Virus-related Cirrhosis Research Articles

LIVER FIBROSIS RESPONSE TO ENTECAVIR TREATMENT IN PATIENTS WITH HBV-RELATED COMPENSATED CIRRHOSIS

Background: Evaluating improvement of liver fibrosis response after anti HBV therapy in our country until now is very limited, especially in patients with cirrhosis. This study aimed at assessing the respone in liver fibrosis determined by ARFI and its related factors for patients with compensated HBV-related cirrhosis undergoing entecavir therapy. Subjects and methods: 60 patients with compensated HBV-related cirrhosis were enrolled at Da Nang Hospital from 06/2016 to 06/2018. All received entecavir 0,5mg a day 2 hours after breakfast and followed in 18 months. Liver fibrosis is measured by Acoustic Radiation Forced Imaging (ARFI). Results: Entecavir treatment may result in improvement of liver fibrosis in 20% after 12 months and 26.67% after 18 months in patients with compensated hepatitis B virus-related cirrhosis. The improvement in fibrosis levels was significant after at least 12 months of treatment. Factors associated with improvement of fibrosis response in this study included AST, ALT, AFP are high, HBeAg (+), low prothrombin time at baseline, and indetectable HBV DNA after 6 months of treatment. Conclusion: Entecavir treatment may help to improve liver fibrosis in patients with hepatitis B virus-related compensated cirrhosis, but long-term treatment is needed. Key words: Entecavir, HBV cirrhosis, liver fibrosis, ARFI

Direct-acting antivirals and hepatocellular carcinoma occurrence and recurrence in hepatitis C virus-related liver cirrhosis: fact or finction

Direct-acting antivirals and hepatocellular carcinoma occurrence and recurrence in hepatitis C virus-related liver cirrhosis: fact or finction

Retrospectively seroprevalence study on anti‐HEV‐IgG antibody in patients with chronic hepatitis or liver cirrhosis in a Chinese teaching hospital

To investigate the serum anti-hepatitis E virus (HEV) antibody positive rate in patients with different types of chronic hepatitis (CH) or cirrhosis. A total of 1751 hospitalized patients were chart reviewed, who were diagnosed with mono-CH or cirrhosis between 2011 and 2016. The total anti-HEV-IgG positive rate was 1.33% (13/981) in CH patients, which was significantly lower than that (6.49%; 50/770) in cirrhosis patients (odds ratio [OR], 4.78 [2.51-9.10]; P = 0.00). The comparison of positive rate of anti-HEV-IgG between the same etiology CH and cirrhosis groups was as follows: chronic hepatitis B 1.27% (10/790) versus hepatitis B virus (HBV)-related cirrhosis 4.21% (22/522) (OR, 3.04 [1.36-6.77]; P = 0.00); chronic alcoholic hepatitis 1.41% (1/71) versus alcoholic cirrhosis 9.40% (11/117) (OR, 8.00 [1.00-64.25]; P = 0.03); chronic autoimmune hepatitis 1.69% (1/59) versus autoimmune cirrhosis 13.33% (12/90) (OR, 13.11 [1.49-115.27]; P = 0.01); the differences above were statistically significant. And chronic hepatitis C 3.23% (1/31) versus hepatitis C virus-related cirrhosis 10.81% (4/37) (OR, 4.40 [0.45-43.53]; P > 0.05); chronic NASH 0.00% (0/30) versus NASH-related cirrhosis 25.00% (1/4) (P > 0.05), the differences were not statistically significant. Anti-HEV-IgG positive rates were also compared among different types of CH groups and no significant difference was found. Likewise, anti-HEV-IgG positive rate was compared among different types of cirrhosis groups, showing that the positive rates of both alcoholic cirrhosis (9.40%) and autoimmune cirrhosis (13.33%) were significantly higher than that of HBV-related cirrhosis (4.21%) (P < 0.05). We observed that the cirrhosis patients had a significantly higher anti-HEV-IgG positive rate comparing with the CH patients, especially in those with HBV-related, alcohol-related, and autoimmune-related cirrhosis (after adjusted for age). Additionally, it seems that the conditions of alcoholic cirrhosis and autoimmune cirrhosis are more susceptible to HEV infection due to the significantly higher positive anti-HEV-IgG rate in these patients.

