Annals of hepatology最新文献

{"title":"P-36 THE PROGNOSTIC ROLE OF NEUTROPHIL-LYMPHOCYTE RATIO IN PATIENTS WITH ALCOHOLIC HEPATITIS","authors":"Moises Coutiño Flores ,&nbsp;Jesús Ignacio Mazadiego Cid ,&nbsp;Katy Alejandra Sanchez Pozos ,&nbsp;Rogelio Zapata Arenas ,&nbsp;Antonio Coutiño Flores ,&nbsp;Maria Del Rosario Herrero Maceda ,&nbsp;Scherezada Maria Isabel Mejia Loza","doi":"10.1016/j.aohep.2024.101650","DOIUrl":"10.1016/j.aohep.2024.101650","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>The neutrophil-lymphocyte ratio (NLR) has been used as a predictor of survival in critically ill patients. However, there are scarce studies that evaluate the relationship between NLR and alcoholic hepatitis.</div><div>To determine the association between NLR with mortality and the degree of acute-on-chronic liver failure (ACLF).</div></div><div><h3>Patients / Materials and Methods</h3><div>Longitudinal, retrospective, observational and descriptive cohort study of a hospital center. The subjects met criteria for alcohol hepatitis established by the National Institute on Alcohol Abuse and Alcoholism. Patients with concomitant infections or conditions that could alter the NLR were excluded.</div><div>Statistical analysis was performed with the SPSS version 26 program. To compare clinical values, Student's T-test or Mann Whitney U test were performed according to the distribution of the data. The association analysis between NLR and 30-day mortality, as well as the association between NLR and ACLF degrees, were carried out using a point-biserial correlation. Cohen's d test was performed to determine the effect size.</div></div><div><h3>Results and Discussion</h3><div>This study included 58 patients with alcoholic hepatis (98% men). There was significant difference between patients who died within 28 days compared with those who survived (Table 1). The mean NLR value in patients who survived was approximately three times the value presented in patients who died within 28 days (p &lt; 0.001). A gradual increase in severity-dependent NLR was identified based on the CLIF-C ACLF SCORE.</div><div>In addition, significant associations between NLR and 28-day mortality (p &lt; 0.001), and between NLR and the degree of ACLF (p &lt; 0.001) were found. According to Cohen's test, the effect size of the NLR was moderate (0.678).</div></div><div><h3>Conclusions</h3><div>The association between high NLR levels and mortality within 28 days is confirmed. Furthermore, there is an association between NLR and the severity of ACLF. Therefore, the NLR could be a useful prognostic factor in the clinical practice for alcoholic hepatitis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101650"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-44 LONG-TERM SURVIVAL IN PATIENTS WITH LIVER TRANSPLANTATION","authors":"MARCIA SAMADA SUAREZ ,&nbsp;Sheyla Moret Vara ,&nbsp;Kenia Valenzuela Aguilera ,&nbsp;Julio César Hernández Perera ,&nbsp;Alejandro Roque Valdez ,&nbsp;Norlan Bressler Hernández ,&nbsp;Raimundo Blanco Selles ,&nbsp;Maricet Fernández Díaz ,&nbsp;Harlim Rodríguez Rodríguez ,&nbsp;Mirtha Infante Velazquez","doi":"10.1016/j.aohep.2024.101658","DOIUrl":"10.1016/j.aohep.2024.101658","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Background: Liver transplant is the only effective treatment for acute or chronic liver diseases in the terminal stage. With advances in the management of immunosuppression and surgical techniques, survival is high, but it can decrease for different reasons depending on the time of evolution of the transplant. <em>Aim:</em> Determine long-term survival in patients with liver transplants and the main causes of mortality.</div></div><div><h3>Patients / Materials and Methods</h3><div>Methods: It is a descriptive, retrospective study in patients with liver transplant from a cadaveric donor, carried out at the Medical Surgical Research Center between 1999 and 2019, 117 patients with one year or more of survival were included. The main variables were causes of mortality and survival at 5, 10, 15 and 20 years, overall and by indication of the transplant (grouped into cirrhosis due to hepatitis B and C viruses, due to alcohol, autoimmune and other etiologies), which were obtained from the Liver Transplant Database. For the statistical analysis, summary measures were used according to the type of variable and the Kaplan Meier method for survival analysis.