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[Application of active immunization in the prevention of de novo hepatitis B virus infection after pediatric liver transplantation with HBcAb positive donor liver].

Thu, 10/12/2017 - 10:01

[Application of active immunization in the prevention of de novo hepatitis B virus infection after pediatric liver transplantation with HBcAb positive donor liver].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Oct;29(10):926-930

Authors: Cui Y, Lu W, Gao W, Dong C, Han C, Liu Y

Abstract
OBJECTIVE: To investigate the effect of active immunization on prevention of post-transplantation de novo hepatitis B virus (HBV) infection in patients receiving liver grafts from hepatitis B core antibody (HBcAb) positive donors.
METHODS: A retrospective analysis was conducted. Eighty-seven children undergoing liver transplantation from HBcAb positive donors admitted to Tianjin First Center Hospital from October 2012 to December 2016 were enrolled, and the data of donors and recipients were collected. The hepatitis B vaccine was given before operation for hepatitis B surface antibody (HBsAb) > 1 000 U/L; hepatitis B immunoglobulin (HBIG) 100 U/kg was given during the operation, in order to prevent children from HBV infected by obtaining passive immunity quickly, children with HBsAb < 200 U/L after operation were injected with hepatitis B vaccine for booster immunization. HBV markers and liver function of recipients were determined before liver transplantation and during the follow-up, which up to April 2017. According to the children got de novo HBV infection after operation or not, the preventive effect of active immunization before and after transplantation operation on HBV infection was analyzed and compared.
RESULTS: In 87 children who received HBcAb positive donor livers, 9 (10.3%) developed de novo HBV infection, which occurred in 16 (10, 25) months after liver transplantation. Among the 9 children with HBV infection, 7 children had HBsAb < 1 000 U/L before the operation, the ratio was statistically increased as compared with the children without HBV infection [77.8% (7/9) vs. 37.2% (29/78), P < 0.05]. After the transplantation, 62 children of 78 without HBV infection showed a good response to hepatitis B vaccination, 1 child after inoculation of hepatitis B vaccine, the titer of HBsAb was still less than 200 U/L, 15 children without administration of hepatitis B vaccine, only with HBIG injection for prevention. The HBsAb of children with de nove HBV infection were less than 200 U/L after operation, the ratio was significantly increased as compared with children without HBV infection [100.0% (9/9) vs. 20.5% (16/78), P < 0.01].
CONCLUSIONS: The establishment of active immunization method can effectively prevent children with de novo HBV infection occurred in pediatric recipients from HBcAb positive donors with preventive treatment.

PMID: 29017655 [PubMed - in process]

Update of literature from cystic fibrosis registries 2012-2015. Part 6: Epidemiology, nutrition and complications.

Thu, 10/12/2017 - 10:01
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Update of literature from cystic fibrosis registries 2012-2015. Part 6: Epidemiology, nutrition and complications.

Pediatr Pulmonol. 2017 Mar;52(3):390-398

Authors: Salvatore D, Buzzetti R, Mastella G

Abstract
Patient registries provide useful information to afford more knowledge on rare diseases like Cystic Fibrosis (CF). Twenty-two studies originating from national CF registries, focusing on demographics, survival, genetics, nutritional status, and non-pulmonary complications, were published between December 2011 and March 2015. The purpose of this review article is to examine these reports, aiming attention to the clinical characteristics of CF patients included in the registries, current, and estimated future epidemiological data, the role of gender gap, the increasing survival in different countries. Some studies offer insights into pubertal growth and non-pulmonary complications, such as liver disease, nephropathy, and cancer. Pediatr Pulmonol. 2017;52:390-398. © 2016 Wiley Periodicals, Inc.

PMID: 27685428 [PubMed - indexed for MEDLINE]

Hazardous air pollutants and primary liver cancer in Texas.

Wed, 10/11/2017 - 12:45

Hazardous air pollutants and primary liver cancer in Texas.