Macrocytic anemia is associated with the severity of liver impairment in patients with hepatitis B virus-related decompensated cirrhosis: a retrospective cross-sectional study

BackgroundMacrocytic anemia is common in liver disease. However, its role in hepatitis B virus (HBV)-related decompensated cirrhosis remains unknown. The aim of the present study was to determine the association between macrocytic anemia and the severity of liver impairment in patients with HBV-related decompensated cirrhosis according to the Model for End Stage Liver Disease (MELD) score.MethodsA total of 463 participants who fulfilled our criteria were enrolled in this cross-sectional study. Patients were classified into three groups according to anemia types, diagnosed based on their mean corpuscular volume level. Multivariate linear regression analyses were used to determine the association between macrocytic anemia and the MELD score for patients with HBV-related decompensated cirrhosis.ResultsPatients with macrocytic anemia had evidently higher MELD scores (10.8 ± 6.6) than those with normocytic anemia (8.0 ± 5.5) or microcytic anemia (6.3 ± 5.1). The association remained robust after adjusting for age, gender, smoking, drinking, and total cholesterol (β = 1.94, CI: 0.81–3.07, P < 0.001).ConclusionsMacrocytic anemia was found to be associated with the severity of liver impairment and might be a predictor for short-term mortality in patients with HBV-related decompensated cirrhosis.

Dynamic thiol-disulfide homeostasis is disturbed in hepatitis B virus-related chronic hepatitis and liver cirrhosis

Background/aim: Thiol-disulfide homeostasis is an important antioxidant defense mechanism. This study was conducted to investigate dynamic thiol-disulfide homeostasis in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis. Materials and methods: Seventy-one treatment-naive patients with chronic hepatitis B (CHB), 50 patients with hepatitis B virusassociated liver cirrhosis, and 45 healthy controls were included in the study. Serum total and native thiol concentrations and serum disulfide concentrations were measured using an automated method. Results: Mean serum total thiol concentrations in the control, CHB, and cirrhosis groups were 481.64 ± 37.87 µmol/L, 438.50 ± 71.35 µmol/L, and 358.07 ± 80.47 µmol/L, respectively (P < 0.001), and mean serum native thiol concentrations in the control, CHB, and cirrhosis groups were 452.92 ± 36.43 µmol/L, 400.16 ± 65.92 µmol/L, and 328.15 ± 74.91 µmol/L, respectively (P < 0.001). Mean serum disulfide concentrations in the control, CHB, and cirrhosis groups were 14.38 ± 3.38 µmol/L, 19.19 ± 6.16 µmol/L, and 14.98 ± 5.53 µmol/L, respectively (P < 0.001). There was a progressive decrease in both mean serum native and total thiol concentrations parallel to the liver fibrosis stage. Conclusion: : Thiol-disulfide homeostasis is disturbed in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis.

Hepatitis C virus related cirrhosis decreased as indication to liver transplantation since the introduction of direct-acting antivirals: A single-center study.

