Annals of hepatology最新文献

{"title":"O3- RECOMPENSATION IN PATIENTS WITH CIRRHOSIS PRIOR TO FIRST LINE SYSTEMIC THERAPY IS ASSOCIATED WITH SIMILAR SURVIVAL OUTCOMES COMPARED TO COMPENSATED CIRRHOSIS","authors":"FEDERICO PIÑERO ,&nbsp;Margarita Anders ,&nbsp;Carla Bermúdez ,&nbsp;Diego Arufe ,&nbsp;Adriana Varón ,&nbsp;Ana Palazzo ,&nbsp;Jorge Rodriguez ,&nbsp;Oscar Beltrán ,&nbsp;Daniela Simian ,&nbsp;Leonardo Gomes da Fonseca ,&nbsp;Ezequiel Ridruejo ,&nbsp;Norberto Tamagnone ,&nbsp;Hugo Cheinquer ,&nbsp;Diana Bejarano ,&nbsp;Juan Ignacio Marín ,&nbsp;Federico Orozco Ganem ,&nbsp;Josefina Pagés ,&nbsp;Jaime Poniachik ,&nbsp;Sebastián Marciano ,&nbsp;Virginia Reggiardo ,&nbsp;Manuel Mendizabal","doi":"10.1016/j.aohep.2024.101598","DOIUrl":"10.1016/j.aohep.2024.101598","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>The term <em>“recompensation”</em> of cirrhosis was proposed in the latest BAVENO VII, underlying dynamic events and prognosis in cirrhosis. However, there is uncertainty regarding its prognosis in patients with advanced hepatocellular carcinoma (HCC) treated with first line systemic therapies (1L). We aimed to compare post-1L survival between compensated (CC), decompensated (DC), and recompensated (RC) cirrhosis.</div></div><div><h3>Patients / Materials and Methods</h3><div>A multicenter prospective Latin-American cohort study including advanced HCC patients with cirrhosis who received any 1L was conducted from 2018 to 2024. Three groups were defined: CC (had never presented decompensation); DC (presenting any decompensated event associated with portal hypertension at time of 1L), and RC group (prior history of any decompensation event at HCC diagnosis who were compensated at time of 1L). Survival since date of 1L was compared using Cox proportional hazard analysis.</div></div><div><h3>Results and Discussion</h3><div>Overall, 306 patients received 1L, including sorafenib 60.5%, atezolizumab + bevacizumab 29.7%, lenvatinib 9.1%, and nivo/pembrolizumab 0.6%. Of these, 83.3% presented cirrhosis. Median 1L treatment duration was 5.1 months with a median overall survival since 1L of 16.0 months (range 12.9-18.3). Significant differences were observed between CC (n=167), DC (n=31) and RC (n=42) groups (Table). In the RC group, median time from decompensation to recompensation was 12.0 months (range 1.9-25.9); being ascites the most frequent event (78.6%). DC group presented decreased post-1L survival [median 8.6 months vs 17.2 months in CC [adjusted HR 1.9 (95% CI 1.05-3.5); P=0.03], while no significant survival difference was observed between RC and CC [median survival 12.5 months; aHR 1.3 (95% CI 0.81-2.1); P=0.28] (Figure). Lower access to second line therapy was observed in DC group.</div></div><div><h3>Conclusions</h3><div>Patients with cirrhosis and advanced HCC who achieve recompensation may benefit from systemic therapies. This demands an observation period of follow up before precluding 1L in decompensated cirrhosis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101598"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094592","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-3 ASSESSING TREATMENT ELIGIBILITY EXPANSION UNDER THE 2024 WHO GUIDELINES FOR CHRONIC HEPATITIS B","authors":"Manuel Mendizabal ,&nbsp;Constanza D Sabate ,&nbsp;Esteban Gonzalez Ballerga ,&nbsp;Fernando Gruz ,&nbsp;Ezequiel Ridruejo ,&nbsp;Alejandro Soza ,&nbsp;Jaime Poniachik ,&nbsp;Grace Vergara ,&nbsp;Victoria Mainardi ,&nbsp;Gabriel Mezzano ,&nbsp;Fernando Bessone ,&nbsp;Margarita Anders ,&nbsp;Mario G Pessoa ,&nbsp;Fernando Cairo ,&nbsp;Nelia Hernandez ,&nbsp;Melisa Dirchwolf ,&nbsp;Hugo Cheinquer ,&nbsp;Melina Susana ,&nbsp;Luis Rondeau ,&nbsp;Grabriel Rifrani ,&nbsp;Sebastian Marciano","doi":"10.1016/j.aohep.2024.101601","DOIUrl":"10.1016/j.aohep.2024.101601","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>The 2024 WHO guidelines for chronic hepatitis B (CHB) aim to expand and simplify treatment eligibility, but these criteria have not been assessed. We aimed to estimate treatment eligibility and uptake according to country-specific guidelines and evaluate potential treatment expansion based on the WHO guidelines.