PLoS One. 2017;12(10):e0185610

Authors: Cicalese L, Curcuru G, Montalbano M, Shirafkan A, Georgiadis J, Rastellini C

Abstract
The incidence of hepatocellular carcinoma (HCC), the most common primary liver cancer, is increasing in the US and tripled during the past two decades. The reasons for such phenomenon remain poorly understood. Texas is among continental states with the highest incidence of liver cancer with an annual increment of 5.7%. Established risk factors for HCC include Hepatitis B and C (HBV, HCV) viral infection, alcohol, tobacco and suspected risk factors include obesity and diabetes. While distribution of these risk factors in the state of Texas is similar to the national data and homogeneous, the incidence of HCC in this state is exceptionally higher than the national average and appears to be dishomogeneous in various areas of the state suggesting that other non-recognized risk factors might play a role. No population-based studies are currently available investigating the effect of exposure to Hazardous Air Pollutants (HAPs) as a contributing risk factor for liver cancer. Incidence rate of liver cancer in Texas by counties for the time period between 2002 and 2012 was obtained from the Texas Cancer Registry (TCR). Through Principal Component Analysis (PCA) a subgroup of pollutants, explaining almost all the dataset variability, were identified and used to cluster Texas counties. The analysis generated 4 clusters showing liver cancer rate either higher or lower than national average in association with either high or low levels of HAPs emission in the environment. The study shows that the selected relevant HAPs, 10 among 253 analyzed, produce a significant correlation (P = 0.01-0.05) and some of these have been previously identified as carcinogens. An association between the increased production and consequent exposure to these HAPs and a higher presence of liver cancer in certain counties is suggested. This study provides a new insight on this complex multifactorial disease suggesting that environmental substances might play a role in the etiology of this cancer.

PMID: 29016628 [PubMed - in process]

Is Visceral Leishmaniasis Different in Immunocompromised Patients Without Human Immunodeficiency Virus? A Comparative, Multicenter Retrospective Cohort Analysis.

Wed, 10/11/2017 - 12:45

Is Visceral Leishmaniasis Different in Immunocompromised Patients Without Human Immunodeficiency Virus? A Comparative, Multicenter Retrospective Cohort Analysis.

Am J Trop Med Hyg. 2017 Sep 05;:

Authors: Ramos JM, León R, Merino E, Montero M, Aljibe A, Blanes M, Reus S, Boix V, Salavert M, Portilla J

Abstract
Although visceral leishmaniasis (VL) can affect immunocompromised patients, data from the human immunodeficiency virus (HIV) infection context are limited, and the characteristics of VL in other immunosuppression scenarios are not well defined. A retrospective review of all cases of VL in immunocompromised patients from January 1997 to December 2014 in two Spanish hospitals on the Mediterranean coast was performed. We included 18 transplant recipients (kidney: 7, liver: 4, lung: 3, heart: 2, and blood marrow: 2), 12 patients with other causes of immunosuppression (myasthenia gravis: 3 and rheumatoid arthritis: 2), and 73 VL HIV-positive patients. Fever was more common in transplant patients (94.4%) and patients with other types of immunosuppression (100%) than in HIV-positive individuals (73.3%). Hepatomegaly was less common in transplant recipients (27.8%) and patients with other types of immunosuppression (41.7%) compared with HIV-positive patients (69.9%) (P = 0.01; P = 0.001, respectively). Patients with other types of immunosuppression had a median leukocyte count of 1.5 × 10(9)/L, significantly lower than HIV-positive patients (2.5 × 10(9)/L) (P = 0.04). Serology was more commonly positive in nontransplant immunosuppressed individuals (75%) and transplant recipients (78.6%) than in HIV-patients (13.8%) (P < 0.001). Antimonial therapy was rarely used in transplant recipients (1.9%) and never in patients with other immunosuppressive conditions, whereas 34.2% of HIV-positive patients received it (P = 0.05 and P = 0.01, respectively). Mortality was 16.7% in both transplant recipients and patients with other immunosuppressive conditions and 15.1% in HIV-positive patients. The features of VL may be different in immunosuppressed patients, with more fever and less hepatomegaly and leukopenia than in HIV-infected patients.

PMID: 29016284 [PubMed - as supplied by publisher]

Hepatic hydrothorax: About a hospital serie of 63 cases.

