Liver Transplantation for Non-hepatocellular Carcinoma Malignancy: A Single-Center Experience.

BACKGROUND: Liver transplantation has become an effective treatment for selected patients with hepatocellular carcinoma with excellent outcomes. More recent reports have described improved outcomes in liver transplantation in a subset of patients with other malignancies like hilar cholangiocarcinoma, unresectable hepatic epithelioid hemangioendothelioma and hepatic metastasis from neuroendocrine tumors. However, hepatic angiosarcoma remains an absolute contraindication to liver transplantation because of the poor outcome. OBJECTIVES: The present study aims to describe liver transplantation for non-hepatocellular carcinoma malignancy. METHODS: A retrospective analysis of patients and review of the literature was performed. RESULTS: A total of 5 patients with non-hepatocellular carcinoma malignancy on explants histopathologic findings were identified. They presented hepatic epithelioid hemangioendothelioma (1), neuroendocrine tumor (1), angiosarcoma (1) and cholangiocarcinoma (2). The mean length of follow-up was 22.8 ± 37.67 (range, 2-90 months). Of 5 patients evaluated, 3 patients remain with stable graft function. CONCLUSION: Future investigations are necessary to redefine the indications of liver transplantations to treat non-hepatocellular carcinoma malignancy and its limitation.

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil.

INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil

Abstract INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.

O primeiro caso de transplante hepático em paciente com infecção pelo vírus da imunodeficiência humana no Ceará / The first case of liver transplantation in human immunodeficiency virus positive patient in Ceará

A doença hepática terminal é a principal causa de morbidade e mortalidade nos indivíduos infectados pelo vírus da Imunodeficiência Humana (HIV). A infecção pelo HIV não é mais contraindicação ao transplante hepático. O objetivo desse trabalho é descrever o primeiro caso de um paciente com cirrose e coinfecção HIV e Hepatite C (HCV), que foi submetido a transplante ortotópico de fígado no Ceará. O avanço dos medicamentos imunossupressores e do tratamento do HIV e Hepatite C tem um impacto na melhoria da sobrevida neste grupo de pacientes.

End-stage liver disease is a leading cause of morbity and mortality in human immunodeficiency virus (HIV)-positive individuals. HIV infection is no longer a contraindication to liver transplantation. The aim of this report is to describe the first case of patient with cirrhosis due to HIV and Hepatitis C coinfection who underwent orthotopic liver transplantation in Ceará. Advancement in immunosuppressive medications and in treatment of HIV and Hepatitis C impact in improved outcomes in this patient cohort.

Insuficiência hepática aguda secundária à infecção pelo vírus Epstein-Barr / Acute liver failure after infecction by Epstein-Barr virus

Introdução: a infecção pelo vírus Epstein-Barr (EBV) possui prevalência elevada, com mais de 90% da população mundial soropositiva. Em geral, é doença benigna, mas pode cursar com complicações. A alteração de transaminases é comum no curso da doença, mas hepatite fulminante é complicação rara que apresenta mortalidade elevada. Relatamos o caso de paciente imunocompetente com infecção por EBV e evolução para hepatite fulminante. Diagnóstico de hepatite fulminante pelo Epstein-Barr foi feito através de biópsia hepática e sorologia. Houve boa evolução, sem necessidade de transplante hepático.

Introduction: the infection by Epstein-Barr Virus (EBV) has a high prevalence with more than 90% of the global population seropositive. It is usually benign but can be associated with complications. The change of transaminases is common in the disease course, but fulminant hepatitis is a rare complication that has high mortality. we report the case of an immunocompetent patient with EBV infection and progression to fulminant hepatitis. The diagnosis of fulminant hepatitis Epstein-Barr was made by liver biopsy and serology. Evolution was good, without the need for liver transplantation.