosis (p = 0.979, r = 0.005)

Albumin-Bilirubin grade predicts prognosis of HCC patients with sorafenib use.

The Albumin-Bilirubin (ALBI) grade is a new index to assess objectively liver function and prognosis in patients with hepatocellular carcinoma (HCC). This study aimed to elucidate the application of ALBI grade in baseline and sorafenib-end in advanced HCC patients who received sorafenib. A total of 415 consecutive advanced HCC patients in Child-Pugh A received sorafenib in our hospital. Sorafenib was terminated when radiologic tumor progression or clinical liver function deterioration (LD) occurred in the reassessment bimonthly. Patients who failed with sorafenib monotherapy were retrospectively analyzed. A total of 260 (62.6%) patients were enrolled, including 98 (37.7%) ALBI grade I and 162 (62.3%) grade II in baseline. More patients in ALBI grade II stopped sorafenib because of LD than in grade I (33.3% vs 14.3%, P<0.001). Those who in baseline ALBI grade I had a superior overall survival than in grade II (8.5months vs 4.4months, P=0.003). Cox regression analysis confirmed that baseline ALBI grade II (P<0.001) and ALBI grade increase during treatment (P<0.001) strongly contributed to the mortality of HCC patients who received sorafenib. After sorafenib failure, those with post-sorafenib treatment had a better post-sorafenib survival than those without (9.3 vs 1.6months, P<0.001). Logistic regression analysis indicated that sorafenib-end ALBI grade and LD occurrence were the only two predictors of post-sorafenib treatment after sorafenib failure. In clinical practice, we firstly demonstrated that not only ALBI grade in baseline but also ALBI grade change during treatment could predict the prognosis of advanced HCC patients who received sorafenib.

Effects of transjugular intrahepatic portosystemic shunt combined with left gastric vein embolization on the liver function of patients with liver cirrhosis

Objective To compare the difference in the effects on liver function between transjugular intrahepatic portosystemic shunt (TIPS) alone and the combination of TIPS and left gastric vein embolization (LGVE) in patients with liver cirrhosis. Methods This research was a retrospective study. From September 2014 to September 2015, 31 patients with liver cirrhosis underwent TIPS (TIPS group) and 29 patients with liver cirrhosis underwent TIPS combined with LGVE (TIPS+ LGVE group) were enrolled. The data of the liver function of patients before and after operation were collected and the Child-Pugh score and model for end-stage liver disease (MELD) were also calculated. Student's t test and chi-squared test were performed for statistical analysis. Results The preoperative portal vein pressures of TIPS group and TIPS+ LGVE group were (28.48±2.77) mmHg (1 mmHg=0.133 kPa) and (28.38±2.92) mmHg, respectively. And after operation, the portal vein pressures decreased to (17.81±1.47) mmHg and (17.97±2.04) mmHg, respectively, and the differences were both statistically significant (t=18.908 and 11.648, both P<0.01). At 12 months after operation, Child-Pugh score of TIPS+ LGVE group was 5.69±1.19, which was significantly lower than that before operation (7.03±1.76), and the difference was statistically significant (t=3.398, P=0.001), which was also lower than that of TIPS group at the same time point (6.52±1.54), and the difference was statistically significant (t=2.303, P=0.025). At 12 months after operation, the component ratio of patients with Child-Pugh grade A of TIPS+ LGVE group was 89.7% (26/29), which was higher than that before operation (44.8%, 13/29), and the difference was statistically significant (χ2=13.228, P<0.01). The component ratio of patients with Child-Pugh grade B was 6.9%(2/29), which was lower than that before operation (41.4%, 12/29), and the difference was statistically significant (χ2=9.416, P<0.01). Conclusions TIPS significantly reduces portal vein pressure in patients with liver cirrhosis and it does not deteriorate liver function of patients in the long term. The combination of TIPS and LGVE is better than TIPS alone in improving liver function in patients with liver cirrhosis, especially in improvig long-term liver function in patients of Child-Pugh A and B grade. Key words: Portasystemic shunt, transjugular intrahepatic; Left gastric vein embolization; Variceal bleeding; Liver cirrhosis; Liver function

Real-Life Experience of Sorafenib Treatment for Hepatocellular Carcinoma in Korea: From GIDEON Data.

