[Non-alcoholic steatohepatitis (NASH) : a model of metabolic inflammation («metaflammation¼)]. / Stéatohépatite non alcoolique (NASH) : un modèle d'inflammation métabolique («métaflammation¼).

Diseases related to fatty liver, independently of alcohol consumption («non-alcoholic fatty liver disease¼ or NAFLD), are increasing because of the epidemics of obesity and type 2 diabetes. These disorders reflect a continuum that comprises isolated steatosis, steatohepatitis (NASH) and fibrosis, with, at the end, an increased risk of cirrhosis and hepatocarcinoma. It has been recently proposed to replace the term NAFLD by MAFLD, i.e. «Metabolic (dysfunction) Associated Fatty Liver Disease¼, which better reflects the pathogenesis of the disease. Inflammation plays a crucial role in the aggravation of the disorder and profoundly influences the prognostic evolution. This article illustrates the natural history of this underestimated metabolic disorder, recall the diagnostic criteria used in clinical practice, emphasizes the deleterious role of inflammation and discusses some therapeutic perspectives.

: Les maladies liées à un «foie gras¼, indépendamment de la consommation d'alcool («non-alcoholic fatty liver disease¼ ou NAFLD), sont en augmentation en raison de l'«épidémie¼ d'obésité et de diabète de type 2. Il s'agit d'un continuum comprenant la stéatose isolée, la stéatohépatite (NASH) et la fibrose avec, in fine, un risque accru de cirrhose et d'hépatocarcinome. Il a été proposé récemment de remplacer le terme NAFLD par MAFLD pour «Metabolic (dysfunction) Associated Fatty Liver Disease¼, ce qui reflète mieux la pathogénie de la maladie. L'inflammation joue un rôle clé dans l'aggravation du trouble et conditionne l'évolution pronostique. Cet article retrace l'histoire naturelle de cette pathologie métabolique sous-estimée, rappelle les critères diagnostiques utilisés en clinique, précise le rôle délétère de l'inflammation et conclut par quelques perspectives thérapeutiques.

[Multidisciplinary management of the primary liver cancers]. / Prise en charge multidisciplinaire des tumeurs malignes primitives du foie.

In Belgium and around the world, the incidence of primary malignant liver tumours is increasing, both for hepatocarcinoma and cholangiocarcinoma. Their curative treatment is based on multidisciplinary and specialized care, of which surgery (including liver transplantation) remains the cornerstone, often associated with other logoregional treatments, as radioembolisation, radiofrequency ablation, and chemoembolisation. For advanced cases, the prognosis remains poor, in particular due to a certain chemoresistance of these tumours. New treatments include targeted therapies (including various tyrosine kinase inhibitors) and immunotherapy. A specialized multidisciplinary discussion is therefore necessary to define the best therapeutic management, individualized to each patient. In this article, the authors review the most recent data relating to the treatment of hepatocarcinoma and cholangiocarcinoma.

En Belgique et dans le monde, l'incidence des tumeurs malignes primitives du foie augmente, tant pour l'hépatocarcinome que le cholangiocarcinome. Leur traitement curatif repose sur une prise en charge multidisciplinaire et spécialisée, dont la chirurgie (incluant la transplantation hépatique) reste la pièce angulaire, souvent associée à d'autres traitements logo-régionaux (radioembolisation, radiofréquence, chimio-embolisation). Pour les cas avancés, le pronostic reste sombre, notamment en raison d'une certaine chimiorésistance de ces tumeurs. Les nouvelles prises en charge incluent des thérapies ciblées (notamment, divers inhibiteurs de tyrosine kinase) et de l'immunothérapie. Une discussion pluridisciplinaire spécialisée est donc nécessaire pour définir la meilleure prise en charge thérapeutique, individualisée pour chaque patient. Dans cet article, les auteurs revoient les données récentes relatives au traitement de l'hépatocarcinome et du cholangiocarcinome.

[Increased neoplastic risks in ulcerative colitis associated with primary sclerosing cholangitis]. / Risques néoplasiques majorés dans la rectocolite ulcéro-hémorragique associée à la cholangite sclérosante primitive.