Wed, 10/11/2017 - 12:45

Hepatic hydrothorax: About a hospital serie of 63 cases.

Tunis Med. 2016 Dec;94(12):867

Authors: Mouelhi L, Daboussi O, Cheffi N, El Jery K, Said Y, Khedher S, Salem M, Dabbèche R, Houissa F, Najjar T

Abstract
BACKGROUND: Hepatic hydrothorax is a less common complication of cirrhosis with an estimated prevalence of 10- 15%. In the vast majority of cases, ascites are also present but significant pleural effusion may develop in patients without ascites. Hepatic hydrothorax is associated with cirrhosis whatever its etiology. The prognosis of hepatic hydrothorax remains unclear and is closely related to available therapeutic options. The aim of our study is to determine the prevalence of hydrothorax in cirrhotic patients, detail its clinical and therapeutic characteristics, and study the evolutive profile of cirrhotic patients with hydrothorax by comparing it to those without hydrothorax. We also search predictive factors of development of this complication in cirrhotic patients.
METHODS: We conduct a retrospective and case-control study including 63 cirrhotic patients with hepatic hydrothorax hospitalized in gastroenterology department of Charles Nicolle hospital of Tunis, during a period of fiveteen years, from January 2000 to January 2015.
RESULTS: The prevalence of hydrothorax was 14.5%. The mean age was 62 ± 14 years (range, 22- 86 years). The sex ratio H/F was 1.52. Hepatic hydrothorax was symptomatic in 35 patients. It was right-sided in 60%, left-sided in 24% and bilateral in 16% of cases. Hydrothorax was on average size abundance in 54% of cases. It was transsudatif in 52.5% of cases. Hepatitis C was the most frequent cause of cirrhosis (54%). Our results show that hepatic hydrothorax was present with important ascites in 35 patients. Hydrothorax was significantly related to Child-Pugh C severity of cirrhosis (p=0.0001). Hydrothorax occurence was significantly associated with a low level of albumin (p=0.001), an important hyponatremia (p=0.001) and a low prothrombin rate (p=0.02). A therapeutic thoracentesis was performed in 57% of cases. Diuretics based on spironolactone and furosemide were indicated in 30 patients. Evolution was favorable in 19 patients. Refractory hepatic hydrothorax was present in 31 patients. Death, in the days which follow the hospitalisation, was in 13 patients. The 5-years survival rate was 60%. The mean survival time of patients with hepatic hydrothorax was 8.41 years against 10.75 years at patients without hepatic hydrothorax.
CONCLUSION: Hepatic hydrothorax is a common complication in our study. The improvement of the prognosis of our patients would require a better therapeutic management and especially the possibility of orthotopic liver transplantation which is the optimal therapeutic option for patients with hepatic hydrothorax.

PMID: 28994887 [PubMed - in process]

Role of Raltegravir in patients co-infected with HIV and HCV in the era of direct antiviral agents.

Wed, 10/11/2017 - 12:45

Role of Raltegravir in patients co-infected with HIV and HCV in the era of direct antiviral agents.

New Microbiol. 2017 Oct 10;40(4)

Authors: Taramasso L, Cenderello G, Riccardi N, Tunesi S, Di Biagio A

Abstract
Integrase strand transfer inhibitors (INSTIs) are the preferred third agent in first-line antiretroviral therapies. Raltegravir (RAL) was the first INSTI to be approved and used in naïve and experienced patients. Due to its good tolerability and low side effects, RAL has been largely used also in hepatitis co-infected patients. Many years of experience in RAL use now allow literature evidence to be gathered on its safety in HIV/HCV-co-infected patients pre, during and post direct acting agents (DAA) treatment, at all possible stages. In both clinical trials and published case series, RAL has been well tolerated in patients harboring HCV co-infection and also in cirrhotic patients with mild hepatic impairment. Literature data show no major interactions or the need for dose adjustments with any of the DAA currently in use for HCV treatment, or with ribavirine. Hence, RAL can be safely administered during HCV treatment with DAA and may be used as a "temporary" regimen in patients who do not present major integrase-inhibitor mutations. Moreover, its characteristics are also favorable in case of orthotropic liver transplantation, both for the evidence of hepatic safety and for possible co-administration with immunosuppressant agents.