PurposeThe purpose of this study is to report real life experiences of sorafenib therapy for hepatocellular carcinoma (HCC) in Korea, using a subset of data from GIDEON (Global Investigation of Therapeutic Decisions in HCC and of Its Treatment with Sorafenib; a large, prospective, observational study).Materials and MethodsBetween January 2009 and April 2012, a total of 497 patients were enrolled from 11 sites in Korea. Of these, 482 patients were evaluable for safety analyses. Case report forms of paper or electronic version were used to record safety and efficacy data from all patients.ResultsMore patients of Child-Pugh A received sorafenib for > 8 weeks than did patients of Child-Pugh B (55.5% vs. 34.3%). Child-Pugh score did not appear to influence the starting dose of sorafenib, and approximately 70% of patients both in Child-Pugh A and B groups received the recommended initial daily dose of 800 mg (69.0% and 69.5%, respectively). The median overall survival (OS) and time to progression (TTP) were 8.5 months and 2.5 months. In Child-Pugh A patients, the median OS and TTP were 10.2 months and 2.5 months. The most frequent treatment-emergent drug-related adverse event was hand-foot skin reaction (31.7%), followed by diarrhea (18.0%). The incidence of treatment-emergent adverse events was similar in both Child-Pugh A (85.4%) and Child-Pugh B (84.8%) patients.ConclusionSorafenib was well tolerated by Korean HCC patients in clinical settings, and the safety profile did not appear to differ by Child-Pugh status. Survival benefit in Korean patients was in line with that of a previous pivotal phase III trial (SHARP).

Measurement of plasma endotoxin and procalcitonin after endoscopic treatment of esophagogastric varices in liver cirrhotic patients and the clinical significance

Objective To study the changes of plasma endotoxin and procalcitonin in patients with esophagogastric varices and provide a theoretical basis for prophylactic antibiotics after endoscopic treatment. Methods Fifty cases of patients with esophageal and gastric varices accepted the endoscopic treatment. The patients were divided into antibiotic group (32 cases) and non-antibiotic group (18 cases). The plasma endotoxin and procalcitonin were measured before and on the first day and 7th day after endoscopic treatment. Results The plasma levels of endotoxin and procalcitonin were not significantly different on the first and 7th day after endoscopic treatment compared with preoperative levels in antibiotic group. But in non-antibiotic group, the levels significantly increased on 7th day after endoscopic treatment compared with preoperative levels (P<0.05). And in patients of Child-Pugh A grade, the level of plasma procalcitonin significantly increased on 7th day after endoscopic treatment compared with preoperative levels (P<0.01), but the procalcitonin was not significantly different on the first and 7th day after operation. And in patients of Child-Pugh B and C grades, the levels of plasma endotoxin and procalcitonin significantly increased on the 7th day(P<0.01). Conclusion The levels of plasma endotoxin and procalcitonin in non-antibiotic group increase after endoscopic treatment, which suggests the risk of infection. Prophylactic antibiotics after endoscopic treatment should be considered for the patients of Child-Pugh B and C grades. Key words: Esophageal and gastric varices; Endoscopes, gastrointestinal; Endotoxins; Calcitonin

Surgery for early stage hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide, and the curative treatment is available only for tumors detected in early stage. In a critical analysis of the therapeutic options in early stage HCC three potential curatives therapies are possible in early stage HCC: total hepatectomy with liver transplantation (LT), partial hepatectomy and radiofrequency ablation (RFA) of very small tumors. Total hepatectomy with LT has proven to be the best treatment for operable and resectable disease (BCLC 0 and A) in a cirrhotic liver, the liver resection, RFA, transarterial chemoembolization (TACE) or percutaneous injection of alcohol (PIA) can be considered for those patients with waiting list time up to six months. Partial hepatectomy as definitive therapy should be used only for patients with patients in Child-Pugh A and B without portal hypertension. In patients with inoperable but localized disease (BCLC A), the RFA or PIA can be indicated.