</div></div><div><h3>Patients / Materials and Methods</h3><div>This cross-sectional study included consecutive treatment-naïve CHB patients from Argentina, Brazil, Chile, and Uruguay who were referred for the first time to hepatology evaluation between January 2010 and June 2024. Treatment candidacy was evaluated according to both country-specific and WHO guidelines. We then estimated the difference in treatment candidacy between these two approaches.</div></div><div><h3>Results and Discussion</h3><div>A total of 719 patients with CHB had complete data available to evaluate treatment candidacy according to both guidelines. Of these patients, 67% were male with a median age of 52 years (IQR 38-62), and 8.1% presented with liver decompensation. Among patients, 64% were HBeAg-negative, median HBV DNA level was 43,000 IU/ml (IQR 633-110,000,000 IU/ml), median ALT was 41 U/L (IQR 23-99 U/L), and 47% had an APRI &gt;0.5. According to country-specific guidelines, 57% (95% CI: 53-60) met criteria for treatment. Antiviral treatment was initiated in 84% of eligible patients, primarily with entecavir (63%) and tenofovir (32%). Compared to country-specific guidelines, the proportion of patients meeting treatment criteria under the WHO guidelines increased to 67% (95% CI: 63.8-70.6), resulting in a 10% (95% CI: 8-13) increase in treatment candidacy (table). Treatment expansion was higher in women (15%; 95% CI: 10-20) than in men (8%; 95% CI: 5-11).</div></div><div><h3>Conclusions</h3><div>According to WHO guidelines, a considerable proportion of CHB patients who do not meet country-specific criteria are eligible for antiviral therapy. Notably, treatment expansion is higher in women. Implementing WHO criteria can enhance treatment rates and advance efforts toward CHB elimination.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101601"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094595","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-45 ANALYSIS OF SURVIVAL RATE AND FACTORS ASSOCIATED WITH LIVER RETRANSPLANTATION: 18-YEAR EXPERIENCE IN BOGOTÁ - COLOMBIA","authors":"Andres Dueñas ,&nbsp;Angelica Sanabria ,&nbsp;Estefania Cristancho ,&nbsp;Gilberto Mejia ,&nbsp;Adriana Varon","doi":"10.1016/j.aohep.2024.101659","DOIUrl":"10.1016/j.aohep.2024.101659","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Liver retransplantation is the only therapeutic option for irreversible hepatic graft failure, this situation raises ethical and practical issues, due to the diminished survival of the second graft and the disparity between the number of liver donors and potential recipients in Colombia. To compare first and third year survival between patients with a single liver transplant and those who have undergone liver retransplantation</div></div><div><h3>Patients / Materials and Methods</h3><div>Analytical observational study of a retrospective cohort patients with liver transplant and retransplant (over 18 years old) at the Cardioinfantil Foundation between December 2005 and December 2023. The associated factors that together explain liver retransplantation, the Cox regression model with constant time and the negative log binomial model will be used. The analysis will be performed using R software. The survival analysis of patients with liver transplant and retransplantation will be performed using the Kaplan Meier method. All statistical tests will be evaluated with a significance level of 5% (p &lt; 0.05).