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Histological Assessment of the Liver Explant in Transplanted HCV-Patients Achieving Sustained Virologic Response with Direct-Acting Antiviral Agents.

Thu, 12/14/2017 - 13:45
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Histological Assessment of the Liver Explant in Transplanted HCV-Patients Achieving Sustained Virologic Response with Direct-Acting Antiviral Agents.

Histopathology. 2017 Dec 13;:

Authors: Putra J, Schiano TD, Fiel MI

Abstract
AIMS: The use of direct-acting anti-viral agents (DAAs) has resulted in extremely high sustained virologic response (SVR) rates in patients being treated while on liver transplantation (LT) waiting lists. The aim of this study was to evaluate the histological findings of HCV patients who achieved SVR after receiving DAA treatment (SVR(+)) prior to LT and comparing them to HCV patients who had not achieved SVR (SVR(-)).
METHODS AND RESULTS: Fifty-eight adult HCV patients who underwent LT at our institution from 2014-2016 were included in the study. Two pathologists, blinded to SVR status, simultaneously evaluated the histological sections. Assessment included the Histology Activity Index (HAI/modified Knodell score), fibrosis stage (Ishak score), and Laennec cirrhosis stage. The study group comprised of 25 SVR(+) patients (56% male, mean age=63.8), while the control group was composed of 33 SVR(-) patients (69% male, mean age=61.7). There was no significant difference in HAI between groups (p=0.414). Patients who achieved SVR also did not show less portal inflammation (p=0.787), interface hepatitis (p=0.999), confluent necrosis (p=0.627), or spotty necrosis (p=0.093) compared to the control group. There was a trend towards higher degree of inflammation in patients who achieved SVR shorter than 24 weeks (p=0.07). The degree of focal lytic necrosis/apoptosis and portal inflammation was more prominent in SVR(+) patients with shorter interval time.
CONCLUSIONS: Our study is the first to report the persistent inflammation in HCV patients who received DAAs prior to LT. This supports the notion that inflammation is immunologically driven and inflammation persists despite the absence of virus. This article is protected by copyright. All rights reserved.

PMID: 29235144 [PubMed - as supplied by publisher]

The Added Diagnostic Value of 18F-Fluorodihydroxyphenylalanine PET/CT in the Preoperative Work-Up of Small Bowel Neuroendocrine Tumors.

Thu, 12/14/2017 - 13:45
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The Added Diagnostic Value of 18F-Fluorodihydroxyphenylalanine PET/CT in the Preoperative Work-Up of Small Bowel Neuroendocrine Tumors.

J Gastrointest Surg. 2017 Dec 12;:

Authors: Addeo P, Poncet G, Goichot B, Leclerc L, Brigand C, Mutter D, Romain B, Namer IJ, Bachellier P, Imperiale A

Abstract
BACKGROUND: The precise localization of the primary tumor and/or the identification of multiple primary tumors improves the preoperative work-up in patients with small bowel (SB) neuroendocrine tumor (NET). The present study assesses the diagnostic value of 18F-fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography/computed tomography (PET/CT) during the preoperative wok-up of SB NETs.
METHODS: Between January 2010 and June 2017, all consecutive patients with SB NETs undergoing preoperative 18F-FDOPA PET/CT and successive resection were analyzed. Preoperative work-up included computed tomography (CT), somatostatin receptor scintigraphy (SRS), and 18F-FDOPA PET/CT. Sensitivity and accuracy ratio for primary and multiple tumor detection were compared with data from surgery and pathology.
RESULTS: There were 17 consecutive patients with SB NETs undergoing surgery. Nine patients (53%) had multiple tumors, 15 (88%) metastatic lymph nodes, 3 (18%) peritoneal carcinomatosis, and 9 patients (53%) liver metastases. A total of 70 SB NETs were found by pathology. Surgery identified the primary in 17/17 (100%) patients and recognized seven of 9 patients (78%) with multiple synchronous SB. Preoperatively, 18F-FDOPA PET/CT displayed a statistically significant higher sensitivity for primary tumor localization (100 vs. 23.5 vs. 29.5%) and multiple tumor detection (78 vs. 22 vs. 11%) over SRS and CT. Compared with pathology, 18F-FDOPA PET/CT displayed the highest accuracy ratio for number of tumor detected over CT and SRS (2.0 ± 2.2 vs. 0.4 ± 0.7 vs. 0.6 ± 1.5, p = 0.0003).
CONCLUSION: 18F-FDOPA PET/CT significantly increased the sensitivity and accuracy for primary and multiple SB NET identification. 18F-FDOPA PET/CT should be included systematically in the preoperative work-up of SB NET.

