Related End-stage Liver Disease Research Articles

A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States.

BACKGROUNDPalliative care (PC) has been shown to be beneficial in end stage liver disease (ESLD), yet the hospitalization data for PC utilization is unknown.AIMTo identify the trend of PC utilization for the special population of alcohol-associated ESLD patients, factors affecting its use and ascertain its impact on healthcare utilization. METHODSWe analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis. We identified patients with PC consultation as a secondary diagnosis. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models.RESULTSOut of the total 1421849 hospitalizations for decompensated liver cirrhosis, 62782 (4.4%) hospitalizations had a PC consult, which increased from 0.8% (1258) of all alcohol-associated ESLD hospitalizations in 2007 to 6.6% in 2014 (P < 0.01). Patient and hospital characteristics associated with increased odds of PC utilization were advanced age, lower income, Medicaid coverage, teaching institution, urban location, length of stay > 3 d, prolonged ventilation, and administration of total parenteral nutrition (all P < 0.01). Palliative encounters in alcohol-associated ESLD and acute-on-chronic liver failure (ACLF) score were associated with increased odds of discharge to a rehabilitation facility, but significantly lower odds of 30-d readmissions (aOR: 0.35, 95%CI: 0.31-0.41), lower total hospitalization charges and lower mean hospitalization days (all P < 0.01).CONCLUSIONInpatient PC is sparingly used for patients with decompensated alcohol related liver disease, however it has increased over the past decade. PC consultation is associated with lower 30-d readmission rates on multivariate analysis, and lower hospitalization cost and length of stay in patients with ACLF score ≥ 2.

Severe Vitamin D Deficiency Is Strongly Associated with Liver Dysfunction and Disease Severity in Hepatitis B Virus Related Cirrhosis and Liver Failure Patients.

Vitamin D deficiency is common in chronic liver diseases, it may increase the severity of the diseases. However, studies on the potential role of vitamin D in hepatitis B virus (HBV) related end stage liver disease are still limited. This study was performed to assess the prevalence of vitamin D deficiency in patients with different stages of chronic HBV infection and explore whether vitamin D deficiency can be established as an index of severity and prognosticator of disease progression. Serum 25(OH)D3 levels were measured in a cohort of 363 patients with chronic HBV infection. Biochemical parameters, the alpha fetoprotein level, HBV DNA load, hepatitis B surface antigen level, and hepatitis B early antigen level were tested. The mean 25(OH)D3 level was significantly lower in patients with chronic HBV-related liver disease than in healthy controls. Overall, 74.9% of patients had 25(OH)D3 deficiency. The 25(OH)D3 level was significantly positively correlated with the albumin level. In total, 77.6% (121/156) of patients with cirrhosis had vitamin D deficiency. The 25(OH)D3 level significantly decreased as the Child-Pugh classification increased in severity. The 25(OH)D3 level was negatively correlated with the model for end-stage liver disease (MELD) score and low 25(OH)D3 concentrations were significantly associated with high MELD score and mortality in patients with liver failure. Vitamin D deficiency is prevalent in patients with chronic HBV infection. Severe vitamin D deficiency is strongly related to liver dysfunction and disease severity in the cirrhosis and liver failure patients.

Influence of IL28B of Donors and Recipients on Liver Transplantation Due to End Stage HCV Related Liver Disease

Abstract Background: Recent studies have described a major impact of the IL28B gene polymorphism on graft survival post liver transplantation. Our study aims to investigate the impact of IL28B of donors and recipients on the natural course and outcome of liver transplantation due to end stage HCV related liver disease. Aim of Study: This study aims to investigate SNP of IL28B gene in Egyptian patients with end stage HCV related liver disease. Correlating the prevalence of IL-28b-alleles with patient and graft survival and with the progression of fibrosis for HCV-induced (graft) liver disease after liver transplantation. Also to correlate IL28B genotype with the outcome after liver transplantation. Patients and Methods: Donor and recipient IL28B rs12979860C>T single nucleotide genotype was determined in 24 patients who had undergone LT for HCV-induced end stage liver disease and received regular follow-up evaluations for two years post liver transplantation. Results: We found that the CC genotype frequency was reduced among patients with HCV related end stage liver disease while, in contrast, the frequency of CT & TT increased. No association was noted between IL 28B polymorphism of donors and recipients regarding fibrosis progression or patient and graft survival, as well as liver outcomes. Conclusions: No impact of IL 28B polymorphism on fibrosis progression, liver outcomes or patient and graft survival.

