Related Chronic Liver Disease Research Articles

The clinical significance of serum chitinase 3-like 1 in hepatitis B-related chronic liver diseases.

AimIn the present study, we purposed to determine serum chitinase 3‐like 1 (CHI3L1) expression characteristics in chronic liver diseases monoinfected with hepatitis B virus and analyze its diagnostic value in liver fibrosis.MethodsA total of 467 chronic hepatitis B (CHB) patients, 312 liver cirrhosis (LC) patients, and 104 hepatocellular carcinoma (HCC) patients at our institution were enrolled, and clinical indicators were analyzed.ResultsOur data have shown that the expression level of serum CHI3L1 was steadily increased from CHB to LC to HCC (P < .001). Serum CHI3L1 expression levels were positively associated with liver stiffness measurement (LSM), fibrosis‐4 (FIB‐4) index, aspartate aminotransferase‐to‐platelet ratio index (APRI), and HCC stage. The receiver operating characteristic (ROC) curve proved that serum CHI3L1 was superior to other noninvasive methods (LSM, FIB‐4, and APRI) with an area under the ROC curve (AUC) of 0.97 in diagnosing significant fibrosis.ConclusionsSerum CHI3L1 harbors significant clinical value in chronic liver diseases infected with hepatitis B virus, especially in the diagnosis of fibrosis.

Circulating microRNAs (miR-21, miR-223, miR-885-5p) along the clinical spectrum of HCV-related chronic liver disease in Egyptian patients

Background and study aimsMicroRNAs (miRNAs), small single stranded RNAs, function in the post-transcriptional regulation of gene expression and incorporated in pathogenesis of HCV related chronic liver disease. This study was designed to evaluate the significance of serum miR-21, miR-223, and miR-885-5p as biomarkers in various clinicopathological stages of HCV related chronic liver disease. Patients and methodsSerum miR-21, miR-223, and miR-885-5p were quantified by quantitative RT PCR in 60 patients with HCV-related liver disease (presumably genotype 4), in addition to 25 healthy controls. HCV patients were classified into: chronic non-cirrhotic HCV (n = 15), HCV related liver cirrhosis (n = 15), and hepatocellular carcinoma (HCC) (n = 30). Results: Serum levels of miR-885-5p in cirrhotic patients ± HCC (n = 45) were significantly higher than the non-cirrhotic patients (n = 15); p = 0.007 and healthy control; p = 0.001. However, no such significance was detected between HCC and non-HCC HCV patients; p = 0.12. Serum miRNA-885-5p was able to discriminate cirrhosis ± HCC from healthy controls using ROC analysis; AUC 0.85, 87% sensitivity and 80% specificity. On the other hand, HCC patients had significantly higher serum miR-2 1evels than non-HCC patients (non-cirrhotic and cirrhotic groups, n = 30); p = 0.048 and the control group; p = 0.002. ROC could differentiate HCC from control group; AUC 0.89, 80% sensitivity, 80% specificity. Both serum bilirubin and albumin showed significant weak correlation with miRNA-885-5p (r = 0.42, p = 0.001) and (r = −0.27, p = 0.04), respectively but no such correlation was observed with serum miRNA-21. In contrast, miRNA-223 showed no significant difference across the studied groups. ConclusionAlong the spectrum of HCV-related chronic liver disease, miR-885-5p could be a potential marker for advanced liver damage while miR-21 could be a helpful diagnostic marker for HCC.

Lack of association between Vitamin D status and free light chains profile with different chronic HCV-related liver and extrahepatic disorders.