PMID: 29235002 [PubMed - as supplied by publisher]

Association of Serum Ferritin with Diabetes and Alcohol in Patients with Non-Viral Liver Disease-Related Hepatocellular Carcinoma.

Thu, 12/14/2017 - 13:45
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Association of Serum Ferritin with Diabetes and Alcohol in Patients with Non-Viral Liver Disease-Related Hepatocellular Carcinoma.

Liver Cancer. 2017 Nov;6(4):307-312

Authors: Siriwardana RC, Niriella MA, Dassanayake A, Ediriweera D, Gunetilleke B, Sivasundaram T, de Silva J

Abstract
INTRODUCTION: Non-alcoholic fatty liver disease is a leading cause for hepatocellular carcinoma (HCC) in Sri Lanka. Diabetes mellitus, alcohol abuse, and liver inflammation are known to increase the risk of HCC. The present study evaluates serum ferritin levels in a cohort of patients with non-viral HCC (nvHCC).
METHODOLOGY: Consecutive patients with nvHCC presenting to the Colombo North Liver transplant Service, Ragama, from January 2012 to July 2013 were investigated. All were negative for hepatitis B and C. At registration, 5 mL of serum was separated into plain tubes, stored at -80°C and analysed for ferritin using an enzyme-linked immunosorbent assay. Correlation between the serum ferritin and patient risk factors, liver status, and tumour characteristics were analysed.
RESULTS: There were 93 patients with nvHCC (median age 65 [12-82] years; 82 [88.2%] males). The median ferritin level was 246.2 μg/L, and 38 (40.86%) patients had elevated ferritin. Non-diabetics (median 363.5 mg/L, p = 0.003) and alcohol abusers (median 261.2 mg/L, p = 0.018) had higher ferritin levels. On multiple-variable analysis, being non-diabetic (p = 0.013) and alcoholic (p = 0.046) was significantly associated with high serum ferritin. No association was found with body mass index, tumour stage, size, macrovascular invasion, number of nodules, alpha-fetoprotein, bilirubin, international normalized ratio, and survival.
CONCLUSION: In patients with nvHCC, serum ferritin levels are higher in non-diabetics and alcoholics.

PMID: 29234634 [PubMed]

Adoption of Sorafenib for the Treatment of Advanced-Stage Hepatocellular Carcinoma in Oncology Practices in the United States.

Thu, 12/14/2017 - 13:45
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Adoption of Sorafenib for the Treatment of Advanced-Stage Hepatocellular Carcinoma in Oncology Practices in the United States.

Liver Cancer. 2017 Jun;6(3):216-226

Authors: Parsons HM, Chu Q, Karlitz JJ, Stevens JL, Harlan LC

Abstract
Background: The adoption of sorafenib into oncology practice as a first-line systemic treatment for advanced hepatocellular carcinoma (HCC) is not well understood. We examined sorafenib use since Food and Drug Administration (FDA) approval in 2007 and associated survival for individuals diagnosed with advanced HCC, conducting a population-based evaluation of treatment patterns and outcomes for this newly approved drug in the US over time.
Methods: We identified individuals diagnosed with Barcelona Clinic Liver Cancer Stage C from the 2007 and 2012 National Cancer Institute Patterns of Care study. We examined trends in use as well as patient and clinical factors associated with receiving sorafenib using multivariate logistic regression analysis. We then evaluated the association between sorafenib use and overall hazard of death using multivariate Cox proportional hazards regression.
Results: Among 550 individuals diagnosed with advanced HCC, we found no significant increase in the proportion of patients treated with sorafenib from 2007 to 2012 (26.3 vs. 30.4%). After adjusting for patient and clinical characteristics, non-Hispanic Blacks (compared to non-Hispanic Whites) and those with a lower Child-Pugh score remained more likely to receive sorafenib. Individuals receiving systemic chemotherapy only, radiation therapy only, or no treatment at all experienced a higher risk of death than those treated with sorafenib, while those receiving a transplant experienced a lower risk of death.
Conclusions: Sorafenib has not been widely adopted into oncology practice since FDA approval for advanced HCC. Few factors apart from Child-Pugh score and race/ethnicity predict sorafenib use in clinical practice, although sorafenib treatment is associated with a lower risk of death.