Abstract No. 402 - Survivals and predictive factors of metastatic hepatocellular carcinoma (MHCC) treated with doxorubicin drug eluting beads transcatheter chemoembolization (DEB TACE)

<h3>Purpose</h3> To investigate the survivals of patients (pts) with mHCC treated with DEB TACE. <h3>Materials and Methods</h3> Consecutive pts with mHCC who received DEB TACE over last 82 months (m) were studied. Progressive enlargement of the lymph node or lung nodule in subsequent scans was considered as metastasis (mets). Survivals were analyzed according to different staging from diagnosis (dx), from 1st DEB TACE (OS-Emb) and from dx of extra-hepatic mets. Statistical analysis was performed using Kaplan-Meier estimator with log-rank testing. Multivariate analysis was performed using Cox proportional Hazard model. <h3>Results</h3> 69 pts (mean age 59.4 years, SD 12.7) were included in this study. Median overall survivals (OS) from dx, 1st DEB TACE and mets were 10.9, 7.4 and 7.2 m. Median OS-Emb per site of extra-hepatic mets are shown in the Table. Two patients received adrenal radiofrequency ablation (RFA) of adrenal mets (n=2) had a median OS of 20m vs 4.8 in patients who did not receive adrenal RFA (p=0. 65). Extra-hepatic mets were present before 1st DEB TACE in 81% of pts vs after 1st DEB TACE in 19%; median OS-Emb 6.7 vs 7.7 m (p=0.9). Child-Pugh Class A, B and C stage were present in 62.3%, 29% and 8.7% of the pts with corresponding median OS-Emb were 10.5m, 5.2m and 1.6m respectively (p<0.001). Okuda stage I, II and III were present in 31.9%, 58% and 10.1% of the pts with corresponding median OS-Emb were 10.6m, 7.4m and 1.6m respectively (p<0.001). 50.7% of pts had portal vein thrombosis (PVT) with median OS-Emb was 4.9m vs 12.1m who did not have PVT (p=0.1). 44.9% of pts received sorafenib systemic chemotherapy with median OS-Emb was 10.5 m vs 5.5 m who did not receive the sorafenib (p=0.1). The following variables were significant prognostic indicators of survival on multivariate analysis; site of mets, Child-Pugh class and Okuda stage. <h3>Conclusion</h3> mHCC patients in Child-Pugh A, isolated mets to adrenal or lung or portahepatic node and Okuda stage I benefited most from DEB TACE therapy. Table 1 Table 2

A sonographic doppler study of hepatic vein, portal vein and hepatic artery in liver cirrhosis: correlation of hepatic haemodynamics and liver dysfunction

s / Clinical Radiology 67 (2012) S1–S10 S10 Results: We present a comprehensive pictorial review of the features of PAPVD across several imaging modalities, including tips for the general radiologist. We also describe the congenital associations which, if present, should prompt a search for PAPVD. Knowledge of the above is important particularly in the diagnostically challenging patient or where precise anatomicalmappingof thepulmonaryveins is requiredprior to intervention. Conclusion: The radiologist plays an important role in diagnosing PAPVD. A knowledge of the imaging features will lead to prompt diagnosis and facilitate pre-procedural planning, contributing to a favourable patient outcome. The CT features of chronic thromboembolic pulmonary hypertension (CTEPH) Authors: Shalini Wijesuriya, Ladli Chandratreya Purpose: Chronic occlusion of pulmonary arteries by emboli can lead to a progressive elevation of pulmonary artery pressures with sequelae such as chronic thromboembolic pulmonary artery hypertension (CTEPH) and right ventricular dysfunction. Diagnosis and early recognition of CTEPH is crucial as it is potentially curablewith pulmonary thromboendarterectomy and if left untreated, is associatedwith significant morbidity andmortality. Unfortunately, patients may go undetected for years and diagnosis is made challenging by the non-specific nature of the clinical presentation. CTEPH is being increasingly recognised and as the radiologist may be the first individual to make a diagnosis of CTEPH, knowledge of the conventional and less common CT features is crucial. Methods and materials: A pictorial review of cases of chronic thromboembolic pulmonary hypertension based on experiences at our institution. Results: We present a comprehensive pictorial review of the vascular, cardiac and pulmonary parenchymal CT features of chronic thromboembolic pulmonary hypertension. Furthermore, we discuss potential pitfalls and help distinguish CTEPH from other common mimics such as acute embolism and idiopathic pulmonary hypertension. Conclusion: We hope that highlighting the key diagnostic features in CTEPH will improve confidence, notably amongst trainees, leading to fewer diagnostic delays and an improvement in overall patient outcome. A sonographic doppler study of hepatic vein, portal vein and hepatic artery in liver cirrhosis: correlation of hepatic haemodynamics and liver dysfunction Authors: Richard H. Lo, Azizah Mohamed Afif, Yanyan Wang, Denise Lau, Chin C. Ooi Purpose: To evaluate parameters involved in haemodynamics of liver vasculature in patients with cirrhosis and in normal healthy volunteers using Doppler Ultrasound. Methods and Materials: A study sample of 32 patients with Child-Pugh A (n1⁄425), B (n1⁄45), and C (n1⁄42) liver cirrhosis was compared with a control group of 26 normal health screening participants. Right hepatic vein (RHV), right portal vein (RPV) and main hepatic artery were interrogated. Results: All patients in control group showed normal triphasic waveform in RHV. In the study group, RHV blunted waveform was detected in 3 patients in Child-Pugh A, 1 in B and all patients in C category. Waveform alteration was independent of Child-Pugh score. Hepatic Artery Resistive Index (HARI) was significantly higher in study group than in control group (p<0.001). Maximum Portal Vein Velocity (MPVV) also was significantly lower in study group than in control group (p1⁄40.02). Mean Maximum Hepatic Vein Velocity (MHVV) and Maximum Hepatic Artery Velocity (MHAV) did not show significant difference between the 2 groups, with p1⁄40.16 and p1⁄40.38 respectively. Conclusion: Altered waveform of hepatic veins is suggestive of changes within a cirrhotic liver. HARI and MPVV can be useful parameters to assess liver cirrhosis. Doppler Ultrasound is a good non-invasive assessment tool for evaluating the haemodynamics of liver cirrhosis.

