Pub Date : 2024-03-05DOI: 10.1016/j.jceh.2024.101392
Ranjan K. Patel , Alamellu Alagapan , Taraprasad Tripathy , Hemant K. Nayak , Bramhadatta Pattnaik , Tanmay Dutta , Sunita Gupta , Sudipta Mohakud , Suprava Naik , Nerbadyswari Deep Bag
Percutaneous transhepatic biliary drainage (PTBD) is a routinely performed interventional radiological procedure. A myriad of complications can occur after PTBD, the most important being hemorrhagic complications that require immediate attention. Hemorrhage following PTBD may result from arterial, portal, or hepatic venous injury. A catheter or pull-back cholangiogram often demonstrates the venous injury. A computed tomogram angiogram aids in identifying bleeding sources and procedural planning. Catheter repositioning, upsizing, or clamping often suffice for minor venous bleeding. However, major venous injury necessitates tract embolization, portal vein embolization, or stent grafting. Arterial injury may lead to significant blood loss unless treated expeditiously. Transarterial embolization is the treatment of choice in such cases. Adequate knowledge about the hemorrhagic complications of PTBD will allow an interventional radiologist to take necessary precautionary measures to reduce their incidence and take appropriate steps in their management. This article entails four different hemorrhagic complications of PTBD and their interventional management. It also discusses the various treatment options to manage different kinds of post-PTBD hemorrhagic complications.
{"title":"Bloody Bile and Rescue Intervention—A Case Series of Post-PTBD Hemorrhagic Complications With a Review of the Literature","authors":"Ranjan K. Patel , Alamellu Alagapan , Taraprasad Tripathy , Hemant K. Nayak , Bramhadatta Pattnaik , Tanmay Dutta , Sunita Gupta , Sudipta Mohakud , Suprava Naik , Nerbadyswari Deep Bag","doi":"10.1016/j.jceh.2024.101392","DOIUrl":"10.1016/j.jceh.2024.101392","url":null,"abstract":"<div><p>Percutaneous transhepatic biliary drainage (PTBD) is a routinely performed interventional radiological procedure. A myriad of complications can occur after PTBD, the most important being hemorrhagic complications that require immediate attention. Hemorrhage following PTBD may result from arterial, portal, or hepatic venous injury. A catheter or pull-back cholangiogram often demonstrates the venous injury. A computed tomogram angiogram aids in identifying bleeding sources and procedural planning. Catheter repositioning, upsizing, or clamping often suffice for minor venous bleeding. However, major venous injury necessitates tract embolization, portal vein embolization, or stent grafting. Arterial injury may lead to significant blood loss unless treated expeditiously. Transarterial embolization is the treatment of choice in such cases. Adequate knowledge about the hemorrhagic complications of PTBD will allow an interventional radiologist to take necessary precautionary measures to reduce their incidence and take appropriate steps in their management. This article entails four different hemorrhagic complications of PTBD and their interventional management. It also discusses the various treatment options to manage different kinds of post-PTBD hemorrhagic complications.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140086165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article aims to evaluate the intrareader and interreader agreement of ultrasound (US) gallbladder reporting and data system (GB-RADS) and validate the risk of malignancy in each GB-RADS category.
Materials and methods
This retrospective study comprised consecutive patients with nonacute gallbladder wall thickening who underwent US evaluation between January 2019 and December 2022. Three radiologists independently read the static US images and cine-loops for GB-RADS findings and assigned GB-RADS categories. The intraobserver (static images) and interobserver (static images and cine-loops) agreement was calculated using kappa statistics and Krippendorff's alpha. Another radiologist assigned a consensus GB-RADS category. The percentage of malignancy in each GB-RADS category was calculated.
Results
Static US images of 414 patients (median age, 56 years; 288 women, benign = 45.6% and malignant = 54.4%) and cine-loops of 50 patients were read. There was weak to moderate intrareader agreement for most GB-RADS findings and moderate intrareader agreement for the GB-RADS category for all readers. On static images, the interreader agreement was acceptable for GB-RADS categories. On cine-loops, the interreader agreement for GB-RADS findings and categories was better than static images. The percentage of malignancy was 1.2%, 37%, 71.1%, and 89.1% in GB-RADS 2, 3, 4, and 5 categories.