PMID: 29234628 [PubMed]

Middle Hepatic Vein Bleed During Donor Hepatectomy: Technique for Safe Practice.

Thu, 12/14/2017 - 13:45
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Middle Hepatic Vein Bleed During Donor Hepatectomy: Technique for Safe Practice.

J Clin Exp Hepatol. 2017 Dec;7(4):376-377

Authors: Jegadeesan M, Goyal N, Gupta S

Abstract
Safe performance of donor hepatectomy is crucial for sustainability of a living donor liver transplantation (LDLT) program. Middle hepatic vein (MHV) is always encountered during parenchymal transection irrespective of right or left donor hepatectomies. Here we present a safe and effective technique for tackling MHV bleed during LDLT from a single centre experience.

PMID: 29234204 [PubMed]

Acute and Chronic Rejection After Liver Transplantation: What A Clinician Needs to Know.

Thu, 12/14/2017 - 13:45
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Acute and Chronic Rejection After Liver Transplantation: What A Clinician Needs to Know.

J Clin Exp Hepatol. 2017 Dec;7(4):358-366

Authors: Choudhary NS, Saigal S, Bansal RK, Saraf N, Gautam D, Soin AS

Abstract
While antibody mediated hyper-acute vasculitic rejection is rare in liver transplant recipients, acute and chronic rejection have clinical significance. The liver allograft behaves differently to other solid organ transplants as acute rejection generally does not impair graft survival and chronic rejection (CR) is uncommon. The incidence of acute and chronic rejection has declined in current era due to improved immunosuppressive regimens. Acute rejection generally improves with steroid boluses and steroid resistant rejection is uncommon. CR may improve with escalation of immunosuppression or may result in irreversible loss of graft function leading to retransplantation or death. The current review discusses diagnosis and management of acute and chronic liver allograft rejection.

PMID: 29234201 [PubMed]

Nutrition and Muscle in Cirrhosis.

Thu, 12/14/2017 - 13:45
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Nutrition and Muscle in Cirrhosis.

J Clin Exp Hepatol. 2017 Dec;7(4):340-357

Authors: Anand AC

Abstract
As the cirrhosis progresses, development of complication like ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma signify increasing risk of short term mortality. Malnutrition and muscle wasting (sarcopenia) is yet other complications that negatively impact survival, quality of life, and response to stressors, such as infection and surgery in patients with cirrhosis. Conventionally, these are not routinely looked for, because nutritional assessment can be a difficult especially if there is associated fluid retention and/or obesity. Patients with cirrhosis may have a combination of loss of skeletal muscle and gain of adipose tissue, culminating in the condition of "sarcopenic obesity." Sarcopenia in cirrhotic patients has been associated with increased mortality, sepsis complications, hyperammonemia, overt hepatic encephalopathy, and increased length of stay after liver transplantation. Assessment of muscles with cross-sectional imaging studies has become an attractive index of nutritional status evaluation in cirrhosis, as sarcopenia, the major component of malnutrition, is primarily responsible for the adverse clinical consequences seen in patients with liver disease. Cirrhosis is a state of accelerated starvation, with increased gluconeogenesis that requires amino acid diversion from other metabolic functions. Protein homeostasis is disturbed in cirrhosis due to several factors such as hyperammonemia, hormonal, and cytokine abnormalities, physical inactivity and direct effects of ethanol and its metabolites. New approaches to manage sarcopenia are being evolved. Branched chain amino acid supplementation, Myostatin inhibitors, and mitochondrial protective agents are currently in various stages of evaluation in preclinical studies to prevent and reverse sarcopenia, in cirrhosis.

PMID: 29234200 [PubMed]

Echocardiographic and Electrocardiographic Predictors of Adverse Outcomes in Spontaneous Bacterial Peritonitis.

Thu, 12/14/2017 - 13:45
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Echocardiographic and Electrocardiographic Predictors of Adverse Outcomes in Spontaneous Bacterial Peritonitis.