AIMTo evaluate waiting list (WL) registration and liver transplantation (LT) rates in patients with hepatitis C virus (HCV)-related cirrhosis since the introduction of direct-acting antivirals (DAAs).METHODSAll adult patients with cirrhosis listed for LT at Padua University Hospital between 2006-2017 were retrospectively collected using a prospectively-updated database; patients with HCV-related cirrhosis were divided by indication for LT [dec-HCV vs HCV/ hepatocellular carcinoma (HCC)] and into two interval times (2006-2013 and 2014-2017) according to the introduction of DAAs. For each patient, indications to LT, severity of liver dysfunction and the outcome in the WL were assessed and compared between the two different time periods. For patients receiving DAA-based regimens, the achievement of viral eradication and the outcome were also evaluated.RESULTSOne thousand one hundred and ninty-four [male (M)/female (F): 925/269] patients were included. Considering the whole cohort, HCV-related cirrhosis was the main etiology at the time of WL registration (490/1194 patients, 41%). HCV-related cirrhosis significantly decreased as indication to WL registration after DAA introduction (from 43.3% in 2006-2013 to 37.2% in 2014-2017, P = 0.05), especially amongst dec-HCV (from 24.2% in 2006-2013 to 15.9% in 2014-2017, P = 0.007). Even HCV remained the most common indication to LT over time (289/666, 43.4%), there was a trend towards a decrease after DAAs introduction (from 46.3% in 2006-2013 to 39% in 2014-2017, P = 0.06). HCV patients (M/F: 43/11, mean age: 57.7 ± 8 years) who achieved viral eradication in the WL had better transplant-free survival (log-rank test P = 0.02) and delisting rate (P = 0.002) than untreated HCV patients.CONCLUSIONIntroduction of DAAs significantly reduced WL registrations for HCV related cirrhosis, especially in the setting of decompensated cirrhosis.

Recurrence of Hepatocellular Carcinoma (HCC) Following Complete Response With Trans Arterial Chemoembolization With Exposure to Direct Acting Antiviral Agents (DAA)

Introduction: It is well known that hepatitis C virus (HCV) related cirrhosis increases the risk of developing hepatocellular carcinoma (HCC). In the past, sustained virologic response (SVR) following interferon-based treatment for chronic HCV was known to be associated with decreased risk of HCC and HCC recurrence. Now in direct acting antiviral agents (DAA) era, studies have demonstrated contrasting evidence with potential increased risk of HCC recurrence (HCCR) after DAA therapy. Aim of our study is to clarify this evidence of HCC recurrence after complete response with trans arterial chemoembolization (TACE) of HCC with DAA therapy. Methods: This was an IRB-approved retrospective analysis of electronic medical records of adult patients >18 years old from December 2013 to May 2018 Louisiana State University Health Sciences Center-Shreveport. We reviewed 275 charts with diagnosis of HCV cirrhosis and HCC. Twelve patients fulfilled the inclusion criteria of DAA exposure and complete response to TACE for HCC. We evaluated them for HCC recurrence after TACE. Results: HCC recurrence was noted in 5 patients (42% of the cohort) with SVR rate only 80%. In the study cohort, 25% were treated with DAA+ribavirin while the rest with DAA alone. The average Model For End-Stage Liver Disease (MELD) before starting DAA was 11, while the average MELD after achieving SVR stabilized at 10. All patients had liver decompensation in the form of ascites during treatment period. In HCCR group, 60% were HCV genotype 1 and 40% with genotype 3; 40% received Epclusa, 60% Harvoni; 80% were males, 60% caucasian, 20% African American. None had vascular invasion; All achieved complete response to locoregional therapy for HCC with one or more sessions. In those with HCCR, 60% were Child Pugh scores (CTP) A, 20% B and 20% C at the end of treatment. Mean Alpha fetoprotein (AFP) at time of HCC diagnosis in HCCR group was 64.84, significantly higher compared to the study cohort mean AFP of 32.98. Conclusion: Despite successful treatment of HCV with DAA and achieving SVR, HCC recurrence was still observed in our population, most notably in caucasian males. No significant differences appreciated in the HCC and HCV characteristics. AFP appears continues to be prognostic marker. Nevertheless, larger prospective studies are needed to further elucidate the relationship between DAA treatment and recurrence of HCC most importantly the time of recurrence and time of DAA exposure.

The association between PIN1 genetic polymorphisms and the risk of chronic hepatitis B and hepatitis B virus-related liver cirrhosis: A case-control study.