Conclusion
GB-RADS has moderate intrareader for GB-RADS categories. As originally proposed, the risk of malignancy is negligible in GB-RADS 2 category and highest in GB-RADS 5 category. However, the discriminatory performance of GB-RADS 3 and 4 categories is low. Larger multicenter studies with more readers must assess the reader agreement and validate the GB-RADS systems for wider clinical utilization.
{"title":"Agreement of Gallbladder Reporting and Data System for Gallbladder Wall Thickening at Ultrasonography: A Multireader Validation Study","authors":"Raghuraman Soundararajan , Pavithra Subramanian , Pankaj Gupta , Pratyaksha Rana , Manika Chhabra , Shravya Singh , Ruby Siddiqui , Chandan Das , Thakur D. Yadav , Vikas Gupta , Lileswar Kaman , Harjeet Singh , Santosh Irrinki , Parikshaa Gupta , Uma N. Saikia , Ritambhra Nada , Usha Dutta , Manavjit S. Sandhu","doi":"10.1016/j.jceh.2024.101393","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101393","url":null,"abstract":"<div><h3>Objective</h3><p>This article aims to evaluate the intrareader and interreader agreement of ultrasound (US) gallbladder reporting and data system (GB-RADS) and validate the risk of malignancy in each GB-RADS category.</p></div><div><h3>Materials and methods</h3><p>This retrospective study comprised consecutive patients with nonacute gallbladder wall thickening who underwent US evaluation between January 2019 and December 2022. Three radiologists independently read the static US images and cine-loops for GB-RADS findings and assigned GB-RADS categories. The intraobserver (static images) and interobserver (static images and cine-loops) agreement was calculated using kappa statistics and Krippendorff's alpha. Another radiologist assigned a consensus GB-RADS category. The percentage of malignancy in each GB-RADS category was calculated.</p></div><div><h3>Results</h3><p>Static US images of 414 patients (median age, 56 years; 288 women, benign = 45.6% and malignant = 54.4%) and cine-loops of 50 patients were read. There was weak to moderate intrareader agreement for most GB-RADS findings and moderate intrareader agreement for the GB-RADS category for all readers. On static images, the interreader agreement was acceptable for GB-RADS categories. On cine-loops, the interreader agreement for GB-RADS findings and categories was better than static images. The percentage of malignancy was 1.2%, 37%, 71.1%, and 89.1% in GB-RADS 2, 3, 4, and 5 categories.</p></div><div><h3>Conclusion</h3><p>GB-RADS has moderate intrareader for GB-RADS categories. As originally proposed, the risk of malignancy is negligible in GB-RADS 2 category and highest in GB-RADS 5 category. However, the discriminatory performance of GB-RADS 3 and 4 categories is low. Larger multicenter studies with more readers must assess the reader agreement and validate the GB-RADS systems for wider clinical utilization.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140180490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent studies from both India and outside India have shown a change in the etiological profile of hepatocellular carcinoma (HCC). We aimed to analyze the etiological spectrum and changing trends of HCC etiology in India using a systematic review of current literature and meta-analysis.
Methods
Electronic databases of PubMed/Medline, Scopus, and Embase were searched from inception to July 2023 for studies reporting the data on the etiology of HCC from India. The pooled proportions with 95% confidence interval were calculated using summative statistics.
Results
A total of 60 studies (n = 12,327) were included in the final analysis. The pooled proportions of HCC cases with at least one positive and negative viral marker were 56.0 (49.5–62.6) and 43.1% (36.5–49.8), respectively. The pooled proportion of HCC cases with positive hepatitis B virus (HBV) markers was 41.0 (35.8–46.1), while those with positive markers for hepatitis C virus were 20.3 (17.0–23.6). The pooled proportion of cases with HCC with significant alcohol intake was 19.0% (15.6–22.4), and those related to nonalcoholic fatty liver disease (NAFLD) were 16.9% (12.1–21.7). Around 7.9% (5.8–10.0) of the cases had HCC with multiple etiologies. Subgroup analysis showed a significant variation with the location of the study based on zone. Meta-regression analysis based on publication year (1990–2023) showed a significant reduction in the proportion of cases with HBV and an increase in cases with NAFLD. In contrast, the proportion of cases with hepatitis C virus and alcohol did not change significantly.
