Impact of sustained virologic response on short-term clinical outcomes in hepatitis C-related cirrhosis.

BACKGROUND: Hepatitis C virus (HCV) is a common cause of cirrhosis, leading to increased morbidity and mortality. Treatment of the underlying etiology has been shown to improve fibrosis and cirrhosis. AIM: We sought to evaluate the impact of a sustained virologic response on liver chemistries, model for end stage liver disease (MELD) score, Child-Pugh-Turcotte score (CPT), and fibrosis 4 score (FIB4) in patients with liver cirrhosis secondary to HCV with portal hypertension, with or without decompensation. METHODS: Patients with HCV seen in our transplant clinic between June 2013 and September 2015 were identified using ICD-9 code 573.3. Charts were reviewed retrospectively. RESULTS: We collected data from 92 patients with a mean pretreatment MELD score of 9.16±2.98. The most common genotype was Ia, n=79 (86%). The mean duration of follow-up was 7.52±2.25 months. Transaminitis improved significantly at follow-up versus pretreatment [mean aspartate transaminase from 81.2±62.9 to 32.4±12.0 (P<0.0001); alanine transaminase 74.7±77.8 to 27.7±19.4 (P<0.0001)]. Albumin, bilirubin, and α-fetoprotein improved significantly. MELD scores improved in patients with pretreatment scores greater than 10 (P<0.0003), but not in patients with pretreatment scores less than 10 (P=0.501). The CPT score decreased from 6.1±0.9 to 5.8±0.9 (P<0.0024). The FIB4 score improved significantly in patients with baseline FIB4 more than 3.24, but not with higher baseline FIB4. CONCLUSION: Use of direct antivirals in patients with decompensated cirrhosis because of HCV leads to improved MELD, FIB4, and CPT scores.

Liver transplantation for hepatocellular carcinoma: indications, bridge therapy and adjuvant therapy.

Hepatocellular carcinoma (HCC) is a major cause of cancer mortality worldwide, and its incidence is increasing in the United and States. Liver transplantation has the potential to improve survival for patients with HCC. Unfortunately, not enough donor livers are available to meet demand for liver transplantation. The Milan Criteria were established to provide candidate selection guidelines for liver transplantation in patients with HCC. Well-established oncologic therapy for HCC ("bridge therapy") has the capacity to suspend tumor progression and to allow HCC patients to maintain active candidacy as long as necessary to obtain a liver. Several techniques are utilized as bridge therapies for HCC patients awaiting liver transplantation. Adjuvant therapies after liver transplantation may reduce HCC recurrence, and may be required for patients with tumors having high-risk biologic or histologic features. Selection criteria, adjunctive techniques, and outcomes in liver transplantation for HCC patients are described.

Chronic HBV with pregnancy: reactivation flare causing fulminant hepatic failure.

Chronic HBV infection is a dynamic state of interaction between HBV, hepatocytes, and the immune system of the host. A series of reactivation flares and remissions may occur due to multiple causes. Among them, spontaneous reactivation and immunosuppressive drugs including steroids or cancer chemotherapy are well known. This is due to immune-mediated destruction of HBV-expressing cells following withdrawal of immunosuppressive effect. Few cases have been reported in females during postpartum period. We report a case of fulminant hepatic failure during pregnancy in a previously unrecognized hepatitis B positive female requiring emergent liver transplantation.

Multiple bile duct hamartomas mimicking diffuse hepatic metastasis: GI image.

Bile duct hamartomas (von Meyenburg complex) are the rare benign neoplasm of the liver due to dysembryogenesis; constituted historically, cystic dilatations of the bile duct encompassed by fibrous stroma. Usually, they are asymptomatic and are not detected on routine radiological examinations including ultrasound or CT scan. Magnetic resonance cholangiography has been suggested as the best investigation for their imaging diagnosis. Their presence can cause diagnostics confusion and complicate the patient's management. We report a 45-year-old female with symptomatic cholelithiasis, whose liver on laparoscopy mimicked multiple hepatic metastases.

Nutritional effects of transjugular intrahepatic portosystemic shunt--an often neglected benefit? "A preliminary report".

Transjugular intrahepatic portosystemic shunt (TIPS) is a useful procedure for preventing complications of portal hypertension. Nutritional effects of TIPS have been described in cirrhotics. In this prospective study, the nutritional effects of TIPS in cirrhotics were aimed to be identified. BMI, anthropometric measurements, laboratory parameters and Chronic liverdisease quality of life score were measured at baseline, three and six moths following TIPS placement. Total of 12 patients (6 male, 6 female; mean age 56 years; range 41-80) were enrolled between March 2002 and June 2004. Mean baseline MELD score was 13. Only 6 out of 12 patients were able to complete the study due to several reasons. BMI increased from 21.4 to 25.5. Estimated muscle mass improved from 16.6 to 20.5 (p < 0.05). Mean serum albumin improved from 2.46 to 2.76. CLDQL score improved from 103 to 150 (p < 0.05). This small study suggests potential nutritional benefits of TIPS.