Peptidyl-prolyl cis/trans isomerase NIMA-interacting 1 (PIN1) reportedly plays a crucial role in tissue inflammation and tumourigenesis. Our previous studies have demonstrated that PIN1 gene polymorphisms are significantly related to the pathogenesis of hepatitis B virus (HBV)-related liver cancer in a Guangxi population. As chronic hepatitis B (CHB), liver cirrhosis (LC), and liver cancer are development processes, we further investigated whether any relationship exists between PIN1 gene polymorphisms and the risk of CHB and HBV-related LC. We used the polymerase chain reaction restriction fragment length polymorphism and the deoxyribonucleic acid sequencing method to analyze 3 common single-nucleotide polymorphisms (SNPs) (rs2233678, rs2233679, and rs2233682) of the PIN1 gene in 192 CHB patients, 171 HBV-related LC patients, and 201 healthy controls in this research. The results revealed that carriers of the rs2233682 A allele had a significantly decreased risk of HBV-related LC (LC vs. controls: odds ratio [OR] = 0.262, 95% confidence interval [CI] = 0.071–0.959, P = .043; LC vs. CHB: OR = 0.198, 95% CI = 0.049–0.803, P = .023). Similar relationships were observed for the PIN1 rs2233682 GA genotype among the groups (LC vs. controls: OR = 0.248, 95% CI = 0.067–0.919, P = .037; LC vs. CHB: OR = 0.184, 95% CI = 0.044–0.773, P = .021). This reduced risk was more obvious in older CHB patients (age ≥50 years). No such correlations were found for PIN1 rs2233678 and rs2233679. However, the haplotypes constructed from these SNP (GCA for controls and CCG for CHB) were associated with a significantly decreased risk of HBV-related LC. In summary, the findings of this study suggest that the PIN1 rs2233682 A allele might be related with a decreased risk of HBV-related LC in a Guangxi population.

Microbiome and bile acid profiles in duodenal aspirates from patients with liver cirrhosis: The Microbiome, Microbial Markers and Liver Disease Study.

AimCirrhosis is a leading cause of death worldwide, yet there are no well‐established risk stratifying tools for lethal complications, including hepatocellular carcinoma (HCC). Patients with liver cirrhosis undergo routine endoscopic surveillance, providing ready access to duodenal aspirate samples that could be a source for identifying novel biomarkers. The aim of this study was to characterize the microbiome and bile acid profiles in duodenal aspirates from patients with liver cirrhosis to assess the feasibility of developing biomarkers for HCC risk stratification.MethodsThirty patients with liver cirrhosis were enrolled in the Microbiome, Microbial Markers, and Liver Disease study between May 2015 and March 2017. Detailed clinical and epidemiological data were collected at baseline and at 6‐monthly follow‐up visits. Duodenal aspirate fluid was collected at baseline for microbial characterization using 16S ribosomal RNA sequencing and bile acid quantification using mass spectroscopy.ResultsAlcohol‐related cirrhosis was associated with reductions in the Bacteroidetes phylum, particularly Prevotella (13‐fold reduction), and expansion of Staphylococcus (13‐fold increase), compared to hepatitis C virus‐related cirrhosis. Participants with hepatic encephalopathy (HE) had less microbial diversity compared to patients without HE (P < 0.05), and were characterized by expansion of Mycobacterium (45‐fold increase) and Gram‐positive cocci including Granulicatella (3.1‐fold increase), unclassified Planococcaceae (3.3‐fold increase), and unclassified Streptococcaceae (4.5‐fold increase). Non‐Hispanic White patients had reduced microbial richness (P < 0.01) and diversity (P < 0.05), and increased levels of conjugated ursodeoxycholic acid (glycoursodeoxycholic acid and tauroursodeoxycholic acid, P < 0.05) compared to Hispanic patients.ConclusionMicrobial profiles of duodenal aspirates differed by cirrhosis etiology, HE, and Hispanic ethnicity.

Abnormal Regional Homogeneity and Functional Connectivity of Baseline Brain Activity in Hepatitis B Virus-Related Cirrhosis With and Without Minimal Hepatic Encephalopathy.

