Post-liver Transplant Patients Research Articles

Systemic Thrombolysis of Acute Portal Venous System Thrombosis in Patients with Liver Cirrhosis: A Pilot Study

Background The prevalence of Portal Vein Thrombosis (PVT) is highly variable at different stages of liver disease: in compensated patients 10%, in decompensated patients 17%, in acute decompensated cirrhosis 9%, and in post-liver transplantation patients 2-26%. Aim The aim of the study was to assess the efficacy and safety of systemic thrombolysis in acute portal vein thrombosis in patients with liver cirrhosis. Methods A total of 10 compensated cirrhotic patients with acute portal vein thrombosis were examined by abdominal ultrasonography with color Doppler and Contrast-enhanced computerized tomography. Continuous intravenous infusion of recombinant tissue plasminogen activator(r-tPA.) and Low molecular weight heparin (LMWH) was used to treat all patients for a maximum of 7 days. Patients were followed up for improvement of clinical symptoms and radiological by abdominal ultrasound with color Doppler and contrast-enhanced computerized tomography. Results The regimen of therapy was found to be well-tolerated by all the patients. At the end of the seven days, six patients (60%) had full recanalization of the portal vein, while three had partial recanalization (30%) and no recanalization in only one patient (10%). Conclusion The preliminary data indicate that systemic thrombolytic therapy combined with low molecular weight heparin for the treatment of PVT appears to be safe and effective over a few days with no clinically significant side effects.

Fluid Responsiveness Is Associated with Successful Weaning after Liver Transplant Surgery.

A positive fluid balance may evolve to fluid overload and associate with organ dysfunctions, weaning difficulties, and increased mortality in ICU patients. We explored whether individualized fluid management, assessing fluid responsiveness via a passive leg-raising maneuver (PLR) before a spontaneous breathing trial (SBT), is associated with less extubation failure in ventilated patients with a high fluid balance admitted to the ICU after liver transplantation (LT). We recruited 15 LT patients in 2023. Their postoperative fluid balance was +4476 {3697, 5722} mL. PLR maneuvers were conducted upon ICU admission (T1) and pre SBT (T2). Cardiac index (CI) changes were recorded before and after each SBT (T3). Seven patients were fluid-responsive at T1, and twelve were responsive at T2. No significant differences occurred in hemodynamic, respiratory, and perfusion parameters between the fluid-responsive and fluid-unresponsive patients at any time. Fluid-responsive patients at T1 and T2 increased their CI during SBT from 3.1 {2.8, 3.7} to 3.7 {3.4, 4.1} mL/min/m2 (p = 0.045). All fluid-responsive patients at T2 were extubated after the SBTs and consolidated extubation. Two out of three of the fluid-unresponsive patients experienced weaning difficulties. We concluded that fluid-responsive patients post LT may start weaning earlier and achieve successful extubation despite a high postoperative fluid balance. This highlights the profound impact of personalized assessments of cardiovascular state on critical surgical patients.

Behavioral prevention of HBV transmission in urban communities toward global elimination of hepatitis in 2030: a systematic review

Hepatitis B is a serious threat to public health on a global scale. The Hepatitis B virus (HBV), which spreads both vertically and horizontally, is easily contracted by anyone. In 2020, the World Health Organization estimates that 257 million people worldwide have hepatitis B, and 900,000 people die from it each year. According to the World Health Organization (2021), there are approximately 39.4 million people in Southeast Asia living with chronic hepatitis B mortality, with 410,000 deaths caused by the disease.  HBV can spread through injections, horizontal transmission, blood transfusions, and organ transplants. Cochrane, Science Direct, PubMed, Elsevier, Sage, Willey, DOAJ, and Google Scholar database sources were used to search for supported research on how to prevent hepatitis virus transmission in urban communities. 15 publications address the primary and secondary prevention of hepatitis B transmission in urban settings. Prevention keeps a person in good health and prevents them from progressing to a later, worse stage. Given that the hepatitis B virus can infect anyone, regardless of age, and that it affects people's health worldwide, as well as their families, communities, and families within them. In order to eradicate the hepatitis B virus, society must be aware of the importance of implementing preventive measures on a continuous and long-term basis through health advocacy activities, hepatitis B virus screening campaigns, health education, counseling, hepatitis B vaccination with community-based activities, and secondary prevention through combination therapy treatment in post-liver transplant patients.

