Prognosis Of Cirrhotic Patients Research Articles

Correlation of serum sodium levels with complications and prognosis in cirrhotic patients

Correlation of serum sodium levels with complications and prognosis in cirrhotic patients

Comparison of Prognosis in Patients with Liver Cirrhosis and its Correlation with the Model for the End-Stage Liver Disease and Child-Pugh Scores in Patients with Esophageal or Gastric Variceal Bleeding

Background
 Variceal bleeding is one of the most serious complications of cirrhosis. Up to now different methods are created for predicting the complications and mortality of cirrhosis. Child- Pugh score and MELD score are two methods for this use. In this study we investigated and compared survival prognosis of cirrhotic patients by the Child-Pugh or MELD score in two groups of esophageal and gastric variceal bleeding.
 Materials and Methods
 In this cross-sectional trial, patients with upper GI bleeding were followed up for a 6 months period. The source of hemorrhage was determined by endoscopy, then patients distributed in two groups of esophageal and gastric variceal hemorrhage. Finally we investigated and compared the relationship between the variables and mortality rates in these two groups by means of the Child-Pugh and the MELD scores. The Student's t-test and Receiver Operating Characteristic were used for statistical analysis.
 Results
 34 patients (12 with gastric varices, 22 with esophageal varices) were investigated. No significant difference between these two groups was observed. In this study mean MELD score was 16.67±8.75 and mean Child-Pugh score was 9.37±2.54. Eight patients (5 with gastric varices and 3 with esophageal varices) expired before 6 weeks and 2 patients (one four each group) expired after 6 weeks. The best cut-off points are 15.5 and 10.5 for MELD and Child-Pugh scores respectively (sensitivity and specificity are 0.75 and 0.98, respectively for both scores).
 Conclusion
 Sensitivity and specificity of both scores were the same in prediction of mortality. However, the chance ratio defined that Child-Pugh score was a better predictor of mortality than MELD score, since the chance of death will increase 2.51 and 1.62 fold per each unit increase in the Child-Pugh and the MELD scores, respectively. However, no significant difference found between Child-Pugh and MELD score between two groups of patients.

OC-35 Post-transcriptional changes of serum albumin and its relationship with clinical features and prognosis in cirrhotic patients

OC-35 Post-transcriptional changes of serum albumin and its relationship with clinical features and prognosis in cirrhotic patients

Intensive Care Unit Admission of Decompensated Cirrhotic Patients: Prognostic Scoring Systems

Cirrhotic patients who need critical care support show high morbidity and mortality rates compared with other critically ill patients. Their prognosis is, in fact, influenced by both the severity of the underlying hepatic disease and the worsening of extrahepatic organ function. Clinicians and investigators have been persistently looking for objective scoring systems capable of providing accurate information on disease severity and short-term prognosis. Risk stratification helps differentiate patients who would not benefit from admission to the intensive care unit (ICU) from those who could achieve better outcomes once aggressively treated. The most common scores, ie, multiple organ dysfunction score, sequential organ failure assessment, and acute physiology and chronic health evaluation, developed in general ICUs to evaluate illness severity, have also been validated to predict the prognosis of cirrhotic patients admitted to the ICU. However, their absolute predictive value has been questioned. A weakness of common prediction models consists in not recognizing the continuum of physiological changes in critically ill decompensated cirrhotic patients. In addition, the predictive power to stratify individual risk is relatively low due to the great variability of liver dysfunction stages, the severity of related manifestations, and the number of nonfunctioning organs on admission. Probability models are not capable of predicting whether a patient will live or die with 100% accuracy, nor can they deny or confirm the indications for mechanical ventilation, vasopressor support or renal replacement therapy, or help to decide when to withhold or withdraw support. Because there are no absolute criteria to predict which cirrhotic decompensated patients will improve with normalization of organ function or deteriorate progressively, a scoring system should be regarded as an adjunct rather than a substitute for clinical judgment in the decision process concerning whether a patient should be admitted to the ICU.

