المؤلفون: Sarkar, Monika, Grab, Joshua, Dodge, Jennifer L, Gunderson, Erica P, Rubin, Jessica, Irani, Roxanna A, Cedars, Marcelle, Terrault, Norah

المصدر: Journal of Hepatology. 73(3)

مصطلحات موضوعية: Reproductive Medicine, Biomedical and Clinical Sciences, Pediatric, Infant Mortality, Clinical Research, Prevention, Perinatal Period - Conditions Originating in Perinatal Period, Chronic Liver Disease and Cirrhosis, Liver Disease, Hypertension, Contraception/Reproduction, Digestive Diseases, Preterm, Low Birth Weight and Health of the Newborn, Reproductive health and childbirth, Good Health and Well Being, Adult, Comorbidity, Diabetes, Gestational, Eclampsia, Female, Fetal Death, Gestational Age, Humans, Infant, Newborn, Maternal Mortality, Non-alcoholic Fatty Liver Disease, Postpartum Hemorrhage, Pre-Eclampsia, Pregnancy, Premature Birth, Prevalence, Retrospective Studies, United States, Non-alcoholic steatohepatitis, Reproductive health, Complications, Chronic liver disease, Clinical Sciences, Public Health and Health Services, Gastroenterology & Hepatology, Clinical sciences

الوصف: Background & aimsThe prevalence of non-alcoholic fatty liver disease (NAFLD) is rising in young adults, with potential implications for reproductive-aged women. Whether NAFLD during pregnancy confers more serious risks for maternal or perinatal health is unclear.MethodsUsing weighted discharge data from the US national inpatient sample, we evaluated temporal trends of NAFLD in pregnancies after 20 weeks gestation, and compared outcomes to pregnancies with other chronic liver diseases (CLDs) or no CLD. Study outcomes included preterm birth, postpartum hemorrhage, hypertensive complications (pre-eclampsia, eclampsia, and/or hemolysis, elevated liver enzymes, and low platelets syndrome), and maternal or fetal death. NAFLD prevalence was estimated by calendar year and temporal trends tested by linear regression. Outcomes were analyzed by logistic regression adjusted for age, race, multiple gestation, and pre-pregnancy diabetes, obesity, dyslipidemia and hypertension.ResultsAmong 18,574,225 pregnancies, 5,640 had NAFLD and 115,210 had other, non-NAFLD CLD. Pregnancies with NAFLD nearly tripled from 10.5/100,000 pregnancies in 2007 to 28.9/100,000 in 2015 (p

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/4pj0w9ghTest
https://escholarship.org/content/qt4pj0w9gh/qt4pj0w9gh.pdfTest

المؤلفون: Sarkar, Monika, Terrault, Norah, Chan, Wesley, Cedars, Marcelle I, Huddleston, Heather G, Duwaerts, Caroline C, Balitzer, Dana, Gill, Ryan M

المصدر: Liver International. 40(2)

مصطلحات موضوعية: Reproductive Medicine, Biomedical and Clinical Sciences, Chronic Liver Disease and Cirrhosis, Hepatitis, Liver Disease, Contraception/Reproduction, Infertility, Clinical Research, Digestive Diseases, Women's Health, Obesity, Reproductive health and childbirth, Good Health and Well Being, Adolescent, Adult, Child, Preschool, Female, Fibrosis, Humans, Middle Aged, Non-alcoholic Fatty Liver Disease, Polycystic Ovary Syndrome, Retrospective Studies, Young Adult, fibrosis, NAFLD, PCOS, testosterone, women, Clinical Sciences, Gastroenterology & Hepatology, Clinical sciences