Liver Insights: Probing Molecular Signatures of Hepatitis C Patients in Hospitals of Lahore- Navigating the Clinical Landscape of Viral Infection and Organ Profiling

Background: Hepatitis C virus (HCV) infection is a major public health problem, leading to chronic liver diseases, cirrhosis, and hepatocellular carcinoma. The disease burden is particularly high in developing countries, with significant gender disparities and varied outcomes across different clinical settings. Objective: The study aimed to assess the prevalence of HCV infections, analyze the clinical correlation of demographic factors with patient outcomes, and examine the age-related duration of hospital stays in a Pakistani cohort. Methods: A cross-sectional retrospective study was conducted on 230 symptomatic liver patients from three major hospitals in Lahore. Inclusion criteria were based on HCV-related liver conditions, excluding post-liver transplant patients. Data on viral load detections were obtained via semi-automated RT-PCR with commercially available kits. Statistical analysis was performed using SPSS version 25 and GraphPad Prism 9.0 to determine frequency distributions, cross-tabulation analyses, and Pearson correlation coefficients. Results: Out of the 230 patients, 69% (158) were male, and 31% (72) were female. Age distribution showed 36.7% (58) of males were over 60 years, and 63.3% (100) under 60 years; 55.6% (40) of females were over 45 years, with 44.4% (32) under 45 years. Most referrals came from the Pulmonary ward (35%), followed by the Surgery (30%) and Gastroenterology (20%) wards. HCV RNA detection was positive in 67% (154) of the patients. Cross-tabulation analysis indicated a mortality rate of 39% in the Pulmonary ward. A significant positive correlation (r=0.494, p<0.000) was observed between patient age and days of hospital stay. Conclusion: The study demonstrates a higher prevalence of HCV in males and a notable age-related impact on the duration of hospitalization. Interdisciplinary approaches and gender-sensitive healthcare interventions are essential for effective HCV management.

A289 MAJOR ADVERSE CARDIAC EVENTS (MACE) IN PATIENTS WITH A HISTORY OF LIVER TRANSPLANTATION: A NATIONWIDE ANALYSIS USING THE NATIONAL INPATIENT SAMPLE

Abstract Background Liver transplantation is the preferred treatment for end-stage liver disease. However, in around one-third of transplant recipients cardiovascular disease remains to be a significant contributor to morbidity and mortality. Aims Using data from the national inpatient sample (NIS), this study aimed to assess the prevalence and patient characteristics of MACE in those who underwent liver transplantation. Methods The study used a cross-sectional design to analyze NIS data, comparing MACE prevalence in hospitalized liver transplant patients. MACE included heart-related events. Patients with MACE and liver transplant history were identified using 2013 NIS data and ICD-9-CM codes. Baseline characteristics were compared, and association strength was assessed via logistic regression. Results Out of 33,725 post-liver transplant patients, 26.1% (8,805) had prior MACE. Those with MACE had higher rates of comorbidities: type 2 diabetes (odds ratio (OR) 1.90, 95% CI 1.69-2.13, p ampersand:003C 0.001), hypertension (OR=2.07, 95% CI 1.83-2.34, pampersand:003C 0.001), dyslipidemia (OR=2.27, 95% CI 1.97-2.60, pampersand:003C 0.001), and morbid obesity (OR=1.69, 95% CI 1.39-2.04, pampersand:003C 0.001). Smoking wasn't significantly linked (p = 0.738). Hospitalization with MACE increased in-hospital mortality (3.25%, p ampersand:003C 0.001). Conclusions These findings highlight the importance of proactive cardiovascular risk factor management to minimize the morbidity and mortality of MACE in this patient population. 1: Baseline characteristics of patients admitted to hospital with or without MACE after liver transplantation. Funding Agencies None

Manifestations, Prevalence, Management and Outcome of Invasive Aspergillosis in Post-Liver Transplant Patients.