Conclusion
Viral hepatitis is the most common etiology of HCC in India, predominantly HBV. The proportions of cases with HCC related to NAFLD are increasing, and those related to HBV are declining.
{"title":"Changing Etiological Spectrum of Hepatocellular Carcinoma in India—A Systematic Review and Meta-analysis","authors":"Suprabhat Giri , Ashok Choudhury , Dibya L. Praharaj , Ankita Singh , Arun Vaidya , Sidharth Harindranath , Prajna Anirvan , Shivam Kalia , Akash Shukla","doi":"10.1016/j.jceh.2024.101391","DOIUrl":"10.1016/j.jceh.2024.101391","url":null,"abstract":"<div><h3>Background</h3><p>Recent studies from both India and outside India have shown a change in the etiological profile of hepatocellular carcinoma (HCC). We aimed to analyze the etiological spectrum and changing trends of HCC etiology in India using a systematic review of current literature and meta-analysis.</p></div><div><h3>Methods</h3><p>Electronic databases of PubMed/Medline, Scopus, and Embase were searched from inception to July 2023 for studies reporting the data on the etiology of HCC from India. The pooled proportions with 95% confidence interval were calculated using summative statistics.</p></div><div><h3>Results</h3><p>A total of 60 studies (n = 12,327) were included in the final analysis. The pooled proportions of HCC cases with at least one positive and negative viral marker were 56.0 (49.5–62.6) and 43.1% (36.5–49.8), respectively. The pooled proportion of HCC cases with positive hepatitis B virus (HBV) markers was 41.0 (35.8–46.1), while those with positive markers for hepatitis C virus were 20.3 (17.0–23.6). The pooled proportion of cases with HCC with significant alcohol intake was 19.0% (15.6–22.4), and those related to nonalcoholic fatty liver disease (NAFLD) were 16.9% (12.1–21.7). Around 7.9% (5.8–10.0) of the cases had HCC with multiple etiologies. Subgroup analysis showed a significant variation with the location of the study based on zone. Meta-regression analysis based on publication year (1990–2023) showed a significant reduction in the proportion of cases with HBV and an increase in cases with NAFLD. In contrast, the proportion of cases with hepatitis C virus and alcohol did not change significantly.</p></div><div><h3>Conclusion</h3><p>Viral hepatitis is the most common etiology of HCC in India, predominantly HBV. The proportions of cases with HCC related to NAFLD are increasing, and those related to HBV are declining.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140083254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/S0973-6883(24)00043-4
{"title":"Issue Highlights","authors":"","doi":"10.1016/S0973-6883(24)00043-4","DOIUrl":"https://doi.org/10.1016/S0973-6883(24)00043-4","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140160010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-29DOI: 10.1016/j.jceh.2024.101367
Manas K. Behera , Prabir Majji , Sanatan Behera , Manoj Pani , Arupam Mohapatro , Umesh C. Patra , Susanta K. Jena
Background
The burden of hepatitis C virus (HCV) in India is alarming, with a major share of this virus being witnessed in patients with end-stage renal disease (ESRD). A pan-genotypic combination of sofosbuvir and velpatasvir is found to be safe, effective, and economical in resource-constraint countries such as ours. However, there are scanty data on the efficacy and safety of sofosbuvir and velpatasvir combination in patients with ESRD. Hence, we performed this study to evaluate the safety and efficacy of the combination of sofosbuvir and velpatasvir in patients of chronic hepatitis C (CHC) with ESRD.