</div></div><div><h3>Results and Discussion</h3><div>Results: Of the 117 patients, 69 had died as of June 2024. Overall survival was 74.4%, 58.4%. 37.5% and 27.5% at 5, 10, 15 and 20 years respectively, with an overall mean of 13 years (95% CI 11.3-14.5), in relation to survival related to the etiology of the transplant the average was 9.3 years for viral cirrhosis, 9.9 for alcoholic etiology, 14.3 for autoimmune, and 15.8 years for others. The most frequent causes of long-term mortality were recurrence of the primary disease (20.5%) with a predominance of hepatitis C virus and de novo tumors (11.1%).</div></div><div><h3>Conclusions</h3><div>The mean long-term overall survival in patients with liver transplantation was greater than 10 years, with a negative impact of cirrhosis due to viruses and alcohol as an indication for transplant.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101658"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-59 SOCIAL DETERMINANTS OF HEALTH AND INEQUITIES IN CHRONIC DISEASES: THE CASE OF LIVER DISEASES","authors":"Luisa Fernanda Santos Cuervo ,&nbsp;Adriana Varon Puerta","doi":"10.1016/j.aohep.2024.101673","DOIUrl":"10.1016/j.aohep.2024.101673","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Cirrhosis is the leading cause of liver-related deaths worldwide. However, it should be highlighted that not only biology determines the disease, since ancient times it has been described that health is socially determined, however, today the same underlying problems continue to arise since its causes remain unresolved. It is clear that the mechanisms of society have a direct influence on the disease and only by taking these aspects into account can we understand social inequities in the field of health and intervene to correct them.</div></div><div><h3>Patients / Materials and Methods</h3><div>Retrospective descriptive ecological study using data from secondary sources, coming from mortality databases, morbidity databases of the National Public Health Surveillance System, Transplant Network, National Institute of Health and Liver and Transplant Associations.</div></div><div><h3>Results and Discussion</h3><div>Although vaccination, screening, and antiviral treatment campaigns for hepatitis B and C have reduced the disease burden in some parts of the world, concomitant increases in injection drug use, alcohol abuse, and metabolic syndrome threaten these trends, moreoveer, we can estimate that the affected population is much larger.</div><div>Alcohol-related liver diseases are a public health problem and remain underestimated. Within alcoholic beverages, those of artisanal production such as chicha and guarapo are so cheap and easy to manufacture while they meet basic needs such as quenching thirst and hunger, and their production is not controlled, alcohol content exceeds regulatory levels, translating into high health care expenditures, and requires culturally accepted interventions.</div></div><div><h3>Conclusions</h3><div>The global burden of cirrhosis is substantial, therefore, ongoing efforts to address it require accurate estimates of epidemiology, study of its social determinants, and establishing public health interventions to decrease the burden of the disease and thus the pressure on the health system.