Aspergillosis is a severe and fatal complication that causes infection in transplant recipients and patients with immunodeficiency syndrome, neutropenia, chronic granulomatosis, and hematologic malignancies. Invasive Aspergillosis has been reported as one of the fungal infections with high mortality in transplant recipients. This study aimed to describe the manifestations, prevalence, management and outcome of invasive Aspergillosis fungal infections in liver transplant patients. This descriptive cross-sectional study was conducted on patients with liver transplantation who were infected with invasive Aspergillosis fungal infections. The data were extracted from the medical records of the archive of Montasryieh Hospital, Mashhad, Iran, between August 2019 and August 2020. In general, 86 patients who had liver transplantation were hospitalized at Montasryieh Hospital from August 2019 to August 2020. Among them, 10 patients were infected with invasive Aspergillosis. Only 6.7% of the patients were categorized under late-onset (> 90 days after liver transplantation), and 93.3% of them were early-onset (< 90 days after liver transplantation). Invasive Aspergillosis fungal infections were suspected based on clinical or radiological signs (possible in 30% of cases; n = 3). The probable diagnosis was reported in 60% (n = 6), and the proven diagnosis was observed only in one patient. In addition, 80% of the patients were diagnosed with Pulmonary Aspergillosis, and two patients had pulmonary Aspergillosis in combination with the central nervous system and cutaneous Aspergillosis. A correlation was found between a comorbid disease and the type of Aspergillosis (r = 0.69; P = 0.02). Voriconazole was effective to treat invasive Aspergillosis in all patients. The prevalence rate of Aspergillosis is relatively high among liver transplant recipient populations (11%). All recipients infected with Aspergillosis had at least one risk factor, including an underlying disease. It seems that Voriconazole therapy is effective among transplant patients with pulmonary Aspergillosis.

Pharmacokinetics and Therapeutic Target Attainment of Meropenem in Pediatric Post-Liver Transplant Patients: Extended vs Intermittent Infusion

The aim of this study is to characterize the concentration-time profile, pharmacokinetics parameters, and therapeutic target attainment of meropenem in pediatric post-liver transplant patients according to the duration of infusion. This is a prospective cohort of pediatric transplant recipients with preserved renal function receiving meropenem 40 mg/kg every 8 hours. The patients were stratified into 2 groups based on infusion duration: G1 (15 minutes of intermittent infusion) and G1 (3 hours of extended infusion). Two blood samples per child were collected during the same interval within 48 hours of starting the antimicrobial. Meropenem concentrations were determined by high-performance liquid chromatography with tandem mass spectrometry. Pharmacokinetic parameters were assessed using a noncompartmental analysis. The therapeutic target was defined as 100% of the time above the minimum inhibitory concentration. Fourteen patients with 28 measured meropenem concentrations were included. Lower values of volume of distribution and meropenem clearance compared with other critically ill pediatric populations were found. All patients achieved the therapeutic target against gram-negative pathogens with a minimum inhibitory concentration of ≤8 mg/L. Patients receiving a 15-minute infusion had higher values of peak and trough concentrations, resulting in unnecessary increased total drug exposure when compared to patients receiving a 3-hour infusion (P < .05). Meropenem at 120 mg/kg/d attained the therapeutic target against sensitive microorganisms in pediatric liver transplant recipients. The extended infusion should be preferred for patient safety. Because of the pharmacokinetic changes resulting from liver transplantation, individualized meropenem dosing regimens may be necessary.

