Hepatology Forum最新文献

Primary Biliary Cholangitis (PBC) is a chronic cholestatic liver disease that can lead to cirrhosis and the development of hepatocellular carcinoma. PBC is not known to be associated with hepatic angiosarcoma. Second-line treatments for PBC, including obeticholic acid, have had less than a decade of clinical use. We present a case of a patient with PBC treated with obeticholic acid who subsequently developed hepatic angiosarcoma. The patient is now on active surveillance following resection of the angiosarcoma. The development of this rare and aggressive cancer should prompt closer post-marketing surveillance for obeticholic acid.

Background and aim: Hydatid cysts are caused by Echinococcus larvae and are prevalent in endemic areas worldwide. We analyzed post-procedure complications and outcomes of patients with liver hydatid cysts.

Materials and methods: We included patients who were managed either by surgery or percutaneous drainage (PAIR) for hydatid liver cysts at Harran University Faculty of Medicine Hospital between January 2017 and February 2021. We recorded age, sex, segmental location, size, number, Gharbi classification, treatment modality, length of hospital stays, and complications.

Results: We included a total of 209 patients who were managed by hydatid liver cysts. Among them, 74 post-procedural complications were developed in a total of 69 (33%) patients. Biliary fistula was the most prevalent complication (n=38,18.2%). Hospitalization duration was a median of 5 days (2-36) and was 5 days (2-36) in patients who underwent surgery and 3 days (range:2-7) in patients managed by PAIR. Patients with cyst diameter ≥9.5 cm were predicted to have an increased risk of complications with 70% sensitivity and 60% specificity. More patients experienced any difficulties in patients who were managed by PAIR than those who underwent surgery (65.4% vs 28.4%, p<0.001).

Conclusion: Our study showed that both surgery and PAIR are safe and effective management strategies for patients with liver cyst hydatid. PAIR was associated with more complications but a shorter duration of hospitalization.

Background and aim: The primary aim of this study was to investigate the concordance of Transient Elastography FibroScan^® (FS) measurements, Fibrosis-4 (FIB-4), and the Aspartate Aminotransferase to Platelet Ratio Index (APRI) scores with each other and with liver biopsies in predicting histological fibrosis.

Materials and methods: In this single-center, cross-sectional, retrospective collected data cohort study spanning seven consecutive years, simultaneous FS measurements, FIB-4, and APRI scores of 778 patients with different diagnoses who had undergone liver biopsy were evaluated.

Results: A total of 417 (53.6%) of the patients were female. The median age was 51 years. The diagnoses were HBV (n=228), metabolic dysfunction-associated steatotic liver disease (MASLD) (n=185), HCV (n=58), cryptogenic (n=53), primary biliary cholangitis (n=40), autoimmune hepatitis (AIH) (n=28), overlap syndrome (OS) (n=23), multiple diagnoses (n=42), and other diagnoses (n=83). All three methods showed a strong correlation with histological fibrosis, and FS demonstrated a statistically significantly superior relationship compared to FIB-4 and APRI. In AIH and OS, FIB-4 and APRI scores do not show a consistent increase with histological stage; however, FS does. In MASLD, all three methods correlate with histologic stage, but FS measurements appear significantly superior.

Conclusion: Although FIB-4, APRI, and FS correlate well with histological fibrosis, especially in MASLD, evaluation with FS, if available, should be preferred. In the evaluation of fibrosis in AIH and OS, laboratory-based indicators should be avoided.

Background and aim: Liver transplantat (LT) is still associated with a significant need for blood product transfusion. This study aimed to identify preoperative factors that can predict the need for platelet transfusion in adults undergoing LT.

Materials and methods: A retrospective analysis of the database from liver transplant recipients was performed to evaluate the use of platelet transfusion during and after LT. Two groups of recipients were assigned, with or without perioperative platelet transfusion (groups A and B, respectively). Preoperative LT recipient variables such as age, gender, body mass index, pre-transplant laboratory tests, cause of liver transplant, the Model for End-Stage Liver Disease score, and other selected perioperative variables, including surgical data, were compared between the two groups.