J Clin Exp Hepatol. 2017 Dec;7(4):321-327

Authors: Shah M, Patnaik S, Maludum O, Patil S, De Venecia TA, Figueredo VM

Abstract
Background: Patients with cirrhosis who develop Spontaneous Bacterial Peritonitis (SBP) suffer from cirrhotic cardiomyopathy which is characterized by impaired contractility in response to stress despite a relatively normal resting cardiac output. We hypothesized that electrocardiographic and echocardiographic information would help prognosticate patients developing SBP in addition to existing scoring systems.
Methods: Cirrhotic patients admitted to Einstein Medical Center from 01/01/2005 to 6/30/2012 for SBP, and did not receive a transplant within one year, were included. Patients were classified as QTc low vs. high, and E/E' low vs. high at cut points ≥480 ms for QTc and ≥10 for E/E' ratio. We estimated 1-year survival using Kaplan Meier curves. Regression analysis and Cox proportional hazards model were used for QTc and E/E' ratio, respectively, for assessing 1-year survival.
Results: Among 112 patients with electrocardiogam, 78 were classified as QTc low. Among 64 patients with echocardiograms, 23 were classified as E/E' low. Higher QTc was associated with increased in-hospital acute kidney injury. QTc and E/E' ratio predicted worse 1-year survival (HR = 2.16, 95% CI 1.29-3.49; HR 2.65, 95% CI 1.31-5.35, respectively) on univariate and multivariate analysis (OR = 1.02, 95% CI 1.01-1.03; HR = 3.26, 95% CI 1.22-9.82 respectively) after adjusting for both Child Pugh stage, MELD score among other risk factors.
Conclusion: In conclusion, cirrhotic patients with SBP who present with a prolonged QTc interval are at a greater risk for acute renal failure during hospitalization. High QTc duration and an E/E' ratio of ≥10 independently predict increased mortality at 1-year follow-up.

PMID: 29234197 [PubMed]

An Insight into Antibiotic Resistance to Bacterial Infection in Chronic Liver Disease.

Thu, 12/14/2017 - 13:45
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An Insight into Antibiotic Resistance to Bacterial Infection in Chronic Liver Disease.

J Clin Exp Hepatol. 2017 Dec;7(4):305-309

Authors: Jain M, Varghese J, Michael T, Kedarishetty CK, G B, Swaminathan S, Venkataraman J

Abstract
Background: End stage liver disease leads to immune dysfunction which predisposes to infection. There has been a rise in antibiotic resistant infections in these patients. There is scanty data f from India or idea regarding the same.
Aim of the study: The present study was undertaken to determine the type of infection acquired and the prevalence of antibiotic resistant infections in cirrhotic patients at a tertiary referral center in South India.
Materials and methods: In this retrospective study, all consecutive cirrhotic patients hospitalized between 2011 and 2013 with a microbiologically-documented infection were enrolled. Details of previous admission and antibiotics if received were noted. In culture positive infections, the source of infection (ascites, skin, respiratory tract: sputum/endotracheal tube aspirate, pleural fluid; urine and blood) and microorganisms isolated and their antibiotic susceptibility was noted.
Results: A total of 92 patients had 240 culture positive samples in the study period. Majority were Klebseilla followed by Escherichia coli and Enterococcus in nosocomial and health care associated infections. However, Enteroccocus was followed by E. coli and Klebsiella in community acquired infections. The antibiotic sensitivity pattern was analyzed for the major causative organisms such as E. coli, Klebsiella and Enterococcus. Most common resistant strains were extended spectrum beta lactamase producing enterobacteriacae (ESBL) followed by carbapenemase producing Klebsiella and methicillin resistant Staphylococcus aureus.
Conclusion: Noscomial infection is the most common type, with Klebsiella and E. coli and there is significant rise in ESBL producing organism.

PMID: 29234194 [PubMed]

Results of Portosystemic Shunt Embolization in Selected Patients with Cirrhosis and Recurrent Hepatic Encephalopathy.

Thu, 12/14/2017 - 13:45
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Results of Portosystemic Shunt Embolization in Selected Patients with Cirrhosis and Recurrent Hepatic Encephalopathy.