Dual graft living donor liver transplantation \u2013 a case report

BackgroundLiving donor liver transplantation (LDLT) has emerged as an equally viable option to deceased donor liver transplant for treating end stage liver disease patients. Optimising the recipient outcome without compromising donor safety is the primary goal of LDLT. Achieving the adequate graft to recipient weight ratio (GRWR) is important to prevent small for size syndrome which is an uncommon but potentially lethal complication of LDLT.Case presentationHere we describe a case of successful dual lobe liver transplant for a 32 years old patient with ethanol related end stage liver disease. A right lobe graft without middle hepatic vein and another left lateral sector graft were transplanted successfully. Recipient and both donors recovered uneventfully.ConclusionDual lobe liver transplant is a feasible strategy to achieve adequate GRWR without compromising donor safety.

Hepatitis B and liver transplantation.

Liver transplantation (LT) is the only effective treatment for hepatitis B-virus (HBV) related end stage liver disease, even if the outcome of these patients, has significantly improved after introduction of effective and well tolerated nucleoside/nucleotide analogues (NUC). Pre-transplant therapy has been initially based on lamivudine, but entecavir and tenofovir represent the currently recommended first-line therapeutic option in patients with HBV decompensated cirrhosis. After LT, the development of hepatitis B immunoglobulin (HBIG) in the early 1990's dramatically changes the prognosis of these patients by reducing the incidence of HBV recurrence and increasing survival rate. Combination of HBIG and NUC is now considered as the standard of care for prophylaxis against HBV recurrence, however personalized therapeutic algorithms based on pre- and post-transplant viral and host factors have been proposed. Finally, liver grafts from hepatitis B core antibody-positive donors and from hepatitis B antigen-positive donors can be safely used in selected patients.

A Bloody Connection: A Case of Hepatic Artery Pseudo Aneurysm Presenting as Hematemesis

Hemobilia is bleeding from biliary tree. It is a rare un-predictable jeopardizing vascular complication that is usually iatrogenic. Other causes include choledochelithiasis, biliary parasites, choledochal varices and biliary tumors. Upper gastrointestinal (GI) bleeding with melena is the most common presentation, followed by abdominal pain and jaundice (Quincke's triad). This triad is present in only 22% of cases. Our patient is a 66-year-old male with past history significant for Hepatitis C related end stage liver disease complicated by hepatocellular carcinoma. He underwent orthotropic liver transplant and he developed elevated liver transaminases postoperatively. Imaging revealed a 13-cm sub capsular collection due to anastomotic bile leak. This was managed initially by placement of a percutaneous biliary drain followed by endoscopic biliary sphincterotomy and 10F bile duct stenting (Figure-1) adjacent to the 6F stent across the anastomosis deployed at surgery. Liver enzymes continued to rise despite adequate biliary drainage and subsequent liver biopsy showed periductular neutrophilic infiltrate consistent with acute cholangitis. Three weeks later, patient suffered an episode of hematemesis of 500 cc of fresh blood. An emergent endoscopy visualized large blood clot in the stomach and oozing of fresh blood from the ampulla of Vater. Prior surgically deployed stent was removed during EGD using rat tooth forceps. CT angiogram revealed a 2-cm PA of the transplanted hepatic artery abutting the bile duct with stent forming a fistula resulting in hemobilia (figure-2). Immediate angiography (figure-3) was performed and a hepatic arterial stent was deployed occluding the PA with prompt cessation of further bleeding. A follow up magnetic resonance cholangiopancreatography confirmed intact CBD and absence of leakage from biliary tree. Hepatic artery dissection and PA, although rare after liver transplantation, can be fatal with mortality reported to be as high as 69%. A high index of suspicion is always required for diagnosis. It's believed that an injury to hepatic artery during liver biopsy is the insult causing PA formation. Although literature was scant on utility of stenting of hepatic PA during acute hemorrhage, our patient responded well to this minimally invasive approach. This report highlights the importance of considering hepatic artery PA, albeit rare, as a cause of hemobilia in those undergoing liver biopsy after liver transplantation.Figure: Blood clot at the ampulla (arrow) along with biliary stents in situ.Figure: A 2-cm PA (red arrow) of the transplanted hepatic artery abutting the bile duct with stent (blue arrow) forming a fistula.Figure: Appearance of PA (red arrow) before stent placement followed by stenting of common hepatic artery PA under fluoroscopic guidance (blue arrow).