T-40 Rebleeding does not affect prognosis of cirrhotic patients with advanced hepatocellular carcinoma

T-40 Rebleeding does not affect prognosis of cirrhotic patients with advanced hepatocellular carcinoma

T-21 Portal vein thrombosis affects prognosis of cirrhotic patients with previous variceal haemorrhage

T-21 Portal vein thrombosis affects prognosis of cirrhotic patients with previous variceal haemorrhage

Effects of late evening snack on diurnal plasma glucose profile in patients with chronic viral liver disease

Glycemic control is important to improve the prognosis in cirrhotic patients with complications from diabetes. A late evening snack (LES) has been recommended for cirrhotic patients. We investigated the effects of LES on diurnal plasma glucose levels. Subjects comprised 47 patients with chronic viral liver disease (chronic hepatitis, n = 11; cirrhosis, n = 36) treated in the Department of Gastroenterology & Hepatology, Dokkyo Medical University Koshigaya Hospital. Diurnal variations in plasma glucose were first investigated with three meals/day, in accordance with the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines. Starting the next day, patients were given four meals including a LES, without changing meal content. Diurnal variations in plasma glucose were examined on day 7, and urine C-peptide immunoreactivity (CPR), and homeostasis model assessment insulin resistance (HOMA-IR) were investigated. With a LES, plasma glucose levels in patients with chronic hepatitis were significantly lower 2 hours before and 2 hours after dinner. In cirrhotic patients, significant decreases in plasma glucose levels were seen 2 hours after breakfast, before lunch, and before dinner. Significant decreases were noted in average plasma glucose levels and highest plasma glucose levels with four meals including a LES in patients with liver cirrhosis. This decrease was greater when maximum plasma glucose levels were higher on the three-meal regimen. Improvements in plasma glucose levels were seen with four meals per day, including a LES, in viral chronic liver disease, particularly cirrhosis.

Right Atrial Pressure Is Not Adequate to Calculate Portal Pressure Gradient in Cirrhosis: A Clinical-Hemodynamic Correlation Study

Hepatic venous pressure gradient (HVPG), the difference between wedge and free hepatic venous pressure, is the preferred method for estimating portal pressure. However, it has been suggested that hepatic atrial pressure gradient (HAPG)--the gradient between wedge hepatic venous pressure and right atrial pressure (RAP)--might better reflect variceal hemodynamics. The aim of this study was to (1) investigate whether HAPG with nonselective beta-blockers correlates with prognosis in cirrhotic patients with portal hypertension at baseline and during treatment; (2) compare the prognostic value of HAPG with that of HVPG; and (3) investigate the agreement between portoatrial gradient (PAG) and portocaval gradient (PCG) in patients with transjugular intrahepatic portosystemic shunt (TIPS). We included 154 cirrhotic patients with varices with a complete hemodynamic study at baseline and on chronic treatment for primary (n = 71) or secondary (n = 83) prophylaxis for bleeding and 99 patients with TIPS. All patients were followed for up to 2 years; portal hypertensive-related bleeding and bleeding-free survival were analyzed. HVPG was equal or lower than HAPG in all patients (-3.2 mm Hg; P < 0.001). Agreement between HAPG and HVPG was modest, especially in patients with increased intra-abdominal pressure. One hundred two patients were HVPG nonresponders and 52 patients were HVPG responders to nonselective beta-blockers, whereas 101 patients were HAPG nonresponders and 53 patients were HAPG responders (k = 0.610). HVPG response revealed an excellent predictive value for bleeding risk and bleeding-free survival; HAPG did not. In our TIPS patients, 20% had a PCG < or =12 mm Hg and a PAG >12 mm Hg, which may have induced unnecessary overdilation of the TIPS. The excellent prognostic information provided by HVPG response to drug therapy is lost if HAPG response is considered. RAP should not be used for the calculation of portal pressure gradient in patients with cirrhosis.

Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices

Purpose To clarify the pre-treatment hemodynamic features involved in the long-term survival of cirrhotic patients with gastric fundal varices (FV) after balloon-occluded retrograde transvenous obliteration (B-RTO). Materials and methods Eighty-one cirrhotic patients with medium- or large-grade FV treated by B-RTO were enrolled in this retrospective study. Pre-treatment flow volume ratio between gastric vein and portal trunk (GP-R) was obtained by Doppler ultrasound. Results The cumulative survival rate was 90% at 1 year, 74.8% at 3 years, 57.2% at 5 years, and 45.8% at 7 years without recurrence in a median period of 1148.5 days The survival was poorer in patients with HCC (47% at 3 years, 9.4% at 5 years, p < 0.0001) than without (89.2% at 3 years, 81.9% at 5 years, 67.5% at 7 years), in patients with Child B/C (57.7% at 3 years, 42.1% at 5 years, 28.1% at 7 years, p = 0.0016) than with Child A (91.8% at 3 years, 71.5% at 5 years, 62.1% at 7 years), and in patients with GP-R ≥ 1.0 (58.9% at 3 years, p = 0.0485) than with GP-R < 1.0 (76.3% at 3 years, 62% at 5 years, 49.6% at 7 years). Multivariate analysis identified the presence of HCC (hazard ratio, 12.486; 95% CI, 4.08–38.216; p < 0.0001), Child B/C (hazard ratio, 3.41; 95% CI, 1.594–7.15; p = 0.0051) and GP-R ≥ 1.0 (hazard ratio, 2.701; 95% CI, 1.07–6.15; p = 0.0221) as independent factors for poor prognosis. Conclusion GP-R ≥ 1.0 on Doppler ultrasound before B-RTO may be a predictive indicator for poor prognosis in cirrhotic patients with FV after B-RTO, in addition to the presence of HCC and severe liver damage.