J Clin Exp Hepatol. 2017 Dec;7(4):300-304

Authors: Choudhary NS, Baijal SS, Saigal S, Agarwal A, Saraf N, Khandelwal R, Jain V, Khandelwal AH, Kapoor A, Jain D, Misra SR, Puri R, Sud R, Soin AS

Abstract
Background: Large portosystemic shunts (PSSs) may lead to recurrent encephalopathy in patients with cirrhosis and embolization of these shunts may improve encephalopathy.
Material and methods: Five patients underwent balloon-occluded retrograde transvenous obliteration (BRTO) or plug-assisted retrograde transvenous obliteration (PARTO) of a large PSS at our center in last 2 years for recurrent hepatic encephalopathy (HE) at a tertiary care center at north India. Data are shown as number and mean ± SD. None of these patients had Child's C cirrhosis or presence of large ascites/large varices.
Results: Five patients (all males), aged 61 ± 7 years, underwent BRTO or PARTO for recurrent HE and presence of lienorenal (n = 4) or mesocaval shunt (n = 1). The etiology of cirrhosis was cryptogenic/non-alcoholic steatohepatitis in 3, and alcohol and hepatitis B in one each. All patients had Child's B cirrhosis; Child's score was 8.6 ± 0.5, model for end-stage liver disease (MELD) score was 13.4 ± 2.3. One patient had mild ascites; 3 patients had small esophageal varices before procedure. Sclerosants (combination of air, sodium tetradecyl sulphate, and lipiodol) were used in two patients, endovascular occlusion plugs were used in two patients, and both sclerosants and endovascular occlusion plug were used in one patient. Embolization of minor outflow veins to allow for stable deposition sclerosants in dominant shunt was done using embolization coils and glue in two patients. One patient needed 2 sessions. The pre-procedure ammonia was 127 ± 35 which decreased to 31 ± 17 after the shunt embolization. There was no recurrence of encephalopathy in any of these patients. One patient was lost to follow-up at 6 months; others are doing well at 6 months (n = 2), 10 months (n = 1) and 2 years (n = 1). None of these patients developed further decompensation in the defined follow-up period.
Conclusion: Good results can be obtained in selected patients after embolization of large PSS for recurrent HE.

PMID: 29234193 [PubMed]

Acute Trans-Diaphragmatic Herniation of the Caudate Lobe of the Liver.

Thu, 12/14/2017 - 13:45
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Acute Trans-Diaphragmatic Herniation of the Caudate Lobe of the Liver.

Ann Thorac Surg. 2018 Jan;105(1):e5-e6

Authors: Loumiotis I, Kinkhabwala MM, Bhargava A

Abstract
Diaphragmatic liver herniation is often associated with thoracoabdominal trauma. Spontaneous diaphragmatic rupture is a thoracoabdominal emergency and requires a high index of suspicion combined with high-resolution imaging studies for establishing an accurate and timely diagnosis. We present a case report of a patient who was admitted to the emergency department with severe substernal chest pain and shortness of breath who was diagnosed with spontaneous diaphragmatic rupture and caudate liver herniation. The caudate lobe was incarcerated, contributing to the patient's symptoms. A celiotomy was performed and the defect was repaired primarily.

PMID: 29233365 [PubMed - in process]

miR-589-5p inhibits MAP3K8 and suppresses CD90+ cancer stem cells in hepatocellular carcinoma.

Thu, 12/14/2017 - 13:45
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miR-589-5p inhibits MAP3K8 and suppresses CD90+ cancer stem cells in hepatocellular carcinoma.