A still uncertain association between vitamin D levels and HCV chronic liver diseases has been reported. Increased levels of serum-free light chains (FLCs) and an altered k/λ FLC ratio correlate with Mixed Cryoglobulinemia (MC) vasculitis and/or B-cell non-Hodgkin's lymphoma in HCV-positive patients. We aimed to investigate the possible role of vitamin D, vitamin D Binding Protein (DBP), and FLCs levels as a tool for discriminating different stages of HCV- related MC and chronic liver diseases. Sixty-five untreated patients were retrospectively enrolled and 21 healthy blood donors (HBD) were used as controls. Vitamin D, DBP, FLCs, and cryoglobulins levels were measured. Based on cryoglobulins, patients were divided in three subgroups (without cryoglobulins, type II, and type III). We didn't find any significant differences in vitamin D and DBP levels between HCV patients' main groups and HBD. Serum FLCs levels were significantly higher in HCV patients than in HBD. FLCs ratio among patients' subgroups did not reveal differences. Our results confirm the presence of an increased serum level of FLCs in HCV patients and suggest that nor vitamin D and DBP or FLC levels can be considered reliable biomarkers for discriminating different stages of HCV-associated chronic liver diseases and/or HCV-associated extrahepatic manifestation. We confirm that serological FLCs levels are significantly higher in patients than in HBD as a signature of B cell activation in course of HCV infection.

584 Apelin Association With Hepatic Fibrosis and Esophageal Varices in Chronic HCV Patients

INTRODUCTION: Portal hypertension (PH) and esophageal varices complicating HCV-related chronic liver disease (CLD) are the most devastating sequelae. Angiogenesis is the hallmark of their pathogenesis. Apelin is one of the recently identified angiogenic and fibrogenic peptides. We studied apelin gene expression, apelin (rs3761581) SNP and serum apelin level in chronic HCV patients, and their association with hepatic fibrosis and esophageal varices. METHODS: 112 patients with HCV related CLD (40 having liver cirrhosis (LC)/low grade varices, 33 with LC/high grade varices and 39 with fibrotic non-cirrhotic liver/no varices), and 80 healthy control subjects were included. Real time PCR was used for apelin gene expression assay and apelin rs3761581 SNP analysis in peripheral blood samples. Serum apelin level was measured by ELISA. RESULTS: Apelin gene expression was undetectable in studied samples. SNP analysis revealed higher frequency of the C-(mutant)-allele among patients compared to controls (P = 0.012, odds ratio 3.67). Serum Apelin level was significantly higher in patients with hepatic cirrhosis/ varices (median 31.6 ng/L) compared to non-cirrhotic patients/ no varices (median 2.9 ng/L) (P &lt; 0.001). Serum apelin level at cut off value 16.55 ng/L predicted the presence of varices with AUROC 0.786. Positive correlation was found between serum apelin level and grade of liver fibrosis (r=0.346, P &lt; 0.001) and PH (r=0.438, P &lt; 0.001). CONCLUSION: Apelin rs3761581 C-allele may be associated with progression of HCV-related CLD and varices formation, and can be considered as a potential therapeutic target to control fibrosis progression. Serum apelin level provided accurate prediction of the presence of esophageal varices.

Evaluation of Health Related Quality of Life of Chronic Liver Disease Patients (Hbv &amp; Hcv Related)

Background: One of the leading causes of death and disability worldwide is viral hepatitis and Hepatitis B (HBV) &amp; Hepatitis C (HCV) constitute 90% of it. In chronic diseases it is more important to evaluate personal impact and disability caused by the disease. Objective: Purpose of this study was to assess the impact of HBV &amp;/or HCV related Chronic Liver Disease (CLD) on health related quality of life of patients, providing insight on present condition of the patients. Materials and methods: This observational study was conducted from June to July, 2018 a private chamber of Chattogram, Bangladesh. Convenience sampling method was used to collect data from 112 HBV &amp;/or HCV patients using EQ-5D-3L questionnaire. SPSS version 23 for windows was used for statistical analysis. Results: In our study, most of the patients could take proper care of themselves but almost one fourth complains some difficulty in walking (28.6%) and performing daily activities (25%). Whereas more than half of total participants had mild physical discomfort or pain (55.4%) and depressive or anxiety (51.8%) experiences in their life. We also found lower quality of life score (Mean 7.13, SD 1.531) in a scale of 5-15 with a comparatively higher well being score (Mean 72.23, SD 21.62) in scale of 0-100 among participants. It was also evident that vaccination status of the spouse were lower in patients with higher wellbeing perception. Conclusion: We tried to evaluate the HRQoL of HBV and HCV related CLD patients to mitigate the burden and provide equitable health care.&#x0D; JCMCTA 2019 ; 30 (1) : 31-35