الوصف: BackgroundPolycystic ovary syndrome (PCOS) affects 10% of reproductive-aged women, and is marked by irregular menses and high androgens. PCOS is a known risk factor for imaging-confirmed steatosis, and we now aim to evaluate whether PCOS influences histologic severity of non-alcoholic fatty liver disease (NAFLD).MethodsRetrospective study of women ages 18-45 years with biopsy-confirmed NAFLD between 2008 and 2019. Metabolic comorbidities were captured within 6 months of biopsy. Histologic features of non-alcoholic steatohepatitis (NASH) were independently evaluated by two pathologists blinded to PCOS status.ResultsAmong 102 women meeting study criteria, 36% (n = 37) had PCOS; median age was 35 years; 27% were white, 6% black, 19% Asian and 47% reported Hispanic ethnicity. Women with PCOS had higher LDL (122 vs 102 mg/dL, P = .05) and body mass index(BMI) (38 vs 33 kg/cm2 , P

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6k60q4zxTest
https://escholarship.org/content/qt6k60q4zx/qt6k60q4zx.pdfTest

المؤلفون: Siddiqui, Mohammad Shadab, Yamada, Goro, Vuppalanchi, Raj, Van Natta, Mark, Loomba, Rohit, Guy, Cynthia, Brandman, Danielle, Tonascia, James, Chalasani, Naga, Neuschwander-Tetri, Brent, Sanyal, Arun J, Allende, Daniela, Dasarathy, Srinivasan, McCullough, Arthur J, Penumatsa, Revathi, Dasarathy, Jaividhya, Lavine, Joel E, Abdelmalek, Manal F, Bashir, Mustafa, Buie, Stephanie, Diehl, Anna Mae, Kigongo, Christopher, Kopping, Mariko, Malik, David, Piercy, Dawn, Cummings, Oscar W, Gawrieh, Samer, Ragozzino, Linda, Sandrasegaran, Kumar, Brunt, Elizabeth M, Cattoor, Theresa, Carpenter, Danielle, Freebersyser, Janet, King, Debra, Lai, Jinping, Neuschwander-Tetri, Brent A, Siegner, Joan, Stewart, Susan, Torretta, Susan, Wriston, Kristina, Gonzalez, Maria Cardona, Davila, Jodie, Jhaveri, Manan, Kowdley, Kris V, Mukhtar, Nizar, Ness, Erik, Poitevin, Michelle, Quist, Brook, Soo, Sherilynn, Ang, Brandon, Behling, Cynthia, Bhatt, Archana, Middleton, Michael S, Sirlin, Claude, Akhter, Maheen F, Bass, Nathan M, Gill, Ryan, Hameed, Bilal, Maher, Jacqueline, Terrault, Norah, Ungermann, Ashley, Yeh, Matthew, Boyett, Sherry, Contos, Melissa J, Kirwin, Sherri, Luketic, Velimir AC, Puri, Puneet, Schlosser, Jolene, Siddiqui, Mohammad S, Yost-Schomer, Leslie, Fowler, Kathryn, Kleiner, David E, Doo, Edward C, Hall, Sherry, Hoofnagle, Jay H, Lee, Jessica J, Robuck, Patricia R, Sherker, Averell H, Torrance, Rebecca, Belt, Patricia, Clark, Jeanne M, Dodge, John, Donithan, Michele, Hallinan, Erin, Isaacson, Milana, Lazo, Mariana, Meinert, Jill, Miriel, Laura, Smith, Jacqueline, Smith, Michael, Sternberg, Alice, Van Natta, Mark L

المصدر: Clinical Gastroenterology and Hepatology. 17(9)

مصطلحات موضوعية: Clinical Research, Chronic Liver Disease and Cirrhosis, Liver Disease, Digestive Diseases, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Good Health and Well Being, Adult, Alanine Transaminase, Aspartate Aminotransferases, Biopsy, Disease Progression, Female, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Non-alcoholic Fatty Liver Disease, Platelet Count, Predictive Value of Tests, Retrospective Studies, Sensitivity and Specificity, Severity of Illness Index, Nonalcoholic Steatohepatitis, Diagnostic, Prognostic, Scoring System Comparison, NASH Clinical Research Network, Clinical Sciences, Gastroenterology & Hepatology