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101673"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-25 IMPEDANCE CARDIOGRAPHY AND SPLEEN STIFFNESS MEASUREMENT TO ASSESS THERAPEUTIC RESPONSE IN CIRRHOTIC PATIENTS TREATED WITH NON-CARDIOSELECTIVE BETA-BLOCKERS","authors":"Martín Elizondo Barceló ,&nbsp;Andreína Tesis Montes ,&nbsp;Marcelo Valverde Gómez ,&nbsp;Ricardo Armentano Feijoo ,&nbsp;Solange Gerona Sangiovanni","doi":"10.1016/j.aohep.2024.101639","DOIUrl":"10.1016/j.aohep.2024.101639","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Non-cardioselective beta-blockers (NCBBs) are used as prophylaxis for variceal bleeding but have limitations in therapeutic follow-up. Impedance cardiography (IC) evaluates systemic hemodynamics, and splenic elastography (SE) quantifies spleen stiffness. A decrease in spleen stiffness measurement (SSM) is associated with a reduction in the hepatic venous pressure gradient, which is the ultimate goal of the treatment. This study aimed to describe systemic hemodynamic changes and SSM in cirrhotic patients under prophylaxis with NCBBs using non-invasive methods.</div></div><div><h3>Patients / Materials and Methods</h3><div>This observational and prospective study involved cirrhotic patients indicated for NCBB treatment at the Military Hospital from July 2022 to June 2024. Hemodynamic assessment was performed using IC with Z_logic® (Exxer®, Argentina) and SSM with FibroScan® (Echosens®, France). Patients were evaluated before treatment and at the target dose.</div></div><div><h3>Results and Discussion</h3><div>Twenty-six patients participated in the study, of which 14 were men. The mean age was 57.8 ± 18.4 years. Alcoholic cirrhosis was the main etiology (n=10). 69% were classified as Child-Pugh A. The MELD-Na score was 11.8 ± 5.3. Before treatment, patients did not present parameters of hyperdynamic circulation, and the SSM was 58.9 ± 15.1 kPa. In 19 patients, there was a decrease in SSM, with an average value dropping to 47.6 ± 17.3 kPa (p=0.018). Systemic vascular resistance (SVR) was higher in patients with a decrease in SSM (1538.8 ± 1068.9 dyn.s.cm^-5 vs. 985.9 ± 164.3 dyn.s.cm^-5, p=0.042) (Table). A negative correlation was observed between the change in SVR and the decrease in SSM (p=0.029, Pearson's r = -0.438).</div></div><div><h3>Conclusions</h3><div>Systemic hemodynamic changes and SSM in NCBB-treated patients were described. SSM showed the most significant changes. A correlation was found between the increase in SVR and the decrease in SSM once the target doses were achieved. According to these findings, SVR values could be a marker of an adequate response to NCBBs.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101639"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-29 DIFFERENCES IN THE PROGRESSION OF BODY COMPOSITION AND LIVER DAMAGE IN A MURINE MODEL OF METABOLIC SYNDROME: A SEX PERSPECTIVE","authors":"Laura Manjarrés ,&nbsp;Aline Xavier ,&nbsp;Leticia González ,&nbsp;Camila Garrido ,&nbsp;Flavia Zacconi ,&nbsp;Carlos Sing-Long ,&nbsp;Marcelo Andia","doi":"10.1016/j.aohep.2024.101643","DOIUrl":"10.1016/j.aohep.2024.101643","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>The Metabolic dysfunction associated with fatty liver (MAFLD) is the most common hepatic affection worldwide¹. The critical pathophysiological hallmark of MAFLD is the hepatocyte's accumulation of intracellular fats².</div><div>The gold standard for diagnosing MAFLD is liver biopsy; however, this method is invasive and cannot be used to follow the progression of the disease. On the other hand, changes in total weight and body fat distribution can be used for clinically suspected indicators of MAFLD progression^3,4; however, sex dependence is not completely elucidated.</div><div>This study aims to investigate the sex differences in body composition changes and their relationship with liver disease progression in the eNOS KO. The eNOS KO is a metabolic model of MAFLD and recapitulates the disease in 8-12 weeks when fed a high-calorie and high-fat diet⁵.</div></div><div><h3>Patients / Materials and Methods</h3><div>We fed 8 groups of 12-week-old eNOS KO mice for 0 weeks (n=6), 4 weeks (n=6), 8 weeks (n=6), and 12 weeks (n=6)</div><div>At each time point, an in vivo MRI imaging of body composition and Dixon Quant quantification were acquired using a Philips Ingenia 3T MR scan. We harvested the liver each time for histology analyses and obtained plasma for serological measurements.