Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2024.101469
Alejandro Gutierrez-Castillo , Héctor Cabrera-Larios , Fernando Segovia-Rivera , Rafael Valdez-Ventura , Nayelli C. Flores-García
Introduction and Objectives
The prevalence of anemia after liver transplantation ranges from 4.3% to 28.2%. Causes that occur in the first two weeks include bleeding, sepsis, medications, and hemolysis. Immune hemolysis represents less than 1% of the cases and includes graft-versus-host disease and hemolysis associated with ABO incompatibility. We present a case of passenger lymphocyte syndrome as a cause of immune hemolytic anemia two weeks after a liver transplant.
Materials and Patients
A 43-year-old woman, blood group A+, with a history of HCV-related liver cirrhosis and BCLC-A hepatocellular carcinoma, was chosen for a liver transplant. Surgery was uneventful, requiring the transfusion of an O+ blood unit. The postoperative evolution was carried out without complications. On day 10, after the transplant, she presented a drop of 3 g/dL in hemoglobin, leukocytosis, elevated acute phase reactants, and mixed hyperbilirubinemia. An esophagogastroduodenoscopy and colonoscopy showed no active bleeding. The hemolysis profile showed a decrease in the haptoglobin value and an increase in DHL, negative Coombs, without schistocytes. An MRCP was requested, with no evidence of bile leakage or active bleeding. Because of the suspicion of hemolysis due to drugs, tacrolimus was changed to mycophenolate mofetil, and because of possible hemolysis due to sepsis, broad-spectrum antibiotic coverage was added without improvement. On day 14, there was a suspicion of transient lymphocyte syndrome. Isohemagglutinin levels were requested and became positive, and two O+ blood units were transfused. The following day, she presented a significant improvement in all laboratory parameters, and on day 20 she was discharged from the hospital without any abnormality in her laboratory parameters.
Results
In our management of hemolytic anemia after liver transplantation, two theories initially emerged: 1) Hemolysis due to tacrolimus, for which it was suspended and changed to mycophenolate mofetil, and 2) Hemolysis due to sepsis, due to leukocytosis and inflammation, initiating coverage with meropenem and vancomycin. But without improvement after both interventions. Finally, due to suspicion of transient lymphocyte syndrome, isohemagglutitins were requested and were positive, and after the transfusion of 2 O+ blood units, containing anti-A+ antibodies, she showed improvement, confirming the diagnosis.
Conclusions
In the passenger lymphocyte syndrome, there is a donor B lymphocyte production of antibodies causing a primary or secondary response to recipient erythrocytes. The incidence is higher in the heart-lung transplant, followed by liver transplantation. The risk also increases according to the donor-recipient ABO mismatch, being more common with group O donors and group A recipient (61%), followed by group O donors and group B recipients (22%). The clinical picture is characterized by
{"title":"Passenger lymphocyte syndrome, an unusual cause of anemia after liver transplantation","authors":"Alejandro Gutierrez-Castillo , Héctor Cabrera-Larios , Fernando Segovia-Rivera , Rafael Valdez-Ventura , Nayelli C. Flores-García","doi":"10.1016/j.aohep.2024.101469","DOIUrl":"https://doi.org/10.1016/j.aohep.2024.101469","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>The prevalence of anemia after liver transplantation ranges from 4.3% to 28.2%. Causes that occur in the first two weeks include bleeding, sepsis, medications, and hemolysis. Immune hemolysis represents less than 1% of the cases and includes graft-versus-host disease and hemolysis associated with ABO incompatibility. We present a case of passenger lymphocyte syndrome as a cause of immune hemolytic anemia two weeks after a liver transplant.</p></div><div><h3>Materials and Patients</h3><p>A 43-year-old woman, blood group A+, with a history of HCV-related liver cirrhosis and BCLC-A hepatocellular carcinoma, was chosen for a liver transplant. Surgery was uneventful, requiring the transfusion of an O+ blood unit. The postoperative evolution was carried out without complications. On day 10, after the transplant, she presented a drop of 3 g/dL in hemoglobin, leukocytosis, elevated acute phase reactants, and mixed hyperbilirubinemia. An esophagogastroduodenoscopy and colonoscopy showed no active bleeding. The hemolysis profile showed a decrease in the haptoglobin value and an increase in DHL, negative Coombs, without schistocytes. An MRCP was requested, with no evidence of bile leakage or active bleeding. Because of the suspicion of hemolysis due to drugs, tacrolimus was changed to mycophenolate mofetil, and because of possible hemolysis due to sepsis, broad-spectrum antibiotic coverage was added without improvement. On day 14, there was a suspicion of transient lymphocyte syndrome. Isohemagglutinin levels were requested and became positive, and two O+ blood units were transfused. The following day, she presented a significant improvement in all laboratory parameters, and on day 20 she was discharged from the hospital without any abnormality in her laboratory parameters.