Ulcerative ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by the presence of continuous, uniform, gapless lesions of healthy mucous membrane extending integrally from the anus over a variable portion of the colon. It is a multisystemic pathology for which we will describe one of its hepatic manifestations, primary sclerosing cholangitis (PSC). We present here the story of a patient, a carrier of the Breast Cancer type 1 gene mutation (BRCA1), who initially presented with epigastric and peri-umbilical abdominal pain associated with several episodes of bloody diarrhea. The initial assessment made it possible to diagnose BRCA1 and the fortuitous discovery of biliary tract stenosis of an undetermined nature. Further investigations led to the conclusion that there was a strong presumption of UC associated with PSC or even cholangiocarcinoma (CCA). In the course of treatment, cancer of the gallbladder was also detected. This clinical case makes it possible to review, in the light of recent publications, the pathophysiological link existing between UC and PSC. This article also presents an in-depth analysis of this entity with malignant potential that can affect different sites of the digestive tract, and its own management, which is the subject of new recommendations.

La rectocolite ulcéro-hémorragique (RCUH) est une maladie inflammatoire chronique de l'intestin, caractérisée par la présence de lésions continues, uniformes et sans intervalle de muqueuse saine, s'étendant d'un seul tenant à partir de l'anus sur une portion variable du côlon. Il s'agit d'une pathologie multisystémique pour laquelle nous décrirons une de ses manifestations hépatiques, la cholangite sclérosante primitive (CSP). Nous exposons ici l'histoire d'un patient, porteur de la mutation du gène Breast Cancer de type 1 (BRCA1), s'étant initialement présenté pour douleurs abdominales épigastriques et péri-ombilicales, associées à plusieurs épisodes de diarrhées sanglantes. Le bilan initialement réalisé a permis de poser le diagnostic de RCUH ainsi que la mise en évidence fortuite d'une sténose des voies biliaires de nature indéterminée. Les explorations complémentaires ont permis de conclure à une forte présomption de RCUH associée à une CSP, voire un cholangiocarcinome (CCA). Dans le décours de la prise en charge, un cancer de la vésicule biliaire a également été mis en évidence. Ce cas clinique permet de revoir, à la lumière des publications récentes, le lien physiopathologique existant entre la RCUH et la CSP. L'article présente une analyse approfondie de cette entité qui possède un potentiel malin important, touchant plusieurs organes du tractus digestif, et qui requiert une prise en charge propre faisant l'objet de recommandations nouvelles.

Liver transplantation during the COVID-19 epidemic : recommendations from the Belgian Liver Intestine Transplant Committee (BeLIAC).

Since January 2020, the Novel Coronavirus Disease 2019 (COVID-19) pandemic has dramatically impacted the world. In March 2020, the COVID-19 epidemic reached Belgium creating uncertainty towards all aspects of life. There has been an impressive capacity and solidarity of all healthcare professionals to acutely reconvert facilities to treat these patients. In the context of liver transplantation (LTx), concerns are raised about organ donation shortage and safety, the ethics of using limited healthcare resources for LTx, selection criteria for LTx during the epidemic and the risk of de novo COVID-19 infection on the waiting list and after LTx. BeLIAC makes several recommendations to try to mitigate the deleterious effect that this epidemic has/will have on donation and LTx, taking into account the available resources, and trying to maximize patients and healthcare professionals' safety.

[Hepatitis C in 2020: from the therapeutic victory over the virus C to the effort on screening]. / Hépatite C en 2020 : de la victoire thérapeutique sur le virus C aux efforts de dépistage.

New antiviral therapies, available in Belgium since 2015, have revolutionized the treatment of hepatitis C. A definitive eradication of the virus can now be obtained in nearly all treated patients whatever the viral genotype or the fibrosis stage. Moreover, due to the excellent security profile of these therapies, all the patients can have access to a therapy whatever their concomitant pathologies. The therapeutic victory against the virus being acquired, efforts are turning towards the screening of the patients unaware of their infection, in order to obtain a near eradication of the virus in 2030.

Le traitement de l'hépatite C a été révolutionné par l'arrivée sur le marché de nouveaux antiviraux en 2015. La guérison sous traitement passe à plus de 95 %, quels que soient le génotype et le degré de fibrose. Vu l'excellent profil de sécurité de ces médicaments, tous les patients peuvent avoir accès au traitement, quelles que soient leurs pathologies associées. La victoire thérapeutique contre le virus C étant acquise, l'effort se tourne vers le dépistage des patients non encore détectés, de façon à obtenir une quasi-éradication du virus C en 2030.

[Diagnosis of anemia associated with alcoholic cirrhosis]. / Diagnostic différentiel de l'anémie dans la cirrhose éthylique.

