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Diagnosis and Management of Hepatobiliary Complications in Autosomal Recessive Polycystic Kidney Disease.

Thu, 06/15/2017 - 15:45
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Diagnosis and Management of Hepatobiliary Complications in Autosomal Recessive Polycystic Kidney Disease.

Front Pediatr. 2017;5:124

Authors: Wehrman A, Kriegermeier A, Wen J

Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a congenital hepatorenal fibrocystic disease. The hepatic manifestations of ARPKD can range from asymptomatic to portal hypertension and massively dilated biliary system that results in liver transplantation. Hepatic complications of ARPKD typically present with signs of portal hypertension (splenomegaly and thrombocytopenia) or cholangitis. Liver disease in ARPKD does not always correlate with severity of renal disease. Management of ARPKD-related liver disease is largely treating specific symptoms, such as antibiotics for cholangitis or endoscopic treatment for variceal bleeding. If complications cannot be managed medically, liver transplantation may be indicated. This mini-review will discuss the clinical manifestations and management of children with ARPKD liver disease.

PMID: 28611971 [PubMed - in process]

Rapid Disease Progression of Liver Metastases following Resection in a Liver-Transplanted Patient with Probable Lynch Syndrome - A Case Report and Review of the Literature.

Thu, 06/15/2017 - 15:45
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Rapid Disease Progression of Liver Metastases following Resection in a Liver-Transplanted Patient with Probable Lynch Syndrome - A Case Report and Review of the Literature.

Case Rep Oncol. 2017 Jan-Apr;10(1):244-251

Authors: Wassano NS, Sergi F, Ferro G, Genzini T, D'Alpino Peixoto R

Abstract
Solid organ transplantation provides life-saving therapy for patients with end-stage organ disease, and its outcomes have been improving dramatically over the past few decades. However, substantial morbidity results from chronic immunosuppressive therapy administered to prevent graft rejection. It predisposes patients to several life-threatening complications, such as opportunistic microbial infections and the development of different types of cancers. Here, we presented the case of a young man with probable Lynch syndrome, who developed an aggressive colon carcinoma after long-term immunosuppressive therapy due to a prior liver transplantation. Based on this case report, we attempt to find an answer to the question about the risk of cancer development or recurrence in patients with familial syndromes receiving long-term immunosuppressive therapy and to find out how it can be minimized. Answering these questions is particularly important, given the facts that disease course is substantially more aggressive among transplanted patients and that prognosis is poor due to lack of immunocompetence, especially in the setting of Lynch syndrome.

PMID: 28611638 [PubMed]

Functional Budd-Chiari Syndrome Associated With Severe Polycystic Liver Disease.

Thu, 06/15/2017 - 15:45
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Functional Budd-Chiari Syndrome Associated With Severe Polycystic Liver Disease.

Clin Med Insights Gastroenterol. 2017;10:1179552217713003

Authors: de Menezes Neves PDM, Balbo BEP, Watanabe EH, Rocha-Santos V, Andraus W, D'Albuquerque LAC, Onuchic LF

Abstract
A 50-year-old woman with end-stage renal disease secondary to autosomal dominant polycystic kidney disease was referred to a quaternary care center due to significantly increased abdominal girth. Her physical examination revealed tense ascites and abdominal collateral veins. A 10-L paracentesis improved abdominal discomfort and disclosed a transudate, suggestive of portal hypertension. A computed tomographic scan revealed massive hepatomegaly caused by multiple cysts of variable sizes, distributed throughout all hepatic segments. Contrast-enhanced imaging uncovered extrinsic compression of hepatic and portal veins, resulting in functional Budd-Chiari syndrome and portal hypertension. Although image-guided drainage followed by sclerosis of dominant cysts could potentially lead to alleviation of the extrinsic compression, the associated significant risk of cyst hemorrhage and infection precluded this procedure. In this scenario, the decision was to submit the patient to a liver-kidney transplantation. After 1 year of this procedure, the patient maintains normal liver and kidney function and refers significant improvement in quality of life.

PMID: 28611533 [PubMed - in process]

Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis.

Thu, 06/15/2017 - 15:45
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Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis.