Results: Of 150 patients, 70 who received platelet transfusions were included in group A. Regarding the preoperative recipient variables, the two groups showed significant differences in the Model for End-Stage Liver Disease score (p=0.013), pre-transplant platelet count (p<0.001), and international normalized ratio (p<0.001). The results of logistic regression analysis showed that pre-transplant platelet count <50×10⁹/L (odds ratio, 0.979; 95% confidence interval [0.969-0.989]; p<0.001), serum creatinine ≥123.76 µmol/L (1.4 mg/dL) (OR, 4.35; 95% CI [1.566-12.097]; p=0.005), international normalized ratio ≥1.5 (OR, 2.771; 95% CI [1.198-6.412]; p=0.017) were identified as predictors for the use of platelet transfusion in LT.

Conclusion: Pre-liver transplant recipients' platelet count, serum creatinine, and international standardized ratio are crucial in predicting platelet utilization during and after LT.

Background and aim: Ataxia-telangiectasia (AT) and ataxia-oculomotor apraxia type 2 (AOA2) are both autosomal recessive cerebellar ataxias characterized by elevated serum alpha-fetoprotein (AFP) levels. However, the source and clinical implications of this increase, as well as its relationship with liver diseases are unknown. In this study, we investigated the frequency of liver diseases and their relationship with high AFP in patients with AT and AOA2.

Materials and methods: The study involved 19 adult patients (13 patients with AT and 6 patients with AOA2) who were followed between January 1992 and March 2023. The demographic and clinical characteristics, serum levels of liver enzymes and AFP, liver imaging, and survival data were retrospectively reviewed.

Results: The mean age of patients was 26.8±5.1 years (11 men and 8 women).While 69% (9/13) of AT patients had elevated liver enzymes and 56% (5/9) had abnormal liver imaging, both were normal in all AOA2 patients.Liver enzyme elevation was associated with the presence of comorbid disease (p=0.007), but not with AFP level (p=0.33) in AT patients. Hepatosteatosis was not associated neither with comorbidity (p=0.524) nor AFP level (p=0.905) in this group. During a median follow-up of 17 (1-29) years, 5 AT patients passed away due to cancer (4 patients) and sepsis (1 patient). AFP level was not associated with the occurrence of cancer (p=0.382).

Conclusion: This study found a high prevalence of liver disease (69%) in AT, unlike in AOA, independent of AFP levels. Since comorbid diseases, especially cancer, were associated with elevated liver enzymes, adult AT patients with abnormal liver functions should be screened for the development of cancers.

Background and aim: The purpose of this research was to ascertain how exposure to extremely low-frequency pulsed electromagnetic fields (ELF-PEMFs) at varying intensities affects apoptosis-related protein expression levels and liver morphology in rats.

Materials and methods: In this experimental study, 40 Wistar albino rats were randomly divided into 4 groups, with 10 animals in each group: Control, Sham, 1 milli Tesla (1mT), and 5 mT groups. The control group did not expose any application during the experiment. Animals in the sham group were placed into the closed ELF-PEMF exposure environment, but the device was kept closed. The rats in the 1mT and 5mT groups were placed into a closed ELF-PEMF exposure environment, and the magnetic field application was applied 5 days a week for 4 hours a day for 8 weeks. At the end of the study, the animals were sacrificed, and their liver tissues were examined morphologically, and the expression levels of proteins related to apoptosis and inflammation in these tissues were analyzed.

Results: Our results indicated that ELF-PEMFs did not lead to any exact morphological alterations in the groups. Tissue apoptotic Bax and Caspase 3 expression levels in the 1mT and 5mT groups were similar (p>0.05) to the control group. Additionally, pro-inflammatory TNF-α and transcription factor NF-κB in the 1mT and 5mT groups were similar (p>0.05) to each other and the control group.

Conclusion: It is feasible to conclude that neither the administration nor the exposure design of this study is changing the immunoexpression of apoptosis-regulating protein expression levels or liver morphology exposed to ELF-PEMF in rats.