الوصف: Background & aimsNoninvasive methods are needed to determine disease stage in patients with nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic performance of several widely available fibrosis models for the assessment of hepatic fibrosis in patients with NAFLD.MethodsWe performed a retrospective analysis of data from individuals enrolled in the NIDDK NASH Clinical Research Network, from 2004 through 2018. Using biopsy as the reference standard, we determined the diagnostic performance of the aspartate aminotransferase (AST):platelet ratio (APRI), FIB-4, ratio of AST:alanine aminotransferase (ALT) and the NAFLD fibrosis score (NFS) in a cross-sectional study of 1904 subjects. The ability of these models to detect changes in fibrosis stage was assessed in a longitudinal data set of 292 subjects with 2 biopsies and accompanying laboratory data. Outcomes were detection of fibrosis of any stage (stages 0-4), detection of moderate fibrosis (stages 0-1 vs 2-4), and detection of advanced fibrosis (stages 0-2 vs 3-4). Diagnostic performance was evaluated using the C-statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) analyses.ResultsIn the cross-sectional study, FIB-4 and NFS outperformed other non-invasive models for detecting advanced fibrosis; the C-statistics were 0.80 for FIB-4 and 0.78 for NFS. In the longitudinal study, 216 patients had non-advanced fibrosis at baseline and 35 patients progressed to advanced fibrosis after median follow up of 2.6 years. After we adjusted for fibrosis stage and model score at initial biopsy, change in APRI, FIB-4, and NFS were significantly associated with change in fibrosis. A unit change in APRI, FIB-4, or NFS was associated with changes in fibrosis stage of 0.33 (95% CI, 0.20-0.45; P < .001), 0.26 (95% CI, 0.15-0.37; P < .001), and 0.19 (95% CI, 0.07-0.31; P = .002), respectively. The cross-validated C-statistic for detecting progression to advanced fibrosis for APRI was 0.82 (95% CI, 0.74-0.89), for FIB-4 was 0.81 (95% CI, 0.73-0.81), and for NFS was 0.80 (95% CI, 0.71-0.88).ConclusionsIn a combined analysis of data from 2 large studies, we found that FIB-4, APRI, and NFS can detect advanced fibrosis and fibrosis progression in patients with NAFLD.

الوصول الحر: https://escholarship.org/uc/item/81g8h62bTest

المؤلفون: Huang, Annsa C, Mehta, Neil, Dodge, Jennifer L, Yao, Francis Y, Terrault, Norah A

المصدر: Hepatology. 68(2)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Hepatitis, Digestive Diseases, Organ Transplantation, Liver Disease, Transplantation, Cancer, Rare Diseases, Chronic Liver Disease and Cirrhosis, Hepatitis - C, Liver Cancer, Clinical Research, Infectious Diseases, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, Aged, Antiviral Agents, Carcinoma, Hepatocellular, Cohort Studies, Female, Hepacivirus, Hepatitis C, Humans, Incidence, Liver, Liver Cirrhosis, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Neoplasm Recurrence, Local, Patient Dropouts, Propensity Score, Retrospective Studies, Risk Factors, Waiting Lists, Medical Biochemistry and Metabolomics, Immunology, Gastroenterology & Hepatology, Clinical sciences

الوصف: Whether direct-acting antivirals (DAAs) increase the risk of hepatocellular carcinoma (HCC) recurrence after tumor-directed therapy is controversial. We sought to determine the impact of DAA therapy on HCC recurrence after local-regional therapy (LRT) and waitlist dropout among liver transplant (LT) candidates with HCC. We performed a retrospective cohort study of 149 LT candidates with hepatitis C virus (HCV) and HCC at a single center from 2014 through 2016. Cumulative incidence of HCC recurrence post-LRT and waitlist dropout was estimated by the DAA group. Factors associated with each outcome were evaluated using competing risks regression. A propensity score stabilized inverse probability weighting approach was used to account for differences in baseline characteristics between groups. The no DAA group (n = 87) had more severe cirrhosis and lower rates of complete radiologic tumor response after LRT than those treated with DAA (n = 62) but had similar alpha-fetoprotein and tumor burden at listing. Cumulative incidence of HCC recurrence within 1 year of complete response after LRT was 47.0% in the DAA group and 49.8% in the no DAA group (P = 0.93). In adjusted competing risk analysis using weighted propensity score modeling, risk of HCC recurrence was similar in the DAA group compared to those without DAA (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.58-1.42; P = 0.67). Patients treated with DAAs had lower risk of waitlist dropout due to tumor progression or death compared to the no DAA group in adjusted weighted analysis (HR, 0.30; 95% CI 0.13-0.69; P = 0.005).ConclusionIn LT candidates with HCV and HCC with initial complete response to LRT, DAA use is not associated with increased risk of HCC recurrence but rather is associated with reduced risk of waitlist dropout due to tumor progression or death. (Hepatology 2018).