Study of Some Serum Biochemical Markers of Liver Fibrosis in Patients with Chronic HCV

Chronic hepatitis C is a major cause of cirrhosis, hepatocellular carcinoma and HCV related end stage liver disease, in many countries it is the first cause of liver transplantation. The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years. Establishing accurate staging of liver disease is very important for enabling both therapeutic decisions and prognostic evaluations. A liver biopsy is considered the gold standard for assessing the stage of hepatic fibrosis, but it has many limitations. During the last decade, several noninvasive markers for assessing the stage of hepatic fibrosis have been developed. Some have been well validated and are comparable to liver biopsy. This paper focused on some noninvasive biochemical markers used to stage liver fibrosis. The aim of this study was to evaluate some serum biochemical markers for diagnosing liver fibrosis in patients with CHC. This study was conducted on 50 patients who were divided into two groups: group 1 included 25 patients with F1 liver fibrosis; group 2 enrolled 25 patients with F2 liver fibrosis (according to metavir scoring system) and fit for the combination therapy (Pegyalated interferon + riba virin). Results: Serum HA. SHASTA index and FIBRO-Q LEVEL were significantly higher in patient with grade-2 fibrosis than grade F1 patients. From the previous study, we can conclude that these parameters could be useful noninvasive markers of liver fibrosis and cost-effective alternative to other serum markers for staging liver fibrosis and for determining the timing of HCV treatment.

Su1591 Magnetic Resonance Cholangio-Pancreatography (MRCP) Has Low Sensitivity in Diagnosing Biliary Strictures After Liver Transplantation: a Single Tertiary Care Center Experience

Su1591 Magnetic Resonance Cholangio-Pancreatography (MRCP) Has Low Sensitivity in Diagnosing Biliary Strictures After Liver Transplantation: a Single Tertiary Care Center Experience

Su1590 Role of the Direct PerOral Cholangioscopy Using an Ultra-Slim Endoscope After Endoscopic Extraction of Choledocholithiasis for Detecting Small Bile Duct Lesions Obscure in Conventional Imagings

Su1590 Role of the Direct PerOral Cholangioscopy Using an Ultra-Slim Endoscope After Endoscopic Extraction of Choledocholithiasis for Detecting Small Bile Duct Lesions Obscure in Conventional Imagings

Retrospective cohort study of liver transplantation in the United Kingdom between 1994 and 2010: the impact of hepatitis C infection

BackgroundLiver transplantation is an important and established treatment option for chronic hepatitis C virus (HCV) related end-stage liver disease (HCV-related ESLD). This study describes trends in elective liver transplantation among persons with HCV-related ESLD. Study designRetrospective cohort. MethodsAnalyses of United Kingdom (UK) Transplant Registry data for the period 1994 to 2010, with follow-up information extending to 2011. ResultsAnnual registrations for liver transplantation increased linearly and alcoholic liver cirrhosis (2075, 24%) and HCV-related ESLD (1213, 14%) were the most common indications. HCV-related ESLD patients were mainly aged 40–49 years (32%) and 50–59 years (43%); males (76%); and of white ethnicity (74%). Overall, 75% (956/1213) received a liver transplant with a linear increase over the period (OR 1.11, 95% CI 1.08, 1.13). Pre transplant mortality was unchanged (adjusted OR 1.0, 95% CI 0.96, 1.05) and post-transplant mortality decreased in both HCV-related (adjusted OR 0.77, 95% CI 0.68, 0.88) and non-HCV-related ESLD (adjusted OR 0.82, 95% CI 0.75, 0.89) patients. ConclusionThe increase in demand for and receipt of liver transplants among persons with HCV-related ESLD requires coordinated efforts to increase not only organ donation, but investment in HCV prevention programmes and improved access to hepatitis C treatment services.