Early Detection of Pancreatic Cancer in Patients With Chronic Liver Disease Under Hepatocellular Carcinoma Surveillance

ObjectiveTo evaluate whether patients with hepatitis B virus (HBV)– and hepatitis C virus (HCV)–related chronic liver disease were diagnosed as having pancreatic cancer (PC) at an early stage during abdominal imaging surveillance for hepatocellular carcinoma (HCC). Patients and MethodsWe retrospectively examined 447 patients with PC diagnosed at Ehime University Hospital and affiliated centers (2011-2013). Data were collected regarding HBV and HCV status, likelihood of PC diagnosis, and Union for International Cancer Control (UICC) stage. Intergroup comparisons were performed using the χ2 test. ResultsThe UICC stage distribution in the HCC surveillance group (n=16) was stage 0 (n=2, 12.5%), stage IA (n=3, 18.8%), stage IB (n=2, 12.5%), stage IIA (n=2, 12.5%), stage IIB (n=2, 12.5%), stage III (n=1, 6.3%), and stage IV (n=4, 25%). The UICC stage distribution in the nonsurveillance group (n=431) was stage 0 (n=4, 0.9%), stage IA (n=28, 6.5%), stage IB (n=27, 6.3%), stage IIA (n=86, 20.0%), stage IIB (n=48, 11.1%), stage III (n=56, 13.0%), and stage IV (n=182, 42.2%). The HCC surveillance group had significantly more patients with stage 0 disease than with stages IA through IV (P=.02). Similar results were observed when including stages IA (P=.007) and IB (P=.004) as early stages but not stage IIA (P=.10). A dilated pancreatic duct led to a PC diagnosis in all 6 patients with stage 0 disease. ConclusionPatients with HBV- and HCV-related chronic liver disease had an early PC diagnosis during HCC surveillance. Careful evaluation of the pancreas is warranted during HCC surveillance.

Updated Treatment of Chronic Hepatitis B

Chronic hepatitis B virus (HBV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma in Korea. The prevalence of HBV infection is gradually decreasing in Korea, but 3.0% of the total population still suffers from HBV- related chronic liver diseases. In this review, we summarize the updated clinical practice guideline for management of chronic hepatitis B, as revised by the Korean Association for the Study of the Liver in 2018. Keywords: Hepatitis B, Chronic; Guidelines; Therapeutics 중심 단어: B형간염, 만성; 가이드라인; 치료

Therapeutic effects of Silybum marianum in the treatment of liver fibrosis and cirrhosis