</div></div><div><h3>Results and Discussion</h3><div>Between 2005 and 2023, 689 liver transplants were performed in adult patients at our hospital, 39 of which (5.6%) were liver retransplantation. The first year retransplant survival was 83.3% and the third year 72.2%, compared with the first year transplant survival 86.1% and the third year 82%. Of the 39 retransplant cases 21 cases (53.8%) were early (&lt; 6 months) while 18 cases (46.1%) were late (&gt; 6 months). Regarding the causes that led to early liver retransplantation, the most frequent was arterial thrombosis 13 (33.3%) cases, followed by primary graft dysfunction 6 cases (15.3%). For late retransplantation the most frequent cause was chronic cellular rejection 7 cases (17.9%) followed by recurrence of the primary disease 3 cases (7.6%).</div></div><div><h3>Conclusions</h3><div>the present study, liver retransplantation is a safe treatment option with mortality compared to liver transplantation and our results do not differ from the global epidemiology.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101659"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095185","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-46 IMMUNOSUPPRESSION IN POST LIVER TRANSPLANTATION: REVIEW OF THE EXPERIENCE IN A CHILEAN UNIVERSITY HOSPITAL","authors":"Richard Esteban Martinez Ruiz ,&nbsp;Renato Francisco Palma Fernandez ,&nbsp;Rodrigo Mauricio Wolff Rojas","doi":"10.1016/j.aohep.2024.101660","DOIUrl":"10.1016/j.aohep.2024.101660","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Liver transplantation is currently a cost-effective therapy for the treatment of advanced liver diseases. Immunosuppression plays a key role in the prevention of organ rejection. Corticosteroids and anti-CD-25 antibodies are used in the induction phase, while calcineurin inhibitors, mycophenolate, corticosteroids and mTOR inhibitors are used in the maintenance phase. <em>Objectives:</em> To describe the type of immunosuppression regimen used in the management of liver transplant patients during the first post-transplant year.</div></div><div><h3>Patients / Materials and Methods</h3><div>Observational, retrospective cohort study of adult patients undergoing liver transplantation at the Hospital Clínico UC (Santiago, Chile), between January 2020 and June 2023. Demographic and clinical data were included. Immunosuppression regimens used in four periods during the first year of follow-up (at discharge, third, sixth and twelfth month) were evaluated. Pediatric patients, combined transplants and cases with post-transplant follow-up in centers not associated with our hospital were excluded.</div></div><div><h3>Results and Discussion</h3><div>A total of 160 patients were analyzed, of whom 149 (93.1%) were cirrhotic. The predominant etiology was MASLD (34.3%). The average age was 54 years, with a predominance of females (53.7%). The active immunosuppression regimen at discharge and at the third month of follow-up was the combination of tacrolimus, mycophenolate, and prednisone, representing 68% and 56%, respectively. The dual tacrolimus-mycophenolate mofetil regimen was the most prevalent at month 6 (26%), while at one year of follow-up, tacrolimus monotherapy was the most commonly used (27%). Only 34% of cases were able to maintain monotherapy at one year after transplant (43 pacients with tacrolimus, 6 with cyclosporine and 6 with everolimus).</div></div><div><h3>Conclusions</h3><div>Tacrolimus is the most frequently used immunosuppressant in the maintenance phase. The use of mycofenate mofetil and prednisone decreases as time progresses post-transplant. Only one third of cases achieved monotherapy at one year of follow-up.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101660"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095186","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-76 MANIFESTATIONS OF PORTAL HYPERTENSION IN PATIENTS WITH COMMON VARIABLE IMMUNODEFICIENCY: PRELIMINARY DATA","authors":"VERONICA GUIDO ,&nbsp;Belen Russo ,&nbsp;Daniela Chiodi ,&nbsp;Nelia Hernandez","doi":"10.1016/j.aohep.2024.101690","DOIUrl":"10.1016/j.aohep.2024.101690","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Liver involvement in common variable immunodeficiency (CVID) can be found in 9% to 79% of cases and may lead to reduced survival. Anicteric cholestasis and portal hypertension (PH) were the main hepatic manifestations. We aimed to establish the prevalence and characteristics of PH in patients with CVID under treatment at a primary immunodeficiency clinic of a tertiary-level hospital.