J Exp Clin Cancer Res. 2016 Nov 11;35(1):176

Authors: Zhang X, Jiang P, Shuai L, Chen K, Li Z, Zhang Y, Jiang Y, Li X

Abstract
BACKGROUND: Cancer stem cells (CSCs) are important in the tumorigenesis and progression of hepatocellular carcinoma (HCC). MicroRNAs (miRNAs) play crucial roles regulating CD133+ and EpCAM+ CSCs in HCC, although it is unclear whether miRNAs regulate CD90+ CSCs in HCC.
METHODS: The miRNA profiles of CD90+ and CD90- HCC cells were analyzed using a miRNA microarray and quantitative real-time PCR (qRT-PCR). CSC characteristics were examined by qRT-PCR and Western blot of pluripotency-associated genes, clone and sphere formation assay, transwell migration assay, and nude mice tumorigenicity assay. miR-589-5p mimic transfection was used to overexpress miR-589-5p in vitro. The CD90 and miR-589-5p expressions of HCC samples were detected by immunohistochemistry and qRT-PCR, respectively.
RESULTS: miR-589-5p and miR-33b-5p were down-regulated in CD90+ cells. Overexpression of miR-589-5p suppressed CD90+ CSC characteristics such as Oct4, Sox2 and Nanog expression, a high likelihood of forming cell spheres, high invasiveness and high tumorigenicity. Luciferase reporter assays demonstrated that miR-589-5p directly binds to the 3'-untranslated region of mitogen-activated protein kinase kinase kinase 8 (MAP3K8) mRNA, and exogenous miR-589-5p down-regulated MAP3K8 expression. In addition, siRNA inhibition of MAP3K8 also suppressed CD90+ CSC characteristics, even in the absence of miR-589-5p overexpression. In HCC tissues, miR-589-5p expression was inversely correlated with CD90 expression, and high CD90 expression and low miR-589-5p expression were positively correlated with vascular invasion and recurrence and significantly decreased disease-free and overall survival by clinical analysis.
CONCLUSION: In HCC, miR-589-5p down-regulates the stemness characteristics of CD90+ CSCs in part by silencing MAP3K8. CD90 and miR-589-5p expression predict HCC outcomes and might be novel molecular targets for HCC treatment.

PMID: 27835990 [PubMed - indexed for MEDLINE]

Nestin overexpression in hepatocellular carcinoma associates with epithelial-mesenchymal transition and chemoresistance.

Thu, 12/14/2017 - 13:45
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Nestin overexpression in hepatocellular carcinoma associates with epithelial-mesenchymal transition and chemoresistance.

J Exp Clin Cancer Res. 2016 Jul 13;35(1):111

Authors: Zhang Y, Zeng S, Ma J, Deng G, Qu Y, Guo C, Shen H

Abstract
BACKGROUND: Nestin expression has been reported to be associated with the prognosis of many solid tumors including human hepatocellular carcinoma (HCC). The present study aimed to identify the role, if any, of Nestin in the chemotherapeutic treatment of HCC.
METHODS: We determined Nestin expression in nine HCC cell lines and 220 tissue samples of advanced HCC patients (retrospectively registered) treated with FOLFOX regimens. We examined the correlations between Nestin expression and clinicopatholgical variables and HCC prognosis. Also, we used in vitro and in vivo methods to determine the effects of Nestin expression on HCC cell invasion, migration and chemosensitivity.
RESULTS: Nestin expression was significantly increased in HCC tissues and drug-resistant cell lines, and the presence of high levels of Nestin was associated with poor survival. We also showed that drug-resistance occurred in HCC cells with epithelial-mesenchymal transition (EMT), which in turn enhanced invasion ability. Nestin depletion reversed drug-resistance in the Bel-7402/5-FU and Bel-7402/ADM cell lines. Nestin knockdown enhanced chemotherapeutic efficacy in nude mice. Moreover, Nestin up-regulation in Bel-7402 was associated with the activation of Wnt/β-catenin signaling.
CONCLUSION: Our findings suggest that Nestin inhibitors may be useful for the chemotherapy of HCC.

PMID: 27412382 [PubMed - indexed for MEDLINE]

Liver: Novel therapeutic strategy for Wilson disease.

Thu, 12/14/2017 - 13:45
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Liver: Novel therapeutic strategy for Wilson disease.

Nat Rev Gastroenterol Hepatol. 2016 08;13(8):436

Authors: Leake I

PMID: 27407047 [PubMed - indexed for MEDLINE]

Older Patients With Hepatocellular Carcinoma Have More Advanced Disease, Lower Rates of Treatment, and Lower Survival.

Thu, 12/14/2017 - 13:45
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Older Patients With Hepatocellular Carcinoma Have More Advanced Disease, Lower Rates of Treatment, and Lower Survival.