Yersinia pseudotuberculosis is a rare pathogenic organism in humans and is encountered mostly in patients with acquired or hereditary iron overload. This case report presents such a case with no known risk factors for iron overload, except heterozygous mutations in MPEG1 and HFE genes, while presenting the first patient with Y. pseudotuberculosis liver abscess in Turkiye. Here we present a 63-years-old male with known long-standing hypertension, type 2 diabetes, peripheral artery disease and chronic kidney disease presenting with right upper quadrant pain, nausea, vomiting and fever, whose imaging studies revealed multiple liver abscesses. While investigating the etiology, Yersinia pseudotuberculosis growth was observed in his abscess aspiration material and blood culture. Genetic analysis conducted after the detection of a ferritin level of 13725 µg/L, showed a heterozygous H63D mutation in HFE. Consequent whole-exon-sequencing reported an additional heterozygous p. Thr73Ala mutation in MPEG1. Even though, Y. pseudotuberculosis is detected mostly in patients with primary hemochromatosis, even heterozygous carriers of hemochromatosis may present clinically if concomitant comorbidities exist and may pose a challenge not only to clinicians but also to laboratory diagnosticians.

Background and aim: To investigate the correlation of the functional liver imaging scores (FLIS) and the scoring system in hepatocellular carcinoma (HCC) patients.

Materials and methods: Between April 2015 and December 2022, the HCC patients who underwent gadoxetic acid-enhanced MRI were analyzed. Three parameters on hepatobiliary phase images were evaluated for FLIS: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. The correlation between Child-Turcotte-Pugh (CTP) classification, the albumin-bilirubin (ALBI) grade, and Fibrosis-4 (F-4) score, and FLIS were analyzed. Receiver operating characteristic curve analysis was performed to demonstrate the cut-off value of FLIS for differentiating between CTP classification and ALBI grade.

Results: We retrospectively analyzed 178 HCC patients (144 men, 34 women; mean age, 65.9 years). A moderate negative correlation was present between CTP classification and ALBI grade, and FLIS (r=-0.596 and r=-0.513, respectively). FLIS ≤3 was determined as the most optimal criterion for differentiating CTP A or B patients from CTP C patients.

Conclusion: This study showed that the FLIS is a simple, non-invasive imaging marker for the assessment of liver function in HCC patients.

Background and aim: Biliary strictures can occur as a result of various benign or malignant processes. The aim of this study is to evaluate the effectiveness and reliability of percutaneous endobiliary brush biopsy in the diagnosis of intrabiliary lesions.

Materials and methods: This retrospective, single-center study was conducted between January 2022 and April 2023, involving a total of 16 patients. Of the patients, 10 were male (62.5%), and 6 were female (37.5%). The average age of the patients was 68.1±8. All patients underwent the procedure using an endobiliary biopsy brush under ultrasound and fluoroscopic guidance.

Results: Technical success was achieved in all patients (100%). Cell detection was not observed in biopsy samples from 2 patients (12.5%), resulting in a diagnostic success rate of 87.5%. Access was made to the right biliary system in 14 patients (87.5%) and to the left biliary system in 2 patients (12.5%). Biopsy locations included the common bile duct in 12 patients (75%), hepatic hilum in 2 patients (12.5%), and bilioenteric anastomosis line in 2 patients (12.5%). The mean fluoroscopy time was 16.2±7.1 minutes. The average radiation dose was 660±370 mSv. Pathological diagnosis revealed malignancy in 8 patients (50%) and benign findings in 6 patients (37.5%). Liver abscess requiring drainage developed in 2 patients (12.5%).

Conclusion: Percutaneous endobiliary brush biopsy performed under imaging guidance is an effective and reliable method for the diagnosis of biliary lesions.

Drug-induced liver injury (DILI) is caused by various medications or herbals/nutritional supplements resulting in liver test abnormalities or hepatic dysfunction. DILI can be categorized as direct (intrinsic), idiosyncratic, or immune-mediated (indirect), and patterns of injury can be categorized as hepatocellular, cholestatic, or mixed injury. DILI is diagnosed after excluding other causes of liver injury. Cessation of the suspected drug along with supportive care is recommended for most DILI cases. In life-threatening situations, liver transplantation (LT) can be considered; however, the risks with LT and lifelong immunosuppression should be considered. In this paper, we summarize the pathophysiology, diagnosis, medical management, and LT for DILI.