We report here the case of a 62-year-old patient with Child-Pugh stage C ethylic cirrhosis associated with severe macrocytic anaemia, refractory to iterative transfusions and withdrawal. After a haemorrhagic, deficiency-related, or sideroblastic etiology was ruled out, haemolytic anaemia was suspected. A blood smear allowed diagnosis of haemolytic anaemia with acanthocytes. This offers the opportunity to discuss anaemia in patients with alcoholic cirrhosis, a frequent complication spanning a broad severity range and having the potential to be life-threatening. Its origin can be multifactorial : acute haemorrhage, dilution, haemolysis (here due to acanthocytosis), marrow insufficiency caused by direct alcohol toxicity, malnutrition, iron deficiency, vitamin B9 or B12 deficiency, chronic inflammation, splenic sequestration induced by portal hypertension...

Nous rapportons le cas d'une patiente de 62 ans atteinte d'une cirrhose éthylique de stade Child-Pugh C associée à une anémie macrocytaire sévère, réfractaire aux transfusions itératives et au sevrage. Après avoir exclu les étiologies hémorragiques, carentielles et sidéroblastiques, une anémie hémolytique (AH) est suspectée. La réalisation d'un frottis sanguin a permis le diagnostic d'une anémie hémolytique à acanthocytes. L'opportunité nous est donnée de discuter de l'anémie chez le patient cirrhotique alcoolique, complication fréquente recouvrant un large spectre de gravité et pouvant menacer la survie. Elle peut être multifactorielle : hémorragie aiguë, dilution, hémolyse (dans le cas particulier, liée à une acanthocytose), insuffisance médullaire par toxicité directe de l'alcool, malnutrition, carence martiale, déficit en vitamine B9 ou B12, inflammation chronique, séquestration splénique induite par l'hypertension portale….

Selection criteria for liver transplantation in patients with hepatocellular carcinoma. Eastern and western experiences, and perspectives for the future.

Ever since the initial description of the Milan criteria, used for selecting patients with hepatocellular carcinoma (HCC) for liver transplantation (LT), there has been a clear need to go further than solely morphological criteria. Tumours exceeding the Milan criteria, but presenting favourable biological behaviour, might still allow for comparable overall- and disease-free survivals after LT. As it is well established that the presence of microvascular invasion is a major factor that influences HCC recurrence after LT, several serum and tissue biomarkers in addition to imaging studies are attracting wider attention as more refined tools for selecting HCC patients for LT. A thorough review of the recent literature on the subject was conducted. In the future a combination of systemic inflammation markers, biomarkers and morphological criteria may be key to more accurate prediction of HCC recurrence after LT. This may allow LT in patients whose HCC tumours exceed the Milan criteria but have favourable biological behaviour. Further prospective studies are required in order to improve patient selection for transplantation in HCC and these could help a move towards more transparent and improved management.

[Alcoholic hepatitis]. / L'hépatite alcoolique aiguë.

Alcoholic hepatitis is a syndrome defined primarily by the clinical onset of jaundice in patients with a concomitant heavy consumption of alcoholic beverages. This pathology is managed by alcohol withdrawal with a 30-day survival rate of 90 %. For patients with severe alcoholic hepatitis, with a Maddrey score greater than 32 (taking into account bilirubin and prothrombin time), treatment with corticosteroids is discussed provided that a possible infection can be sufficiently excluded or adequately managed. The administration of corticosteroids is continued for 28 days if the Lille score, calculated after 7 days of treatment, is favourable (inferior to 0.45), leading to a survival rate of 80-90 %. However, if the Lille score is unfavourable (superior to 0.45), the prognosis is bad, with a survival of only 25-30 % at 6 months. Special attention needs to be paid to assure a sufficient caloric intake during the treatment period for a successful management. Liver transplantation, previously prohibited for this indication, can be discussed under certain circumstances. However, the success of treatment is contingent upon the alcohol withdrawal. Innovative drugs are currently under investigation to improve the prognosis of this condition.