</div></div><div><h3>Patients / Materials and Methods</h3><div>A retrospective and descriptive study examined the medical records of patients with confirmed CVID.</div></div><div><h3>Results and Discussion</h3><div>out of the eleven patients with CVID, eight were women, and the median age was 34 years (range 23-72). PH was suspected in five (45.4%), with three patients experiencing clinically significant PH and one case complicated by variceal bleeding. Table 1 compares both groups (with and without PH). Thrombocytopenia was found in most patients, consistent with the higher incidence of splenomegaly. Liver biopsies performed only in two patients with suspected PH excluded cirrhosis but identified regenerative nodular hyperplasia in one case. Both cases had liver stiffness measurements by shear wave elastography, showing a median of 14.2 kPa. No association was identified with other non-infectious complications of CVID (gastrointestinal and pulmonary disease).</div></div><div><h3>Conclusions</h3><div>Liver disease is often underdiagnosed in patients with CVID, with portal hypertension appearing to be frequent. Early screening is essential to avoid severe complications.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101690"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095210","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-34 ALBUMIN-BILIRUBIN GRADE ANALYSIS OF OVERALL SURVIVAL WITH ATEZOLIZUMAB PLUS BEVACIZUMAB IN PATIENTS WITH UNRESECTABLE HEPATOCELLULAR CARCINOMA","authors":"Cristina Cheinquer Coelho Borges ,&nbsp;Alexandre de Araújo ,&nbsp;Mario Alvares-da-Silva Reis ,&nbsp;Rui Weschenfelder ,&nbsp;Hugo Cheinquer","doi":"10.1016/j.aohep.2024.101648","DOIUrl":"10.1016/j.aohep.2024.101648","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Atezolizumab-bevacizumab (atezo-bev) is currently recommended as first-line therapy for patients with unresectable hepatocellular carcinoma (uHCC). However, its effectiveness in patients with albumin-bilirrubin (ALBI) grade 2 has been questioned in a recent post-hoc analysis of the Phase III IMbrave 150 study, which showed that atezo-bev had a similar overall survival (OS) compared to sorafenibe in that population. To evaluate the impact of ALBI grade on OS in patients with uHCC treated as first-line systemic therapy with atezo-bev.</div></div><div><h3>Patients / Materials and Methods</h3><div>This prospective cohort study was conducted in Hospital de Clinicas de Porto Alegre and Hospital Moinhos de Vento, two tertiary healthcare centers in the city of Porto Alegre, Brazil. It comprised all Child A patients with uHCC that started atezo-bev as first line therapy between August 2020 and May 2023. ALBI grade within 30 days of treatment initiation was calculated using MDCalc, available online free of charge. Mean OS was established for patients with ALBI-1 versus ALBI-2 and 3.</div></div><div><h3>Results and Discussion</h3><div>A total of 20 Child A patients with uHCC were included, 1 classified as Barcelona Clinic Liver Cancer B (BCLC-B) and 19 as BCLC-C. Mean age was 65 years, 75.6% were males and all were cirrhotic. According to ALBI grade, 10 patients were classified as ALBI-1 and 10 as ALBI non-1 (9 grade 2 and 1 grade 3). Mean OS among those with ALBI-1 was 56.3 weeks and among those with ALBI non-1 was 32 weeks (P&lt;0.05). Macrovascular invasion (MVI) was similar in ALBI-1 vs non-1 (40% vs 50%, respectively). However, variceal bleeding during atezo-bev was remarkably different among ALBI-1 vs non-1 patients (0 vs 50%, respectively).</div></div><div><h3>Conclusions</h3><div>Overall, the findings of this study showed that the baseline ALBI grade was superior to Child score in predicting the prognosis of patients with uHCC treated with atezo-bev.