Frailty and Sarcopenia in Acute-on-Chronic Liver Failure.

In patients with cirrhosis, sarcopenia is a critical reduction in skeletal muscle mass and frailty represents a status of global physical dysfunction caused by under nutrition, muscle wasting, and functional impairment. Both are prevalent conditions in liver transplant candidates and have shown to be independent predictors of adverse outcome. Evidence supports their incorporation into clinical practice both as a prognostic factor guiding clinical decision making and as a tool to identify candidates for physical and nutritional interventions. The wide heterogeneity of instruments used for sarcopenia and frailty measurement, the absence of a single suitable instrument for sarcopenia and frailty assessment in the outpatient versus inpatient acute-on-chronic clinical scenario, and the lack of strong evidence showing a beneficial effect of sarcopenia and frailty improvement on outcomes before and after transplantation are some of the questions that remain unanswered.

Physical frailty in liver transplantation.

In patients with cirrhosis, frailty represents a status of global physical dysfunction associated with a multiplicity of factors, including muscle wasting, undernutrition and malnutrition, and functional impairment. This condition is particularly prevalent among those with advanced cirrhosis, such as liver transplant (LT) candidates. Studies in this vulnerable population have demonstrated that its presence is independently predictive of adverse outcomes both pre- and post-transplantation, and thus that its incorporation into clinical practice could result in improved clinical decision-making, particularly regarding the identification of candidates for physical and nutritional interventions. There are, however, some limitations to its immediate incorporation into organ allocation prioritization models, including the wide heterogeneity of instruments used for measuring frailty, and particularly the lack of a single one suitable in all LT clinical scenarios (inpatient vs outpatient; pre- vs post-transplant). Finally, the data on the potential effects of frailty improvement on the diverse range of outcome measures are still preliminary.

Introduction to hepatitis C virus infection: Overview and history of hepatitis C virus therapies.

Chronic hepatitis C virus (HCV) infection is an infection that affects over 71 million people worldwide that primarily leads to significant morbidity and mortality through its predisposition to liver fibrosis, cirrhosis, and liver cancer. In addition, extrahepatic manifestations, such as mixed cryoglobulinaemia-associated vasculitis including renal disease, or type II diabetes are frequently encountered in chronically infected individuals. HCV treatment aims to permanently eradicate the virus in order to prevent both liver and extra-hepatic manifestations. Over two decades after the HCV discovery, treatments have evolved from nonspecific immune modulating therapies based on interferon to specific drug combinations, targeting viral proteins. In the present review, we give an overview of HCV infection with a special emphasis on the history of the treatment of viral hepatitis C and the substantial improvement in efficacy and tolerability profile with the recent development of new direct-acting antiviral therapies.