Background and Aims: Abnormalities in neural activity have been reported in cirrhosis with minimal hepatic encephalopathy (MHE). However, little is known about the neurophysiological mechanisms in this disorder. We aimed to investigate the altered patterns of regional synchronization and functional connections in hepatitis B virus-related cirrhosis (HBV-RC) patients with and without MHE using both regional homogeneity (ReHo) and region of interest (ROI)-based functional connectivity (FC) computational methods.Methods: Data of magnetic resonance imaging scans were collected from 30 HBV-RC patients with MHE, 32 HBV-RC patients without MHE (NMHE) and 64 well-matched controls. Several regions showing differences in ReHo after one-way analysis of variance (ANOVA) were defined as ROIs for FC analysis. Next, post hoc t-tests were applied to calculate the group differences in ReHo and FC (false discovery rate (FDR) correction, p < 0.05). Correlations between clinical variables and the altered ReHo and FC were then assessed in patient groups.Results: Across three groups, significant ReHo differences were found in nine ROI regions mainly within the visual network (VN), dorsal attention network (DAN), somatomotor network (SMN), fronto parietal control (FPC) network and thalamus. Compared with healthy controls (HC), the MHE group exhibited abnormal FC mainly between the right calcarine (CAL.R) and middle frontal gyrus (MFG.L)/right thalamus. The MHE patients showed increased FC between the MFG.L and CAL.R compared to NMHE patients. Disease duration of MHE patients was positively correlated with increased mean ReHo values in the right fusiform gyrus (FFG); psychometric hepatic encephalopathy score (PHES) test scores were negatively correlated with increased FC between MFG.L and CAL.R and positively correlated with reduced FC between the CAL.R and THA.R. For NMHE patients, the mean ReHo values in the right frontal pole were positively correlated with disease duration and positively correlated with the PHES scores.Conclusion: Our results exhibited that the functional brain modifications in patients with and without MHE are characterized by compound alterations in local coherence and functional connections in the VN, SMN, DAN, FPC networks and thalamus by using a combination of ReHo and ROI-based FC analysis. These functional imaging changes are correlated with disease duration/PHES. This study helped us gain a better understanding of the features of brain network modifications in cirrhosis.

Reduced frequency of natural killer cell on siglec-7(+) is associated with progression of hepatitis B virus-related cirrhosis

Objective: To explore the relationship between sialic-acid-binding immunoglobulin-like lectin 7 (Siglec-7) expressed on NK cells and hepatitis B virus-related cirrhosis. Methods: Peripheral venous blood samples were collected from 23 healthy controls and 31 patients with hepatitis B virus-related cirrhosis (Child-Pugh A, n = 7; Child-Pugh B, n = 12; Child-Pugh C, n = 12). Peripheral blood mononuclear cells (PBMCs) were obtained by using Ficoll-Hypaque density gradient centrifugation and the expression of Siglec-7 and NK cells phenotype and their subpopulations were detected by flow cytometry. Comparisons between various groups were performed using t -test, one-way analysis of variance (ANOVA), and correlations between variables were analyzed using Pearson's-correlation coefficient. Results: (1) There was no significant difference in the percentage of NK cells and in their subpopulations with HBV-related cirrhosis and healthy controls. (2) Siglec-7 expression on NK cells in patients with HBV-related cirrhosis(62.44±13.45%)was significantly down-regulated than that to healthy controls(75.39±12.19%)while the frequency of Siglec-7(+) NK cells were negatively correlated with Child-Pugh score. (3) Subpopulation analysis showed that Siglec-7 expression on CD56(bright)CD16(-)NK cells(66.99±15.93%)was significantly lower than CD56(dim)CD16(+)NK cells(76.54±13.9%) in HBV-related cirrhosis. However, the expression of Siglec-7 in healthy controls showed no difference in these two NK cell subsets. (4) Phenotypic analysis showed that Siglec-7(+) NK cells express higher levels of activating receptor CD16, CD38, NKp46 and lower levels of inhibitory receptor CD158b. Indeed, the frequency of CD16 and CD38 on Siglec-7(+) NK cells in HBV-related cirrhosis was lower than that in healthy controls. Conclusion: The disease progression in patients with hepatitis B virus-related cirrhosis is associated to decreased frequencies of Siglec-7(+)NK cells.