PMID: 28994443 [PubMed - as supplied by publisher]

Cholangiocarcinoma - evolving concepts and therapeutic strategies.

Wed, 10/11/2017 - 12:45

Cholangiocarcinoma - evolving concepts and therapeutic strategies.

Nat Rev Clin Oncol. 2017 Oct 10;:

Authors: Rizvi S, Khan SA, Hallemeier CL, Kelley RK, Gores GJ

Abstract
Cholangiocarcinoma is a disease entity comprising diverse epithelial tumours with features of cholangiocyte differentiation: cholangiocarcinomas are categorized according to anatomical location as intrahepatic (iCCA), perihilar (pCCA), or distal (dCCA). Each subtype has a distinct epidemiology, biology, prognosis, and strategy for clinical management. The incidence of cholangiocarcinoma, particularly iCCA, has increased globally over the past few decades. Surgical resection remains the mainstay of potentially curative treatment for all three disease subtypes, whereas liver transplantation after neoadjuvant chemoradiation is restricted to a subset of patients with early stage pCCA. For patients with advanced-stage or unresectable disease, locoregional and systemic chemotherapeutics are the primary treatment options. Improvements in external-beam radiation therapy have facilitated the treatment of cholangiocarcinoma. Moreover, advances in comprehensive whole-exome and transcriptome sequencing have defined the genetic landscape of each cholangiocarcinoma subtype. Accordingly, promising molecular targets for precision medicine have been identified, and are being evaluated in clinical trials, including those exploring immunotherapy. Biomarker-driven trials, in which patients are stratified according to anatomical cholangiocarcinoma subtype and genetic aberrations, will be essential in the development of targeted therapies. Targeting the rich tumour stroma of cholangiocarcinoma in conjunction with targeted therapies might also be useful. Herein, we review the evolving developments in the epidemiology, pathogenesis, and management of cholangiocarcinoma.

PMID: 28994423 [PubMed - as supplied by publisher]

Addiction medicine ethics: relapse, no lapse and the struggle to treat addicts like everyone else.

Wed, 10/11/2017 - 12:45

Addiction medicine ethics: relapse, no lapse and the struggle to treat addicts like everyone else.

Intern Med J. 2017 Oct;47(10):1121-1123

Authors: Douglas C

Abstract
Two case studies are presented as a focus for discussion of ethics in addiction medicine. The first is that of the alcohol-dependent patient who receives a liver transplant. The second is that of a heroin-dependent patient who continues to inject himself while in a general medical ward. I make some comments about the obligations of doctors to treat those who cause harm to themselves as they would treat those who are 'not responsible'.

PMID: 28994253 [PubMed - in process]

Liver Transplantation for High Risk Hepatocellular Carcinoma After Liver Resection: A Sequential or Salvage Approach?

Wed, 10/11/2017 - 12:45

Liver Transplantation for High Risk Hepatocellular Carcinoma After Liver Resection: A Sequential or Salvage Approach?

Ann Transplant. 2017 Oct 10;22:602-610

Authors: Lin CC, Elsarawy AM, Li WF, Lin TL, Yong CC, Wang SH, Wang CC, Kuo FY, Cheng YF, Chen CL