J Clin Gastroenterol. 2017 Apr;51(4):378-383

Authors: Yan M, Ha J, Aguilar M, Liu B, Frenette CT, Bhuket T, Wong RJ

Abstract
GOALS: To evaluate age-specific disparities in cancer stage at diagnosis, receipt of treatment, and survival among adults with hepatocellular carcinoma (HCC).
BACKGROUND: HCC has become the fastest rising cause of cancer-related deaths in the United States. The aging population coupled with the rising incidence of HCC will result in an emerging cohort of older patients with HCC placing significant burden health care systems.
STUDY: Using 2003 to 2011 Surveillance, Epidemiology, and End Results data, a US population-based cancer registry, we retrospectively evaluated age-specific disparities in cancer stage at diagnosis, receipt of treatment, and survival among adults with HCC. Multivariate logistic regression models evaluated HCC stage at diagnosis and HCC treatment received. Multivariate Cox proportional hazard models evaluated long-term survival.
RESULTS: Compared with HCC patients below 50 years old, patients aged 70 years or older were less likely to have HCC within Milan criteria [odds ratio, 0.58; confidence interval (CI), 0.54-0.63; P<0.001]. Older age was also associated with significantly lower rates of receiving HCC treatment. Even after adjusting for stage of disease, patients aged 70 years or older had the lowest odds of receiving any HCC treatment compared with patients below 50 years old (odds ratio, 0.52; CI, 0.46-0.60; P<0.001). On multivariate Cox regression, HCC patients aged 70 years or older had significantly lower survival compared with patients below 50 years old (hazards ratio, 1.22; CI, 1.15-1.30; P<0.001).
CONCLUSIONS: Among US adults with HCC, patients aged 70 years or older were less likely to have HCC within Milan criteria at diagnosis, less likely to receive any HCC treatment, and had significantly lower long-term survival.

PMID: 27380460 [PubMed - indexed for MEDLINE]

Therapy: HCV drugs reduce transplantation need.

Thu, 12/14/2017 - 13:45
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Therapy: HCV drugs reduce transplantation need.

Nat Rev Gastroenterol Hepatol. 2016 07;13(7):376

Authors: Ridler C

PMID: 27251206 [PubMed - indexed for MEDLINE]

Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts.

Thu, 12/14/2017 - 13:45
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Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts.

J Clin Gastroenterol. 2017 Apr;51(4):360-363

Authors: Suraweera D, Jimenez M, Viramontes M, Jamal N, Grotts J, Elashoff D, Lee EW, Saab S

Abstract
AIM: To compare age-related morbidity and mortality after transjugular intrahepatic portosystemic shunts (TIPS).
METHODS: We performed a retrospective chart review of patients who underwent TIPS at the University of California Los Angeles Medical Center between 2008 to 2014. Elderly patients (65 y and older) were matched with nonelderly patients (controls, below 65 y) by model for end-stage liver disease (MELD) score (±3), indication for TIPS (refractory ascites vs. variceal bleeding), serum sodium level (±5), in a ratio of 1:1. Endpoints measures were hospital stay post-TIPS, rifaximin, or lactulose use, TIPS failure at 30 days, readmission at 90 days, MELD at 90 days, and mortality at 90 days.
RESULTS: A total of 30 patient matches were included in this study: 30 control and 30 elderly patients. The median [interquartile (IQR)] MELD scores for controls and elderly were 11 (9, 13.8) for the controls and 11.5 (9, 14.8) for elderly patients (P=0.139). There were no significant differences in serum sodium and indication for TIPS. Thirty and 90-day follow-up laboratory test results were also similar between elderly and control patients. Event-free survival at 90 days was similar between controls and elderly patients [odds ratio (OR), 0.86; 95% confidence interval (CI), 0.3-2.5; P>0.05]. There was a trend toward greater hospitalization (OR, 1.76; 95% CI, 0.52-5.95; P=0.546) and mortality (OR, 3.3; 95% CI, 0.3-14.01; P=0.182).
CONCLUSIONS: The results of this study suggest event-free survival is similar between nonelderly and elderly patients. Although statistically significant, there is a tendency toward greater mortality and hospitalization in the elderly.

PMID: 27159421 [PubMed - indexed for MEDLINE]

Orthotropic live transplantation for cirrhosis from hepatitis C virus leads to correction of factor IX deficiency allowing for ankle arthroplasty without factor replacement in a patient with moderate haemophilia B.

Wed, 12/13/2017 - 13:45
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Orthotropic live transplantation for cirrhosis from hepatitis C virus leads to correction of factor IX deficiency allowing for ankle arthroplasty without factor replacement in a patient with moderate haemophilia B.