World J Gastroenterol. 2017 May 28;23(20):3730-3743

Authors: Li H, Zhang JB, Chen XL, Fan L, Wang L, Li SH, Zheng QL, Wang XM, Yang Y, Chen GH, Wang GS

Abstract
AIM: To perform a systematic review and meta-analysis on minimally vs conventional invasive techniques for harvesting grafts for living donor liver transplantation.
METHODS: PubMed, Web of Science, EMBASE, and the Cochrane Library were searched comprehensively for studies comparing MILDH with conventional living donor hepatectomy (CLDH). Intraoperative and postoperative outcomes (operative time, estimated blood loss, postoperative liver function, length of hospital stay, analgesia use, complications, and survival rate) were analyzed in donors and recipients. Articles were included if they: (1) compared the outcomes of MILDH and CLDH; and (2) reported at least some of the above outcomes.
RESULTS: Of 937 articles identified, 13, containing 1592 patients, met our inclusion criteria and were included in the meta-analysis. For donors, operative time [weighted mean difference (WMD) = 20.68, 95%CI: -6.25-47.60, P = 0.13] and blood loss (WMD = -32.61, 95%CI: -80.44-5.21, P = 0.18) were comparable in the two groups. In contrast, analgesia use (WMD = -7.79, 95%CI: -14.06-1.87, P = 0.01), postoperative complications [odds ratio (OR) = 0.62, 95%CI: 0.44-0.89, P = 0.009], and length of hospital stay (WMD): -1.25, 95%CI: -2.35-0.14, P = 0.03) significantly favored MILDH. No differences were observed in recipient outcomes, including postoperative complications (OR = 0.93, 95%CI: 0.66-1.31, P = 0.68) and survival rate (HR = 0.96, 95%CI: 0.27-3.47, P = 0.95). Funnel plot and statistical methods showed a low probability of publication bias.
CONCLUSION: MILDH is safe, effective, and feasible for living donor liver resection with fewer donor postoperative complications, reduced length of hospital stay and analgesia requirement than CLDH.

PMID: 28611526 [PubMed - in process]

Surgical management of liver diseases invading the hepatocaval confluence based on IH classification: The surgical guideline in our center.

Thu, 06/15/2017 - 15:45
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Surgical management of liver diseases invading the hepatocaval confluence based on IH classification: The surgical guideline in our center.

World J Gastroenterol. 2017 May 28;23(20):3702-3712

Authors: Li W, Han J, Wu ZP, Wu H

Abstract
AIM: to investigate the short-term outcomes and risk factors indicating postoperative death of patients with lesions adjacent to the hepatocaval confluence.
METHODS: We retrospectively analyzed 54 consecutive patients who underwent hepatectomy combined with inferior vena cava (IVC) and/or hepatic vein reconstruction (HVR) from January 2012 to January 2016 at our liver surgery center. The patients were divided into 5 groups according to the range of IVC and hepatic vein involvement. The patient details, indications for surgery, operative techniques, intra- and postoperative outcomes were compared among the 5 groups. Univariate and multivariate analyses were performed to explore factors predictive of overall operative death.
RESULTS: IVC replacement was carried out in 37 (68.5%) patients and HVR in 17 (31.5%) patients. Type I2H2 had the longest operative blood loss, operative duration and overall liver ischemic time (all, P < 0.05). Three patients of Type I3H1 with totally occluded IVC did not need IVC reconstruction. Total postoperative morbidity rate was 40.7% (22 patients) and the operative mortality rate was 16.7% (9 patients). Factors predictive of operative death included IVC replacement (P = 0.048), duration of liver ischemia (P = 0.005) and preoperative liver function being Child-Pugh B (P = 0.025).
CONCLUSION: IVC replacement, duration of liver ischemia and preoperative poor liver function were risk factors predictive of postoperative death. We should be cautious about IVC replacement, especially in Type I2H2. For Type I3H1, it was unnecessary to replace IVC when the collateral circulation was established.

PMID: 28611523 [PubMed - in process]

Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation.

Thu, 06/15/2017 - 15:45
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Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation.