</div><div>All data were analyzed using no parametric statistics in Prism 9.0.0 (GraphPad Software Inc, La Jolla, CA). Principal Component Analysis (PCA) statistical package R v4.0.2.</div></div><div><h3>Results and Discussion</h3><div>Males and females increased their weight during the diet intervention (23% males, 13% females, fig. 1A); however, both groups ate a similar amount of food. Males showed greater visceral fat accumulation than females throughout the intervention period; when we adjust for body weight, males have a significantly higher proportion of visceral fat volume per unit of mass than females (fig. 1B).</div><div>During the dietary intervention, the mice showed a progressive increase in the NAS score, with females reaching a maximum score of 3 and males reaching 5 (fig. 1C).</div><div>Using the dimensionality reduction technique and the KNN classification boundary, it was possible to demonstrate that the animals are grouped according to the progression of the disease but also grouped by sex (fig. 1D).</div></div><div><h3>Conclusions</h3><div>The progression of MAFLD showed different phenotypes in males and females. Using markers from body composition, liver and muscle fat fraction, it was possible to identify sex-dependent clusters that correlate with the liver damage progression. Our results suggest the need to identify diagnostic and progression markers of MAFLD differentiated by sex.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101643"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-4 HYPOTHERMIC OXYGENATED PERFUSION USING AN ECMO DEVICE IN LIVER TRANSPLANTATION: AN ANALYSIS OF THE FIRST 100 CASES AT A CHILEAN PUBLIC HOSPITAL","authors":"FRANCISCA MAGDALENA MARTÍNEZ VENEZIAN ,&nbsp;Elizabeth Rivas ,&nbsp;Valeria Galaz ,&nbsp;Valentina Castillo ,&nbsp;Julio Benitez ,&nbsp;Edmundo Martinez ,&nbsp;Rodrigo Wolff ,&nbsp;Blanca Norero ,&nbsp;Erwin Buckel ,&nbsp;Rolando Rebolledo","doi":"10.1016/j.aohep.2024.101618","DOIUrl":"10.1016/j.aohep.2024.101618","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Hypothermic machine perfusion using ECMO devices has emerged as a promising technique to enhance the viability of marginal liver grafts. This study aims to present the clinical outcomes of a series of 100 liver grafts subjected to this advanced preservation methods.</div></div><div><h3>Patients / Materials and Methods</h3><div>A prospective analysis between October 2022 and May 2024 was conducted on 100 consecutive liver perfusion cases involving hypothermic perfusion with an ECMO device, followed by a subgroup comparison of regular and marginal grafts. Post-transplantation, key outcomes such as liver functionality, early complications, and overall survival were monitored in all patients. Statistical analyses included T-tests and Fisher's exact tests to evaluate differences in means and frequencies between groups.</div></div><div><h3>Results and Discussion</h3><div>Three grafts were discarded due to severe steatosis. The patient cohort had a mean MELD Na score of 29.0 ± 8.72. The one-year survival rate was 82.7%. The major complication was infectious, observed in 57.7% of cases. The mean ICU and hospital stay was 10.98 ± 14.29 and 28.24 ± 24.78 days, respectively. Eighty-one liver grafts were categorized as regular (83.5%) and 16 as marginal (16.4%). Vascular complications were significantly more frequent in marginal grafts compared to regular grafts. No statistically significant differences in other clinical outcomes were observed between the regular and marginal graft groups (Table 1).</div></div><div><h3>Conclusions</h3><div>The findings suggest that hypothermic perfusion using ECMO devices facilitates the safe utilization of marginal liver grafts. While the overall clinical outcomes are promising and comparable to international standards, the high incidence of infectious complications and extended ICU and hospital stays highlight significant areas for improvement. These challenges appear to be more related to the severity of the patient's conditions, as indicated by the elevated average MELD Na score, rather than the quality of the grafts. Therefore, hypothermic perfusion represents a viable strategy for expanding liver graft selection criteria in transplantation.