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الوصول الحر: https://escholarship.org/uc/item/9k19p9j9Test

المؤلفون: Lee, Brian P, Mehta, Neil, Platt, Laura, Gurakar, Ahmet, Rice, John P, Lucey, Michael R, Im, Gene Y, Therapondos, George, Han, Hyosun, Victor, David W, Fix, Oren K, Dinges, Lisanne, Dronamraju, Deepti, Hsu, Christine, Voigt, Michael D, Rinella, Mary E, Maddur, Haripriya, Eswaran, Sheila, Hause, Jessica, Foley, David, Ghobrial, R Mark, Dodge, Jennifer L, Li, Zhiping, Terrault, Norah A

المصدر: Gastroenterology. 155(2)

مصطلحات موضوعية: Substance Misuse, Clinical Research, Transplantation, Digestive Diseases, Prevention, Liver Disease, Alcoholism, Alcohol Use and Health, Chronic Liver Disease and Cirrhosis, Organ Transplantation, Hepatitis, Oral and gastrointestinal, Good Health and Well Being, Adult, Age Factors, Alcohol Abstinence, Alcohol Drinking, Female, Follow-Up Studies, Humans, Incidence, Liver Diseases, Alcoholic, Liver Transplantation, Male, Middle Aged, Patient Selection, Recurrence, Retrospective Studies, Risk Factors, Survival Analysis, Time Factors, Treatment Outcome, United States, Recidivism, Relapse, UNOS, Months, ACCELERATE-AH, Clinical Sciences, Neurosciences, Paediatrics and Reproductive Medicine, Gastroenterology & Hepatology

الوصف: Background & aimsThe American Consortium of Early Liver Transplantation for Alcoholic Hepatitis comprises 12 centers from 8 United Network for Organ Sharing regions studying early liver transplantation (LT) (without mandated period of sobriety) for patients with severe alcoholic hepatitis (AH). We analyzed the outcomes of these patients.MethodsWe performed a retrospective study of consecutive patients with a diagnosis of severe AH and no prior diagnosis of liver disease or episodes of AH, who underwent LT before 6 months of abstinence from 2006 through 2017 at 12 centers. We collected data on baseline characteristics, psychosocial profiles, level of alcohol consumption before LT, disease course and treatment, and outcomes of LT. The interval of alcohol abstinence was defined as the time between last drink and the date of LT. The primary outcomes were survival and alcohol use after LT, defined as slip or sustained.ResultsAmong 147 patients with AH who received liver transplants, the median duration of abstinence before LT was 55 days; 54% received corticosteroids for AH and the patients had a median Lille score of 0.82 and a median Sodium Model for End-Stage Liver Disease score of 39. Cumulative patient survival percentages after LT were 94% at 1 year (95% confidence interval [CI], 89%-97%) and 84% at 3 years (95% CI, 75%-90%). Following hospital discharge after LT, 72% were abstinent, 18% had slips, and 11% had sustained alcohol use. The cumulative incidence of any alcohol use was 25% at 1 year (95% CI, 18%-34%) and 34% at 3 years (95% CI, 25%-44%) after LT. The cumulative incidence of sustained alcohol use was 10% at 1 year (95% CI, 6%-18%) and 17% at 3 years (95% CI, 10%-27%) after LT. In multivariable analysis, only younger age was associated with alcohol following LT (P = .01). Sustained alcohol use after LT was associated with increased risk of death (hazard ratio, 4.59; P = .01).ConclusionsIn a retrospective analysis of 147 patients who underwent early LT (before 6 months of abstinence) for severe AH, we found that most patients survive for 1 year (94%) and 3 years (84%), similar to patients receiving liver transplants for other indications. Sustained alcohol use after LT was infrequent but associated with increased mortality. Our findings support the selective use of LT as a treatment for severe AH. Prospective studies are needed to optimize selection criteria, management of patients after LT, and long-term outcomes.