Abstract
BACKGROUND Liver transplantation (LT) is the best radical treatment of hepatocellular carcinoma (HCC). Salvage liver transplantation (SalvLT) provides good outcomes for recurrent HCC cases after initial curative liver resection (LR). However, the salvage strategy is not feasible in all situations due to aggressive recurrences. Recently, sequential liver transplantation (SeqLT) was proposed for cases that show adverse pathological features after LR, thus LT is performed pre-emptively before recurrence. In this report, we compared the outcomes of SalvLT and SeqLT for surgical treatment of HCC. MATERIAL AND METHODS One hundred and ten cases underwent LR for HCC, then were subjected to either SalvLT (n=91) or SeqLT (n=19), from January 2001 to December 2015. For cases that underwent several LR before LT, we collected the data of the last LR before transplantation. A comparison was made according to pre- and post-transplant clinical and pathological variables. Survival analysis and comparison between both pathways are provided. RESULTS The median interval (months) between LR and LT for the SeqLT group and the SalvLT group were 9.6 and 22.2, respectively. (p=0.01). The LR histopathological features were similar in both groups. In the SalvLT group, the histopathological comparison between the criteria of last LR and the criteria of liver explants revealed that 14 cases advanced from stage I to stage II, one cases from stage I to stage IIIa, one case from stage I to stage IIIb, one case from stage I to stage IIIc, three cases from stage II to stage IIIb and one case from stage II to stage IIIc. The overall rate of pathological upstaging in the SalvLT group was 27%. The incidence of post-transplant HCC recurrence was 5% (1/19) and 11% (10/91) for the SeqLT and SalvLT groups, respectively (p=0.4). The incidence of post-LT in-hospital mortality was 0% among the SeqLT group and 2% (2/91) among the SalvLT group. The estimated rates of five-year overall survival and cancer specific survival for the SeqLT group versus the SalvLT group were (92.3% versus 87.6%; p=0.4) and (92.3% versus 91.9%; p=0.7), respectively. CONCLUSIONS The SeqLT approach might be associated with low incidence of cancer recurrence, better overall survival, and less operative mortality. Another possible benefit is the avoidance of aggressive non-transplantable HCC recurrences. More studies and/or randomization are required for highre evidence conclusions.

PMID: 28993607 [PubMed - in process]

Twenty-year Comparative Analysis of Patients With Autoimmune Liver Diseases on Transplant Waitlists.

Wed, 10/11/2017 - 12:45

Twenty-year Comparative Analysis of Patients With Autoimmune Liver Diseases on Transplant Waitlists.

Clin Gastroenterol Hepatol. 2017 Oct 06;:

Authors: Webb GJ, Rana A, Hodson J, Akhtar MZ, Ferguson JW, Neuberger JM, Vierling JM, Hirschfield GM

Abstract
BACKGROUND & AIMS: The rarity of autoimmune liver disease poses challenges to epidemiology studies. However, waitlists for liver transplantation can be used to study patients with end-stage liver diseases. We used these waitlists to assess trends in numbers and demographics patients awaiting liver transplant for primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), or autoimmune hepatitis (AIH).
METHODS: We collected data from United Kingdom (UK) and United States (US) national registries for all adults on liver transplant waitlists, from January 1, 1995 through December 31, 2014. We analyzed from data on patients with PBC (n=1434 in the UK and n=5598 in the US), PSC (n=1093 in the UK and n=6820 in the US), and AIH (n=538 in the UK and n=4949 in the US). Numbers of listings per year were adjusted to the estimated populations during each year. Regression analyses were used to examine trends and comparative statistics used to evaluate differences in individual characteristics among groups.
RESULTS: Over the total study period, listings for PBC were 1.2 and 1.0 per million population per year in the UK and US respectively; for PSC, 0.9 and 1.2 per million population per year; and for AIH, 0.5 and 0.8 per million population per year. Over the period studied, numbers of listings for PBC decreased by 50% in both countries; changes in numbers of listings for PSC and AIH were smaller and not consistent between countries. By 2014, PSC had become the leading indication for liver transplantation among patients with autoimmune liver diseases in both countries. Median patient ages at time of listing were lower than those reported as median age of diagnosis for AIH and PBC. The ratio of women:men with PBC decreased by almost 50% from 1995 through 2014. Men with PSC were placed on the waitlist with higher disease severity scores than women in both countries. Among patients with PBC, those of black race were under-represented on waitlists from both countries. Among patients with PSC, Hispanics were under-represented on waitlists in the US. Patients of non-white races were placed on waitlists at younger ages for all diseases; age differences in waitlist placement varied by up to 10 years, depending on race, among patients with PBC.
CONCLUSION: In an analysis of data collected from UK and US national liver transplant registries over 20 years, we found that PSC has become the leading indication for liver transplantation among patients with autoimmune liver diseases. Numbers of patients with PBC placed on waitlists, and the ratio of women:men with PBC, each decreased by almost 50%, possibly due to increased treatment with ursodeoxycholic acid. Within groups of patients on the transplant waitlisted for PBC, PSC, or AIH, we found differences in age, sex, disease severity scores, and ethnicity between diseases and countries that require further study.