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101618"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OP- 11 Detection Strategy for Patients with Viral Hepatitis Using Laboratory Records of Blood Samples for HBsAg and HCV Antibodies: PANRELINK","authors":"Fernando Cairo ,&nbsp;Lucia Navarro ,&nbsp;Nicolas Dominguez ,&nbsp;Ignacio Roca ,&nbsp;Omar Galdame ,&nbsp;Laura Gonzalez ,&nbsp;Lucia Guillen ,&nbsp;Stella Loudet ,&nbsp;Manuel Barbero","doi":"10.1016/j.aohep.2024.101609","DOIUrl":"10.1016/j.aohep.2024.101609","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Patients diagnosed with viral hepatitis often fail to follow up, a problem exacerbated by the pandemic. The \"relink\" strategy aims to reconnect these patients to ensure they receive the necessary follow-up and treatment.</div><div>The objective of our work was to generate a PANRELINK program based on the analysis of blood samples tested for HBsAg and anti-HCV antibodies from the reference laboratory database at Hospital El Cruce and to implement a relink strategy for patients with positive results.</div></div><div><h3>Patients / Materials and Methods</h3><div>We analyzed the results of blood samples tested for HBsAg and HCV antibodies by chemiluminescence, conducted at the reference laboratory from 2012 to 2022. Samples were stratified by origin (primary care centers [CAP] vs. medium and high complexity hospitals [MHC]). Statistical analyses chi-squared and t-tests.</div></div><div><h3>Results and Discussion</h3><div>A total of 108,261 blood samples were tested for HBsAg, with a test positivity rate (TPR) of 0.28% (306/108,261). For HCV, 106,917 samples were tested, with a TPR of 1.09% (1,162/106,917). When stratified by sample origin, TPR for HBsAg was 0.11% (101/86,609) in CAP and 0.96% (205/21,652) in MHC (p&lt;0.001). For HCV, TPR was 0.43% (384/88,625) in CAP and 4.34% (778/17,130) in MHC (p&lt;0.001). Among HBsAg-positive patients, 11% (34/306) were already in treatment at the time of relink, 16% (49/306) had died, 11% (33/306) were acute cases, and 52% (163/306) were potential candidates for relink. Among HCV-positive patients, 21% (242/1,162) had been treated, 25% (289/1,162) had died, 6% (67/1,162) were in treatment at the time of relink, 2% (26/1,162) were false positives, and 46% (538/1,162) were potential candidates for relink. In HCV-positive patients, a relink program was implemented. The phone contact rate with patients for reconnection was 16% (86/538) on the first call. The low contact rate was due to phone number changes. The attendance rate was 70% (60/86).</div></div><div><h3>Conclusions</h3><div>The study reveals that a significant proportion of patients with viral hepatitis do not receive adequate follow-up, highlighting the need for effective reconnection strategies. The PANRELINK strategy was effective in identifying patients from laboratory records. This PANRELINK modality can serve as a replicable high-volume model in other health contexts, improving long-term health outcomes and reducing the disease burden. Addressing communication barriers, such as phone number changes, is crucial to improve contact and attendance rates in future reconnection initiatives.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101609"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-51 TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS), EXPERIENCE IN A UNIVERSITY CENTER","authors":"Caterina Chesta Alegría ,&nbsp;Álvaro Urzúa Manchego ,&nbsp;Víctor Henríquez Auba ,&nbsp;Patricio Palavecino Rubilar ,&nbsp;Nicolás Martínez Roje ,&nbsp;Tomás Cermenati Bahrs ,&nbsp;Claudio Lema Olivares ,&nbsp;Máximo Cattaneo Buteler ,&nbsp;Juan Pablo Roblero Cum ,&nbsp;Jaime Poniachik Teller","doi":"10.1016/j.aohep.2024.101665","DOIUrl":"10.1016/j.aohep.2024.101665","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that diverts portal blood flow to the hepatic vein with the aim of reducing portal hypertension, being an alternative for managing its complications, such as variceal gastrointestinal bleeding and ascites, in both cirrhotic and non-cirrhotic patients. <em>Objetives:</em> To characterize patients who underwent TIPS between January 2007 and July 2024 at the Hospital Clínico De la Universidad de Chile</div></div><div><h3>Patients / Materials and Methods</h3><div>Observational, retrospective cohort study. 