Hepatology Forum最新文献

Background and aim: This study aimed to define the relapse frequency and risk determinants in chronic hepatitis B (CHB) patients who discontinued nucleoside analog (NA) treatment, were HBeAg-negative, and had achieved both a virological and biochemical response.

Materials and methods: This retrospective cohort study reviewed patients with HBeAg-negative CHB who received antiviral therapy for at least 65 months between January 1, 2013, and December 31, 2020. These patients discontinued treatment after demonstrating a biochemical and virological response and were evaluated at 6, 12, and 24 months post-treatment discontinuation.

Results: Sixty-seven patients with CHB who received NA therapy for at least 65 months, discontinued treatment, and had undetectable HBV DNA and normal ALT values were evaluated. After cessation of NA therapy, a relapse was observed in 38 patients (56.7%). The relapse rate was 71.0% in patients treated with tenofovir disoproxil fumarate (TDF) as the last NA type and 37.9% in patients treated with entecavir (ETV) (p=0.017). The cutoff value for the best estimate of age for predicting relapse was 42 years. The relapse rate was 69.2% in patients aged ≥42 years and 39.2% in patients aged <42 years (p=0.007). The relapse rate was 51.3% in patients with a pre-treatment fibrosis score of 2, 56.0% in those with a fibrosis score of 3, and 100% in those with a fibrosis score of 4 (p=0.089).

Conclusion: Among HBeAg-negative CHB patients who achieved a virological and biochemical response to long-term antiviral therapy, those aged 42 years and older, those with high fibrosis scores before treatment, and those who used TDF before treatment cessation should be closely monitored for relapse, especially in the first 12 months after stopping NA treatment.

Background and aim: The objectives of the study were to present the hemostatic effect of hydroalcoholic extract of Achillea millefolium L. in localized bleeding and to evaluate the safety of this plant after topical usage in rat's liver.

Materials and methods: The aerial parts of this plant were macerated for 2 days using methanol. After anesthesia and laparotomy of 12 female Wistar rats (120-220 g), the liver was exposed and two incisions were performed for bleeding. One was packed by sponge with A. millefolium and another without A. millefolium as a control group. Animals were divided into two groups that A. millefolium (150 mg/kg) was used in the first incision for one group and in the second incision for another. Liver biopsy was taken after 4, 6, and 8 weeks.

Results: We observed that usage of A. millefolium for liver incisions, either in the first incision or in the second incision; bleeding time decreases significantly (36.1% and 31.9%, respectively). Histopathological evaluations revealed no signs of toxic and hepatic damage for periods 4, 6, and 8 weeks in the female rats.

Conclusion: This study confirmed the hemostatic effect of hydroalcoholic extract of A. millefolium in localized bleeding and also the safety of this plant for topical usage.

Background and aim: Patients with hepatocellular carcinoma (HCC) are managed in various hospital departments, which complicates the assessment of the overall picture. In our large liver transplant institute, we evaluate all HCC patients in a weekly multi-disciplinary liver tumor board, and their data are prospectively collected in an institutional HCC database to evaluate HCC causes, tumor features, treatments, and survival.

Materials and methods: Baseline data for patients (n=1322) were prospectively recorded, including hepatitis status, routine clinical serum parameters, radiological assessment of maximum tumor diameter (MTD), tumor number, presence of macroscopic portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP) levels.

Results: Cirrhosis was found in 81.1% of patients; 58.5% had hepatitis B virus (HBV), 14.9% hepatitis C virus (HCV), 8.9% cryptogenic cirrhosis, and less than 2% had alcoholism. MTD was <5 cm in 61.95% of patients, and 31.9% had PVT. The median overall survival was more than six-fold greater for the 444 liver transplant patients than for those without surgery. Transplanted patients had smaller tumors, whereas larger tumors (MTD >10 cm) were primarily in the no-surgery group. Parallel differences were found for AFP levels (highest in the no-surgery group). PVT was present in similar proportions (25.0% for transplant, 28.0% for no-surgery). The presence of cirrhosis was higher in the transplant group. MTD and levels of serum AFP, gamma-glutamyl transferase (GGT), and blood platelets were prognostic parameters for transplant. Furthermore, AFP and GGT levels were prognostic for transplanted PVT patients. Only albumin was prognostic in the no-surgery patients.

Conclusion: Transplanted HCC patients have longer survival, smaller tumors, and more severe liver damage than no-surgery patients. Prognostic subsets were identified within the surgery and the PVT groups.

Riedel's lobe of the liver is a rare anatomical variant often incidentally found on imaging or through the presence of hepatomegaly on physical examination. While patients are usually asymptomatic, the presentation of this condition can vary, ranging from nonspecific symptoms to more severe issues such as torsion, obstruction, rupture, and bleeding. We present a case of a patient with asymptomatic hepatomegaly who was incidentally found to have Riedel's lobe of the liver, accompanied by an elevated IgG mitochondrial antibody. The range of symptoms associated with this rare anatomical variation underscores its importance in diagnosis and surveillance within this patient population.

Echinococcus granulosus is predominantly found in the liver and can be effectively managed through antihelminthic therapy, surgical intervention, or interventional radiology. Percutaneous treatment (PT) has gained widespread popularity due to its minimally invasive nature. An integral step in surgical and PT procedures involves the utilization of protoscolicidal agents to eliminate the parasites. However, the administration of protoscolicidal agents carries the risk of inducing caustic sclerosing cholangitis (SC) if there is a communication between the cyst and the biliary tract. In this pioneering study, we present two cases of caustic SC that occurred subsequent to PT for hydatid liver, necessitating further progression of the disease and ultimately leading to liver transplantation.