Background: Cirrhosis is the late, symptomatic stage of chronic liver disease which occurs when scar tissue (fibrosis) largely replaces healthy liver tissue, compromising the function of the organ and predisposing to liver failure and hepatocellular carcinoma. It is mainly caused by hepatitis B and C virus infections or prolonged excessive consumption of alcohol.&#x0D; Aims and Objective: To study the therapeutic effects of Silybum marianum on liver fibrosis and cirrhosis in patients with chronic hepatitis C virus infection with Child Pugh Stage A&amp; B.&#x0D; Materials and Methods: In this study 119 patients were treated for 6 months with Silybum marianum, their Liver stiffness measurements were carried out through Fibroscan, which is a non-invasive technique to assess liver fibrosis. Liver Fibrosis Scores viz; Aspartate aminotransferase/platelet ratio index(APRI) and fibrosis index based on four factors(FIB-4) were also employed at baseline and end of treatment.&#x0D; Results: Pre-treatment Liver Stiffness Measurement (LSM) score was 22.54 kilopascals(kPa) and post treatment was 17.30 kPa, a statistically significant change of 5.24 kPa (P ˂ 0.01) was observed, the mean percent change was 23.24%, its impact was observed in all METAVIR stages. Of the 72 (60.5%) patients with LSM ≥ 12.5 kPa (cirrhosis) at baseline 23 (32%) proved to have no cirrhosis (≥ 1 decrease in fibrosis stage) at post treatment. Similarly, 19 patients moved to stage F0-F1, 28 patients in F2 and 23 in F3. Overall fibrosis stage was improved (≥ 1 decrease in fibrosis stage) in 46 (38.7%) of 119 patients after 6 months of treatment. Serum fibrosis scores APRI and FIB-4 significantly decreased in comparison to baseline values. APRI values drooped from 1.24 to 0.83. FIB-4 score changed from 3.90 to 2.10.&#x0D; Conclusion: Our result suggests significant improvement with Silybum marianum in the patients status of liver fibrosis and cirrhosis associated with hepatitis C related chronic liver disease. Silybum marianum shows therapeutic effect in real life setting on the entire aspect of disease, as evaluated with the fibroscan and serum fibrosis score.

Transient Elastography- a Non-invasive Alternative to Upper Endoscopy for Detection of Gastric and Esophageal Varices in HBV and HCV Cirrhosis

Introduction: Esophageal and gastric varices are one of the most important complications of liver cirrhosis leading to Upper GI Bleed with a significant mortality and morbidity. Upper endoscopy is the currently recommended method for variceal screening and treatment to prevent upper GI bleed. However this method is invasive and carries a small but definitive risk of complications as well as an incremental expense. Non invasive methods to detect patients with large esophageal varices at high risk for bleeding are desirable. In this respect, several clinical, biological, ultrasonographic and elastrographic (transient elastography-TE) methods have been proposed Some of these have been validated as non-invasive alternatives to endoscopy Our study was done with the objective of studying the validity of liver stiffness measurement by fibroscan to predict the presence of esophageal and gastric varices in cirrhotic patients due to hepatitis C and B infection Methods: A retrospective analysis of medical records of 75 patients who underwent fibro scan and then screening endoscopy was carried out. This data was then analyzed to correlate the fibroscan findings with the presence of esophageal and gastric varices. Patients aged 18 to 80 years with HCV and HBV related chronic liver disease were included in this study. Patients with Hepatocellular carcinoma and cirrhosis due to non- HBV/ HCV related liver disease were excluded. Results: The results produced from this data shows that there is a significant association between liver stiffness measured during transient elastography and the presence of esophageal varices. .The results also show that fibro scan score is a better predictor of esophageal varices then gastric varices. There is no strong association between gastric varices and fibro scan score. So fibro scan can be used as screening for only esophageal varices and not for gastric varices Conclusion: The results produced from this data shows that there is a significant association between fibro scan score and esophageal varices. This shows that a non invasive modality like fibroscan score can be used as a screening tool for presence and degree of esophageal varices in patients with chronic hepatitis B and C. The results also show that fibro scan score is a better predictor of esophageal varices then gastric varices.