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101648"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094739","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-38 EVALUATION OF THE GENETIC AND VIROLOGICAL PROFILE OF PREGNANT WOMEN INFECTED WITH HEPATITIS B AND C VIRUSES IN A REFERENCE CENTER IN RIO DE JANEIRO, BETWEEN 2016 AND 2022","authors":"Kaio Ferreira Callebe Pedro ,&nbsp;Vinicius Mello Motta ,&nbsp;Giovana Nascimento Guimarães Santos ,&nbsp;Giovana Angelice Paula ,&nbsp;Paulo Sergio Sousa Fonseca ,&nbsp;Aryele Raíra Pereira da Silva ,&nbsp;Nathalia Balassiano ,&nbsp;Caroline Baldin ,&nbsp;Poliana Fernandes ,&nbsp;Girleide Oliveira Pereira ,&nbsp;Livia Villar Melo ,&nbsp;Barbara Lago Vieira ,&nbsp;Lia Laura Lewis-Ximenez","doi":"10.1016/j.aohep.2024.101652","DOIUrl":"10.1016/j.aohep.2024.101652","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>It is estimated that there are around 400 million people living with hepatitis B (HBV) and/or C virus (HCV) infections worldwide. This situation is relevant because both viruses can be transmitted vertically (VT). Despite efforts to prevent VT, many measures still need to be reinforced, especially regarding the spread of clinically relevant viral variants. Therefore, this study aimed to demonstrate the clinical/laboratory profile of pregnant women identified as positive for HBV and HCV during prenatal care, and referred to a specialized viral hepatitis unit in Rio de Janeiro between 2016-2022, and to identify those with clinically relevant mutations that can be transmitted vertically.</div></div><div><h3>Patients / Materials and Methods</h3><div>To this end, all pregnant women with positive rapid tests were retested by eletrochemioluminescence using commercial tests for HBV antigens and antibodies against HBV and HCV. In addition, molecular tests were carried out to quantify HBV DNA and/or HCV RNA. Liver enzyme tests were also carried out in order to classify pregnant women according to HBV clinical phase.</div></div><div><h3>Results and Discussion</h3><div>Two hundred and thirty-two pregnants women with HBV and HCV infection were analyzed. Among the 138 pregnant women with HBV, 95% had HBeAg-negative chronic infection and the mean viral load was 3.70 log IU/ml. Up to now, 6 samples were sequenced, Genotypes A1 (n=5/6,83%) and D3 (n=1/6,16%) were identified and the mutation Y100C was found. In 94 pregnant women with HCV, 75.7% had HCV RNA successfully amplified, with subtypes 1a (n=12/33; 36,4%), 1b (n=17/33; 51,5%) and 3a (n=3/33; 9,1%) detected. Clinically relevant mutations were found V321L, V321IV, C316N.</div></div><div><h3>Conclusions</h3><div>Identifying mutations in HBV and HCV infections is crucial for epidemiological surveillance and postpartum treatment. Our findings highlight the importance of monitoring drug-resistant mutations in pregnant women with these infections.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101652"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094743","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-31 ACUTE LIVER FAILURE DUE TO WILSON'S DISEASE IN COSTA RICA: A LOOK AT GENETICS","authors":"Jorge Andres Herrera Corrales ,&nbsp;Francisco Hevia Urrutia ,&nbsp;Danny Alvarado ,&nbsp;Fernanda Vasquez Carit ,&nbsp;Francisco Vargas Navarro ,&nbsp;Jorge Eduardo Vargas Madrigal ,&nbsp;Karina Hidalgo ,&nbsp;Mildred Jimenez","doi":"10.1016/j.aohep.2024.101645","DOIUrl":"10.1016/j.aohep.2024.101645","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Acute liver failure (ALF) can be defined as a complex clinical syndrome characterized by coagulopathy, alteration in liver biochemistry and encephalopathy in a patient without underlying chronic liver disease. An exception occurs in patients with Wilson's Disease (WD) manifested precisely by ALF. Costa Rica is known as a country with a high incidence of WD, a pioneer in the study of the genetics of this disease, documenting more than 1,161 pathogenic variants. Taking advantage of the work of the genetics laboratory of the National Children's Hospital, we undertook the task of assessing the genetic spectrum of patients with FHA due to Wilson in the last 2 years in our country. <em>Objective</em>: To analyze and describe the genetic spectrum of acute liver failure due to WD in Costa Rica during the last two years.