: L'hépatite alcoolique aiguë (HAA) se définit selon des paramètres essentiellement cliniques (ictère d'apparition récente chez un patient avec une consommation abusive d'alcool). L'HAA peu sévère est prise en charge par un sevrage éthylique, avec un espoir de survie de 90 % à un mois. Pour les patients atteints d'HAA sévère (évaluée par le score de Maddrey sup�rieur a 32, tenant compte de la bilirubine et du temps de prothrombine), un traitement par corticoïdes se discute, pour autant qu'une éventuelle infection ait pu être exclue ou jugulée. Le traitement par corticoïdes est poursuivi 28 jours si le score de Lille, calculé après 7 jours de corticoïdes, est favorable (inf�rieur a 0,45), avec un espoir de survie de 80-90 %. Par contre, si le score de Lille est défavorable (sup�rieur a 0,45), le pronostic est nettement plus péjoratif avec une survie de 25-30 % à 6 mois. Dans la prise en charge, on apportera une attention toute particulière à la nutrition avec un apport calorique suffisant. La transplantation hépatique, autrefois non autorisée dans cette indication, peut actuellement être discutée dans certaines circonstances particulières. La clé de la réussite résidera, de toute façon, dans le sevrage. Des médicaments novateurs sont actuellement en cours d'étude pour améliorer le pronostic de cette affection.

[Considerations on liver transplantation in the alcoholic patients]. / Problématique de la transplantation hépatique chez le patient alcoolique.

In Belgium as in many other countries, alcohol is one of the leading causes of adult liver transplantation. Liver transplantation for terminal liver failure due to excessive alcohol intake raises clear ethical issues concerning the use of grafts to save patients suffering from a self-inflecting affection. Alcoholic liver disease is one of the best indications for liver transplantation, with excellent results in terms of length of survival and post transplantation quality of life, if this transplantation is proposed by a multidisciplinary team in a patient able to and helped by a supporting family and social environment.

En Belgique, comme dans beaucoup d'autres pays, la maladie alcoolique constitue une des causes les plus fréquentes menant à la transplantation hépatique chez l'adulte. Or la transplantation hépatique chez des patients alcooliques pose de claires questions éthiques concernant l'utilisation de greffons pour soigner des patients souffrant d'une maladie trop souvent considérée comme étant auto-infligée. La maladie alcoolique du foie est une des meilleures indications de greffe hépatique, avec d'excellents résultats en termes de durée de survie et de qualité de vie après transplantation. Le pré-requis est que cette transplantation soit proposée par une équipe multidisciplinaire, chez un patient capable de se prendre en charge et soutenu par un environnement familial et social favorable.

A multicentre, observational study on demographic and disease characteristics of patients seeking care for chronic hepatitis C in Belgium in 2016.

BACKGROUND AND STUDY AIMS: Direct-acting antivirals provide interferon-free treatments for chronic hepatitis C (CHC) virus infection. In Belgium, in 2016, access to these agents was limited to patients with advanced liver fibrosis stages F3 and F4. This study is the first to describe Belgium's patient population ineligible for interferon-free treatment. PATIENTS AND METHODS: This was an observational, cross-sectional, multicentre study that enrolled adult patients with CHC ineligible for interferon-free treatment. Patient data recorded at a single visit included demographic data, disease characteristics, comorbidities, co-medications, treatment status, and laboratory data. RESULTS: Three hundred and three patients from 16 centres in Belgium were included in the statistical analysis. On average, patients were aged 53.5 years and 50.2% were women ; 94.1% had health insurance and 99.0% resided in Belgium. The current hepatitis C virus (HCV) infection was the first infection for 96.0% of patients and the mean time since infection was 20.0 years. Liver fibrosis stage was F0 for 23.7%, F0/F1 or F1 for 38.3%, F1/F2 or F2 for 25.8%, F3 for 7.1%, and F4 for 5.1% of patients ; 28.4% of patients were CHC treatment-experienced. The main reason for ineligibility for interferon-free treatment was lack of reimbursement (84.8%). Other reasons included no treatment urgency or medical decision to wait (27.1%), waiting for future treatment option (8.3%), and no social insurance coverage (3.6%). CONCLUSIONS: This study provides recent data on the CHC patient population and disease characteristics in Belgium that could help medical communities and government agencies manage CHC disease burden.

[Multidisciplinary management of a giant hepatic hydatidosis]. / Prise en charge multidisciplinaire d'une volumineuse hydatidose hépatique.

Cystic echinococcosis or hydatidosis, is a zoonosis caused by larval stages of Echinococcus granulosus that can be encountered in Belgium in patients originating from endemic countries. The liver is the most commonly affected organ. In this paper, the authors describe the multidisciplinary management of this pathology based on the clinical case of a patient suffering from a 28 cm cystic echinococcosis treated by combination of albendazole and liver resection. Several treatment options are described in the literature although there is currently no clear consensus on the management of this condition.