Evaluation of indocyanine green clearance and model for end‐stage liver disease for estimation of short‐term prognosis in decompensated cirrhosis

Indocyanine green (ICG) clearance has been proposed as a quantitative liver function test several decades ago. Interest in this method has been renewed following the development of finger pulse densitometry for noninvasive estimation of the ICG plasma disappearance rate (PDR). On the other hand, the model for end-stage liver disease (MELD), which is based on routine laboratory parameters, is widely used for estimation of short-term survival in cirrhosis, but its prognostic value in critically ill cirrhotic patients is unclear. The aim of the present study was to compare the diagnostic accuracy of ICG PDR vs. MELD for estimation of short-term prognosis in cirrhotic patients. Ninety consecutive cirrhotic patients who were admitted for decompensated disease or were being evaluated for liver transplantation were screened. Patients who underwent liver transplantation within the following 90 days and those with hepatocellular carcinoma were excluded. In the remaining 70 patients, routine laboratory parameters and ICG clearance were analysed. Following an injection of ICG 0.25 mg/kg, PDR was measured by finger pulse densitometry. The diagnostic accuracy of ICG PDR and MELD for prediction of 90-day survival was assessed by receiver-operating characteristic (ROC) curve analysis. ROC curve analysis revealed superior diagnostic accuracy for MELD as compared with ICG PDR in predicting 90-day survival (area under the ROC curve 0.89 vs. 0.71). A MELD cut-off of 22 provided the best discrimination for prediction of 90-day survival. MELD is superior to ICG PDR for estimation of short-term survival in patients with decompensated cirrhosis.

Baroreceptor sensitivity and baroreceptor effectiveness index in cirrhosis: the relevance of hepatic venous pressure gradient

Autonomic dysfunction has been reported as one of the complications of cirrhosis. The aim of this study was to test autonomic dysfunction in cirrhotic patients by analysing the baroreflex sensitivity and the baroreceptor effectiveness index (BEI), in order to determine its correlation with the severity and the aetiology of liver disease. Moreover, we explored the relationship between baroreceptor function and mortality in our cohort of patients. Clinical and laboratory evaluation, hepatic venous pressure gradient (HVPG) and haemodynamic setting and baroreceptor function were assessed in 45 cirrhotic patients (median age 55, range 38-72 years) divided in groups according to the severity of their disease (26 patients Child A, 13 patients Child B and six patients Child C). Baroreceptor sensitivity and BEI were impaired in more advanced cirrhotic patients compared with subjects with milder disease (P<0.001). HVPG was significantly, independently and inversely correlated with baroreceptor sensitivity (P=0.003). More severe impairment of baroreceptor function was associated with a higher mortality (P=0.04) and subjects with alcohol-related cirrhosis presented worse baroreceptor function (P=0.032) and poorer survival (P=0.003) compared with subjects with post-viral liver disease. These data support the hypothesis that liver disease severity and particularly portal hypertension have an important role in the derangement of baroreceptor function. The aetiology of cirrhosis seems to be related to baroreceptor impairment as well. Mortality rate is higher in subjects with a more damaged autonomic system, strengthening the idea of a worse prognosis in cirrhotic patients with autonomic neuropathy.