Methods
This is an observational study comprising of 40 CHC patients with ESRD on maintenance hemodialysis. All patients were treated with a fixed-dose combination of sofosbuvir and velpatasvir for 12 weeks in case of non-cirrhotic or compensated cirrhosis and 24 weeks in case of decompensated cirrhosis. The efficacy was assessed by sustained virological response defined by negative HCV RNA at 12 weeks (sustained virological response [SVR] 12) post treatment, and safety was assessed by recording any side-effects of all patients.
Results
Out of the 40 patients enrolled in our study, majority were non-cirrhotic (77%), and all were treatment-naive. The mean age was 49.87 ± 12.13 years, and 80% patients were male. The mean baseline HCV RNA was 2.61 ± 7.83 × 106 IU/ml. All the 40 patients (100%) achieved undetectable HCV RNA at the end of treatment; however, 39 patients (97.5%) achieved SVR 12. There was no significant deterioration of estimated glomerular filtration rate (eGFR) after completion of antiviral therapy as compared to the baseline eGFR (13.27 ± 10.32 vs13.54 ± 11.38, P = 0.54). None of the patients reported any serious adverse effects during treatment.
Conclusion
The fixed-dose combination of sofosbuvir and velpatasvir is effective and has showed excellent safety profile in patients of CHC with ESRD.
{"title":"The Fixed Dose Combination of Sofosbuvir and Velpatasvir is Safe and Effective in Patients of Chronic Hepatitis C With End-stage Renal Disease","authors":"Manas K. Behera , Prabir Majji , Sanatan Behera , Manoj Pani , Arupam Mohapatro , Umesh C. Patra , Susanta K. Jena","doi":"10.1016/j.jceh.2024.101367","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101367","url":null,"abstract":"<div><h3>Background</h3><p>The burden of hepatitis C virus (HCV) in India is alarming, with a major share of this virus being witnessed in patients with end-stage renal disease (ESRD). A pan-genotypic combination of sofosbuvir and velpatasvir is found to be safe, effective, and economical in resource-constraint countries such as ours. However, there are scanty data on the efficacy and safety of sofosbuvir and velpatasvir combination in patients with ESRD. Hence, we performed this study to evaluate the safety and efficacy of the combination of sofosbuvir and velpatasvir in patients of chronic hepatitis C (CHC) with ESRD.</p></div><div><h3>Methods</h3><p>This is an observational study comprising of 40 CHC patients with ESRD on maintenance hemodialysis. All patients were treated with a fixed-dose combination of sofosbuvir and velpatasvir for 12 weeks in case of non-cirrhotic or compensated cirrhosis and 24 weeks in case of decompensated cirrhosis. The efficacy was assessed by sustained virological response defined by negative HCV RNA at 12 weeks (sustained virological response [SVR] 12) post treatment, and safety was assessed by recording any side-effects of all patients.</p></div><div><h3>Results</h3><p>Out of the 40 patients enrolled in our study, majority were non-cirrhotic (77%), and all were treatment-naive. The mean age was 49.87 ± 12.13 years, and 80% patients were male. The mean baseline HCV RNA was 2.61 ± 7.83 × 10<sup>6</sup> IU/ml. All the 40 patients (100%) achieved undetectable HCV RNA at the end of treatment; however, 39 patients (97.5%) achieved SVR 12. There was no significant deterioration of estimated glomerular filtration rate (eGFR) after completion of antiviral therapy as compared to the baseline eGFR (13.27 ± 10.32 vs13.54 ± 11.38, <em>P</em> = 0.54). None of the patients reported any serious adverse effects during treatment.</p></div><div><h3>Conclusion</h3><p>The fixed-dose combination of sofosbuvir and velpatasvir is effective and has showed excellent safety profile in patients of CHC with ESRD.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140187001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-29DOI: 10.1016/j.jceh.2024.101368
Ashok Choudhury , Satender P. Singh , Akhil Desmukh , Bishnupriya Sahoo , Mohammed Eslam
Non-alcoholic steatohepatitis (NASH) is the second most frequent cause of liver transplantation following alcoholic liver disease. With longer follow-up and increased survival rates, the occurrence rate of the metabolic syndrome is increasing with time among liver transplant recipients. Reappearances of non-alcoholic fatty liver disease after transplantation, both as recurring cases and new instances, are prevalent; nonetheless, the recurrence of fibrosis is minimal. Recognizing populations at elevated risk and enhancing the management of metabolic-related conditions are crucial for maintaining a healthy transplanted organ, particularly considering the prolonged utilization of immunosuppressive treatments. Furthermore, NASH-related cirrhosis patients who had transplant are at a greater risk of cardiovascular, renal events and increased incidence of cancer, necessitating a unique care strategy. This review discusses post-transplant metabolic syndrome, risk factors, pathogenesis, diagnosis, prevention strategy, recurrent and de novo NAFLD and customized immunosuppression.