Telbivudine Prophylaxis for Hepatitis B Virus Recurrence After Liver Transplantation Improves Renal Function

IntroductionRenal impairment after liver transplantation represents an important issue in the management of transplantation patients, particularly when those subjects may need prophylaxis for fungal or viral infection. Herein we report our experience with 12 transplantation patients receiving telbivudine 600 mg/d while on the waiting list, followed by treatment for 18 months after liver transplantation, showing an improvement on their renal function during the follow-up period. MethodsOur series consisted of men with hepatitis B virus (HBV)–related end-stage liver disease. The viral load decreased rapidly while on the waiting list once the patient was started on antiviral treatment. Those subjects were compared with 12 patients on lamivudine prophylaxis. All patients were evaluated for liver and renal function, immunosuppression trough levels, and creatine phosphokinase (CPK) before liver transplantation (T0) and at 3, 6, 12, and 18 months (T3, T6, T12, T18). ResultsAll patients received a calcineurin inhibitor immunosuppression-based regimen. Creatinine clearance (Modification of Diet in Renal Disease) was 67 mL/min at T0, with a statistically significant improvement after month 6 compared with those on lamivudine and with the value at the beginning of the prophylaxis (Mann-Whitney U test P < .05). Neither CPK nor transaminase serum levels increased throughout the study period. Once HBV DNA was cleared while on the waiting list, it remained negative throughout the follow-up period. ConclusionsTelbivudine prophylaxis for HBV is safe and effective, without any significant deleterious effect on the liver; on the contrary, it seems to improve renal function after liver transplantation through 18 months. Further studies and larger series are warranted to confirm these findings.

Outcomes and management of viral hepatitis and human immunodeficiency virus co-infection in liver transplantation

Liver transplantation for human immunodeficiency virus (HIV) positive patients with viral hepatitis co-infection is increasingly offered in many North American and European liver transplant centers. Prior studies have demonstrated acceptable post-transplant outcomes and no increased risk of HIV complications in patients co-infected with hepatitis B virus (HBV). However, liver transplantation in HIV positive patients with hepatitis C virus (HCV) has poorer outcomes overall, requiring careful selection of candidates. This review aims to summarize the published literature on outcomes after transplant in HIV patients with HBV or HCV related end-stage liver disease and recommendations for management. In particular the pre-transplant factors impacting outcomes in HCV/HIV co-infected candidates and importance of multidisciplinary management will be discussed.

Angiotensin Blockade Does Not Affect Fibrosis Progression in Recurrent Hepatitis C After Liver Transplantation

BackgroundLiver transplantation (LT) for hepatitis C virus (HCV)–related end-stage liver disease is impaired by universal disease recurrence and suboptimal response to antiviral therapy. Inhibition of angiotensin-II signalling by angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II receptor blockers (ARB) decreases hepatic stellate cell activation in vitro and hepatic fibrogenesis in animal models. A single-center retrospective analysis suggested that angiotensin blockade (AB) inhibits fibrosis progression in recurrent HCV post-LT. This study assessed the effect of AB on fibrosis progression in an independent patient cohort. MethodsChart review of all patients who underwent transplantation in our institution for HCV-related ESLD between January 2000 and February 2008 revealed 109 patients with ≥2 protocol liver biopsies and free of antiviral therapy post-LT up to the last biopsy analyzed; 27 of 109 patients were treated with ACE-I/ARB for ≥12 months, 82 were not. Fibrosis was staged using METAVIR. ResultsLive-donor LT was more frequent in controls than in the AB group (25% vs 11%; P < .05). However, parameters known to affect outcome of recurrent HCV, including donor age, prevalence of diabetes, acute cellular rejection, and immunosuppression, were similar in both groups. Time between first and last biopsy (median, 23 months), stage of fibrosis, fibrosis progression rates (median 0.47 vs 0.45 unit/y; P = .46), and time to develop fibrosis stage ≥2 did not differ between groups. Results held true if deceased-donor LT were analyzed separately. ConclusionOur study does not support the contention of a previous report that use of AB reduces fibrosis progression in recurrent HCV post-LT.