39 patients medical records who underwent the procedure during the specified period were reviewed.</div></div><div><h3>Results and Discussion</h3><div>39 patients were analyzed, 53.8% of whom were men, with an average age of 60.7 years. The procedure was performed in 51% (20/39) of the patients within a period of just 4 years (2019 to 2024). The main indication was secondary to variceal gastrointestinal bleeding (59%), followed by refractory ascites (36%). Additionally, 33.3% presented some degree of portal vein thrombosis, and 33.3% had reported hepatic encephalopathy episodes before the procedure. The average MELD Na score was 15.4. Only three patients experienced hemorrhagic complications related to the procedure, with one resulting in death. 53.8% reported some degree of hepatic encephalopathy after the procedure. One-year survival was analyzed, showing 47.4% in patients whose procedure was performed before 2019 versus 76.9% in the period between 2020 and 2023 (p 0.095). Four patients underwent transplants after TIPS, without complications.</div></div><div><h3>Conclusions</h3><div>We have observed a progressive increase in the indication for TIPS over time at our center, with half of the cases concentrated in the last four years. In addition, survival outcomes appear to be better, probably due to improved patient selection and more timely indications. The procedure was safe, with a low rate of acute complications and an incidence of encephalopathy similar to that reported in the literature. Longer-term follow-up will allow us to verify its effectiveness in our population</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101665"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-53 IMMUNE-MEDIATED ADVERSE EVENTS FOLLOWING ATEZOLIZUMAB PLUS BEVACIZUMAB IS ASSOCIATED WITH DECREASED SURVIVAL IN PATIENTS WITH CIRRHOSIS","authors":"FEDERICO PIÑERO ,&nbsp;Margarita Anders ,&nbsp;Carla Bermúdez ,&nbsp;Ezequiel Demirdjian ,&nbsp;Adriana Varón ,&nbsp;Daniela Perez ,&nbsp;Jorge Rodriguez ,&nbsp;Oscar Beltrán ,&nbsp;Javier Delgado García ,&nbsp;Leonardo Gomes da Fonseca ,&nbsp;Ezequiel Ridruejo ,&nbsp;Pablo Caballini ,&nbsp;Alexandre Araujo ,&nbsp;Juan Diego Torres Florez ,&nbsp;Juan Ignacio Marín ,&nbsp;Marina Villa ,&nbsp;Federico Orozco Ganem ,&nbsp;Jaime Poniachik ,&nbsp;Sebastián Marciano ,&nbsp;Fernando Bessone ,&nbsp;Manuel Mendizabal","doi":"10.1016/j.aohep.2024.101667","DOIUrl":"10.1016/j.aohep.2024.101667","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Clinical trials evaluating the efficacy of first line systemic immune therapies for patients with advanced hepatocellular carcinoma (HCC) have recruited a lower proportion of patients with cirrhosis. In this group of patients, immune related adverse events (irAEs) may lead to decreased prognostic outcomes. The aim of this study was describe the incidence rate of irAEs and its impact on survival.</div></div><div><h3>Patients / Materials and Methods</h3><div>A multicenter prospective Latin-American cohort study was conducted including HCC patients who received A+B since its regional approval, either as first or sub-sequent systemic lines, to March 15, 2024. Overall survival since A+B, and survival since date of irAE was compared between patients developing and not developing irAEs (date since A+B), through Cox proportional hazard analysis (Harrell's c-index).