{"title":"Post-Liver Transplant Metabolic Syndrome","authors":"Ashok Choudhury , Satender P. Singh , Akhil Desmukh , Bishnupriya Sahoo , Mohammed Eslam","doi":"10.1016/j.jceh.2024.101368","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101368","url":null,"abstract":"<div><p>Non-alcoholic steatohepatitis (NASH) is the second most frequent cause of liver transplantation following alcoholic liver disease. With longer follow-up and increased survival rates, the occurrence rate of the metabolic syndrome is increasing with time among liver transplant recipients. Reappearances of non-alcoholic fatty liver disease after transplantation, both as recurring cases and new instances, are prevalent; nonetheless, the recurrence of fibrosis is minimal. Recognizing populations at elevated risk and enhancing the management of metabolic-related conditions are crucial for maintaining a healthy transplanted organ, particularly considering the prolonged utilization of immunosuppressive treatments. Furthermore, NASH-related cirrhosis patients who had transplant are at a greater risk of cardiovascular, renal events and increased incidence of cancer, necessitating a unique care strategy. This review discusses post-transplant metabolic syndrome, risk factors, pathogenesis, diagnosis, prevention strategy, recurrent and <em>de novo</em> NAFLD and customized immunosuppression.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140180488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-27DOI: 10.1016/j.jceh.2024.101389
Kaleem Ullah, Sidhant Ochani, Hafiz B. Ahmad
This study presents a case of a living liver donor who developed a hepatitis E virus (HEV) infection postdonation, complicating his recovery. The donor was a 28-year-old male with no prior health issues who underwent a right lobe hepatectomy. Initially, his postoperative course was uneventful, but on the third postoperative day, he became lethargic and icteric. Laboratory tests showed elevated liver function markers, with peak levels on the 5th day. The HEV infection was confirmed through serological and polymerase chain reaction (PCR) testing. The donor was managed supportively and recovered, with normal liver function at discharge. Unfortunately, the recipient of the liver graft died on the 5th postoperative day due to sepsis, and the impact of HEV infection on the recipient could not be fully assessed due to the complicating factors. This case highlights the importance of considering HEV infection in donors with abnormal postoperative liver functions, especially in regions with high HEV prevalence, and suggests the potential benefit of HEV vaccination for liver donors. Further research is needed to better understand and manage HEV infection in the context of liver donation.