Assessment of HCV - Induced Insulin Resistance in Egyptian HCV End - Stage Cirrhotic Patients before and after Living Donor Liver Transplantation ( LDLT )

HCV virus has been shown to induce insulin resistance (IR) itself. The aim of this work: was to evaluate HCV-induced IR in Egyptian HCV cirrhotic patients after LDLT and correlate the occurrence of IR with the level of HCV-RNA viremia and the status of HCV disease recurrence post LDLT. 67 patients had received LDLT from November 2010 to November 2012. 17 of them were included in this prospective research by the following criteria :1) Patients with HCV related End Stage Liver Disease , who were eligible for liver transplantation . 2) Patients with an estimate of IR using HOMA-IR level more than or equal 2 +/- [impaired fasting plasma glucose (FPG) and/or impaired oral glucose tolerance test (OGTT)] .Patients were followed up with the following schedule : FPG , OGTT and HOMA were routinely done 3 , 6 and 12 months post LDLT. HCV RNA level by PCR was performed 1 , 6 and 12 months to follow up the level of viremia post LDLT . Protocol liver biopsies were taken 6 and 12 months post LDLT. The median HOMA value showed reduction during the first year post LDLT , which was not significant at 3 months post LDLT (p value = 0.055) , was highly significant at 6 months post LDLT (p value =0.002) and was again significant at 12 months post LDLT (p value = 0.028) . Recurrence of HCVdisease was documented histologically in 9 patients (52.9%) at 6 months and 10 patients (58.8%) 1 year post LDLT. There was no statistically significant relation between median HOMA values and either level of HCV-RNA viremia or histological recurrence of HCV 6 and 12 months post LDLT. To our knowledge , this is the first study of HCV-induced IR that was conducted on LDLT recipients. HCV-induced insulin resistance is improved 1 year after after LDLT.

Management of Hepatitis B Virus Infection in Liver Transplantation Setting; The Rising Concerns and Growing Hopes, Report From 10th Congress of the Iranian Society for Organ Transplantation, 2011, Shiraz, Iran

Hepatitis B infection is the main cause of liver related mortality in many countries including Iran. Liver transplantation in cirrhosis due to HBV infection before 1990 was an absolute contraindication. Recurrent infection was a significant event in post liver transplant setting and resulted in increased risk of graft failure and death except successful transplanted individuals. Advances in antiviral prophylaxis have now made graft reinfection majority patients as a rare event. Graft and patient survival have been improved significantly during the past two decades, and consequences of transplantation for hepatitis B virus are now superior to those achieved for most other indications. This has encouraged many centers including the major liver transplantation center of Iran, in Shiraz, to provide liver transplantation to more patients with HBV related end stage liver disease. Management of these patients begins before transplantation along with special care after transplantation. There are some myths and doubts in the management of these patients and one should always balance the cost and efficiency. One of the major concerns is the high economic and social cost of recurrence and all possible efforts should be performed to avoid the ominous consequences of reinfection. Having a clear scientific grasp on the management of HBV cirrhosis before and after liver transplantation, options and protocols, and changing the concept which HBV infected are contraindicated ones for liver transplantation, and future hopes in increasing patients survival after liver transplantation using the new nucleosides analogues and availability of hepatitis B immunoglobulin in the transplantation setting. This scientific report paper outlines the insights communicated at the HBV and liver transplantation symposium during 10th Congress of the Iranian Society for Organ Transplantation, May 2011, Shiraz, Iran.