T-5 Oncostatin M, overexpressed in hepatocellular carcinoma, up-regulates SERPIN-B3 expression in hepatic cancer cells

Background: In the western world HCV is the leading etiologic factor of HCC. Overall HCV impact on HCC-related mortality is increasing, but recent data from Italy suggest an initial drop. Aims: To evaluate epidemiology, clinical features and survival of HCV-related HCC in a wide time range in Italy. Methods: Multicenter retrospective study including 2769 patients prospectively recruited by the ITA.LI.CA group. The patients were classified in 3 groups (Group A [G.A.], HCV associated or not with other etiologies, Group B [G.B.], pure HCV, and Group C [G.C.], alternative etiologies) and sub-grouped in 5 years time cohorts (1986-90, 91-95, 96-2000, 2001-2005) but for the last one (2006-2008). Age, gender, Child-Pugh status, diagnosis for surveillance, stage, thrombosis and metastases, treatment and survival (Kaplan-Meier, Log-Rank) were analyzed. Results: 1780 patients were included in G.A., 1430 in G.B., 989 in G.C. The number of G.A. and G.B. patients reached a peak in the 1996-2000 to then gradually drop, lowest values being observed in the last three years (p=0.0001 G.A., 0.01 G.B.). Mean age at diagnosis progressively increased in G.A. (p<0.0001) and G.B. (p<0.001), but not in G.C, as did the percentage of cases diagnosed under surveillance (G.A. p=0.019, G.B. p=0.0038) and the share of patients in Child-Pugh A stage (G.A. p=0.01, G.B. p=0.007). Tumor size decreased in all subgroups, stage improved significantly only in G.B. Median survival significantly increased in all groups but more significantly in G.A. and G.B., with a significant difference among G.A. and G.B. vs G.C. in the last 3 time periods (p=0.02). Conclusions: The incidence of HCC in HCV-related liver disease is decreasing in Italy since 2001. HCV-related HCC patients are older, more frequently diagnosed under surveillance, more frequently characterized by conserved liver function and smaller tumors, with an earlier tumor stage when HCV is the only etiologic factor. Finally their survival dramatically improved in the last 15 years, more than in patients with different etiology. We therefore expect a further drop in incidence and mortality for the disease in Italy in the years to come.

The intermediate hepatocellular carcinoma stage: Should treatment be expanded?