World J Gastroenterol. 2017 May 28;23(20):3690-3701

Authors: Nicolini D, Agostini A, Montalti R, Mocchegiani F, Mincarelli C, Mandolesi A, Robertson NL, Candelari R, Giovagnoni A, Vivarelli M

Abstract
AIM: To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT).
METHODS: We retrospectively evaluated the preoperative predictors of HCC recurrence in 70 patients treated with conventional (n = 16) or doxorubicin-eluting bead TACE (n = 54) before LT. The patient and tumour characteristics, including the static and dynamic alpha-fetoprotein, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR) measurements, were recorded. Treatment response was classified according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and the European Association for the Study of the Liver (EASL) criteria as complete response (CR), partial response (PR), stable disease or progressive disease. After examination of the explanted livers, histological necrosis was classified as complete (100% of the cumulative tumour area), partial (50%-99%) or minimal (< 50%) and was correlated with the preoperative radiological findings.
RESULTS: According to the pre-TACE radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. After TACE procedures, the objective response (CR + PR) rates were 71.4% and 70.0% according to mRECIST and EASL criteria, respectively. The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). Complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Using histopathology as the reference standard, mRECIST criteria correctly classified necrosis in 72.9% (51/70) of patients and EASL criteria in 68.6% (48/70) of cases. The mRECIST non-response to TACE [Exp(b) = 9.2, p = 0.012], exceeding UCSF criteria before TACE [Exp(b) = 4.7, p = 0.033] and a preoperative PLR > 150 [Exp(b) = 5.9, p = 0.046] were independent predictors of tumour recurrence.
CONCLUSION: The radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of TACE-treated candidates for LT.

PMID: 28611522 [PubMed - in process]

The correlation between the expression of genes involved in drug metabolism and the blood level of tacrolimus in liver transplant receipts.

Thu, 06/15/2017 - 15:45
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The correlation between the expression of genes involved in drug metabolism and the blood level of tacrolimus in liver transplant receipts.

Sci Rep. 2017 Jun 13;7(1):3429

Authors: Wang J, Li K, Zhang X, Teng D, Ju M, Jing Y, Zhao Y, Li G

Abstract
Immunosuppressive medications, such as tacrolimus and mycophenolate mofetil, are commonly used for reducing the risk of organ rejection in receipts of allogeneic organ transplant. The optimal dosages of these drugs are required for preventing rejection and avoiding toxicity to receipts. This study aimed to identify the correlation between the expression profiling of genes involved in drug metabolism and the blood level of tacrolimus in liver transplant receipts. Sixty-four liver transplant receipts were enrolled in this retrospective study. Receipts were divided into low (2-5.9 ng/ml) and high (6-15 ng/ml) tacrolimus groups. Clinical assessment showed that the blood level of tacrolimus was inversely correlated with the liver function evaluated by blood levels of total bilirubin and creatinine. Compared to the high tacrolimus group, expression levels of six cytochrome P450 enzymes, CYP1A1, CYP2B6, CYP3A5, CYP4A11, CYP19A1, and CYP17A1 were significantly higher in the low tacrolimus group. The expression levels of these genes were negatively correlated with the tacrolimus blood level. Enzyme assays showed that CYP3A5 and CYP17A1 exerted direct metabolic effects on tacrolimus and mycophenolate mofetil, respectively. These results support clinical application of this expression profiling of genes in drug metabolism for selection of immunosuppressive medications and optimal dosages for organ transplant receipts.

PMID: 28611384 [PubMed - in process]

Role of N-acetylcysteine treatment in non-acetaminophen-induced acute liver failure: A prospective study.

Thu, 06/15/2017 - 15:45
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Role of N-acetylcysteine treatment in non-acetaminophen-induced acute liver failure: A prospective study.

Saudi J Gastroenterol. 2017 May-Jun;23(3):169-175

Authors: Nabi T, Nabi S, Rafiq N, Shah A

Abstract
BACKGROUND/AIMS: Acute liver failure (ALF) is a rare but severe medical emergency. To date, there is no established treatment for non-acetaminophen-induced acute liver failure (NAI-ALF) other than liver transplantation, and little is known about the use of N-acetylcysteine (NAC) in NAI-ALF. A randomized case control study was conducted with the aim to determine the effect of NAC on the mortality of NAI-ALF patients, as well as to evaluate the safety and efficacy of NAC use.
PATIENTS AND METHODS: A total of 80 patients diagnosed with NAI-ALF were included in the study. Forty patients received NAC infusion for 72 h whereas the control group received placebo. The variables evaluated were demographic characteristics, signs and symptoms, biochemical parameters, and clinical course during hospitalization.
RESULTS: The two groups (NAC and control) were comparable for various baseline characteristics (such as etiology of ALF, INR, alanine aminotransferase, creatinine, albumin, and grade of encephalopathy), except for age. Although majority of patients had undetermined etiology (32.5% in NAC group and 42.5% in control group), the second main cause was acute hepatitis E and drug or toxin-induced ALF. The mortality decreased to 28% with the use of NAC versus 53% in the control group (P = 0.023). The use of NAC was associated with shorter length of hospital stay in survived patients (P = 0.002). Moreover, the survival of patients was improved by NAC (P = 0.025). Also, drug-induced ALF showed improved outcome compared to other etiologies.
CONCLUSION: The findings of the study recommend the use of NAC along with conventional treatments in patients with NAI-ALF in non-transplant centers while awaiting referrals and conclude the use of NAC as safe.