442 THE CURRENT PRACTICE OF LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN ITALY: INSIGHTS FROM THE LIVER-MATCH STUDY

Background and Aims: Since the implementation of MELD scorebased allocation system, the sickest patients have the highest priority for transplantation. This policy gave renewed interest to the management of patients with acute-on-chronic liver failure. Except for elective surgery, the need for mechanical ventilation (MV) in cirrhotic patients is associated with a poor outcome. However, prognostic factors in this population have not been clearly defined. The aim of this study was to better identify prognostic factors in critically ill cirrhotic patients undergoing MV. Methods: One hundred cirrhotic patients admitted in the ICU for acute complications necessitating MV were studied. Mean age was 52±11 years. The cause of cirrhosis was alcohol in 60, chronic viral hepatitis in 29 and others in 9. Mean MELD score was 28±9. Indications for MV were variceal bleeding in 10%, encephalopathy in 33%, acute respiratory distress syndrome in 46% and miscellaneous in 11%. Results: Thirty, 60 and 90-day survival rates were 25%, 19% and 18% respectively. Based upon ROC curve analysis, MELD score was more accurate for predicting 90-day mortality (c-statistic: 0.80) than the more general APACHE II and SOFA scores (c-statistic: 0.69 for both). On multivariate analysis (Cox model) the following variables were independent predictive factors of mortality: MELD score (p< 0.0001), cause of cirrhosis (alcohol vs others; p = 0.0005) and baseline serum bicarbonate (p = 0.007). Patients with alcoholic cirrhosis and high serum bicarbonate had better outcome compared to others. A score for predicting 90-day mortality risk was created combining these 3 variables: score = (0.07·MELD) − (0.05·bicarbonate[mmol/L]) + (0.84·cause of cirrhosis [1 if alcohol, 2 if other]). Ninety-day survival was 56% in those with a score below 1.23 (25% of patients) compared to 4% in those with a score over 1.23. The c statistic of this 90-day mortality risk score was 0.87. Conclusions: This series confirms that the prognosis of cirrhotic patients undergoing MV is poor. However, a simple prognostic score may allows identify a subgroup with more than 50% 90-day survival. It may help better identify the patients who should undergo aggressive management in the ICU, with a reasonable chance of access to transplantation. 441 A NATIONAL SURVEY ON THE QUALITY OF DECEASED LIVER DONORS AND THEIR ALLOCATION IN RELATION TO RECIPIENTS DISEASE SEVERITY IN ITALY

Low serum concentration of apolipoprotein A-I is an indicator of poor prognosis in cirrhotic patients with severe sepsis

Severe sepsis is frequently associated with hypocholesterolemia which is also a common finding in cirrhotic patients. Lipoprotein is capable of binding endotoxin to which cirrhotic patients exhibit an excessive pro-inflammatory response. We evaluated the relationship between lipid levels, inflammatory cytokines and clinical outcomes in 103 cirrhotic patients with severe sepsis. The non-survivors had significantly lower concentrations of total cholesterol, high-density lipoprotein (HDL), and apolipoprotein A-I (APO A-I). HDL and APO A-I levels were inversely correlated with interleukin-6, tumor necrosis factor-alpha, and various disease severity scores. Serum creatinine, mean arterial pressure and low level of APO A-I (<47.5mg/dl) were independent factors to predict 90-day mortality. The cumulative survival rates at 90 days were 63.8% and 8.9% for the high APO A-I and low APO A-I groups (p<0.0001). Low APO A-I was also associated with lower mean arterial pressure, higher rate of vasopressor dependency, and greater plasma renin activity. Serum levels of HDL and APO A-I are inversely correlated with liver reserve and disease severity in cirrhotic patients with severe sepsis. Low level of APO A-I is associated with a marked impairment of effective arterial volume, multiple organ dysfunction and a poor prognosis.

Impaired Oral Glucose Tolerance Test and Diabetes mellitus Predict Short Term Prognosis of Patients with Liver Cirrhosis