The most utilized staging system for establishing the prognosis of patients with hepatocellular carcinoma (HCC) and concurrently supporting the choice of best treatment strategy is the Barcelona Clinic Liver Cancer (BCLC), which includes 4 disease stages (early, intermediate, advanced, terminal). The BCLC intermediate stage (BCLC-B) consists of patients in Child-Pugh A or B with multinodular large HCC and preserved performance status. This definition is rather broad and includes a heterogeneous patient population, according to either tumor extension (from bifocal HCC to subtotal tumor replacement of liver parenchyma) or liver function (from Child-Pugh compensated A5 to decompensated B9). The recommended treatment modality for this HCC stage is, in general, transarterial chemoembolization (TACE). However, according to the heterogeneity of the intermediate population, patients are best served when the treatment decision is individualized and taken within a multidisciplinary team. For instance, patients in Child-Pugh B may not benefit at all from TACE or even suffer detrimental effects. TACE achieves complete radiological necrosis in about 35–60% of cases (after 2–3 courses). Patients not achieving complete necrosis and patients with early large recurrence should be managed individually, taking into consideration systemic treatments, which usually are reserved for advanced cases.

Endoscopic sphincterotomy versus surgery in treatment of choledocholithiasis concomitant with liver cirrhosis

Objective To compare the therapeutic efficacy and procedure related complications between endoscopic sphincterotomy （EST） and surgery in treatment for choledocholithiasis concomitant with liver cirrhosis. Methods The data of patients with choledocholithiasis concomitant with cirrhosis who underwent EST （n = 139） or surgery （n =98） for stone clearance from August 1985 to May 2008, were retrospectively analyzed and compared. Results The success rates of complete stone clearance in EST and surgery groups were 95% and 100% , respectively. There was a significant difference in the rate of procedure-related complications between EST and surgery groups （ 16. 5% vs. 62. 2% , P 〈0. 01 ）, as well as the mortality rate （5.0% vs. 24. 5% ）. When patients were further grouped according to Child-Pugh liver function classification, a siguifieant difference in rate of procedure-related complications was detected between 2 groups in patients of Child-Pugh B and C, as well as the mortality rate in patients of Child-Pugh C. Conclusion For patients with choledocholithiasis concomitant with liver cirrhosis, EST, with a stone clearance rate at 95% , is superior to surgery with a significant reduction in risk of procedure-related complication and mortality rate. Key words: Liver cirrhosis ; Choledocholithiasis ; Endoscopic sphincterotomy ; Surgical procedures

Percutaneous Ethanol Injection in the Treatment of Hepatocellular Carcinoma: A Multicenter Survey of Evaluation Practices and Complication Rates

Background: Percutaneous ethanol injection (PEI) has become a widely used procedure in the treatment of hepatocellular carcinoma (HCC). However, the criteria for selecting patients are not standardized, and little information is available about the complications of the procedure. Methods: A questionnaire was sent to 11 experienced Italian centers. It investigated: the size and the number of HCC nodules suitable for treatment and the Child-Pugh risk class of the associated cirrhosis; the performance of the procedure; the number and characteristics of the patients treated; and, finally, any complications. Results: Most of the centers performed PEI in single HCC nodules less than 5 cm in diameter or in multiple nodules if fewer than three, the larger being less than 3 cm. Patients in Child-Pugh's classes A, B, and C with single nodules were generally considered for PEI. A prothrombin time of less than 40% and a platelet count of less than 40, 000/mm3 contraindicated PEI in most of the centers. PEI was generally performed on outpatients, using Chiba or spinal needles. One thousand and sixty-six patients (8118 sessions) were enrolled; 74% had a single HCC nodule and 26% multiple nodules. All except four had cirrhosis; 53% were in Child class A, 38% in class B, and 9% in class C. The mean number of sessions needed to destroy an HCC nodule was 6.7 (range, 2–14), with a mean alcohol injection volume of 5.0 ml per session (range, 2–20 ml). One death (0.09%) and 34 complications (3.2%) were reported. Among the complications we call attention to the hemorrhagic ones (eight cases) and tumoral seeding (seven cases). Severe pain experienced during the maneuver led to discontinuation of the procedure in 3.7% of the patients; 13.5% of the patients required analgesics and 24% had fever after PEI. Conclusions: Some procedural aspects of PEI treatment differ among the various centers: a standardization is advisable. In the present survey PEI is a low-risk technique.