Background and aim: Several tumor and non-tumor factors affect the prognosis of hepatocellular carcinoma (HCC) patients. This study aimed to investigate the effects of hepatitis B virus (HBV) viral load on tumor and non-tumor factors in patients with HBV-associated HCC.

Materials and methods: Patients with hepatitis B and HCC who presented to the HCC council at the Faculty of Medicine, Marmara University Liver Transplantation Institute, were included in our study. Patients were divided into two groups according to the presence or absence of HBV-DNA, and it was determined whether there were differences between these two groups with respect to tumor and non-tumor parameters.

Results: Comparison of serum alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), hepatitis B surface antigen (HBsAg), and C-reactive protein (CRP) levels between HBV-DNA negative and positive patients showed significant differences (respectively p<0.01, p<0.01, p<0.05, and p<0.05). A major finding was a very significant difference between the two patient groups in terms of portal vein invasion (PVI) and venous invasion (p<0.001 and p<0.01, respectively). However, there was no significant difference in metastasis or lymph node involvement between HBV-DNA negative and positive patients.

Conclusion: Our findings suggest that HBV viral load plays an important role in PVI in HCC patients, and there is a significant relationship between HBV viral load and inflammation.

Background and aim: To investigate the relationship between ultrasonography (US) and magnetic resonance (MR) proton density fat fraction (PDFF) techniques, using the modified DIXON method, in determining the severity of liver steatosis.

Materials and methods: This study included seventy consecutive patients who underwent upper abdominal MRI for various reasons between June 2016 and January 2017. Fatty liver staging was performed using US as indicated.The liver fat percentage was measured and staged according to PDFF values.

Results: In the study, of the 70 cases, 36 were male and 34 were female. On US, 18.5% of the cases had stage 0, 32.8% had stage 1, 42.8% had stage 2, and 5.7% had stage 3 liver steatosis. A significant correlation was found between ultrasonographic evaluation and PDFF in determining the percentage of liver fat (r=0.775, p<0.001). When comparing the percentages, MR-evaluated PDFF and ultrasonographic staging were most compatible at grade 3 and least compatible at grade 2. When the PDFF threshold value was set at 8.1%, the sensitivity of US in distinguishing between obvious and indistinct steatosis was 97.1%, and the specificity was 88.9%.

Conclusion: Ultrasound continues to be a useful tool for detecting fatty liver disease. However, magnetic resonance (MR) proton density fat fraction (PDFF) imaging is essential for accurately determining the severity and prevalence of steatosis. Our study revealed inconsistencies between US and MR PDFF in grading liver steatosis, showing higher agreement in severe cases and lower agreement in moderate cases. Therefore, we recommend classifying steatosis as either uncertain or apparent rather than using a grading system in US.

Background and aim: Alpha-fetoprotein (AFP), an oncofetal protein and biomarker in hepatocellular carcinoma (HCC), has unclear roles and actions.To evaluate the relationships between AFP, liver function tests, and HCC aggressiveness.

Materials and methods: A retrospective analysis of an HCC patient database was conducted to examine the relationships between baseline serum AFP values, liver function tests, and tumor characteristics.

Results: Statistically significant positive trends were observed between AFP levels and both AST and bilirubin, along with negative trends between AFP and albumin. Significant correlations were also found between AFP and MTD, multifocality, and PVT. Increases in MTD, multifocality, and PVT were noted even at low AFP levels, indicating both AFP-independent and AFP-dependent processes. However, these parameter changes were minimal compared to the substantial changes in AFP levels. Relationships between AFP-related liver and tumor characteristics were found to be similar but inverse to those for albumin, with normal albumin levels associated with more favorable tumor characteristics. Additionally, serum levels of albumin and AFP were inversely related.

Conclusion: AFP and albumin levels significantly, but inversely, correlate with tumor parameters, suggesting that albumin may suppress HCC functions and could serve as a potential prognostic marker.

Background and aim: The prevalence of fibrosis and steatosis in patients with psoriasis, as determined by vibration-controlled transient elastography (VCTE), has not been evaluated in Turkiye to date. The present cross-sectional study aims to present the first systematic screening results, focusing on two primary objectives: 1) establishing the prevalence of fibrosis and steatosis, and 2) identifying independent predictors for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) values in this patient population.

Materials and methods: Patients were eligible for inclusion if they had a confirmed diagnosis of psoriasis by a qualified dermatologist based on characteristic signs and symptoms and histopathological examination, and had undergone VCTE for LSM and CAP measurements.

Results: The diagnosis of severe fibrosis and cirrhosis - identified by LSM values of 10.0-13.9 and ≥14.0 kPa, respectively - was significantly prevalent (7.0% and 10.1%, respectively) among a sizeable cohort of relatively young Turkish patients with psoriasis (n=328; mean age: 49.5±12.7 years). Additionally, severe steatosis, as diagnosed by VCTE and characterized by a CAP value exceeding 290 dB/m, was identified in up to 43.3% of patients. Although body mass index (BMI) was the only variable found to be an independently associated with LSM, multivariable linear regression analysis failed to identify any statistically independent predictor of CAP values.

Conclusion: The prevalence of hepatic fibrosis and steatosis in Turkish patients with psoriasis is far from negligible, with BMI identified as an independent risk factor for fibrosis.