Pharmacokinetics and therapeutic target attainment of vancomycin in pediatric post-liver transplant patients

IntroductionVancomycin is widely prescribed to treat or prevent Gram-positive infections in pediatric liver transplant recipients. The objective of this prospective cohort study is to describe vancomycin pharmacokinetics and to evaluate the therapeutic target attainment after initial dose regimen. Materials and methodsPatients with previous renal injury were excluded. Vancomycin therapy started with 40‒60 mg/kg/day. The pharmacokinetic parameters were assessed using two steady-state blood samples and the first-order kinetic equations. Therapeutic target was defined as vancomycin 24-hour Area Under the Curve/Minimum Inhibitory Concentration (AUC/MIC) ≥ 400 and < 600. ResultsSixteen patients were included. The found vancomycin clearance, half-life, and volume of distribution were, respectively: 2.1 (1.3‒2.8) mL/kg/min, 3.3 (2.7‒4.4) hours, and 0.7 (0.5‒0.9) L/kg. With the initial dose, only 6 (37 %) patients reached the therapeutic target against Gram-positive pathogens with MIC 1 mg/L. After individual dose adjustments, all patients reached the target. The correlation between trough levels and AUC was low (R2 = 0.5). ConclusionsPediatric patients with preserved renal function after liver transplantation have an increased volume of distribution for vancomycin, and most patients present subtherapeutic levels after the standard initial dosing regimen. With the vancomycin AUC-guided monitoring and dosing, it is possible to improve therapeutic target attainment.

De Novo Autoimmune Hepatitis After Liver Transplantation: Natural History and Diagnosis

De novo autoimmune hepatitis (dnAIH) refers to autoimmune hepatitis manifesting in post-liver transplant patients for whom liver transplant was performed for pathologies other than autoimmune hepatitis. dnAIH, also called plasma cell-rich hepatitis though rare, is a form of graft rejection and is one of the causes of late graft dysfunction. This paper reviews the literature on the subject, focusing on the treatment and outcomes of dnAIH in both pediatric and adult populations. Diagnosis of dnAIH relies on serological and histological examinations however dnAIH should not be ruled out in seronegative patients. 

Complications in Post-Liver Transplant Patients.

Liver transplantation (LT) is the treatment of choice for liver failure and selected cases of malignancies. Transplantation activity has increased over the years, and indications for LT have been widened, leading to organ shortage. To face this condition, a high selection of recipients with prioritizing systems and an enlargement of the donor pool were necessary. Several authors published their case series reporting the results obtained with the use of marginal donors, which seem to have progressively improved over the years. The introduction of in situ and ex situ machine perfusion, although still strongly debated, and better knowledge and treatment of the complications may have a role in achieving better results. With longer survival rates, a significant number of patients will suffer from long-term complications. An extensive review of the literature concerning short- and long-term outcomes is reported trying to highlight the most recent findings. The heterogeneity of the behaviors within the different centers is evident, leading to a difficult comparison of the results and making explicit the need to obtain more consent from experts.

The Prevalence of Malnutrition in Post-liver Transplant Patients

The Prevalence of Malnutrition in Post-liver Transplant Patients

TUBERCULOSIS IN LIVER TRANSPLANT RECIPIENT : A SYSTEMATIC REVIEW

Background: Despite claims, transplant recipients' TB rates are random. The rate of posttransplant tuberculosis depends on the organ transplanted, pre-transplant latent tuberculosis screening, and previous antituberculosis medication. This rate may also depend on recipient and donor tuberculosis rates. Active tuberculosis after solid organ transplantation increases the risk of graft loss and death four-fold compared to the general population.&#x0D; Aim: This article examines the link between tubercolis and liver transplant recipient. &#x0D; Methods: This study showed that it met all of the requirements by looking at the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. So, the experts could make sure that the study was as current as possible. The search method used a number of electronic reference databases, such as Pubmed and SagePub, to look for papers that were published between 2000 and 2023. We didn't look at review papers, articles that had already been published, or articles that were only half done. &#x0D; Result: In the PubMed database, the results of our search brought up 66  articles, whereas the results of our search on SagePub brought up 23 articles. The results of the search conducted for the last year of 2013 yielded a total of 23 articles for PubMed and 18 articles for SagePub. In the end, we compiled a total of 20 papers, 16 of which came from PubMed and four of which came from SagePub. We included five research that met the criteria.&#x0D; Conclusion: Patients who have undergone organ transplantation are at high risk of developing latent TB. This shows the importance of administering prophylactic drugs such as isoniazid in post-liver transplant patients.