Impact of Anti-HCV Therapy and HCV-RNA Titer on Graft Survival after Liver Transplant in Patients with HCV

Background: HCV related end stage liver disease is becoming the leading indication for liver transplant (OLTx), however it's prognosis is still dismal. Even though the relapse of the HCV infection is almost universal, certainly some of the liver recipients with HCV relapse can maintain good graft function as long as the liver recipients without HCV infection. The rate of sustained viral response (SVR) in the treatment of recurrent HCV after OLTx using interferon or pegylated interferon (peg IFN) have been reported as ranging from 5 to 50%, and once SVR was established, the degree of graft inflammation and fibrosis were downgraded. However the long-term outcome after the anti-viral therapy for recurrent HCV have not been addressed yet. The aim of this study is to identify the factor that can affect graft survival after the OLTx for the HCV related patients, and evaluate the impact of the anti-HCV therapy on the long-term graft survivals. Methods: Four handred fifty six patients, who underwent OLTx in University of Miami/Jackson Memorial Hospital since 2002 to 2006, were reviewed retrospectively. Patients with hepatocellular carcinoma were excluded. One handred sixty one recipients had HCV-related liver disease (HepC), and 295 uninfected contolols were identified (control). Graft loss was defined as at time of recipient's death or time of retransplant. Anti-HCV therapy using peg IFN with ribavirin (pegIFN/Rib) was initiated when the patients showed abnormal allo-graft function and HCV re-infection confirmed by histologically. Median follow-up time was 45 month (range 0-79 months). Statistical analysis was performed using R version 2.7.2. Results: One handred five grafts were lost in total of 456 recipients. Graft survival in HCV was shorter than control, without reaching significance (p=0.56). The cumulative incidence of early graft loss (graft loss within 2 years after OLTx) was higher in HCV than controls (26% in HCV and 16% in controls). High postoperative HCV-RNA titer (more than 500,000 IU/ml), administration of muromonab-CD3 and MELD score greater than 20 appeared to be significant predictive factors for early graft loss from logistic regression analysis among HepC (p=0.04, 0.002 and 0.03, respectively). One handred patients underwent peg IFN/Rib therapy in total of 161 HepC patients, and the SVR in our series was 21%. 5 year graft survival from the patients with or without pegIFN/Rib were 77% and 57%, respectively. The cumulative graft survival of the patients with pegIFN/Rib was significantly longer than the patients without pegIFN/Rib (p< 0.001). Also, lower postoperative HCV-RNA titer appeared to be significant predictors for long-term graft survival from log rank test (p=0.003). Conclusion: High HCV-RNA titer was implicated in early graft loss after OLTx, whereas lower HCV-RNA titer had positive impact for long-term graft survival in patients with HCV. PegIFN with ribavirin therapy after OLTx also had a positive impact for long-term graft survival in patients with HCV.

Liver Transplantation for Hepatitis C From Donation After Cardiac Death Donors: An Analysis of OPTN/UNOS Data

Donation after cardiac death (DCD) liver transplantation is increasing largely because of a shortage of organs. However, there are almost no data that have specifically assessed the impact of using DCD livers for HCV patients. We retrospectively studied adult primary DCD liver transplantation (630 HCV, 1164 non-HCV) and 54 129 donation after brain death (DBD) liver transplantation between 2002 and 2009 using the UNOS/OPTN database. With donation after brain death (DBD) livers, HCV recipients had significantly inferior graft survival compared to non-HCV recipients (p < 0.0001). Contrary to DBD donors, DCD livers used in HCV patients showed no difference in graft survival compared to non-HCV patients (p = 0.5170). Cox models showed DCD livers and HCV disease had poorer graft survival (HR = 1.80 and 1.28, p < 0.0001, respectively). However, the hazard ratio of DCD and HCV interaction was 0.80 (p = 0.02) and these results suggest that DCD livers on HCV disease do not fare worse than DCD livers on non-HCV disease. The graft survival of recent years (2006-2009) was significantly better than that in former years (2002-2005) (p = 0.0482). In conclusion, DCD liver transplantation for HCV disease showed satisfactory outcomes. DCD liver transplantation can be valuable option for HCV related end-stage liver disease.