L'échinococcose cystique, appelée aussi hydatidose, est une zoonose causée par le développement chez l'homme de la larve d'un ténia échinocoque de type Echinococcus granulosus. Il s'agit d'une pathologie cosmopolite qui peut être rencontrée en Belgique chez des patients originaires de pays endémiques et qui atteint, le plus souvent, le foie. Dans cet article, les auteurs discutent la prise en charge multidisciplinaire de cette pathologie en partant du cas d'un patient souffrant d'un kyste échinococcique hépatique de 28 cm traité par albendazole et résection hépatique. Plusieurs options de traitement de l'échinococcose cystique sont décrites dans la littérature bien qu'il n'existe pas, à l'heure actuelle, de consensus clair concernant la prise en charge de cette pathologie.

[Multidisciplinary management of alveolar echinococcosis : Echino-Liege Working Group]. / Prise en charge multidisciplinaire de l'échinococcose alvéolaire : le groupe Echino-Liège.

Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis. However, recent studies carried out in southern Belgium have revealed, through post-mortem examination, high prevalences (up to 62 %) in foxes. Cats and dogs can act as definitive hosts. Human are accidentally infected by ingestion of food contaminated by the feces. After a long incubation period, invasive hepatic lesions may appear, as well as extra-hepatic lesions. The disease may be fatal. The diagnosis is based on imaging techniques, serology and nucleic acid detection in tissues. Early diagnosis may allow surgical removal of the lesion associated with at least 2 years of albendazole postoperative treatment. In case of contraindication to surgery, a long term treatment with albendazole is necessary. Liver transplantation is sometimes necessary. This article presents the epidemiologic, clinical, diagnostic and therapeutics features of this zoonotic disease.

L'échinococcose alvéolaire est une zoonose due à Echinococcus multilocaris, un cestode, dont l'hôte définitif est le renard roux (Vulpes vulpes). Jusqu'il y a peu, la Belgique était un pays considéré comme à très faible risque pour cette parasitose, mais de récentes autopsies de renards ont montré des prévalences élevées chez ceux-ci (pouvant dépasser les 60 %). Les chiens et les chats peuvent également être des hôtes définitifs. La transmission humaine (hôte accidentel) se fait principalement via la consommation d'aliments souillés par les déjections animales contaminées donnant, après une longue période d'incubation, des lésions hépatiques infiltrantes et, éventuellement, des atteintes extra-hépatiques pouvant être mortelles. Le diagnostic est fondé sur l'imagerie médicale couplée à des tests sérologiques et la PCR sur des tissus. La prise en charge curative est chirurgicale, lorsque la résection complète est possible. Elle est associée à un traitement de deux ans post-opératoire à base d'albendazole. En cas d'impossibilité de résection complète, un traitement au long cours par de l'albendazole est préconisé. Enfin, dans certains cas, une transplantation hépatique peut être envisagée. En raison de l'augmentation des cas autochtones rencontrés en Wallonie, un groupe spécialisé dans la prise en charge de l'échinococcose a été créé au sein de l'université de Liège. Cet article illustre les caractéristiques épidémiologiques, cliniques, diagnostiques et thérapeutiques de cette zoonose.

Stopping nucleos(t)ide analogue treatment in Caucasian hepatitis B patients after HBeAg seroconversion is associated with high relapse rates and fatal outcomes.