Objective: The aim of this study was to evaluate whether oral glucose tolerance test (OGTT) and manifest diabetes mellitus are useful in prediction of short term prognosis of patients with liver cirrhosis. Methods: Seventy-nine patients with liver cirrhosis of different etiologies were enrolled in a prospective cohort study. Diabetes mellitus (DM) and impaired glucose tolerance (IGT), which was diagnosed by a 75-g OGTT, were defined according to current World Health Organization criteria. The relationship of clinical variables to the cirrhosis-related prognosis was investigated using regression analysis. Results: IGT was diagnosed in 29 subjects (37%), DM in 27 subjects (34%), and normal glucose tolerance (NGT) in 23 subjects (29%). 3-month survival analysis showed that compared to normal glucose tolerance, disturbed metabolic status (IGT and DM) is a predictor of poor survival (odds-ratio 4,3), as well as liver cirrhosis classified as stadium Child-Pugh C compared to patients with liver cirrhosis stadium Child-Pugh A and B (odds ratio 3,9). Multiple regression analysis yielded Child-Pugh C and disturbed metabolic status (IGT and DM) as the most powerful negative predictors of short-time survival. Conclusions: IGT and DM appear to be useful for evaluating the prognosis of cirrhotic patients not only in long-term survival, as it was shown by Nishida et al.(1) and Bianchi et al. (2) before, but also in evaluating short-term prognosis. Literatur: (1) Nishida T. et al., Oral Glucose Tolerance Test Predicts Prognosis of Patients with Liver Cirrhosis, Am J Gastroenterol. 2006 Jan;101(1):70-5. (2) Bianchi G. et al., Prognostic significance of diabetes in patients with cirrhosis, Hepatology. 1994 Jul;20(1 Pt 1):119-25.

Valor pronóstico de un episodio de peritonitis bacteriana espontánea en pacientes cirróticos en la práctica clínica

To assess survival and predictive factors of mortality after an episode of spontaneous bacterial peritonitis (SBP) in cirrhotic patients and to analyze the diagnostic and therapeutic measures used. We retrospectively reviewed the medical records of 158 consecutive episodes of SBP treated between January 2003 and December 2005. Survival was studied by Kaplan-Meier curves, compared by the log-rank test. Independent predictive factors of mortality were obtained by a Cox regression model, while independent predictive factors of in-hospital mortality were obtained by logistic regression analysis. A total of 80.4% of the SBP episodes occurred in men and the mean age was 61.23 +/- 12.49 years. The most frequent etiology of cirrhosis was viral (51.3%), followed by alcoholic (39.9%). The distribution of Child-Pugh classification was 5.7% (A), 63.3% (B) and 31% (C). Overall 3-year survival in the sample was 43.3%. Four variables were identified as independent predictive factors of in-hospital and 3-month mortality: renal impairment, hepatic encephalopathy, diagnosis of hepatocellular carcinoma (HCC) and mean arterial pressure (MAP) < 75 mmHg. At the end of the monitoring period, the results of the analysis were as follows: diagnosis of HCC, MAP < 75 mmHg, and age > 65 years. Microbiological detection was achieved in 21% of the episodes. The most frequent microorganisms detected were Escherichia coli in ascitic fluid and Staphylococcus aureus in blood cultures. SBP has a poor short- and long-term prognosis in cirrhotic patients. Independent predictive factors of short-term survival are renal impairment, hepatic encephalopathy, MAP < 75 mmHg, and the presence of HCC.

Contrast-Enhanced Ultrasonography: A Recent Application for the Diagnosis and Treatment of Hepatocellular Carcinoma

Hepatocellular carcinoma has a decisive influence on the prognosis of cirrhotic patients, and the use of imaging modalities is essential for the screening, diagnosis and treatment of hepatocellular carcinoma. Ultrasound plays a major role among them, because it provides real-time and non-invasive observation by a simple and easy technique. In addition, ultrasound-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of hepatocellular carcinoma. The development of digital technology has led to the detectability of blood flow by color Doppler ultrasound, and the sensitivity for tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents. Moreover, near real-time three-dimensional ultrasound images are now available. These advancements in the ultrasound field have led to rapid progress in hepatocellular carcinoma management, and continuing advances are expected. This article reviews the current application of contrast-enhanced ultrasound for hepatocellular carcinoma in clinical practice.

Abnormality of the hepatic vein waveforms in cirrhotic patients with portal hypertension and its prognostic implications

We investigated the prognostic significance of changes in the Doppler hepatic vein (HV) waveforms in cirrhotic patients with portal hypertension and the mechanisms of these changes. A total of 103 consecutive patients were included in this study and their HV waveforms were classified into four types: type I, triphasic waveform; type II, biphasic waveform; type III, biphasic waveform with reduced phasic oscillations; and type IV, a flat waveform. Type I was observed in 34, type II in 40, type III in 23, and type IV in six patients. The 5-year survival rates were 90%, 89%, 41%, and 0% in type I, II, III, and IV, respectively. Five variables including the Child-Pugh score, albumin, bilirubin, ascites, and HV waveform significantly correlated with the survival in a univariate analysis. A multivariate analysis only identified the HV waveform (type III and IV) to be an independent prognostic value. Even in Child-Pugh class B patients, the 5-year survival rate for type III or IV was as poor as 26% in comparison to 92% for type I or II. In contrast, in Child-Pugh class C patients, the 5-year survival rate for type I or II was as good as 63% in comparison to 25% for type III or IV. Furthermore, the changes in HV waveforms correlated with the extent of hepatic fibrosis, the increase in portal perfusion per liver volume, or the decrease in portal vascular resistance. Analyzing the HV waveforms was thus found to be a simple method for accurately assessing the prognosis in cirrhotic patients with portal hypertension.