Role of Biomarkers to Assess the Use of Alcohol.

Alcohol-associated liver disease has seen a significant rise in the last 2 decades, with an associated rise in the need for accurate alcohol use assessment. Alcohol use has been associated with poor outcomes in both the pre-liver transplant and post-liver transplant patients. Patients with alcohol use disorder often under-report their alcohol consumption because of varying factors, highlighting the need for objective assessment of alcohol use. Aside from the available self-report questionnaires, multiple serologic biomarkers are currently available to assist clinicians to assess recent alcohol consumption among patients with chronic liver disease, liver transplant candidates, and recipients. In this review, we will assess some of these alcohol biomarkers, discuss their strengths and weakness, and review-available data to discuss their role in pre-liver transplant and post-liver transplant population.

Graft-Derived Cell-Free DNA Quantification following Liver Transplantation Using Tissue-Specific DNA Methylation and Donor-Specific Genotyping Techniques: An Orthogonal Comparison Study.

Background: Graft-derived cell-free DNA (gdcfDNA) analysis has shown promise as a non-invasive tool for monitoring organ health following solid organ transplantation. A number of gdcfDNA analysis techniques have been described; however, the majority rely on sequencing or prior genotyping to detect donor-recipient mis-matched genetic polymorphisms. Differentially methylated regions of DNA can be used to identify the tissue-of-origin of cell-free DNA (cfDNA) fragments. In this study, we aimed to directly compare the performance of gdcfDNA monitoring using graft-specific DNA methylation analysis and donor-recipient genotyping techniques in a pilot cohort of clinical samples from patients post-liver transplantation. Results: 7 patients were recruited prior to LT, 3 developed early, biopsy-proven TCMR in the first 6 weeks post-LT. gdcfDNA was successfully quantified in all samples using both approaches. There was a high level of technical correlation between results using the two techniques (Spearman testing, rs = 0.87, p < 0.0001). gdcfDNA levels quantified using the genotyping approach were significantly greater across all timepoints in comparison to the tissue-specific DNA methylation-based approach: e.g., day 1 post-LT median 31,350 copies/mL (IQR 6731-64,058) vs. 4133 copies/mL (IQR 1100-8422), respectively. Qualitative trends in gdcfDNA levels for each patient were concordant between the two assays. Acute TCMR was preceded by significant elevations in gdcfDNA as quantified by both techniques. Elevations in gdcfDNA, using both techniques, were suggestive of TCMR in this pilot study with a 6- and 3-day lead-time prior to histological diagnosis in patients 1 and 2. Conclusions: Both the graft-specific methylation and genotyping techniques successfully quantified gdcfDNA in patients post-LT with statistically significant concordance. A direct comparison of these two techniques is not only important from a technical perspective for orthogonal validation, but significantly adds weight to the evidence that gdcfDNA monitoring reflects the underlying biology. Both techniques identified LT recipients who developed acute TCMR, with several days lead-time in comparison to conventional diagnostic workflows. Whilst the two assays performed comparably, gdcfDNA monitoring based on graft-specific DNA methylation patterns in cfDNA offers major practical advantages over the donor-recipient genotyping, and hence enhances the potential to translate this emerging technology into clinical practice.

Gastroduodenal Ulcers in Liver Transplant Recipients under Immunosuppressive Therapy