PMID: 28611340 [PubMed - in process]

The role of N-acetylcysteine in the treatment of non-acetaminophen acute liver failure.

Thu, 06/15/2017 - 15:45
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The role of N-acetylcysteine in the treatment of non-acetaminophen acute liver failure.

Saudi J Gastroenterol. 2017 May-Jun;23(3):131-132

Authors: Teriaky A

PMID: 28611335 [PubMed - in process]

Two Cases of Primary Hepatic Neuroendocrine Tumors and a Review of the Current Literature.

Thu, 06/15/2017 - 15:45
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Two Cases of Primary Hepatic Neuroendocrine Tumors and a Review of the Current Literature.

Ann Hepatol. 2017 Aug 01;16(4):621-629

Authors: R DeLuzio M, L Barbieri A, Israel G, Emre S

Abstract
Neuroendocrine tumors comprise approximately 1-2% of all gastrointestinal tumors, and while the liver is the most common site for metastasis of these tumors, primary hepatic neuroendocrine tumors are very rare entities. Since first being reported in 1958, there have been less than 150 cases reported in the literature. Because of the infrequent occurrence of these tumors, the pool of data available for analysis regarding these tumors is small. As such, the medical community must rely on the publication of case report data to further enlarge this data pool, with the hopes of eventually having enough data to draw meaningful, statistically significant conclusions with regard to diagnosis and management of these rare tumors. We have encountered two patients at our institution within the last year with primary hepatic neuroendocrine tumors. We present their cases in this manuscript in an effort to contribute to the available data on the disease. We also provide a concise review of the literature available to date regarding primary hepatic neuroendocrine tumors.

PMID: 28611270 [PubMed - in process]

Occult Hepatitis C Infection Among Hemodialysis Patients: A Prevalence Study.

Thu, 06/15/2017 - 15:45
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Occult Hepatitis C Infection Among Hemodialysis Patients: A Prevalence Study.

Ann Hepatol. 2017 Aug 01;16(4):510-513

Authors: Naghdi R, Ranjbar M, Bokharaei-Salim F, Keyvani H, Savaj S, Ossareh S, Shirali A, H Mohammad-Alizadeh A

Abstract
INTRODUCTION AND AIM: Occult hepatitis C infection (OHCI) is the presence of HCV-RNA in the liver or peripheral blood mononuclear cells (PBMC) accompanying with negative serologic results. The aim of this study was to evaluate the prevalence of OHCI among Iranian chronic hemodialysis (HD) patients.
MATERIAL AND METHODS: In this cross sectional study 200 chronic HD patients with negative HCV antibody enrolled the study. Blood sample of patients were obtained, followed by Polymerase Chain reaction (PCR) testing for detection of HCV RNA. Patients with positive serum HCV RNA were considered as manifest hepatitis C infection (MHCI). However, patients with negative serum HCV RNA underwent further tests on PBMCs for detection of OHCI.
RESULTS: Serum HCV RNA was positive in 2 (1%) patients whom considered as MHCI, and 6 (3.03%) patients had positive PBMC HCV RNA.
CONCLUSION: In conclusion, chronic HD patients have been considered as a high risk group for hepatitis C infection. The results of this study suggest that these patients are also at risk for OHCI. Furthermore, evaluating PBMCs to detect HCV RNA would be a sensitive diagnostic method to find OHCI patients.

PMID: 28611267 [PubMed - in process]

Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients.

Thu, 06/15/2017 - 15:45
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Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients.