Characteristics of Recipients With 10 or More Years of Allograft Survival in Deceased Donor Kidney Transplantation

BackgroundThe development of immunosuppressants improved the short-term outcomes of deceased donor kidney transplantation (DDKT), but the long-term survival rate was not improved. MethodsThe study included 127 patients who received first-time kidneys from deceased donors at Keimyung University Dongsan hospital between October 1994 and June 2007. We analyzed the clinical features of recipients with long-term allograft survival. ResultsThe mean follow-up period was 163 months. Among the 127 recipients, 53 (41.7%) maintained allograft survival for more than 10 years (AS group), 58 (45.7%) lost allograft function (AL group), and 16 (12.6%) were lost to follow-up. The 5- and 10-year allograft survival rates were 84.7% and 65.5%. The 5- and 10-year patient survival rates were 95.9% and 92.5%. The patient survival rate was significantly higher in the AS group than in the AL group. In the AS group, the use of basiliximab and mycophenolate mofetil (MMF) were significantly higher, and the number of HLA-DR mismatches and the incidence of rejection and infection were significantly lower. In multivariate Cox proportional hazards analysis, the use of MMF reduced the risk of allograft loss (hazard ratio [HR], 0.361; 95% confidence interval [CI], 0.172–0.757; P = .007). On the other hand, the incidence of rejection, hepatitis B virus-related liver cirrhosis (HBV-LC), and viral infection were independent risk factors for allograft loss (HR, 5.327; 95% CI, 2.813–10.090; P < .001; HR, 5.862; 95% CI, 1.891–18.168; P = .002; HR, 2.614; 95% CI, 1.355–5.043; P = .004, respectively). ConclusionFor long-term survival of allograft kidney in DDKT, it is important to use appropriate immunosuppressants including MMF and prevent complications such as rejection, HBV-LC, and viral infection.

Liver Transplantation for Hepatitis B Virus-related Hepatocellular Carcinoma in Hong Kong.

Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related deaths worldwide. Curative resection is frequently limited in Hong Kong by hepatitis B virus-related cirrhosis, and liver transplantation is the treatment of choice. Liver transplantation has been shown to produce superior oncological benefits, when compared to hepatectomy for HCC. New developments in the context of patient selection criteria, modification of organ allocation, bridging therapy, salvage liver transplantation and pharmaceutical breakthrough have improved the survival of HCC patients. In this article, we will share our experience in transplanting hepatitis B virus-related HCC patients in Hong Kong and discuss the recent progress in several areas of liver transplantation.

Platelet count/prothrombin time ratio as a noninvasive predictor for esophageal varices in Egyptian patients with hepatitis C virus-related liver cirrhosis

Background and aimA need has arisen to develop new noninvasive predictors for esophageal varices in patients with cirrhosis that could help prioritize listing them for endoscopy. Our study aims to evaluate platelet count/prothrombin time ratio compared with platelet count/splenic diameter ratio in p

FRI-299 - Red blood cell distribution width to albumin ratio is a potential index for predicting long-term prognosis for hepatitis B virus-related liver cirrhosis

FRI-299 - Red blood cell distribution width to albumin ratio is a potential index for predicting long-term prognosis for hepatitis B virus-related liver cirrhosis

Hepatocellular carcinoma recurrence in hepatitis C virus-related cirrhosis treated with direct-acting antivirals: a case-control study.