</div></div><div><h3>Patients / Materials and Methods</h3><div>Molecular Sequencing (Sanger NGS) for molecular confirmation, as well as MLPA techniques and Copy Number Variation Analysis (CNVs).</div></div><div><h3>Results and Discussion</h3><div>During the period (2022-2023), 86 patients with WD variants were identified, of which 30 had confirmatory genetics of the disease. 4 of them presented as having FHA, being managed with a liver transplant, and to this day all of them are alive. It was evident that 100% of the patients presented the c.3809A&gt;G variant, with half of the patients being homozygous and the other half being c.3207C&gt;A / c.3809A&gt;G compound heterozygotes.</div></div><div><h3>Conclusions</h3><div>The c.3809A&gt;G variant was found in all patients who presented ALF due to Wilson's disease in Costa Rica in the last 2 years. There is a lack of studies that assess the association between this variant and more aggressive presentations of the disease, however these results allow us to open a debate about the study of genetics as a predictor of ALF due to WD.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101645"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094832","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- 4 EPIDEMIOLOGY OF PRIMARY BILIARY CHOLANGITIS IN LATIN AMERICA: PRELIMINARY RESULTS FROM ALLATIN COHORT","authors":"Guilherme Grossi Lopes Cançado ,&nbsp;Rafael Theodoro ,&nbsp;Ezequiel Ridruejo ,&nbsp;Lorena Castro Solari ,&nbsp;Cristiane Alves Villela-Nogueira ,&nbsp;Pablo Andres Coste Murillo ,&nbsp;Harlim Rodríguez ,&nbsp;Carlos Benítez Gajardo ,&nbsp;Álvaro Urzúa ,&nbsp;Eira Cerda Reyes ,&nbsp;Paulo Lisboa Bittencourt ,&nbsp;Alejandro Sosa ,&nbsp;Emilia Vera ,&nbsp;Luciana Costa Faria ,&nbsp;Maria Lucia Ferraz ,&nbsp;Mario Guimarães Pessoa ,&nbsp;Debora Raquel Benedita Terrabuio ,&nbsp;Eduardo Luiz Rachid Cançado ,&nbsp;Claudia Alves Couto","doi":"10.1016/j.aohep.2024.101602","DOIUrl":"10.1016/j.aohep.2024.101602","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Primary biliary cholangitis (PBC) may present differently depending on various factors such as ethnicity and genetic background. Latin America has a highly admixed population with a unique genetic diversity compared to other regions of the world. However, there is limited information available on the presentation and epidemiology of PBC in this region. This study aims to address the epidemiology of PBC in Latin America.</div></div><div><h3>Patients / Materials and Methods</h3><div>Ongoing retrospective, international, multicentric cohort study sponsored by ALEH that enrolls PBC patients from different countries in Latin America.</div></div><div><h3>Results and Discussion</h3><div>Data were accrued on 231 patients [Brazil (52%), Argentina (27.4%), Chile (10.8%), Costa Rica (4.5%), Cuba (3.6%), and Mexico (0.9%)], 92.1% female (mean age at diagnosis 50.5 years), 25.6% with cirrhosis at baseline. Overlap with autoimmune hepatitis was reported in 16.0% of cases. Most patients were symptomatic (67.9%) at diagnosis, with fatigue (41.9%) and pruritus (40.5%) being the main symptoms. Anti-mitochondrial antibodies (AMA) were positive in 70.8% and antinuclear antibodies (ANA) in 60.6%. Hashimoto thyroiditis (23.7%) and Sjogren syndrome (9.1%) were the most common extrahepatic autoimmune diseases associated with PBC. Mean baseline alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and bilirubin levels were 445.9 (± 407), 89.8 (± 137.2), 37.6 (± 8.9) U/L, and 1.6 (± 3.1) mg/dL, respectively. Almost all patients (99.1%) were treated with ursodeoxycholic acid (UDCA). 