本研究介绍了一例活体肝脏捐献者,他在捐献后感染了戊型肝炎病毒(HEV),这使他的康复变得更加复杂。捐献者是一名 28 岁的男性,之前没有任何健康问题,接受了右叶肝切除术。最初,他的术后过程并无大碍,但在术后第三天,他开始嗜睡并出现黄疸。实验室检查显示肝功能指标升高,第 5 天达到峰值。通过血清学和聚合酶链反应(PCR)检测证实了 HEV 感染。捐献者经过支持性治疗后康复出院,出院时肝功能正常。不幸的是,肝脏移植的受体在术后第 5 天因败血症死亡,由于并发症因素,无法全面评估 HEV 感染对受体的影响。本病例强调了在术后肝功能异常的供体中考虑 HEV 感染的重要性,尤其是在 HEV 感染率较高的地区,并提示了肝脏供体接种 HEV 疫苗的潜在益处。要更好地了解和处理肝脏捐献中的 HEV 感染,还需要进一步的研究。
{"title":"Acute Viral Hepatitis E Infection Complicating Postliving Liver Donor Hepatectomy Recovery","authors":"Kaleem Ullah, Sidhant Ochani, Hafiz B. Ahmad","doi":"10.1016/j.jceh.2024.101389","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101389","url":null,"abstract":"<div><p>This study presents a case of a living liver donor who developed a hepatitis E virus (HEV) infection postdonation, complicating his recovery. The donor was a 28-year-old male with no prior health issues who underwent a right lobe hepatectomy. Initially, his postoperative course was uneventful, but on the third postoperative day, he became lethargic and icteric. Laboratory tests showed elevated liver function markers, with peak levels on the 5th day. The HEV infection was confirmed through serological and polymerase chain reaction (PCR) testing. The donor was managed supportively and recovered, with normal liver function at discharge. Unfortunately, the recipient of the liver graft died on the 5th postoperative day due to sepsis, and the impact of HEV infection on the recipient could not be fully assessed due to the complicating factors. This case highlights the importance of considering HEV infection in donors with abnormal postoperative liver functions, especially in regions with high HEV prevalence, and suggests the potential benefit of HEV vaccination for liver donors. Further research is needed to better understand and manage HEV infection in the context of liver donation.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140113847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Most chronic medical illnesses are associated with significant psychiatric comorbidity, especially in the form of depression, anxiety, and suicidality. Chronic liver disease (CLD) is no exception to this and rather is placed uniquely as compared to other diseases because of its intersection with alcohol use disorder and other substance use, which in itself is a mental illness. Patients with CLD may have comorbid psychiatric illnesses; the pharmacokinetic concerns arising out of hepatic dysfunction which affects pharmacotherapy for depression and vice versa. The high prevalence of medical comorbidities with CLD may further complicate the course and outcome of depression in such patients, and diagnostic and management issues arise from special situations like transplant evaluation, alcohol use disorder, and hepatic encephalopathy or multifactorial encephalopathy seen in a disoriented or agitated patient with CLD. For this narrative review, we carried out a literature search in PubMed/PubMed Central and in Google Scholar (1980–2023) with the keywords “depression in cirrhosis”, “antidepressants in liver disease”, “anxiety in liver disease”, “depression in liver transplantation”, and “drug interactions with antidepressants”. This review presents a comprehensive view of the available research on the use of antidepressants in patients with CLD, including deciding to use them, choosing the right antidepressant, risks, drug interactions, and adverse reactions to expect, and managing the same. In addition, liver transplant fitness and the overlap of hepatic encephalopathy with neuropsychiatric illness will be discussed.
大多数慢性内科疾病都与严重的精神并发症有关,尤其是抑郁、焦虑和自杀。慢性肝病(CLD)也不例外,与其他疾病相比,慢性肝病具有独特性,因为它与酒精使用障碍和其他药物使用有交叉,而酒精使用障碍和其他药物使用本身就是一种精神疾病。CLD 患者可能合并有精神疾病;肝功能障碍引起的药代动力学问题会影响抑郁症的药物治疗,反之亦然。CLD患者合并内科疾病的高发率可能会使这类患者的抑郁过程和结果更加复杂,而特殊情况下的诊断和管理问题也会随之而来,如移植评估、酒精使用障碍、肝性脑病或多因素脑病等,这些都会在神志不清或躁动不安的CLD患者身上出现。为了撰写这篇叙事性综述,我们在 PubMed/PubMed Central 和 Google Scholar 中进行了文献检索(1980-2023 年),关键词为 "肝硬化中的抑郁"、"肝病中的抗抑郁药"、"肝病中的焦虑"、"肝移植中的抑郁 "和 "抗抑郁药的药物相互作用"。这篇综述全面介绍了关于在慢性肝病患者中使用抗抑郁药的现有研究,包括决定使用抗抑郁药、选择合适的抗抑郁药、风险、药物相互作用、预期的不良反应以及处理这些不良反应。此外,还将讨论肝移植适应症以及肝性脑病与神经精神疾病的重叠问题。