3. An enigmatic case of undiagnosed severe diarrhoea post living donor liver transplant

Background and Aims: Graft versus Host Disease (GVHD) after orthotopic liver transplant (OLT), although rare, carries >80% mortality. Early diagnosis, prompt treatment, and aggressive supportive care are imperative to potentially reverse this otherwise fatal ailment. We describe a case of recurrent severe diarrhoea post living donor OLT who was diagnosed with acute GVHD. Case Summary: A 56 year old lady underwent an uneventful (swap) living donor OLT for Hepatitis C related chronic liver disease with multifocal hepatocellular carcinoma. Initial immunosuppression consisted of tacrolimus, mycophenolate mofetil and prednisolone. At ten weeks post- transplantation, sirolimus was introduced and Tacrolimus tapered gradually. At 78 and 84 weeks post-transplantation she had two episodes of acute cellular rejection treated with pulse methylprednisolone therapy. She developed profuse watery painless diarrhoea with significant nocturnal symptoms at 90 weeks post-transplantation, for which she was admitted on several occasions. Multiple stool examinations were bland (no pus cells, red blood cells, mucus, ova and cysts), negative for cryptosporidium and clostridium difficile (antigen + toxin) and there was no Cytomegalovirus viremia. Laboratory parameters revealed mild anemia, thrombocytopenia, hypoalbuminemia and transaminitis. Celiac serology was negative. Every time her symptoms settled with intravenous fluids and antibiotics, only to recur within few days. An upper gastrointestinal endoscopy and duodenal biopsy was normal. Random normal appearing terminal ileum and colonic mucosal biopsies revealed mild active GVHD. Lamina propria showed mild chronic inflammatory cell infiltrate along with lymphoid aggregates. Few crypts demonstrated apoptosis (Fig. 1). There were no crypt dropouts, cryptitis or crypt abscesses (GVHD grade I). She was started on oral budesonide therapy. Her symptoms responded briskly and diarrhoea subsided. At six months follow-up, she was completely asymptomatic. Conclusions: This is the first case of GVHD with isolated gastrointestinal manifestations post OLT to be reported from India and treated successfully with oral budesonide. The authors have none to declare.

3. Study on lipid profile among adults with HBV and HCV related chronic liver diseases in Bangladesh-report from a tertiary centre

Background and Aims: Chronic Hepatitis B and C are the major causes of cirrhosis of Liver and Hepatocellular carcinoma in Bangladesh. Development of cirrhosis of liver result in derangement of metabolic functions. This study was conducted to find out the changes of lipid profile among adult with Chronic Viral Hepatitis B and C. Methods: This was cross sectional descriptive study in Medicine Inpatient Department of Rajshahi Medical College Hospital from June 2015 to july 2016. Total Number of Patients were 130. Among them 114 Chronic Hepatitis B and 16 patients chronic Hepatitis C. Age 18–65 years. Male 107, female 23. There were no comorbidities of these patients. Results: Among 130 Patients (116 Child's Pugh A & 14 Child's Pugh B). In HBV group Male 96, Female 18 and in HCV group Male 11, Female 05. Serum Total cholesterol, HDL, LDL and Serum Triglyceride were done in all patients in six monthly intervals. The results were reduction of Serum Total Cholesterol and HDL in 45 (39.47%) and increased Serum Triglyceride in 11 (09.65%) patients in HBV group. In HCV group increased Serum Total cholesterol and Serum Triglyceride in 07 (43.75%) and reduction of HDL in 03 (18.75%) patients. Conclusion: Developing countries like Bangladesh are likely to face an enormous burden of CLD and prevention and early diagnosis is essential to reduce economic loss and health system burden. Dyslipidemia is frequent in CLD & found with severity of the disease. Moreover, it may acts as a good predictor of CLD management. Till now, no needful studies are available in Bangladesh. Understanding the pattern of Dyslipidemia of hepatitis B & C related CLD in Bangladesh may enrich the clinician and may act as a baseline study for further research. The authors have none to declare.