Blood Coagul Fibrinolysis. 2017 Dec 11;:

Authors: Ono K, Hirose J, Chang SH, Kubota M, Kinkawa J, Noguchi M, Takedani H

Abstract
: Liver transplantation is one of the treatments for haemophilic patients having severe liver cirrhosis who are infected with the hepatitis C virus. Patients with haemophilia can develop arthroplasty requiring surgical intervention, and the surgical outcomes of patients undergoing such procedures after liver transplant has not been reported. Treatment for arthropathy is important for improving the quality of life for patients who survive after liver transplantation. We report the first case of ankle arthroscopic arthrodesis in a patient with haemophilia B after undergoing living donor liver transplantation. We carefully monitored the patient's factor IX (FIX) plasma levels during his perioperative period, and we successfully performed his arthroscopic ankle arthrodesis without administration of any additional FIX concentrates. Our case has demonstrated the feasibility of joint surgery after liver transplantation without administration of additional clotting factors while monitoring FIX activity.

PMID: 29232254 [PubMed - as supplied by publisher]

Novel Techniques and Preliminary Results of Ex Vivo Liver Resection and Autotransplantation for End-Stage Hepatic Alveolar Echinococcosis: A Study of 31 Cases.

Wed, 12/13/2017 - 13:45
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Novel Techniques and Preliminary Results of Ex Vivo Liver Resection and Autotransplantation for End-Stage Hepatic Alveolar Echinococcosis: A Study of 31 Cases.

Am J Transplant. 2017 Dec 12;:

Authors: Yang X, Qiu Y, Huang B, Wang W, Shen S, Feng X, Wei Y, Lei J, Zhao J, Li B, Wen T, Yan L

Abstract
Ex vivo liver resection combined with autotransplantation is a recently introduced approach to cure end-stage hepatic alveolar echinococcosis (HAE), which is considered unresectable by conventional radical resection due to echinococcal dissemination into the crucial intrahepatic conduits and adjacent structures. This manuscript aims discuss the manipulation details and propose reasonable indications for this promising technique. All patients successfully underwent liver autotransplantation with no intraoperative mortality. The median weight of the autografts was 636 g (360-1300 g), the median operation time was 12.5 h (9.4-19.5 h), and the median anhepatic phase was 309 min (180- 460 min). Intraoperative blood loss averaged 1800 mL (1200-6000 mL). Postoperative complications occurred in 13 patients during hospitalization; five patients experienced postoperative complications classified as Clavien-Dindo Grade III or higher, and two patients died of intra-abdominal bleeding and acute cerebral hemorrhage, respectively. Twenty-nine patients were followed for a median of 14.0 months (3-42 months), and no HAE recurrence was detected. The technique requires neither an organ donor nor any postoperative immunosuppressant, and the success of the treatment relies on meticulous preoperative assessments and precise surgical manipulation. This article is protected by copyright. All rights reserved.

PMID: 29232038 [PubMed - as supplied by publisher]

Liver transplantation beyond or downstaging within the Milan criteria for hepatocellular carcinoma.

Wed, 12/13/2017 - 13:45
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Liver transplantation beyond or downstaging within the Milan criteria for hepatocellular carcinoma.

Expert Rev Gastroenterol Hepatol. 2017 Dec 12;:

Authors: Rudnick SR, Russo MW

Abstract
INTRODUCTION: Unresectable hepatocellular carcinoma (HCC) is a common indication for liver transplantation (LT). The Milan criteria became standard criteria but expansion beyond the Milan criteria (tumor size and number) have resulted in similar post-transplant outcomes, thus suggesting LT is a viable treatment option for HCC presenting beyond the Milan criteria Areas covered: Expanded criteria and the use of downstaging therapies to meet Milan criteria are reviewed. Surrogates of tumor biology (including biomarkers and response to therapy) are described in detail. The controversy regarding treatment of HCV infection prior to transplant for HCC is addressed. Predictors of post-transplant recurrence and therapeutic options are explored. English-language manuscripts pertaining to LT criteria for HCC, downstaging, and tumor prognosis were reviewed. Effort was made to include manuscripts from throughout the world to ensure the reader a broad international perspective. Expert Commentary: Patients can be successfully transplanted with HCC beyond Milan criteria, or patients beyond Milan criteria can be downstaged to within Milan criteria and achieve successful post-liver transplant outcomes. The current reliance on tumor burden (size and number) alone ignores the mounting data supporting the prognostic use of additional surrogates of tumor biology in identifying appropriate candidates.

PMID: 29231769 [PubMed - as supplied by publisher]

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