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الوصول الحر: https://escholarship.org/uc/item/3wd6b2ftTest

المؤلفون: Saxena, Varun, Nyberg, Lisa, Pauly, Marypat, Dasgupta, Aditi, Nyberg, Anders, Piasecki, Barbara, Winston, Bradley, Redd, Jacquelyn, Ready, Joanna, Terrault, Norah A

المصدر: Hepatology. 62(3)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Hepatitis, Clinical Research, Digestive Diseases, Chronic Liver Disease and Cirrhosis, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Infection, Good Health and Well Being, Aged, Analysis of Variance, Antiviral Agents, Case-Control Studies, Drug Therapy, Combination, Female, Follow-Up Studies, Hepacivirus, Hepatitis C, Humans, Liver Cirrhosis, Logistic Models, Male, Middle Aged, Multivariate Analysis, Patient Safety, Reference Values, Retrospective Studies, Ribavirin, Risk Assessment, Severity of Illness Index, Simeprevir, Sofosbuvir, Treatment Outcome, Medical Biochemistry and Metabolomics, Immunology, Gastroenterology & Hepatology, Clinical sciences

الوصف: UnlabelledRisks and benefits of simeprevir plus sofosbuvir (SIM+SOF) in patients with advanced cirrhosis are unknown. We assessed the safety and sustained virological responses (SVR) of SIM+SOF with and without ribavirin (RBV) in patients with Child-Pugh (CP)-B/C versus CP-A cirrhosis and compared to matched untreated controls. This study was of a multicenter cohort of adults with hepatitis C virus genotype 1 and cirrhosis treated with SIM+SOF with/without RBV for 12 weeks. Controls were matched on treatment center, age, CP class, and Model for End-Stage Liver Disease (MELD) score. Of 160 patients treated with SIM+SOF with/without RBV, 35% had CP-B/C and 64% had CP-A, with median baseline MELD 9 (interquartile range, 8-11). Sustained virological response at week 12 (SVR12) was achieved by 73% of CP-B/C versus 91% of CP-A (P

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/4zm8p3m6Test

المؤلفون: Verna, Elizabeth C, Saxena, Varun, Burton, James R, O’Leary, Jacqueline G, Dodge, Jennifer L, Stravitz, Richard T, Levitsky, Josh, Trotter, James F, Everson, Gregory T, Brown, Robert S, Terrault, Norah A

المصدر: Transplantation. 99(8)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Hepatitis, Organ Transplantation, Liver Disease, Emerging Infectious Diseases, Chronic Liver Disease and Cirrhosis, Hepatitis - C, Digestive Diseases, Infectious Diseases, Clinical Research, Transplantation, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, Antiviral Agents, Biomarkers, Cholestasis, Drug Therapy, Combination, Female, Genotype, Hepacivirus, Hepatitis C, Humans, Liver Cirrhosis, Liver Transplantation, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Oligopeptides, Proline, RNA, Viral, Recurrence, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, United States, Viral Load, CRUSH-C Consortium, Medical and Health Sciences, Surgery, Clinical sciences, Immunology