Introduction: The proportion of gastroduodenal ulcers caused by drugs is increasing. However, the risk of gastroduodenal ulcer from drugs other than nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin is unclear. An association between immunosuppressive drugs and gastroduodenal ulcers has been suggested. We aimed to identify the immunosuppressive drugs and clinical characteristics associated with gastroduodenal ulcers in post-liver transplant patients. Methods: The study investigated 119 patients who underwent esophagogastroduodenoscopy after liver transplantation, and 2 patients were excluded. Clinical characteristics, medications, and endoscopic images were retrospectively reviewed. Results: Among 117 post-living donor liver transplant recipients, gastroduodenal ulcers were found in 10 (9.2%) patients. The ulcer group had endoscopic gastritis more frequently (40%) compared with the non-ulcer group (10%). Logistic regression analysis revealed gastritis, NSAID use, and mycophenolate mofetil were risk factors in the post-liver transplant patients. Among 103 patients not on NSAIDs, 8 (7.8%) had peptic ulcer. The most common ulcer site and ulcer shape were the gastric antrum and a circular shape, respectively. All patients in the ulcer group were taking mycophenolate mofetil, which was the only immunosuppressive drug that showed a significant difference between the two groups. Five out of 8 ulcer patients (63%) were taking gastric acid suppressants, and gastroduodenal ulcers in post-liver transplant recipients were suggested to be refractory. Conclusion: Patients treated with immunosuppressive drugs after liver transplantation can develop gastroduodenal ulcers, even with gastric acid suppressant medication. Mycophenolate mofetil may increase the risk of gastroduodenal ulcers compared with other immunosuppressive drugs.

Safety of laparoscopic repair of incisional hernias in liver transplant recipients.

Incisional hernia is a common complication following liver transplantation occurring in 5%-34% of patients. Traditionally, open repair was standard due to fear of abdominal adhesions, postoperative complications and lack of experience with laparoscopic techniques. Laparoscopic incisional hernia repair (LIHR) has now become routine in non-transplant patients, with improved postoperative outcomes. In this study, we compared outcomes after laparoscopic and open incisional hernia repair after liver transplantation at a high-volume liver transplant center. We performed a retrospective cohort study including all incisional hernia repairs performed on post-liver transplant patients at a major liver transplant center in Australia from 2010 to 2021. Donor, recipient, intraoperative and postoperative variables were collected from the electronic medical record focusing on laparoscopic and open repairs. Between January 2010 and March 2021, 138 patients underwent incisional hernia repair: 40 laparoscopic (29%) and 98 open (71%). No difference in wound infection (2.5%vs. 7.7%, p=.243); wound dehiscence (.00%vs. 2.3%, p=.332) or hernia recurrence (16.3%vs. 23.0%, p=.352) was seen between treatment groups. For larger incisional hernias (>5cm) we found that a laparoscopic repair reduced length of stay compared to open-repair (3.89vs. 4.57 days, p=.026). Laparoscopic repair of larger incisional hernias reduced postoperative length of hospital stay, whilst potential advantages may include reduced wound complications and hernia recurrence. Importantly, laparoscopic repair did not increase postoperative complication rates and represents a safe technique for repair in this demographic.

Impact of Text Message Reminders on Drug Adherence in Post-Liver Transplant Patients

Non-adherence among post liver transplant recipients may lead to serious consequences. Hence, there is a dire need to improve medication adherence, particularly among post-liver transplant recipients. Till date, no sufficient data has been published related to our study from Sindh province or even from Pakistan. Therefore, this study will not only help highlight the rate of Medication non-adherence but also implementation of a particular method that could be more helpful to improve the adherence among the study population. The main objective of this study was to determine medication adherence in post-liver transplant recipients before and after text message remainders. A cross sectional study was conducted on 103 post liver transplant patients at Pir Abdul Qadir Shah Institute of Medical Sciences Gambat. BAASIS Scale was used to measure medication adherence among study subjects, after that text messages reminders were given to enrolled patients and adherence was measured again using the same scale to determine the impact of text message reminders on adherence. Among enrolled patients, majority of the study subjects were male, whereas only one participant was transgender. Mostly patients belong to rural areas. Majority of the patients were of matriculation pass, while minorities of the patients were primary pass. Majority of the patients were unemployed, while few had non-government jobs, whereas government job study subjects were in minority. Majority of the patients were of age from 41 to 50, where minority of the patients were aged from 61 to 70. Majority of the patients were prescribed four drugs, whereas no any patient was prescribed only one drug. Majority of the patients were prescribed two immunosuppressant drugs while only few study subjects were prescribed only one immunosuppressant drug. Initially 86% patients were non-adherent to therapy, but after text message reminders, adherence was improved from 24% to 80%. This study concluded that the rate of adherence was improved by giving text message reminders to the patients.