{"title":"Antidepressants in People With Chronic Liver Disease and Depression: When Are They Warranted and How to Choose the Suitable One?","authors":"Swapnajeet Sahoo , Eepsita Mishra , Madhumita Premkumar","doi":"10.1016/j.jceh.2024.101390","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101390","url":null,"abstract":"<div><p>Most chronic medical illnesses are associated with significant psychiatric comorbidity, especially in the form of depression, anxiety, and suicidality. Chronic liver disease (CLD) is no exception to this and rather is placed uniquely as compared to other diseases because of its intersection with alcohol use disorder and other substance use, which in itself is a mental illness. Patients with CLD may have comorbid psychiatric illnesses; the pharmacokinetic concerns arising out of hepatic dysfunction which affects pharmacotherapy for depression and vice versa. The high prevalence of medical comorbidities with CLD may further complicate the course and outcome of depression in such patients, and diagnostic and management issues arise from special situations like transplant evaluation, alcohol use disorder, and hepatic encephalopathy or multifactorial encephalopathy seen in a disoriented or agitated patient with CLD. For this narrative review, we carried out a literature search in PubMed/PubMed Central and in Google Scholar (1980–2023) with the keywords “depression in cirrhosis”, “antidepressants in liver disease”, “anxiety in liver disease”, “depression in liver transplantation”, and “drug interactions with antidepressants”. This review presents a comprehensive view of the available research on the use of antidepressants in patients with CLD, including deciding to use them, choosing the right antidepressant, risks, drug interactions, and adverse reactions to expect, and managing the same. In addition, liver transplant fitness and the overlap of hepatic encephalopathy with neuropsychiatric illness will be discussed.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140113846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-27DOI: 10.1016/j.jceh.2024.101388
Soe T. Maung , Pakanat Decharatanachart , Sombat Treeprasertsuk , Roongruedee Chaiteerakij
Background and aims
Chronic viral hepatitis B (CHB)-infected patients occasionally develop cirrhosis despite having persistent viral suppression with antiviral therapy. We aimed to identify risk factors for developing cirrhosis in hepatitis B virus (HBV)-suppressed patients.
Methods
We conducted a case–control study involving 120 noncirrhotic CHB-infected patients achieving viral suppression with antiviral treatment, with 40 cases developing cirrhosis and 80 age-, sex-, and Fibrosis-4 (FIB-4)-matched controls. Clinical and laboratory data at viral suppression, including body mass index (BMI), comorbidities, pretreatment HBV viral load, HBe antigen status, hepatitis C virus (HCV) and HIV coinfections, liver chemistries, and AST to Platelets Ratio Index (APRI) values, were retrospectively abstracted. Risk factors for cirrhosis post-HBV suppression were identified using Cox proportional hazard analysis.
Results
Case and control groups had similar ages (51.4 ± 9.9 vs. 51.4 ± 10.2 years), proportions of males (80% vs. 80%), and FIB-4 values (1.32 vs. 1.31). The cirrhosis group showed significantly higher BMI (25.1 vs. 22.7, P = 0.01) and more diabetes prevalence (50.0% vs. 26.3%, P = 0.01), while other comorbidities and laboratory parameters were comparable (P > 0.05). By univariate analysis, BMI >23 kg/m2, diabetes, and APRI >0.7 were significantly associated with cirrhosis, with hazard ratios (HRs) (95%CI) of 2.99 (1.46–6.13), 2.31 (1.23–4.36), and 2.71 (1.05–6.99), P = 0.003, 0.010, and 0.039, respectively. In multivariate analyses adjusted for APRI, BMI>23 kg/m2 remained significantly associated with cirrhosis (aHR: 2.76, P = 0.006), while diabetes showed borderline significance (aHR: 1.99, P = 0.072).
Conclusions
In HBV-infected patients achieving viral suppression with therapy, a BMI >23 kg/m2 increases the risk of cirrhosis. Therefore, a comprehensive approach addressing metabolic factors is imperative for preventing disease progression in HBV-infected patients.