The relationship between hepatocellular carcinoma recurrence and hepatitis B virus recurrence after liver transplantation

To investigate the relationship between hepatocellular carcinoma (HCC) recurrence and hepatitis B virus (HBV) recurrence. The clinical data of 340 patients underwent liver transplantation due to HBV related end-stage liver disease and received long-term follow up in our hospital from Jan 2004 to Dec 2008 were retrospectively analyzed. All patients received nucleoside analogues therapy formally before entering into the waiting list and nucleoside analogues combined low-dose HBIG therapy during and after transplantation. Patients were regularly followed up at the outpatient, monitoring the HBV recurrence and survival. Multivariate Cox regression analysis was used to evaluate the risk factors for hepatitis recurrence. 33 patients suffered from HBV recurrence post transplantation. The 1-, 3- and 5- year recurrence rates were 7.0%, 10% and 13% respectively. The median HBV recurrence time was 5 months (1-21 months). COX regression analysis revealed that risk factors for HBV recurrence were HCC (HR = 2.98; 95% CI 1.08-8.25; P < 0.05) and pre-transplantation HBV-DNA load over 5 log10 copies/ml (HR = 3.99; 95% CI 1.85-8.62; P < 0.01). Further stratified analysis showed that patients who suffered from carcinoma recurrence had a higher incidence of HBV recurrence than those who did not, which were 27.9% and 8.7% (HR = 4.58;95% CI 1.88-11.12; P < 0.01) respectively. 12 patients suffered from both HCC and HBV recurrence. Spearman correlation analysis demonstrated a strong correlation between HBV and HCC recurrence times (r = 0.583, P < 0.05). Post transplantation HCC recurrence is a risk factor for HBV recurrence.

Hepatitis C Treatment Response in Liver Transplant Recipients

BackgroundHepatitis C virus (HCV)–related end-stage liver disease is the leading indication for liver transplantation (LT). HCV recurrence after LT is universal leading to accelerated recurrence of cirrhosis. Therapeutic response to currently available regimen is reported lower compared to treatment of HCV in non LT patients.ObjectiveEvaluate the response of HCV treatment in LT recipients.MethodsIt was a retrospective study in which medical records of subjects who underwent liver transplant for HCV related liver disease from September 1991 to August 2009 were reviewed.ResultsOne hundred ninety-five subjects with HCV LT recipients charts were reviewed, 139 were excluded as there were not treated. Fifty-six subjects were treated with pegylated interferon and ribavirin standard dose. Mean age was 60 years, predominantly males (82%). Twenty-eight (50%) were white, 18 (32%) were Hispanic and 10 (18%) were African American. Average body mass index was 28, and genotype (GT) 1 was predominant (84%). Median METAVIR fibrosis score was 2. Overall sustained virological response (SVR) in this cohort was 32%. Hispanics and Whites had similar SVR rates (50%) but none of the African Americans achieved SVR and had 40% relapse rate. There were no deaths in subjects who achieved SVR whereas 4 died in non SVR group.ComplicationsSVR group: one subject underwent re-transplantation due to hepatic artery issues, 6 had acute cellular rejection (ACR) during treatment and one had chronic rejection. Overall, 16% received blood transfusions, 21% required erythropoietin respectively for anemia.ConclusionTable 1Treatment Response According to GenotypeGT-1 (n = 47)GT-2 (n = 2)GT-3 (n = 7)SVR13 (28%)5 (71%)No SVR17 (36%)Relapser14 (30%)1 (50%)2 (29%)Treatment intolerant3 (6%)1 (50%)GT, genotype; SVR, sustained virological response. Open table in a new tab BackgroundHepatitis C virus (HCV)–related end-stage liver disease is the leading indication for liver transplantation (LT). HCV recurrence after LT is universal leading to accelerated recurrence of cirrhosis. Therapeutic response to currently available regimen is reported lower compared to treatment of HCV in non LT patients. Hepatitis C virus (HCV)–related end-stage liver disease is the leading indication for liver transplantation (LT). HCV recurrence after LT is universal leading to accelerated recurrence of cirrhosis. Therapeutic response to currently available regimen is reported lower compared to treatment of HCV in non LT patients. ObjectiveEvaluate the response of HCV treatment in LT recipients. Evaluate the response of HCV treatment in LT recipients. MethodsIt was a retrospective study in which medical records of subjects who underwent liver transplant for HCV related liver disease from September 1991 to August 2009 were reviewed. It was a retrospective study in which medical records of subjects who underwent liver transplant for HCV related liver disease from September 1991 to August 2009 were reviewed. ResultsOne hundred ninety-five subjects with HCV LT recipients charts were reviewed, 139 were excluded as there were not treated. Fifty-six subjects were treated with pegylated interferon and ribavirin standard dose. Mean age was 60 years, predominantly males (82%). Twenty-eight (50%) were white, 18 (32%) were Hispanic and 10 (18%) were African American. Average body mass index was 28, and genotype (GT) 1 was predominant (84%). Median METAVIR fibrosis score was 2. Overall sustained virological response (SVR) in this cohort was 32%. Hispanics and Whites had similar SVR rates (50%) but none of the African Americans achieved SVR and had 40% relapse rate. There were no deaths in subjects who achieved SVR whereas 4 died in non SVR group. One hundred ninety-five subjects with HCV LT recipients charts were reviewed, 139 were excluded as there were not treated. Fifty-six subjects were treated with pegylated interferon and ribavirin standard dose. Mean age was 60 years, predominantly males (82%). Twenty-eight (50%) were white, 18 (32%) were Hispanic and 10 (18%) were African American. Average body mass index was 28, and genotype (GT) 1 was predominant (84%). Median METAVIR fibrosis score was 2. Overall sustained virological response (SVR) in this cohort was 32%. Hispanics and Whites had similar SVR rates (50%) but none of the African Americans achieved SVR and had 40% relapse rate. There were no deaths in subjects who achieved SVR whereas 4 died in non SVR group. ComplicationsSVR group: one subject underwent re-transplantation due to hepatic artery issues, 6 had acute cellular rejection (ACR) during treatment and one had chronic rejection. Overall, 16% received blood transfusions, 21% required erythropoietin respectively for anemia. SVR group: one subject underwent re-transplantation due to hepatic artery issues, 6 had acute cellular rejection (ACR) during treatment and one had chronic rejection. Overall, 16% received blood transfusions, 21% required erythropoietin respectively for anemia. ConclusionTable 1Treatment Response According to GenotypeGT-1 (n = 47)GT-2 (n = 2)GT-3 (n = 7)SVR13 (28%)5 (71%)No SVR17 (36%)Relapser14 (30%)1 (50%)2 (29%)Treatment intolerant3 (6%)1 (50%)GT, genotype; SVR, sustained virological response. Open table in a new tab GT, genotype; SVR, sustained virological response.