Prevalence and predictors of metabolic-associated fatty liver disease in liver transplant recipients: A cross-sectional prospective study.

Metabolic-associated fatty liver disease (MAFLD) has emerged as a significant global health concern. However, the prevalence and predictors of MAFLD in post-liver transplantation (LT) patients remain uncertain. This study aimed to determine the prevalence and predictors of MAFLD in LT recipients and to assess the effectiveness of controlled attenuation parameter (CAP) values in diagnosing post-transplant MAFLD. A cross-sectional prospective study was conducted involving 128 adult patients who had undergone LT, and had received liver imaging, and vibration-controlled transient elastography (VCTE). MAFLD was diagnosed on the basis of the presence of liver steatosis detected through imaging and specific metabolic risk abnormalities. The prevalence of MAFLD after LT was 34.4%, with 22.1% categorized as de novo MAFLD, and 12.3% as recurrent MAFLD. Posttransplant diabetes (OR: 4.88; 95% CI 1.30-18.34; p=0.019) and higher CAP values (OR: 1.04; 95% CI 1.02-1.06; p=0000) were identified as independent predictors of post-LT MAFLD. A CAP cutoff value of 270 dB/m exhibited an area under the receiver operating curve of 0.84 in detecting MAFLD. These findings underscore the notable prevalence of MAFLD in liver transplant recipients and suggest the potential utility of VCTE as a non-invasive tool for its detection.

Changes in Physical Activity Due to Fear of COVID-19 and Its Impact on Depression Among Post-Liver Transplant Patients in Japan: A Longitudinal Survey Study.

BACKGROUND Regular physical activity (PA) is important for maintaining mental and physical health after liver transplantation (LT); however, the fluctuations in routine PA during COVID-19 and its putative impacts are currently unknown. This study examined the changes in PA during the COVID-19 pandemic and explored its association with fear and depression during the pandemic. MATERIAL AND METHODS This longitudinal study included 83 LT patients whose PA was measured using the short form of the International Physical Activity Questionnaire before and during COVID-19. Fear of COVID-19 was estimated based on previous studies, and depression was assessed using the Patient Health Questionnaire-9. Participants were also asked about important sources of information on COVID-19. PA was classified as inactive or active depending on the changes in PA, and logistic regression analyses with PA as a dependent variable were conducted to explore the associations among PA, depression, and fear of COVID-19. RESULTS Moderate and high PA exhibited decreasing trends before and during the COVID-19 pandemic, especially in males. Fear of being infected with SARS-CoV-2, the virus that causes COVID-19, while shopping was significantly higher in females and was significantly independent of inactivity during the COVID-19 pandemic. Only 1 patient reported that their transplant center was their main source of information about COVID-19. Only 4.9% of the LT participants were depressed. CONCLUSIONS Our study results indicate the need to support the provision of accurate information about COVID-19 by health care professionals in transplant centers, especially for patients with low PA, to prevent PA decline in LT patients.

Spectrum of drug-induced liver injury in a tertiary hospital in southern India.

Background Anti-tuberculosis drugs are thought to account for about 50% of drugs that cause liver injury in India. We show that the spectrum of drugs is much wider than previously reported. Methods We evaluated all patients with unexplained acute liver injury presenting during 2006-2016 using a structured proforma for drug-induced liver injury (DILI). The Roussel Uclaf Causality Assessment Method was used to assess causality. Results DILI was found in 143 of 2534 patients with acute liver injury. Nineteen patients had probable ayurvedic DILI. The other common causes of DILI were statins (16 patients) and anti-tuberculosis drugs (11 patients). Eight patients had DILI post-liver transplant. Fluconazole was the most common cause of post-liver transplant DILI. Chronic DILI (abnormal liver function test after 12 months of stopping the suspected drug) was found in 2 patients. Conclusion In otherwise unexplained acute liver injury, DILI due to ayurvedic drugs should be sought. DILI should be considered in post-liver transplant patients. Patients with DILI should be monitored for at least 12 months to exclude progression to chronic DILI.