BACKGROUND: Stopping nucleos(t)ide analogues (NA) after hepatitis B e antigen (HBeAg) seroconversion is associated with high relapse rates in Asian patients, but data in Caucasian cohorts are scarce. Clinical course, outcomes and immunological aspects of chronic hepatitis B infections differ substantially between distinct ethnicities. AIM: The aim of this study was to determine relapse rates, factors predicting relapse and clinical outcomes after nucleos(t)ide analogue cessation in a large, predominantly Caucasian cohort of chronic hepatitis B patients with nucleos(t)ide analogue-induced HBeAg seroconversion. METHODS: This is a nationwide observational cohort study including HBeAg positive, mono-infected chronic hepatitis B patients with nucleos(t)ide analogue-induced HBeAg seroconversion from 18 centres in Belgium. RESULTS: A total of 98 patients with nucleo(s)tide analogue-induced HBeAg seroconversion were included in the study. Of the 62 patients who stopped treatment after a median consolidation treatment of 8 months, 30 relapsed. Higher gamma-glutamyl transferase levels at both treatment initiation (HR 1.004; P = 0.001 per unit increment) and HBeAg seroconversion (HR 1.006; P = 0.013 per unit increment) were associated with an increased risk of clinically significant relapse in a multivariate Cox regression model. Treatment cessation led to liver-related death in 2 patients, of whom one showed a severe flare. Of the patients who continued treatment after HBeAg seroconversion, none relapsed or developed severe hepatic outcomes. CONCLUSION: Treatment withdrawal in Caucasian chronic hepatitis B patients after nucleos(t)ide analogue-induced HBeAg seroconversion results in viral relapses in more than half of patients with potential fatal outcomes. These real-world data further lend support to preferentially continue NA treatment after HBeAg seroconversion until HBsAg loss.

[RENDU-OSLER DISEASE: A RARE CAUSE OF AMMONIA ENCEPHALOPATHY]. / LA MALADIE DE RENDU-OSLER: une cause rare d'encéphalopathie ammoniacale.

Hereditary Hemorrhagic Telangiectasia (HHT) also known as Rendu-Osler disease is a group of related disorders inherited in an autosomal dominant fashion and characterized by the development of arteriovenous malformations (AVM) in the skin, mucous membranes, and/or internal organs such as the brain, lungs, and liver. The prevalence of liver involvement is clinically estimated between 8 and 31 percent. It can be revealed by the following clinical signs : ascites, edema of the lower extremities, abdominal pain, dyspnea, and, rarely, hepatic encephalopathy and gastrointestinal bleeding associated with portal hypertension. This case illustrates the highlight of liver damage revealed by an ammonia encephalopathy associated with iconographic anomalies on ultrasonography and magnetic resonance liver as part of Rendu-Osler disease.

[Budd-Chiari syndrome: a case report and review of the literature]. / LE CAS CLINIQUE DU MOIS. Le syndrome de Budd-Chiari. Revue de la literature.

We report the history of a 20-year-old woman admitted for thrombosis of the sus-hepatic veins and of the inferior vena cava (IVC) with extension of the thrombus into the right atrium. The etiological research was negative and a diagnosis of idiopathic Budd-Chiari syndrome was retained. In view of the absence of vein repermeabilisation under adequate anticoagulant therapy, a venous thrombectomiy was performed under cardiopulmonary bypass, which improved the hepatic venous drainage. Budd-Chiari syndrome is a very serious disorder. Its treatment implies a step by step procedure. An effective anticoagulation must first be established. The complications of portal hypertension then require attention. For a symptomatic patient, one should assess the possibility of restoring the venous permeability, improving the hepatic drainage and decompressing the liver by radiological interventional or surgical procedures. Finally, an hepatic transplantation should be considered in case of treatment ineffectiveness, of fulminant hepatic failure, or of an evolution towards cirrhosis.

[Alpha interferon induced hyperthyroidism: a case report and review of the literature]. / LE CAS CLINIQUE DU MOIS. Hyperthyroïdie induite par interféron alpha: rapport d'un cas et revue de la literature.

Treatment with alpha interferon in hepatitis C triggers a thyroid autoimmunity in a variable percentage of cases (2-8%). This complication raises some questions about its screening, the possibility to continue anti-viral therapy and thyroid treatment. Alpha interferon has an immunomodulatory effect on the thyroid, but also an inhibitory effect on thyroid hormone synthesis. This explains the occurrence of cases of thyroid dysfunction, which often remain undetected because of their latency. Factors predicting thyroid dysfunction with interferon use are: female sex, history of thyroid disease and previous autoimmunity. Several clinical aspects are encountered including hypothyroidism (the most frequent depending on the series) and hyperthyroidism related to Graves' disease. For their detection, a cooperation between general practionners, gastroenterologists and endocrinologists is mandatory thyroid function tests are requested before, during and after treatment,with alpha interferon. Therapeutic aspects of thyroid disorders range from simple monitoring to symptomatic treatment, such as thyroxine prescription in the presence of hypothyroidism. Antithyroid drugs radioactive iodine or thyroid surgery are used in cases of severe or persistent Graves' disease induced by alpha interferon.

[Cirrhotic cardiomyopathy: a brief overview]. / La cardiomyopathie du cirrhotique: un bref apercu.