{"title":"Risk Factors for Development of Cirrhosis in Chronic Viral Hepatitis B Patients Who Had Persistent Viral Suppression With Antiviral Therapy","authors":"Soe T. Maung , Pakanat Decharatanachart , Sombat Treeprasertsuk , Roongruedee Chaiteerakij","doi":"10.1016/j.jceh.2024.101388","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101388","url":null,"abstract":"<div><h3>Background and aims</h3><p>Chronic viral hepatitis B (CHB)-infected patients occasionally develop cirrhosis despite having persistent viral suppression with antiviral therapy. We aimed to identify risk factors for developing cirrhosis in hepatitis B virus (HBV)-suppressed patients.</p></div><div><h3>Methods</h3><p>We conducted a case–control study involving 120 noncirrhotic CHB-infected patients achieving viral suppression with antiviral treatment, with 40 cases developing cirrhosis and 80 age-, sex-, and Fibrosis-4 (FIB-4)-matched controls. Clinical and laboratory data at viral suppression, including body mass index (BMI), comorbidities, pretreatment HBV viral load, HBe antigen status, hepatitis C virus (HCV) and HIV coinfections, liver chemistries, and AST to Platelets Ratio Index (APRI) values, were retrospectively abstracted. Risk factors for cirrhosis post-HBV suppression were identified using Cox proportional hazard analysis.</p></div><div><h3>Results</h3><p>Case and control groups had similar ages (51.4 ± 9.9 vs. 51.4 ± 10.2 years), proportions of males (80% vs. 80%), and FIB-4 values (1.32 vs. 1.31). The cirrhosis group showed significantly higher BMI (25.1 vs. 22.7, <em>P</em> = 0.01) and more diabetes prevalence (50.0% vs. 26.3%, <em>P</em> = 0.01), while other comorbidities and laboratory parameters were comparable (<em>P</em> > 0.05). By univariate analysis, BMI >23 kg/m2, diabetes, and APRI >0.7 were significantly associated with cirrhosis, with hazard ratios (HRs) (95%CI) of 2.99 (1.46–6.13), 2.31 (1.23–4.36), and 2.71 (1.05–6.99), <em>P</em> = 0.003, 0.010, and 0.039, respectively. In multivariate analyses adjusted for APRI, BMI>23 kg/m<sup>2</sup> remained significantly associated with cirrhosis (aHR: 2.76, <em>P</em> = 0.006), while diabetes showed borderline significance (aHR: 1.99, <em>P</em> = 0.072).</p></div><div><h3>Conclusions</h3><p>In HBV-infected patients achieving viral suppression with therapy, a BMI >23 kg/m<sup>2</sup> increases the risk of cirrhosis. Therefore, a comprehensive approach addressing metabolic factors is imperative for preventing disease progression in HBV-infected patients.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140134086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-24DOI: 10.1016/j.jceh.2024.101387
Lipika Lipi , Narendra S. Choudhary , Swapnil Dhampalwar , Abhishek Kathuria , Neeraj Saraf , Arvinder S. Soin
A 44-year-old male had persistent hypoalbuminemia and ascites after liver transplantation. Imaging of the liver and gastrointestinal system was normal. Urine examination was negative for proteinuria. A diagnosis of protein-losing enteropathy was suspected, and a duodenal biopsy was done. Duodenal biopsy was positive for cytomegalovirus (CMV). The patient improved with CMV treatment.
{"title":"Cytomegalovirus Duodenitis Causing Persistent Hypoalbuminemia and Ascites After Liver Transplantation","authors":"Lipika Lipi , Narendra S. Choudhary , Swapnil Dhampalwar , Abhishek Kathuria , Neeraj Saraf , Arvinder S. Soin","doi":"10.1016/j.jceh.2024.101387","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101387","url":null,"abstract":"<div><p>A 44-year-old male had persistent hypoalbuminemia and ascites after liver transplantation. Imaging of the liver and gastrointestinal system was normal. Urine examination was negative for proteinuria. A diagnosis of protein-losing enteropathy was suspected, and a duodenal biopsy was done. Duodenal biopsy was positive for cytomegalovirus (CMV). The patient improved with CMV treatment.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140062770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}