Current role of ultrasound for the management of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) has a decisive influence on the prognosis of cirrhotic patients. Although alpha-fetoprotein (AFP) is a known and specific tumor maker for HCC, it is not suitable for the screening and surveillance of HCC because of its poor predictive value and low sensitivity. The use of imaging modalities is essential for the screening, diagnosis and treatment of HCC. Ultrasound (US) plays a major role among them, because it provides real-time and non-invasive observation by a simple and easy technique. In addition, US-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of HCC. The development of digital technology has led to the detection of blood flow by color Doppler US, and the sensitivity for detecting tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents. Moreover, near real-time 3-dimensional US images are now available. As for the treatment of HCC, high intensity focused ultrasound (HIFU) was developed as a novel technology that provides transcutaneous ablation effect without needle puncture. These advancements in the US field have led to rapid progress in HCC management, and continuing advances are expected. This article reviews the current application of US for HCC in clinical practice.

Hemorrhagic Bullae Represent an Ominous Sign for Cirrhotic Patients

Hemorrhagic bullae are a clinical manifestation of many underlying diseases, especially soft-tissue infection. The aim of this study was to evaluate the characteristics and prognosis of cirrhotic patients with hemorrhagic bullae. Fifteen patients with liver cirrhosis and hemorrhagic bullae had been admitted to Chang Gung Memorial Hospital, Kaohsiung, from January to December 2003. Their clinical courses were retrospectively reviewed in detail and all of the collected data were analyzed. This study puts emphasis on the clinical presentation and outcome of these cases. The mean age of patients was 55.0 ± 12.1 years, and 12 patients were male. Prostration and unusual extremity pain were the two leading reasons to visit our Emergency Department. The hemorrhagic bullae were located on the upper or lower extremities and in one patient, on the whole body. In this series all hemorrhagic bullae were infection-related. Although aggressive treatment was started immediately upon arrival, 14 patients died of overwhelming sepsis and 12 patients died within 48 h from the emergence of hemorrhagic bullae. Hemorrhagic bullae in cirrhotic patients usually imply a fatal infection and Gram-negative bacteria are the most common pathogen. Appropriate antimicrobial therapy and early surgical intervention are necessary to achieve survival in these patients.

Detection of telomerase activity in biopsy samples for predicting prognosis in cirrhotic patients with hepatocellular carcinoma after laparoscopic radiofrequency ablation therapy

To explore the role of telomerase activity detected in biopsy samples for evaluating the efficacy of laparoscopic radiofrequency ablation (RFA) therapy in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. From August 2001 to October 2004, 34 cirrhotic patients with HCC were treated by laparoscopic RFA under general anesthesia. A total of 34 tumors, with a mean maximum tumor diameter of 4.0 ± 1.0 cm, were all located on the liver surface or adjacent to the gallbladder. Laparoscopic ultrasound-guided core biopsy for liver lesions was performed before and immediately after RFA therapy. In these biopsy samples, telomerase activity was detected by the ELISA-based telomeric repeat amplification protocol (ELISA-TRAP) assay, and pathological examination was routinely performed. Laparoscopic RFA was successfully performed in all the 34 patients. A complete tumor necrosis was achieved in all patients on the contrast-enhanced helical CT scanning one month after laparoscopic RFA. The positive rates of telomerase activity and histopathologic diagnosis in biopsy samples were 91.2% (31/34) and 100% (34/34) respectively before RFA, and 26.5% (9/34) and 0% respectively after RFA. During a median follow-up period of 35 months (range, 18–51 months), the rates of local tumor recurrence at the ablation sites in post-RFA telomerase-positive and negative patients were 88.9% (8/9) and 4% (1/25) respectively (P 0.05). For cirrhotic patients with HCC treated by laparoscopic RFA, detection of telomerase activity in biopsy samples may be useful for evaluating the therapeutic efficacy of RFA and predicting postoperative local tumor recurrence.