Ann Hepatol. 2017 Aug 01;16(4):591-598

Authors: Al Enezi A, Al-Jahdali F, E Ahmed A, Shirbini N, Al-Harbi A, Salim B, Z Ali Y, Abdulrahman A, Khan M, Khaleid A, Hamdan AJ

Abstract
Background/propose. Sleep disturbance and excessive daytime sleepiness (EDS) have been reported in patients with hepatic cirrhosis with no hepatic encephalopathy (HE). The objective of this study was to evaluate daytime sleepiness and risk of obstructive sleep apnea (OSA) among liver cirrhosis patients.
MATERIAL AND METHODS: A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC)-Riyadh over a period of six months, using a structured questionnaire that investigated: 1) Sleep patterns and daytime sleepiness using the Epworth Sleeping Scale (ESS), and 2) The risk for sleep apnea using the Berlin Questionnaire (BQ). We enrolled patients with a confirmed diagnosis of liver cirrhosis who were being followed at the hepatology and pre-liver transplant clinics.
RESULTS: We enrolled 200 patients with liver cirrhosis, 57.5% of whom were male. The mean age was 60 (± SD 12.2). The reported prevalence of EDS, OSA, and both EDS and OSA were 29.5%, 42.9%, and 13.6%, respectively. The prevalence of EDS was higher in patients with Hepatitis-C and patients with DM, who experienced short sleep duration. We did not find any association between the severity of liver disease and EDS or OSA as measured by Child-Pugh scores (CPS).
CONCLUSIONS: The risk of OSA and EDS is high among liver cirrhosis patients. Those patients with cirrhosis secondary to Hepatitis C are at higher risk of EDS and OSA. Both EDS and OSA affect patients designated as CPS Class A more frequently than patients designated as CPS Class B.

PMID: 28611264 [PubMed - in process]

Relative Adrenal Insufficiency is Associated with the Clinical Outcome in Patients with Stable Decompensated Cirrhosis.

Thu, 06/15/2017 - 15:45
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Relative Adrenal Insufficiency is Associated with the Clinical Outcome in Patients with Stable Decompensated Cirrhosis.

Ann Hepatol. 2017 Aug 01;16(4):584-590

Authors: Cholongitas E, Goulis I, Pagkalidou E, B Haidich A, K A Karagiannis A, Nakouti T, Pipili C, Oikonomou T, Gerou S, Akriviadis E

Abstract
BACKGROUND: The clinical impact of relative adrenal insufficiency (AI) on patients with stable decompensated cirrhosis (DeCi) has not been yet elucidated.
AIM: Explore the association between AI and outcome [death or liver transplantation (LT)] in patients with DeCi.
MATERIAL AND METHODS: Patients with DeCi presenting no active complication have been included. Clinical and laboratory data, including serum levels of corticosteroid-binding globulin (CBG), interleukin (IL)-1b, IL-6 and tumor necrosis factor (TNFα) were recorded in each participant. Salivary cortisol (SC) and serum total cortisol (STC) were assessed at (T0) and 1 h (T60) after intravenous injection of 250 μg corticotropin.
RESULTS: 113 consecutive patients were totally tested. Median SC was 3.9 ng/mL and 15.5 ng/mL and median STC was 10.7 μg/dL and 22.7 μg/dL at T0 and T60 respectively. The patients with AI [group 1, n = 34 (30%)] had significantly lower systolic blood pressure (106 ± 12 vs. 113 ± 13 mmHg, p = 0.05), serum sodium (133 ± 7 vs. 137 ± 12 mEq/ L, p = 0.04), HDL (29.9 ± 14 vs. 38.6 ± 18 mg/dL, p = 0.034) and albumin (2.7 ± 0.5 vs. 3.1 ± 0.5 g/dL, p = 0.002), but higher direct bilirubin (median: 1.6 vs. 0.8 mg/dL, p = 0.029) compared to those without AI [group 2, n = 79 (70%)]. Moreover, group 1 patients presented more frequently past history of spontaneous bacterial peritonitis (SBP) [10/34 (29.4%) vs. 6/79 (7.5%), p = 0.002]. AI was significantly associated with death [HR = 2.65, 95% C.I.: 1.55 - 4.52, p = 0.003 over a follow up period of 12 (6-48) months.] Conclusions. The presence of AI in patients with stable DeCi predispose to obvious clinical implications since it is associated with circulatory dysfunction, previous history of SBP and worse survival.