Six-Minute Walk Test: A Useful Tool for Evaluating Functional Capacity in Chronic hepatitis C

BACKGROUND AND AIM: Chronic liver disease leads to reduction in health-related quality of life, particularly functional capacity. The data about the use of Six Minute Walk Test (6MWT) among cirrhotic patients are limited. The current study was done to evaluate the use of 6MWT in patients with HCV related chronic liver disease for assessing the functional capacity and to determine the correlation between the 6MWD and severity of chronic liver diseases. METHODS: This analytic cross-sectional study was carried out on 20 healthy volunteers (Group I), 40 HCV patients with early liver disease (Group II), and 40 HCV patients with liver cirrhosis (Group III). Six minute walk distance (6MWD) was calculated. RESULTS: The mean 6MWD was significantly lower in Groups II and III (325.8 ± 56.65 meter, and 131.79 ± 43.40 meter) compared to that of Group I (359.91 ± 38.63 meter) (p 0.05). CONCLUSIONS: Six-minute walk test is a reliable indicator to measure the functional capacity for patients with HCV related chronic liver diseases.

Association between Presence of Esophageal Varices on Endoscopy and Extreme Degree of F4-Stage Fibrosis on Fibroscan in HCV-Related Chronic Liver Disease

Background: Hepatitis C Virus (HCV) infection is one of the causes which cause liver fibrosis, cirrhosis and carcinoma if left untreated. Patients who present with acute HCV infection, 50-70% of them develop chronic infection. This study attempted to see an association between F4 fibrosis in liver on fibroscan and esophageal varices on endoscopy in HCV related chronic liver disease (CLD) patients. Method: This study was conducted in Gastroenterology and Hepatology division of holy family hospital, Rawalpindi. Total 117 patients of 10 to 90 years were included. All patients were having HCV related CLD. Patients having F4 fibrosis stage were included while patients having fibrosis stage up to F3 fibrosis stage were excluded. All data regarding age, gender, F4 fibrosis and esophageal varices was entered and analyzed using the statistical package of social sciences while descriptive analysis was performed. Results: Amongst 114 patients who presented with F4 fibrosis stage on fibroscan 69.3% (79) of them were diagnosed for esophageal varices on endoscopy and 30.7% (35) were not having esophageal varices on endoscopy. Patients who were having esophageal varices on endoscopy 84.5% (49) of them were males and 55.9% (33) were females. Study participants having F4 fibrosis stage, 98.3% of them were males and 96.6% were females. So, there was not much difference between males and females having an extreme degree of fibrosis on fibroscan. Conclusion: Patients who were having F4 fibrosis stage on fibroscan, 2/3 of them were having esophageal varices on endoscopy. Esophageal varices were more present in males as compared to females.

HBV genome analysis in the progression of HBV related chronic liver disease

HBV genome analysis in the progression of HBV related chronic liver disease

Prevalence of Type 2 Diabetes Mellitus in patients with Chronic Liver Disease

Background and Purpose: The development of type 2 diabetes mellitus (T2DM) is caused by a combination of genetic factors and lifestyle factors like obesity, lack of physical activity and stress. T2DM can develop in chronic liver disease (CLD) though its actual mechanism is not fully understood. In case of hepatitis B virus (HBV) related CLD, HBV infection has been directly related to development of abnormal glucose metabolism by pancreatic islets cell injury. Development of Insulin resistance in case of hepatitis C virus (HCV) is the key pathogenesis of development of type 2 diabetes. We aimed to study the magnitude of the problem of T2DM among the patients with various types of CLD and to find out the association of diabetes mellitus with the demographic and clinical characteristics of the patient admitted in Medicine ward in Dhaka Medical College Hospital.Methods: This was an observational cross sectional study of 60 patients admitted into department of Medicine, Dhaka Medical college hospital between June, 2013 to December, 2013. It included all patients ?18 years of age and admitted with CLD. A diagnosis of CLD was made clinically by any 2 stigmata of liver disease and biochemical, ultrasonographic, endoscopic evidence of esophageal varices ± liver biopsy.Results: Of the total 60 CLD patients, 40 (66.7%) suffered from chronic HBV infection, 11 (18.3%) chronic HCV infection and alcoholic liver disease 5 (8.3%), Autoimmune 1 (1.7%), Wilson disease 1 (1.7%) and unknown cause were 2 (3.3%). Among the study subjects 21.67% had overt Diabetes Mellitus and it was found to be highest among those with chronic hepatitis C (36.4%) and those with chronic hepatitis B (20%) alcohol (20%). Type 2 DM was significantly higher among the CLD patients aged more than 50 years or more.Conclusions: It can be concluded that the occurrence of diabetes and impaired glucose tolerance (IGT) could be a matter of great concern in CLD patients, indicating towards the need for regular monitoring of the glycemic status in these patients, which would have a definite role upon the treatment strategy.J MEDICINE July 2017; 18 (2) : 68-74