Direct-acting antivirals (DAAs) therapy against hepatitis C viral (HCV) infection has markedly improved the sustained viral response. However, recent studies have suggested an unsuspected high rate of hepatocellular carcinoma (HCC) recurrence. A retrospective case-control study was carried out to investigate the impact of DAAs on tumor recurrence in patients with complete response to HCC treatment within our HCV-related cirrhosis cohort. Patients who received [group 1 (G1), n=22] or not [group 2 (G2), n=49] a DAAs therapy were matched 1 : 2 for age, sex, liver function, HCC stage, and treatment. Initial HCC were mostly Barcelona Clinic Liver Cancer stage A (95% G1, 94% G2). Sustained viral response with DAAs was achieved in 86% of patients. After a similar median overall follow-up time with similar radiologic surveillance after HCC treatment, 41% of patients developed radiologic tumor recurrence in G1 versus 35% of patients in G2 (P=0.7904). There was no significant difference in time to progression between the two groups [12 (9-16) months G1 vs. 14 (8-21) months G2, P=0.7688], or Barcelona Clinic Liver Cancer stage at recurrence. However, the interval between HCC treatment and antiviral therapy was significantly different among DAAs patients with recurrence and those without recurrence [7.0 (2.5-9.0) months vs. 36.0 (9.0-58.0) months, P=0.0235, respectively]. In our case-control study, HCV therapy with DAAs does not accelerate or prevent early HCC recurrence compared with untreated patients. The rate of recurrence, time to progression, and HCC pattern are similar. Early DAAs treatment (<12 months) after HCC cure should be discouraged considering the HCC recurrence rate during this period.

EUS-guided radiofrequency ablation of a hepatocellular carcinoma of the liver

Percutaneous and intraoperative radiofrequency ablations (RFA) of hepatocellular carcinoma (HCC) are widely used treatment methods. EUS-guided RFA has recently been used for pancreatic tumors, whereas, to our knowledge, there are no reports of EUS-guided RFA for HCC. We present the case of a 75-year-old man with hepatitis C virus–related cirrhosis who, in May 2015, underwent percutaneous RFA for an HCV-related HCC in the VIII liver segment. The patient was in good clinical condition until June 2017, when a follow-up abdominal MRI showed a 25- × 20-mm hypovascular lesion of the III liver segment (Fig. 1A). At evaluation by a multidisciplinary board, percutaneous RFA was not taken into account because of the difficult approach to the III liver segment with that technique. Therefore, EUS-guided RFA of the lesion was planned (Video 1, available online at www.VideoGIE.org). The EUS-RFA procedure was done with an Olympus GF-UCT180 (Olympus, Tokyo, Japan) EUS endoscope and an EUS-guided RFA 19-gauge 10-mm-long needle (Starmed-Taewoong Medical, Seoul, South Korea) (Figs. 1B and C) for EUS-guided RFA. After the lesion was punctured with the RFA needle, a 30-W per 3 to 8 seconds monopolar electric current was delivered under direct EUS control directly into the principal lesion and into the satellite lesions. This was done multiple times until all areas of the lesions had acquired echogenic changes. No immediate adverse events were registered, and the patient was discharged the following day. Abdominal MRI 1 month after the procedure showed evidence of complete disappearance of the lesion in the III liver segment (Fig. 1D). At the follow-up visit, the patient was in good clinical condition. To our knowledge, this is the first report of EUS-guided RFA of HCC. The treatment was technically and clinically successful. This treatment could be a good therapeutic option for patients who are not candidates for percutaneous RFA because of a difficult approach. The safety and efficacy of this treatment should be evaluated in a larger series because major adverse events such as liver abscess, bile leaks, and bleeding might occur. Dr Costamagna is a consultant for Cook Medical. All other authors disclosed no financial relationships relevant to this publication. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI1YzQzYjQ1ODU3MTc4YzNlMzdkNDg4ODZmZjhlMjhkOSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjMzNTk1NTg5fQ.GXiFNPXB6TP8Gia14W7Q0zeRUQE3K1E9uMZh2R6Fv4T56eaB8dBVODOQwaVThbFXlrvGbRtUwb_uHOkcTITWWQ5HTNxMA4zbnHJJ4JVm9S5R3VpMRvxr0SONMLYFkSJX8UH5eQpyMwgX-759M0TK7oepVnZCqS37Nym5Z_mqQ7hOUmIw5y3fmF7G9iHZN6MTmyZbwRHoxwxa1PLwkUyp-8CKCfHq7j1JExo5boGWVVw5oAV3Fj-Zz58VzhSchmwQxUmNCYBkmZkqiGmjRMKG0JyWZgpCG_yd74RswMMg9sbd_5XyR0kg-nF5nKOdky3DsrChkEBKWLr56fFE3FI8Tw Download .mp4 (112.59 MB) Help with .mp4 files Video 1Successful EUS-guided radiofrequency ablation of hepatocellular carcinoma of the III liver segment. Download .docx (.01 MB) Help with docx files Video Script