PMID: 28611262 [PubMed - in process]

Prevalence, Risk Factors, and Survival of Patients with Intrahepatic Cholangiocarcinoma.

Thu, 06/15/2017 - 15:45
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Prevalence, Risk Factors, and Survival of Patients with Intrahepatic Cholangiocarcinoma.

Ann Hepatol. 2017 Aug 01;16(4):565-568

Authors: Chinchilla-López P, E Aguilar-Olivos N, García-Gómez J, K Hernández-Alejandro K, Chablé-Montero F, Motola-Kuba D, Patel T, Mendez-Sánchez N

Abstract
PURPOSE: To investigate the prevalence, related risk factors, and survival of intrahepatic cholangiocarcinoma in a Mexican population.
MATERIAL AND METHODS: We conducted a cross-sectional study at Medica Sur Hospital in Mexico City with approval of the local research ethics committee. We found cases by reviewing all clinical records of in-patients between October 2005 and January 2016 who had been diagnosed with malignant liver tumors. Clinical characteristics and comorbidities were obtained to evaluate the probable risk factors and the Charlson index. The cases were staged based on the TNM staging system for bile duct tumors used by the American Joint Committee on Cancer and median patient survival rates were calculated using the Kaplan-Meier method.
RESULTS: We reviewed 233 cases of hepatic cancer. Amongst these, hepatocellular carcinomas represented 19.3% (n = 45), followed by intrahepatic cholangiocarcinomas, which accounted for 7.7% (n = 18). The median age of patients with intrahepatic cholangiocarcinoma was 63 years, and most of them presented with cholestasis and intrahepatic biliary ductal dilation. Unfortunately, 89% (n = 16) of them were in an advanced stage and 80% had multicentric tumors. Median survival was 286 days among patients with advanced stage tumors (25th-75th interquartile range, 174-645 days). No correlation was found between the presence of comorbidities defined by the Charlson index, and survival. We evaluated the presence of definite and probable risk factors for the development of intrahepatic cholangiocarcinoma, that is, smoking, alcohol consumption, and primary sclerosing cholangitis.
DISCUSSION: We found an overall prevalence of intrahepatic cholangiocarcinoma of 7.7%; unfortunately, these patients were diagnosed at advanced stages. Smoking and primary sclerosing cholangitis were the positive risk factors for its development in this population.

PMID: 28611259 [PubMed - in process]

Isolated Intrapulmonary Vascular Dilatations and the Risk of Developing Hepatopulmonary Syndrome in Liver Transplant Candidates.

Thu, 06/15/2017 - 15:45
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Isolated Intrapulmonary Vascular Dilatations and the Risk of Developing Hepatopulmonary Syndrome in Liver Transplant Candidates.

Ann Hepatol. 2017 Aug 01;16(4):548-554

Authors: Mendizabal M, S Goldberg D, Piñero F, T Arufe D, José de la Fuente M, Testa P, Coronel M, Baratta S, G Podestá L, B Fallon M, O Silva M

Abstract
BACKGROUND: The natural history of intrapulmonary vascular dilations (IPVD) and their impact on patient outcomes in the setting of portal hypertension has only been described in small series.
AIMS: To assess the development of hepatopulmonary síndrome (HPS) in patients with isolated IPVD and to evaluate outcomes of IPVD and HPS among patients evaluated for liver transplantation (LT).
MATERIAL AND METHODS: Data from a prospective cohort of patients evaluated for LT with standardized screening for HPS were analyzed. IPVDs were defined as the presence of microbubbles in the left atrium &gt; 3 cycles following right atrial opacification. HPS was defined as the presence of IPVD and hypoxemia (Alveolar-arterial gradient ≥ 15 mmHg) in the absence of concomitant cardiopulmonary disease.
RESULTS: A total of 104 patients with negative contrast-enhanced echocardiogram (CE) were compared to 63 patients with IPVD and 63 patients with HPS. Only four patients were categorized as 'severe' HPS based on degree of hipoxemia (defined as PaO2 &lt; 60 mmHg). Twenty IPVD patients were followed with ABG over a mean duration of 21 months (range 9-43), of whom 7 (35%) subsequently met HPS criteria. Overall unadjusted survival from the time of LT evaluation using multi-state survival models that accounted for pre- and post-LT time was not statistically different among the three groups (negative CE, IPVD, and HPS; p &gt; 0.5).
CONCLUSIONS: Patients with IPVD appear to have a substantial risk of developing oxygenation impairment over time and progress to HPS. In our cohort, survival in patients with HPS and isolated IPVD is not different when compared to those without IPVDs.