Monocyte chemoattractant protein 1 released from macrophages induced by hepatitis C virus promotes monocytes migration

Hepatitis C Virus (HCV) infection usually progress to chronic liver disease and shows a significant increase in total monocyte/macrophages numbers in the liver. Monocyte chemoattractant protein-1 (MCP-1) plays a role in the recruitment of monocytes to the liver. In this study we found that MCP-1 were up-regulated in macrophages cultured with cell-culture derived infectious HCV particles (HCVcc) and promoted the migration of monocytes. IL1β, IL6 and TNFα were factors that induced MCP-1 expression, which were up-regulated in macrophages induced by HCV. Long-term of HCV incubation induced apoptosis of macrophages. Finally, we observed the effect of HCV infected macrophages on nearby liver cells. Huh7 cells continuously co-cultured with monocyte/macrophages displayed increased expression of pro-inflammatory cytokines and the morphology of Huh7 cells were greatly changed. Taken together, our study provides more information for the role of monocyte/macrophages in HCV related chronic liver disease.

Antiviral Therapy Only for Patients With Hepatitis B Post Liver Transplant—Single Center Experience

Background and Aim: Liver Transplantation is an important treatment modality for patients with Hepatitis B related chronic liver disease. The risk of reinfection with Hepatitis B post-transplant is a grave concern. Current recommendations endorse use of both Hepatitis B immunoglobulin (HBIG) and antiviral drugs post-transplant. We report our center's experience with using only antiviral therapy post liver transplant. Methods: Data was collected on all patients undergoing liver transplantation for Hepatitis B related chronic liver disease at our center between FY 2006 and FY 2016. Results: During the 10 year study period a total of 234 patients underwent liver transplant for Hepatitis B related liver disease. No HBIG was given to the patients post transplant. They were only treated with antiviral therapy. We did not find any evidence of Hepatitis B reinfection in our patients during the 10-year study period. Conclusion: We report no incidence of Hepatitis B reinfection following liver transplantation in patients treated with only antiviral therapy. HBIG is an expensive medication and may not be required even in the immediate post-transplant period thus significantly reducing costs. The authors have none to declare.

Temporal Trends in the Etiology of Chronic Liver Disease in Coastal Eastern Odisha

Background and Aim: The etiology of chronic liver disease (CLD) is known to change with time due to various factors including awareness, preventive interventions as well as life style changes in society. However there is scarce Indian data available about time trends in etiology of CLD. Methods: This is a retrospective study conducted in the Department of Gastroenterology, SCB Medical College, Cuttack from January 2005 to December 2016. Hospital records of indoor patients were searched manually and relevant parameters of CLD patients were noted, especially demographic profile, etiology and clinical features. A two way ANOVA was performed among the three groups of etiology, which are Alcoholism, Viral and “others”. All data were analysed using SPSS version 21 software. Results: Total 3645 patients were studied (male 84.7%; females 15.3%). There mean age was 46.18 ± 13.39 years. The mean age for males was 46.59 ± 12.73 and for the females was 43.91 ± 16.39. Alcoholism was the most common cause of CLD in our study; the proportion of CLD due to ALD increased over the years from 38.6% in 2005 to 60.2% in 2016. Viral infection including both chronic hepatitis B and chronic hepatitis C as the etiology of chronic liver disease declined from 39.4% in 2005 to 21.1% in 2016. The time trends of the etiology of CLD are summarized in Figure 1. Following post hoc Tukey test, it was observed that the disease population increased significantly over time for alcoholic liver disease patients over those due to viral and other etiologies (P < 0.0001). Conclusions: Alcohol is the most common cause of chronic liver disease and the burden of alcohol related chronic liver disease is significantly increasing in comparison to other causes including viral infection, NASH and autoimmune hepatitis. The authors have none to declare.