How can we improve the performance of Model for End-Stage Liver Disease sodium score in patients with hepatitis B virus-related decompensated liver cirrhosis commencing antiviral treatment?

We aimed to develop a more efficient prognostic model to predict 1-year mortality in patients with hepatitis B virus-related decompensated cirrhosis beginning antiviral treatment. Using Cox regression analysis, survival analyses were performed on 554 patients with decompensated cirrhosis who were followed up from the start of nucleos(t)ide analogue antiviral treatment. At baseline, ascites and hepatic encephalopathy were found in 78.0% and 18.1% of patients, respectively. Eighty-six events (77 deaths and 9 emergency liver transplants) occurred within the first year of treatment. Severity of ascites, presence of hepatic encephalopathy, and the Model for End-Stage Liver Disease (MELD)-sodium (MELDNa) score were independent risk factors for 1-year mortality. The new prognostic model (the revised MELDNa) constructed by adding ascites and encephalopathy to the MELDNa score significantly improved the area under the receiver operating characteristics curve for predicting 1-year events at baseline compared with the Child-Turcotte-Pugh system, MELD and MELDNa models, and Fontana index (0.905 vs 0.867, 0.843, 0.871, and 0.815, respectively; P<0.05). Furthermore, repetitive application of revised MELDNa at 0, 1, 2, 3, and 6months of treatment could predict 81.4% (70/86) of 1-year events, which was significantly (P<0.05) higher than the sensitivity of the Child-Turcotte-Pugh system (68.6%), MELD (70.9%) and MELDNa (68.6%) scores, and Fontana index (64.0%), achieving similar specificities of ~96%. Ascites and encephalopathy should be considered together with the MELDNa score when predicting short-term mortality and planning liver transplant in patients with decompensated hepatitis B virus-related cirrhosis starting antiviral treatment.

Effect of Splenectomy on Serum Cytokine Profiles in Hepatitis B Virus-Related Cirrhosis Patients with Portal Hypertension.

Emerging evidences showed the promoting role of spleen in the development of cirrhosis and hepatocellular carcinoma, in the context of portal hypertension and hypersplenism due to hepatitis B virus-related cirrhosis. In this study, we tried to explore the precise mechanism of how spleen regulates this process from the serum cytokines profile level. Compared with the 16 healthy subjects, the RayBio Human Cytokine Antibody Array identified 136 cytokines differentially expressed in 36 cirrhotic patients. Splenectomy resulted in significant changes in 28 cytokines. Differentially expressed cytokines were mainly involved in cellular processes, responses to stimuli, immune processes, binding, extracellular regions, and extracellular matrix. These cytokines were mainly enriched in cytokine-cytokine receptor interactions, Jak-STAT and MAPK signaling pathways, and pathways in cancer. These results may provide new clues to the function of the spleen, and modulation of cytokine expression maybe a potential alternative therapeutic strategy for these patients.

SVR is the strongest predictor of occurrence and recurrence of hepatocellular carcinoma in HCV cirrhotic patients after treatment with direct acting antivirals: A prospective multicenter Italian study

Patients with hepatitis C virus (HCV) related cirrhosis have an expected high rate of progression to liver decompensation and hepatocellular carcinoma (HCC); dramatic improvement in viral eradication rates has been reached with direct antiviral agents (DAAs). Nevertheless, the real benefit of viral eradication after DAAs on disease progression, including HCC development, are still limited and controversial. We aim to prospectively assess the risk of HCC occurrence and early recurrence in a large prospective cohort of DAA-treated HCV-cirrhotic patients.