PMID: 28993258 [PubMed - as supplied by publisher]

Pitfalls in the non-invasive assessment of liver fibrosis with eLIFT-FM(VCTE) algorithm.

Wed, 10/11/2017 - 12:45

Pitfalls in the non-invasive assessment of liver fibrosis with eLIFT-FM(VCTE) algorithm.

J Hepatol. 2017 Oct 06;:

Authors: Wang XC, Zhang XY, Zhang X, Yuan ZX, Li XH, Wang JC, Sun B, Lu XJ

PMID: 28993184 [PubMed - as supplied by publisher]

Gastrointestinal tract post-transplant lymphoproliferative disorder after liver transplantation.

Wed, 10/11/2017 - 12:45

Gastrointestinal tract post-transplant lymphoproliferative disorder after liver transplantation.

Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):556-558

Authors: Xie QF, Chen P, Chen XH, Liu JM, Lerut J, Zheng SS

PMID: 28992890 [PubMed - in process]

Polymorphic multiple hepatocellular adenoma including a non-steatotic HNF1α-inactivated variant.

Wed, 10/11/2017 - 12:45

Polymorphic multiple hepatocellular adenoma including a non-steatotic HNF1α-inactivated variant.

Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):552-555

Authors: Mohkam K, Darnis B, Cazauran JB, Rode A, Manichon AF, Ducerf C, Bancel B, Mabrut JY

PMID: 28992889 [PubMed - in process]

Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats.

Wed, 10/11/2017 - 12:45

Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats.

Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):506-511

Authors: Ulmer TF, Weiland A, Lurje G, Klink C, Andert A, Alizai H, Heidenhain C, Neumann U

Abstract
BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70% partial hepatectomy.
METHODS: Seventy-two male Wistar rats were randomly assigned into three groups (n=24 in each group): 70% partial hepatectomy as control (PHC), 70% partial hepatectomy with splenectomy (PHS) or 70% partial hepatectomy with a micropump for terlipressin administration (PHT). Eight rats in each group were sacrificed on postoperative day (POD) 1, 3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine (BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and 7.
RESULTS: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups (PHT: 8.13±1.55, 10.38±1.30, 6.25±0.89 cmH2O and PHS: 7.50±0.93, 8.88±2.42, 5.75±1.04 cmH2O) was lower compared to the control group (PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1 (BrdU: PHS vs PHC, 20.85%±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96%±11.69%). However, none of the differences were statistically significant.
CONCLUSIONS: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of liver regeneration.

PMID: 28992883 [PubMed - in process]

Bone metastases from hepatocellular carcinoma: clinical features and prognostic factors.

Wed, 10/11/2017 - 12:45

Bone metastases from hepatocellular carcinoma: clinical features and prognostic factors.

Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):499-505

Authors: Lu Y, Hu JG, Lin XJ, Li XG

Abstract
BACKGROUND: Bone metastases (BMs) from hepatocellular carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among patients with different treatments for HCC.
METHODS: Forty-three consecutive patients who were diagnosed with BMs from HCC between January 2010 and December 2014 were retrospectively enrolled. The clinical features were identified, the impacts of prognostic factors on survival were statistically analyzed, and clinical data were compared.
RESULTS: The median patient age was 54 years; 38 patients were male and 5 female. The most common site for BMs was the trunk (69.3%). BMs with extension to the soft tissue were found in 14 patients (32.5%). Most (90.7%) of the lesions were mixed osteolytic and osteoblastic, and most (69.8%) patients presented with multiple BMs. The median survival after BMs diagnosis was 11 months. In multivariate analyses, survival after BM diagnosis was correlated with Karnofsky performance status (P=0.008) and the Child-Pugh classification (P<0.001); BM-free survival was correlated with progression beyond the University of California San Francisco criteria (P<0.001) and treatment of primary tumors (P<0.001). BMs with extension to soft tissue were less common in liver transplantation patients. During metastasis, the control of intrahepatic tumors was improved in liver transplantation and hepatectomy patients, compared to conservatively treated patients.
CONCLUSIONS: The independent prognostic factors of survival after diagnosis of BMs were the Karnofsky performance status and Child-Pugh classification. HCC patients developed BMs may also benefit from liver transplantation or hepatectomy.