</div></div><div><h3>Results and Discussion</h3><div>Overall, 99 patients treated with A+B were included (n=8 received it as second line post sorafenib), 82.3% presented cirrhosis. The median treatment duration was 6 months [number of cycles 5 (range 3-11.5)], with a median overall survival of 17.0 months (range 12.6-19.8). Over a median follow-up of 7.7 months (range 4.5-17.2), the irAE incidence rate was 2.1 cases per 100 persons-months [cumulative incidence 18.1% (95% CI 11.1-27.2%); n=18]. Median time to irAE was 2.3 months (range 1.4-4.8), most frequently hepatitis (n=6), thyroiditis (n=5), and 8/18 required steroids (Table). Follow-up and treatment duration times were similar regardless irAEs occurrence. On multivariable Cox regression model, AFP values before A+B &gt;400ng/ml [HR 2.9 (95% CI 1.1-7.6)], adjusted for HCC diffuse intrahepatic pattern was associated with irAE development (c-statistic 0.66). Patients developing irAEs presented decreased overall and post-irAE survival [median 2.9 months vs 18.5 months; HR 6.2 (95% CI 2.7-14.2); P&lt;.0001] (Figure).</div></div><div><h3>Conclusions</h3><div>Cautions management in patients with irAEs is of relevant importance in our region, highlighting the role of onco-hepatologists in the clinical-decision making process of these patients.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101667"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-70 ALCOHOL CONSUMPTION RECURRENCE IN LIVER TRANSPLANT PATIENTS WITH ALCOHOLIC CIRRHOSIS: HEALTH AND SOCIAL IMPACT","authors":"Fernando Cairo ,&nbsp;Lucia Navarro ,&nbsp;Ignacio Roca ,&nbsp;Ana Saracho ,&nbsp;Nicolas Dominguez ,&nbsp;Omar Galdame ,&nbsp;Manuel Barbero","doi":"10.1016/j.aohep.2024.101684","DOIUrl":"10.1016/j.aohep.2024.101684","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Alcoholic cirrhosis is a leading cause of liver transplantation. However, post-transplant alcohol recurrence remains a significant challenge, affecting graft survival and patient outcomes. Identifying predictive factors for relapse is crucial for optimizing the allocation of scarce donor organs. <em>Objetives</em>: To evaluate the recurrence rate of alcohol consumption in patients who have undergone liver transplantation due to alcoholic cirrhosis and identify clinical and psychosocial variables predicting relapse risk.</div></div><div><h3>Patients / Materials and Methods</h3><div>A retrospective observational study was conducted on 167 consecutive patients who underwent liver transplantation for alcoholic cirrhosis between January 2013 and July 2023. Pre-transplant data, including demographics, alcohol consumption history, and psychosocial variables, were collected from medical records. Post-transplant alcohol consumption was assessed using the AUDIT questionnaire. Statistical analyses included chi-square tests, Fisher's exact tests, t-tests, and Mann-Whitney U tests.</div></div><div><h3>Results and Discussion</h3><div>Among the 167 patients, a 5% (9/167) recurrence rate of alcohol consumption was observed. The recurrence group showed significantly lower adherence to post-transplant treatment (p=0.021) and higher rates of graft dysfunction (p&lt;0.001) compared to the non-recurrence group. No significant differences were found in demographic variables, pre-transplant alcohol consumption, or psychological awareness of disease. The education level was lower in the recurrence group (p=0.05). The average AUDIT score in the recurrence group was 8, indicating intermediate risk. Recurrence was associated with a longer post-transplant follow-up period (p&lt;0.001) and higher alcohol intake (median 40g/day).</div></div><div><h3>Conclusions</h3><div>Predicting post-transplant alcohol relapse based solely on pre-transplant indicators is complex. Lower adherence to post-transplant treatment and higher graft dysfunction rates were significant in the recurrence group. The AUDIT questionnaire was useful in assessing post-transplant alcohol consumption risk. Comprehensive pre- and post-transplant evaluations incorporating medical and psychosocial factors are needed to enhance patient long term outcomes and optimize the use of limited transplant resources.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101684"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}