الوصف: BackgroundAntiviral treatment with sustained virologic response (SVR) improves survival in liver transplant (LT) recipients, and is especially relevant to patients with advanced recurrent hepatitis C virus (HCV). We assessed the safety and efficacy of protease inhibitor-based triple therapy in patients with recurrent advanced fibrosis and cholestatic hepatitis.MethodsThe LT recipients with genotype 1 HCV and advanced fibrosis (F3-4/4) or cholestatic hepatitis treated with telaprevir- or boceprevir-based triple therapy at 6 centers (CRUSH-C consortium) were retrospectively assessed. The primary endpoints were SVR at 12 weeks (SVR12) and safety.ResultsForty-five patients with advanced fibrosis and 9 with cholestatic hepatitis (74% men, 57% genotype 1a, 63% previous nonresponders) were included. SVR12 occurred in 51% with advanced fibrosis and 44% with cholestatic hepatitis. Extended rapid virologic response was highly predictive of SVR12. Hispanic ethnicity (odds ratio, 0.16; P = 0.03), previous null/partial response (0.24; P = 0.02), IL28B genotype CC (7.0; P = 0.02), albumin (3.87; P = 0.03), platelet count (1.01; P = 0.02), and steroid use (0.21; P = 0.03) were associated with SVR12. Six (11%) patients died, and hepatic decompensation occurred in 22% with advanced fibrosis and 33% with cholestatic hepatitis. Albumin (0.02; P = 0.001), encephalopathy (12.0; P = 0.04) and Hispanic ethnicity (odds ratio, 6.17; P = 0.01) were associated with death or decompensation.ConclusionsFor LT recipients with recurrent advanced HCV and at greatest need of cure, protease inhibitor-based triple therapy achieved approximately 50% SVR12. However, there is significant risk of serious adverse events, arguing for earlier intervention. The availability of treatments with better efficacy and safety is of particular importance for posttransplant patients with advanced disease.

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الوصول الحر: https://escholarship.org/uc/item/8gp2m329Test

المؤلفون: Flemming, Jennifer A, Vagefi, Parsia A, Freise, Chris E, Yao, Francis Y, Terrault, Norah A

المصدر: Liver Transplantation. 20(10)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Infectious Diseases, Hepatitis - C, Chronic Liver Disease and Cirrhosis, Emerging Infectious Diseases, Liver Disease, Clinical Research, Organ Transplantation, Transplantation, Hepatitis, Good Health and Well Being, Adult, Age Factors, California, Disease Progression, Female, Follow-Up Studies, Hepatitis C, Chronic, Humans, Liver Transplantation, Male, Middle Aged, Patient Dropouts, Prognosis, Retrospective Studies, Survival Rate, Time Factors, Tissue Donors, Transplant Recipients, Waiting Lists, Young Adult, Surgery, Clinical sciences

الوصف: Older donor age is associated with lower graft and patient survival among all recipients of liver transplantation (LT). Among patients with hepatitis C virus (HCV), donor age is one of the strongest predictors of fibrosis severity and graft loss. We evaluated the implementation of a donor age restriction policy for LT patients with HCV at a single center and the effects that this policy had on wait-list (WL) and post-LT outcomes for HCV and non-HCV patients. This was a cohort study of 2388 WL patients and 1015 LT recipients between March 2002 and January 2013 and reflected 3 different eras of donor age policies. With the donor age restriction, the median donor age was reduced in LT recipients with HCV versus LT recipients without HCV (30 versus 48 years, P

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الوصول الحر: https://escholarship.org/uc/item/62q21176Test

المؤلفون: Goel, Aparna, Mehta, Neil, Guy, Jennifer, Fidelman, Nicholas, Yao, Francis, Roberts, John, Terrault, Norah

المصدر: Liver Transplantation. 20(10)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Transplantation, Rare Diseases, Liver Cancer, Clinical Research, Cancer, Chronic Liver Disease and Cirrhosis, Liver Disease, Digestive Diseases, Organ Transplantation, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Oral and gastrointestinal, Good Health and Well Being, Adult, Aged, Biliary Tract, California, Carcinoma, Hepatocellular, Chemoembolization, Therapeutic, Constriction, Pathologic, Female, Follow-Up Studies, Forecasting, Hepatic Artery, Humans, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Preoperative Care, Retrospective Studies, Risk Factors, Survival Rate, Surgery, Clinical sciences