PMID: 28992882 [PubMed - in process]

Cost-effectiveness analysis of transcatheter arterial chemoembolization with or without sorafenib for the treatment of unresectable hepatocellular carcinoma.

Wed, 10/11/2017 - 12:45

Cost-effectiveness analysis of transcatheter arterial chemoembolization with or without sorafenib for the treatment of unresectable hepatocellular carcinoma.

Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):493-498

Authors: Zhao RC, Zhou J, Wei YG, Liu F, Chen KF, Li Q, Li B

Abstract
BACKGROUND: Transcatheter arterial chemoembolization (TACE) and TACE in combination with sorafenib (TACE-sorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma (HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.
METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.
RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.
CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.

PMID: 28992881 [PubMed - in process]

Delayed introduction of immunosuppressive regimens in critically ill patients after liver transplantation.

Wed, 10/11/2017 - 12:45

Delayed introduction of immunosuppressive regimens in critically ill patients after liver transplantation.

Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):487-492

Authors: Luo Y, Ji WB, Duan WD, Shi XJ, Zhao ZM

Abstract
BACKGROUND: The manipulation of immunosuppression therapy remains challenging in patients who develop infectious diseases or multiple organ dysfunction after liver transplantation. We evaluated the outcomes of delayed introduction of immunosuppression in the patients after liver transplantation under immune monitoring with ImmuKnow assay.
METHODS: From March 2009 to February 2014, 225 consecutive liver recipients in our institute were included. The delayed administration of immunosuppressive regimens was attempted in 11 liver recipients with multiple severe comorbidities.
RESULTS: The median duration of non-immunosuppression was 12 days (range 5-58). Due to the infectious complications, the serial ImmuKnow assay showed a significantly low ATP level of 64±35 ng/mL in the early period after transplantation. With the development of comorbidities, the ImmuKnow value significantly increased. However, the acute allograft rejection developed when a continuous distinct elevation of both ATP and glutamyltranspeptidase levels was detected. The average ATP level measured just before the development of acute rejection was 271±115 ng/mL.
CONCLUSIONS: The delayed introduction of immunosuppressive regimens is safe and effective in management of critically ill patients after liver transplantation. The serial ImmuKnow assay could provide a reliable depiction of the dynamics of functional immunity throughout the clinical course of a given patient.

PMID: 28992880 [PubMed - in process]

Surgical resection versus liver transplantation for hepatocellular carcinoma within the Hangzhou criteria: a preoperative nomogram-guided treatment strategy.

Wed, 10/11/2017 - 12:45

Surgical resection versus liver transplantation for hepatocellular carcinoma within the Hangzhou criteria: a preoperative nomogram-guided treatment strategy.

Hepatobiliary Pancreat Dis Int. 2017 Oct 15;16(5):480-486

Authors: Li Y, Ruan DY, Jia CC, Zhao H, Wang GY, Yang Y, Jiang N

Abstract
BACKGROUND: With the expansion of surgical criteria, the comparative efficacy between surgical resection (SR) and liver transplantation (LT) for hepatocellular carcinoma is inconclusive. This study aimed to develop a prognostic nomogram for predicting recurrence-free survival of hepatocellular carcinoma patients after resection and explored the possibility of using nomogram as treatment algorithm reference.
METHODS: From 2003 to 2012, 310 hepatocellular carcinoma patients within Hangzhou criteria undergoing resection or liver transplantation were included. Total tumor volume, albumin level, HBV DNA copies and portal hypertension were included for constructing the nomogram. The resection patients were stratified into low- and high-risk groups by the median nomogram score of 116. Independent risk factors were identified and a visually orientated nomogram was constructed using a Cox proportional hazards model to predict the recurrence risk for SR patients.
RESULTS: The low-risk SR group had better outcomes compared with the high-risk SR group (3-year recurrence-free survival rate, 71.1% vs 35.9%; 3-year overall survival rate, 89.8% vs 78.9%, both P<0.001). The high-risk SR group was associated with a worse recurrence-free survival rate but similar overall survival rate compared with the transplantation group (3-year recurrence-free survival rate, 35.9% vs 74.1%, P<0.001; 3-year overall survival rate, 78.9% vs 79.6%, P>0.05).
CONCLUSIONS: This nomogram offers individualized recurrence risk evaluation for hepatocellular carcinoma patients within Hangzhou criteria receiving resection. Transplantation should be considered the first-line treatment for high-risk patients.