Non-cirrhotic portal fibrosis related end stage liver disease in adults: evaluation from a study on living donor liver transplant recipients

That non-cirrhotic portal fibrosis (NCPF) can lead to end stage chronic liver disease (CLD) has been convincingly demonstrated only recently after the study of explant livers from clinically cirrhosis cases. This study attempted to determine the frequency of NCPF among adults transplanted for end stage CLD and to identify parameters for a pre-transplant diagnosis of NCPF. Several parameters were analyzed in three categories of cases: pure NCPF (n=10), overlap NCPF (n=10), and NAFLD cirrhosis controls (n=44). Morphologic features of NCPF were looked for in explant livers of all these. Explant livers in the pure NCPF group were non-cirrhotic and showed histologic features of NCPF. These features were also present in all cases of overlap NCPF in the background of established cirrhosis of other etiologies but absent in the NAFLD cirrhosis controls. Values of seven objective and two subjective parameters showed significant differences between pure NCPF and NAFLD control groups. Compared to NAFLD controls, the model for end stage liver disease (MELD) score, body mass index (BMI), bilirubin, albumin, aspartate amino transferase (AST), and international normalized ratio (INR) were significantly less, whereas variceal grade was higher in the pure NCPF group. The study concludes that in our population, NCPF constitutes about 5% of the subset of end stage CLD considered eligible for liver transplantation (LT), presenting mostly as cryptogenic cirrhosis (CC). A diagnosis of NCPF should be considered when patients presumed to have cryptogenic or other cirrhosis become eligible for LT even in the presence of relatively well-preserved liver function and low MELD scores. End stage CLD manifests at earlier age, when cirrhosis of another etiology supervenes on pre-existent NCPF.