PMID: 28611257 [PubMed - in process]

High-resolution CT findings of pulmonary tuberculosis in liver transplant patients.

Thu, 06/15/2017 - 15:45
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High-resolution CT findings of pulmonary tuberculosis in liver transplant patients.

Clin Radiol. 2017 Jun 10;:

Authors: Schuhmacher Neto R, Giacomelli IL, Schuller Nin C, da Silva Moreira J, Comaru Pasqualotto A, Marchiori E, Loureiro Irion K, Hochhegger B

Abstract
AIM: To assess the high-resolution computed tomography (HRCT) findings in liver transplant patients diagnosed with pulmonary Mycobacterium tuberculosis infection.
MATERIALS AND METHODS: The HRCT findings from 19 patients diagnosed with pulmonary tuberculosis infection after liver transplantation were reviewed. The patients included were 12 men and seven women, age range 23-65 years; mean age 57 years. The diagnosis was established with Mycobacterium tuberculosis detection in bronchoalveolar lavage, sputum, or biopsy. HRCT images were reviewed independently by two observers who reached a consensus decision. The HRCT findings were classified as (1) miliary nodules; (2) cavitation and centrilobular tree-in-bud nodules; (3) ground-glass attenuation and consolidation; and (4) mediastinal lymph node enlargement.
RESULTS: The time between the transplantation and the diagnosis of pulmonary tuberculosis ranged from 7 to 153 days with an average of 79 days. The main HRCT pattern was cavitation and centrilobular tree-in-bud nodules (79%) followed by mediastinal lymph node enlargement (10.4%), ground-glass attenuation or consolidation (5.2%) and miliary nodules (5.2%). None of the patients presented pleural effusion. The cavitation and centrilobular tree-in-bud nodules pattern had upper lobe predominance, and ground-glass attenuation and consolidation pattern had middle lobe/lingular segment predominance.
CONCLUSION: The main HRCT pattern of pulmonary tuberculosis in liver transplant patients was cavitation and centrilobular tree-in-bud nodules.

PMID: 28610889 [PubMed - as supplied by publisher]

Interventional Treatment for Hepatic Artery Thrombosis after Liver Transplantation.

Thu, 06/15/2017 - 15:45
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Interventional Treatment for Hepatic Artery Thrombosis after Liver Transplantation.

J Vasc Interv Radiol. 2017 Jun 11;:

Authors: Zhang H, Qian S, Liu R, Yuan W, Wang JH

Abstract
PURPOSE: To evaluate short-term and long-term effectiveness of interventional treatment for hepatic artery thrombosis (HAT).
MATERIALS AND METHODS: From March 2003 to October 2015, 34 patients (32 male and 2 female; mean age, 45 y; range 7-64 y) with HAT were identified 0-21d (mean 6.5 d ± 6.0) after liver transplantation and underwent interventional treatments. Technical success, clinical success, complications, hepatic artery patency, and survival time were assessed.
RESULTS: All 34 patients underwent urokinase thrombolytic treatment. The mean dosage of urokinase was 1,250,000 U ± 1,000,000 (range, 350,000-9,000,000 U). Thrombolysis treatment required 5-120 h (mean 50 h ± 31) for completion. In 21 patients, stents were also implanted during thrombolytic treatment. In 3 patients with splenic artery steal syndrome, proximal splenic artery embolization was performed during thrombolytic treatment. The technical and clinical success rate was 91% (31/34), with treatment failure in 3 children. Hemorrhage was observed in 11 cases. Local necrotic foci in the transplanted liver were found on CT in 5 patients. Complications associated with the interventional procedures occurred in 2 patients. Patency rates of the hepatic artery at 1 y, 2 y, 3 y, and 5 y were 96%, 93%, 83%, and 83%. Overall survival rate at 1 y, 2 y, 3 y, and 5 y were 82%, 73%, 57%, and 57%.
CONCLUSIONS: Interventional treatment can achieve satisfactory short-term and long-term effectiveness for adult HAT.