PMID: 28992879 [PubMed - in process]

Comprehensive detection of viruses in pediatric patients with acute liver failure using next-generation sequencing.

Wed, 10/11/2017 - 12:45

Comprehensive detection of viruses in pediatric patients with acute liver failure using next-generation sequencing.

J Clin Virol. 2017 Oct 03;96:67-72

Authors: Suzuki T, Kawada JI, Okuno Y, Hayano S, Horiba K, Torii Y, Takahashi Y, Umetsu S, Sogo T, Inui A, Ito Y

Abstract
BACKGROUND: Pediatric acute liver failure (PALF) is a rare and severe syndrome that frequently requires liver transplantation. Viruses are one of the most frequent causes of this disease, however, pathogenic viruses are not determined in many patients. Recently next-generation sequencing (NGS) has been applied to comprehensively detect pathogens of infectious diseases of unknown etiology.
OBJECTIVES: To evaluate an NGS-based approach for detecting pathogenic viruses in patients with PALF or acute hepatitis of unknown etiology.
STUDY DESIGN: To detect virus-derived DNA and RNA sequences existing in sera/plasma from patients, both DNA and RNA sequencing were performed. First, we validated the ability of NGS to detect viral pathogens in clinical serum/plasma samples, and compared different commercial RNA library preparation methods Then, serum/plasma of fourteen patients with PALF or acute hepatitis of unknown etiology were evaluated using NGS.
RESULTS: Among three RNA library preparation methods, Ovation RNA-Seq System V2 had the highest sensitivity to detect RNA viral sequences. Among fourteen patients, sequence reads of torque teno virus, adeno-associated virus, and stealth virus were found in the sera of one patient each, however, the pathophysiological role of these three viruses was not clarified. Significant virus reads were not detected in the remaining 11 patients.
CONCLUSIONS: This finding might be due to low virus titer in blood at the time of referral or a non-infectious cause might be more frequent. These results suggest an NGS-based approach has potential to detect viral pathogens in clinical samples and would contribute to clarification of the etiology of PALF.

PMID: 28992518 [PubMed - as supplied by publisher]

Outcomes of Organ Transplants When the Donor Is a Prior Recipient.

Wed, 10/11/2017 - 12:45

Outcomes of Organ Transplants When the Donor Is a Prior Recipient.

Am J Transplant. 2017 Oct 09;:

Authors: Lee GS, Goldberg DS, Levine MH, Abt PL

Abstract
Organ shortage continues to challenge the field of transplantation. One potential group of donors are those who have been transplant recipients themselves, or Organ Donor After Transplant (ODAT). We conducted a retrospective cohort study to describe ODAT donors and to compare outcomes of ODAT grafts versus conventional grafts. From 10/1/87 to 6/30/15, 517 former recipients successfully donated 803 organs for transplant. Former kidney recipients generally survived a median of approximately four years before becoming an ODAT donor whereas liver, lung, and heart recipients generally survived less than a month prior to donation. In the period 1/1/05 to 12/31/14, liver grafts from ODAT donors had a significantly higher risk of graft failure compared to non-ODAT liver transplants (p = 0.008). Kidney grafts donated by ODAT donors whose initial transplant occurred >1 year prior were associated with significantly increased graft failure (p = 0.012). Despite increased risk of graft failure amongst certain ODAT grafts, five year survival was still high. ODAT donors should be considered another form of expanded criteria donor under these circumstances. This article is protected by copyright. All rights reserved.

PMID: 28992380 [PubMed - as supplied by publisher]

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