A Retrospective Analysis of Explant Liver Pathology: Experience from A Tertiary Care Center in India

Background and Aim: The histological spectrum of explant liver pathology and their prevalence has rarely been reported from Indian subcontinent. The study was performed to provide new insight into the prevalence of explant liver pathologies in this part of world by retrospective analysis of spectrum of histological changes. Secondly, to study etiopathological association of cirrhosis and third to study the etiopathogenesis for development of hepatocellular carcinoma and to analyze whether there is any association of macro regenerative and dysplastic nodule with hepatocellular carcinoma. Methods: Written records of all explant liver pathology were entered into an electronic database. Retrospective analysis of liver explants was performed from May 2015 to July 2016 at a tertiary care center in India. Results: Maximum (97.2%) number of liver explants showed cirrhosis with only 2.8% cases of acute liver failure (ALF) and acute on chronic liver failure (ACLF). HCV related chronic liver disease is the commonest etiological factor for development of cirrhosis in this part of world followed by HBV and alcoholic. HCV is also found to be associated with primary hepatic lymphoma (PHL) in one case. The association between hepatocellular carcinoma (HCC) and HBV was found to be significant with a p value of 0.009. The association between dysplastic nodules and HCC was also found to be significant. Conclusion: This study describes the histological spectrum of explant liver pathology from India. HCV forms the major disease burden for chronic liver disease. There is significant association of dysplastic nodules with HCC postulating their role as a precursor lesion in HCC. The author has none to declare.Table 1Number and Sex Distribution of Explant Cases.

Bone Health and Impact of Tenofovir Treatment in Men with Hepatitis-B Related Chronic Liver Disease

Chronic Liver Disease (CLD) has been shown to have an adverse impact on bone health. Hepatitis-B related CLD and its treatment with tenofovir may have additional effects on skeleton. To study the impact of HBV related CLD and its treatment with Tenofovir on bone health in Indian subjects. This cross sectional study included men (18-60 years) and comprised of three groups: Group-1 was treatment naïve HBV related CLD (n=79), Group-2 those with HBV related CLD on tenofovir for at least 1 year (n=136), Group-3 age, sex and Body Mass Index (BMI) matched healthy controls (n=58). Bone biochemistry and Bone Mineral Density (BMD) at spine, Femoral Neck (FN) and forearm were studied. Independent t-test or ANOVA was used to compare the means of continuous variables and chi-square test for categorical variables. Multiple logistic regression was used to assess the factors causing Low Bone Mass (LBM) at FN. A significantly greater proportion (P<0.05) of patients (40%) with CLD (group 1 and group 2) had vitamin D deficiency (<20ng/ml) in comparison with control group (22%). The mean serum C-Terminal telopeptide was significantly higher (P<0.05) and the mean BMD was significantly lower (P<0.05) in subjects with HBV related CLD than controls. The prevalence of LBM was higher in group 1 at the spine (31%) and forearm (18.4%) when compared to controls (8.1% and 7.8% respectively) (P<0.05). The proportion of patients with LBM at FN was highest in group 2 (12.3%) compared to those in group 1 (8%) and group 3 (4%) (P<0.05). Advanced age, low BMI, and high viral load (>10,000IU/ml) emerged as significant risk factors for LBM at FN. The impact of hepatitis-B related CLD as well as its treatment on bone health is significant. Bone health need to be periodically evaluated in these subjects especially in older men who are lean and have a higher viral load.