67.4% achieved adequate response to UDCA according to the Toronto criteria and 32% normalized alkaline phosphatase at 12 months. Only 19.9% received second-line therapy, all with fibrates (89.1% bezafibrate, 8.7% ciprofibrate, 4.3% fenofibrate). Of the patients, 9% died, with 33% of deaths being liver-related, while 6% underwent liver transplantation. Hepatocellular carcinoma was diagnosed in 1.7% of patients.</div></div><div><h3>Conclusions</h3><div>In this unprecedented study, the epidemiology of PBC in Latin America appears similar to that in other parts of the world. However, lower rates of AMA positivity were observed, and most patients were still diagnosed with symptomatic disease. Second-line therapy options were limited to the availability of fibrates only.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101602"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093987","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-48 COMPARISON OF THE ALBI MODEL (ALBUMIN/BILIRUBIN INDEX) WITH ESTABLISHED SCALES AS PREDICTOR OF RESPONSE TO STEROID TREATMENT IN PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS","authors":"CLAUDIA LETICIA DORANTES NAVA ,&nbsp;Maria de Fatima Higuera de la Tijera ,&nbsp;Juan Carlos Silis Cravioto ,&nbsp;Julio Cesar Zavala Castillo ,&nbsp;Miguel Yael Carmona Castillo ,&nbsp;Ernesto Javier Medina Avalos ,&nbsp;Sandra Teutli Carrion ,&nbsp;Raquel Yazmin Lopez Perez","doi":"10.1016/j.aohep.2024.101662","DOIUrl":"10.1016/j.aohep.2024.101662","url":null,"abstract":"<div><h3>Conflict of interest</h3><div>No</div></div><div><h3>Introduction and Objectives</h3><div>Alcoholic hepatitis (AH) is acute liver inflammation associated with excessive alcohol consumption. Due to its high mortality rate, various predictive models have been studied. The ALBI model (serum albumin/bilirubin index) predicts patient mortality without the need for subjective data in patients with chronic liver disease, achieving significantly better performance than Child Pugh and MELD models.</div><div>Evaluate the prognostic utility of the ALBI model for determining the response to steroid treatment in patients diagnosed with severe alcoholic hepatitis.</div></div><div><h3>Patients / Materials and Methods</h3><div>Retrospective cohort study from October 2019 to September 2023. We evaluated severity criteria, demographic characteristics, and endoscopic features. Maddrey, MELD, MELDNa, ABIC, Glasgow, and ALBI models were compared at the time of admission, and the Lille score was calculated 7 days after steroid treatment. Statistical analysis was performed using SPSS 26 software, with a p-value of &lt;0.005 considered statistically significant.</div></div><div><h3>Results and Discussion</h3><div>We included 170 patients, 21 women (12.4%) and 149 men(87.6%), average age of 45 ± 13.5 years. Of these, 30.6% were classified as Child-Pugh B and 69.4% as Child-Pugh C. Concomitant infection was documented in 15.3%, with urinary tract infections being the most prevalent, and the most frequent endoscopic finding was portal hypertensive gastropathy in 98% of patients, of which 65.5% were mild and 34.4% were severe. The 90-day follow-up mortality rate was reported at 34.7%. Comparing the different scales, we found good diagnostic accuracy for ALBI(AUC:0.64[95%CI:0.57–0.73];p=0.002),MELD 3.0(AUC:0.62[95%CI:0.53–0.70];p=0.009),MELDNa(AUC:0.61[95%CI:0.52–0.69];p=0.01),and ABIC(AUC:0.60[95%CI:0.51–0.69];p=0.02).</div></div><div><h3>Conclusions</h3><div>The ALBI model, due to its objective and straightforward nature, is increasingly employed in the evaluation of hepatic dysfunction. It provided prognostic assessment comparable to MELD, MELDNa, and MELD3.0 for predicting the response to steroid treatment in patients with severe alcoholic hepatitis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"29 ","pages":"Article 101662"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094037","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}