Even though cardiac disorders were described in alcoholic cirrhosis more than fifty years ago, cirrhotic cardiomyopathy was not defined until the end of the eighties. The term is used to describe all the cardiac structural and functional abnormalities observed in cirrhotic patients without any underlying cardiac disease. This cardiomyopathy is characterized by impaired systolic function, often unmasked during stress, diastolic dysfunction, and electrophysiological abnormalities. It can be detected by the electrocardiogram, transthoracic echocardiography and measurements of cardiac biomarkers (BNP). The pathophysiological mechanisms underlying this disease are complex: anomalies of adrenergic transduction pathways, alterations of myocyte membrane fluidity, fibrosis, cardiac hypertrophy, hormonal disturbances, and various ion channels derangements. To date, there is no specific treatment. Liver transplantation may be curative. The possibility of such a condition must be taken into account, when a TIPS or a liver transplantation are considered.

Donor age as a risk factor in donation after circulatory death liver transplantation in a controlled withdrawal protocol programme.

BACKGROUND: Results of donation after circulatory death (DCD) liver transplantation are impaired by graft loss, resulting mainly from non-anastomotic biliary stricture. Donor age is a risk factor in deceased donor liver transplantation, and particularly in DCD liver transplantation. At the authors' institute, age is not an absolute exclusion criterion for discarding DCD liver grafts, DCD donors receive comfort therapy before withdrawal, and cold ischaemia is minimized. METHODS: All consecutive DCD liver transplantations performed from 2003 to 2012 were studied retrospectively. Three age groups were compared in terms of donor and recipient demographics, procurement and transplantation conditions, peak laboratory values during the first post-transplant 72 h, and results at 1 and 3 years. RESULTS: A total of 70 DCD liver transplants were performed, including 32 liver grafts from donors aged 55 years or less, 20 aged 56-69 years, and 18 aged 70 years or more. The overall graft survival rate at 1 month, 1 and 3 years was 99, 91 and 72 per cent respectively, with no graft lost secondary to non-anastomotic stricture. No difference other than age was noted between the three groups for donor or recipient characteristics, or procurement conditions. No primary non-function occurred, but one patient needed retransplantation for artery thrombosis. Biliary complications were similar in the three groups. Graft and patient survival rates were no different at 1 and 3 years between the three groups (P = 0.605). CONCLUSION: Results for DCD liver transplantation from younger and older donors were similar. Donor age above 50 years should not be a contraindication to DCD liver transplantation if other donor risk factors (such as warm and cold ischaemia time) are minimized.

A non-interventional phase IV Belgian survey to assess the antiviral effectiveness of pegylated interferon-alpha-2b and ribavirin treatment according to the stage of liver fibrosis in previously untreated patients with genotype 1/4/5/6 chronic hepatitis C (PRACTICE).

BACKGROUND AND STUDY AIMS: This was an observational, non-interventional, multicenter, phase IV study, in patients with genotype 1/4/5/6 chronic hepatitis C (CHC). The primary objectives were to evaluate SVR in patients with no or minimal fibrosis (METAVIR F0-F1) versus well established fibrosis (F2-F4), and to estimate response on Weeks 12, 24 and 48 on treatment in previously untreated patients with genotypes 1/4/5/6 CHC. PATIENTS AND METHODS: 538 patients treated with pegylated interferon alfa 2b 1.5 mcg/kg in combination with ribavirin 800-1200 mg/day were enrolled in 55 sites in Belgium and Luxembourg, 505 being considered for the analysis. 40% of the patients were female and 60% male, the average age was 47.5 years, 10.5% were 65 or older. RESULTS: SVR was observed in 35% of the patients, EVR in 68%, of which pEVR in 33% and cEVR in 35%. SVR was observed in 43% of the low fibrosis group (F0, F1) and 30% of the high fibrosis group (F2, F3, F4) (p = 0.005). SVR rates were 34% for genotype 1, 37% for genotype 4, and 47% for genotype 5 (NS). Multivariate analysis showed that EVR and baseline METAVIR score are independent prognostic factors for SVR. CONCLUSIONS: This trial confirms that fibrosis stage and early viral response are the most important key-factors to predict sustained response, suggesting that the earlier patients are treated, the better the outcome. Non-invasive techniques enable us to closely monitor progression of fibrosis, allowing a better selection of patients for antiviral treatment in the DAA-era.