PMID: 28610742 [PubMed - as supplied by publisher]

Transplantation of human bone marrow mesenchymal stromal cells reduces liver fibrosis more effectively than Wharton's jelly mesenchymal stromal cells.

Thu, 06/15/2017 - 15:45
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Transplantation of human bone marrow mesenchymal stromal cells reduces liver fibrosis more effectively than Wharton's jelly mesenchymal stromal cells.

Stem Cell Res Ther. 2017 Jun 13;8(1):143

Authors: Rengasamy M, Singh G, Fakharuzi NA, Siddikuzzaman, Balasubramanian S, Swamynathan P, Thej C, Sasidharan G, Gupta PK, Das AK, Rahman AZA, Fakiruddin KS, Nian LM, Zakaria Z, Majumdar AS

Abstract
BACKGROUND: Mesenchymal stromal cells (MSCs) from various tissues have shown moderate therapeutic efficacy in reversing liver fibrosis in preclinical models. Here, we compared the relative therapeutic potential of pooled, adult human bone marrow (BM)- and neonatal Wharton's jelly (WJ)-derived MSCs to treat CCl4-induced liver fibrosis in rats.
METHODS: Sprague-Dawley rats were injected with CCl4 for 8 weeks to induce irreversible liver fibrosis. Ex-vivo expanded, pooled human MSCs obtained from BM and WJ were intravenously administered into rats with liver fibrosis at a dose of 10 × 10(6) cells/animal. Sham control and vehicle-treated animals served as negative and disease controls, respectively. The animals were sacrificed at 30 and 70 days after cell transplantation and hepatic-hydroxyproline content, histopathological, and immunohistochemical analyses were performed.
RESULTS: BM-MSCs treatment showed a marked reduction in liver fibrosis as determined by Masson's trichrome and Sirius red staining as compared to those treated with the vehicle. Furthermore, hepatic-hydroxyproline content and percentage collagen proportionate area were found to be significantly lower in the BM-MSCs-treated group. In contrast, WJ-MSCs treatment showed less reduction of fibrosis at both time points. Immunohistochemical analysis of BM-MSCs-treated liver samples showed a reduction in α-SMA(+) myofibroblasts and increased number of EpCAM(+) hepatic progenitor cells, along with Ki-67(+) and human matrix metalloprotease-1(+) (MMP-1(+)) cells as compared to WJ-MSCs-treated rat livers.
CONCLUSIONS: Our findings suggest that BM-MSCs are more effective than WJ-MSCs in treating liver fibrosis in a CCl4-induced model in rats. The superior therapeutic activity of BM-MSCs may be attributed to their expression of certain MMPs and angiogenic factors.

PMID: 28610623 [PubMed - in process]

StatPearls

Thu, 06/15/2017 - 15:45

StatPearls

Book. 2017 06

Authors:

Abstract
Hepatorenal syndrome (HRS) is a multiorgan condition affecting the kidneys and the liver. It is a cause of acute kidney injury that can be seen in those with acute or chronic liver disease. The first association of renal failure in cirrhosis was observed in the late 1800's. In the mid to late 1900's, further research revealed that renal failure in liver cirrhosis was functional. This was demonstrated in patients with HRS with normal kidney histology in addition to the absence of proteinuria. This was further demonstrated clinically when kidney's from patients with HRS were transplanted into those with chronic kidney disease as well as the improvement of renal function in liver cirrhosis patient's that underwent liver transplant. Further research investigating renal clearance established the association of renal vasoconstriction in HRS.


PMID: 28613606

DIC in Decompensated Cirrhosis caused by Prothrombin Complex Concentrate and Recombinant Activated Factor VII: A Word of Caution.

Wed, 06/14/2017 - 12:45

DIC in Decompensated Cirrhosis caused by Prothrombin Complex Concentrate and Recombinant Activated Factor VII: A Word of Caution.

Liver Int. 2017 Jun 13;:

Authors: Glass J, Im GY

Abstract
We would like to respond to Scott et al. and the accompanying editorial.(1,2) Concentrated factor products like recombinant activated factor VII (NovoSeven(®) , Novo Nordisk Pharmaceuticals Inc.) and prothrombin complex concentrate (Kcentra(®) , CSL Behring GmbH) are agents that can rapidly reverse coagulopathy for invasive procedures. This article is protected by copyright. All rights reserved.

PMID: 28609569 [PubMed - as supplied by publisher]

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