الوصف: Liver transplantation (LT) is the treatment of choice for patients with cirrhosis and hepatocellular carcinoma (HCC) not amenable to resection. Locoregional therapies for HCC are often used to reduce tumor burden, bridge patients to LT, and down-stage HCC so that patients are eligible for LT. We hypothesized that prior endovascular antitumor therapy may increase the risk of hepatic artery (HA) and biliary complications after LT. The aim of this study was to compare HA and biliary complications in LT recipients with HCC who received transarterial chemoembolization (TACE) before LT with complications in LT recipients with HCC who did not receive TACE before LT. This was a retrospective cohort study of HCC patients at two transplant centers. The prevalence of HA complications (HA thrombosis, stenosis, or pseudoaneurysm) and biliary complications (nonanastomotic stricture, bile leak, and diffuse injury) were compared between patients treated with or without TACE. There were 456 HCC patients with a median age of 61 years (77% were male, and 63% had hepatitis C virus), and 328 (72%) received TACE before LT. The overall prevalence of HA complications was 4.7% in the no-TACE group and 7.9% in the TACE group (P = 0.22). All HA stenosis complications (n = 14) occurred in the TACE group (P = 0.018 versus the no-TACE group). An older donor age and a lower albumin level significantly increased the odds of HA complications. There was a nonstatistically significant increased odds of HA complications in the TACE group versus the no-TACE group according to an adjusted analysis (odds ratio = 2.02, 95% confidence interval = 0.79-5.16, P = 0.14). The overall prevalence of biliary complications was 16.4% in the no-TACE group and 19.8% in the TACE group (P = 0.40). In conclusion, a lower pre-LT albumin level and an older donor age were significantly associated with higher odds of HA complications after LT. TACE was not associated with higher odds of overall HA complications but was associated with a higher prevalence of HA stenosis. Further studies are warranted to confirm the HA stenosis findings and elucidate the pathogenesis.

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الوصول الحر: https://escholarship.org/uc/item/6qc9d4v5Test

المؤلفون: Sarkar, Monika, Shvachko, Valentina A, Ready, Joanna B, Pauly, Mary Pat, Terrault, Norah A, Peters, Marion G, Manos, M Michele

المصدر: Digestive Diseases and Sciences. 59(9)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Chronic Liver Disease and Cirrhosis, Hepatitis - B, Cancer, Rare Diseases, Digestive Diseases, Clinical Research, Liver Cancer, Health Services, Infectious Diseases, Liver Disease, Hepatitis, Good Health and Well Being, Adolescent, Adult, Aged, Alanine Transaminase, Antiviral Agents, California, Carcinoma, Hepatocellular, DNA, Viral, Delivery of Health Care, Integrated, Female, Gastroenterology, Guideline Adherence, Hepatitis B Surface Antigens, Hepatitis B virus, Hepatitis B, Chronic, Humans, Infectious Disease Medicine, Liver Neoplasms, Male, Middle Aged, Patient Selection, Practice Guidelines as Topic, Practice Patterns, Physicians', Primary Health Care, Retrospective Studies, Watchful Waiting, Young Adult, alpha-Fetoproteins, Community, Management, Provider, Treatment, Gastroenterology & Hepatology, Clinical sciences

الوصف: BackgroundFew population-based studies have described characteristics and management of patients with chronic hepatitis B (CHB) in the USA.MethodsWe retrospectively studied adults with CHB in the Northern California Kaiser Permanente Medical Care Program (KPNC) from July 2009 to December 2010 (n = 12,016). Laboratory tests, treatment patterns, and hepatocellular carcinoma (HCC) surveillance were ascertained during a "recent" 18-month study window (July 2009-December 2010), or as "ever" based on records dating to 1995.ResultsThe mean age was 49 years; 51 % were men, 83 % Asian, and 87 % KPNC members >5 years. Overall, 51 % had ≥ 1 liver-related visit, 14 % with gastroenterology or infectious disease specialists, and 37 % with primary care providers (PCP) only. Less than 40 % of patients had both hepatitis B virus (HBV) DNA and ALT testing conducted recently, while 56 % of eligible patients had received HCC surveillance. Recent laboratory testing and HCC surveillance were more frequent in patients seen by a specialist versus PCP only (90 vs. 47 % and 92 vs. 73 %, respectively, p values

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الوصول الحر: https://escholarship.org/uc/item/3b36204mTest