</p></div><div><h3>Results</h3><p>In our management of hemolytic anemia after liver transplantation, two theories initially emerged: 1) Hemolysis due to tacrolimus, for which it was suspended and changed to mycophenolate mofetil, and 2) Hemolysis due to sepsis, due to leukocytosis and inflammation, initiating coverage with meropenem and vancomycin. But without improvement after both interventions. Finally, due to suspicion of transient lymphocyte syndrome, isohemagglutitins were requested and were positive, and after the transfusion of 2 O+ blood units, containing anti-A+ antibodies, she showed improvement, confirming the diagnosis.</p></div><div><h3>Conclusions</h3><p>In the passenger lymphocyte syndrome, there is a donor B lymphocyte production of antibodies causing a primary or secondary response to recipient erythrocytes. The incidence is higher in the heart-lung transplant, followed by liver transplantation. The risk also increases according to the donor-recipient ABO mismatch, being more common with group O donors and group A recipient (61%), followed by group O donors and group B recipients (22%). The clinical picture is characterized by ","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268124002631/pdfft?md5=bf610286ea8bee244e3d23efa4189365&pid=1-s2.0-S1665268124002631-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140067352","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}
Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2023.101273
Luis Antonio Díaz , Sergio García , Rayan Khan , Gustavo Ayares , Javier Uribe , Francisco Idalsoaga , José Miguel Fuentealba , Eduardo Fuentes , Katherine Maldonado , Mariana Lazo , Catterina Ferreccio , Manuel Mendizabal , Melisa Dirchwolf , Patricia Guerra , Claudia P. Oliveira , Mario Guimarães , Mario Reis , Giada Sebastiani , Mayur Brahmania , Alnoor Ramji , Juan Pablo Arab
Introduction and Objectives
Although the WHO strategy aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030, national strategies are variable worldwide. This study aimed to assess the establishment of different policies and strategies to eliminate HCV in the Americas.
Materials and Methods
We conducted a 23-item survey about HCV-related policies and strategies among gastroenterologists and hepatologists in the Americas. The survey was carried out electronically (2022–2023). Data were compared with governmental institutions, regulatory agencies, scientific societies, and scientific publications. We estimated an index obtained from a regression scoring method through exploratory analysis, and row values were normalized from 0 to 100.
Results
We obtained 52 responses from 19 countries. The median HCV-related policies index was 51.4 [IQR:27.3–70.1]. The lower establishment of HCV-related policies was observed in Ecuador (0.0), Honduras (6.6), and Costa Rica (9.8), while the highest performance was observed in Argentina (94.1), Colombia (94.7), and Canada (100)(Figure 1A). Fifteen (78.9%) countries have adopted a national strategic plan to eliminate HCV. Three (15.8%) countries have universal screening for HCV infection (Figure 1B). After a positive HCV serological test, 10 (52.6%) countries perform reflex testing to confirm HCV diagnosis using the same sample. However, only 7 (36.8%) countries have an alert system for the requesting physician. Twelve (63.2%) countries have a direct referral system for specialized care of HCV-positive cases. Universal access to direct-acting antivirals (DAAs) exists in 15 (78.9%) countries. Universal access to DAAs was not widely available in Cuba, Ecuador, Venezuela, and the United States. Seven (36.8%) countries have generic DAAs available. Only 3 (15.8%) countries performed a retrospective search for HCV-positive cases that could have been lost to follow-up.
Conclusions
Although most countries have adopted a national strategic plan to eliminate HCV, there are several issues and barriers to elimination in the Americas.
{"title":"O- 23 STRATEGIES TO ELIMINATE HEPATITIS C VIRUS INFECTION IN THE AMERICAS","authors":"Luis Antonio Díaz , Sergio García , Rayan Khan , Gustavo Ayares , Javier Uribe , Francisco Idalsoaga , José Miguel Fuentealba , Eduardo Fuentes , Katherine Maldonado , Mariana Lazo , Catterina Ferreccio , Manuel Mendizabal , Melisa Dirchwolf , Patricia Guerra , Claudia P. Oliveira , Mario Guimarães , Mario Reis , Giada Sebastiani , Mayur Brahmania , Alnoor Ramji , Juan Pablo Arab","doi":"10.1016/j.aohep.2023.101273","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101273","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>Although the WHO strategy aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030, national strategies are variable worldwide. This study aimed to assess the establishment of different policies and strategies to eliminate HCV in the Americas.</p></div><div><h3>Materials and Methods</h3><p>We conducted a 23-item survey about HCV-related policies and strategies among gastroenterologists and hepatologists in the Americas. The survey was carried out electronically (2022–2023). Data were compared with governmental institutions, regulatory agencies, scientific societies, and scientific publications. We estimated an index obtained from a regression scoring method through exploratory analysis, and row values were normalized from 0 to 100.</p></div><div><h3>Results</h3><p>We obtained 52 responses from 19 countries. The median HCV-related policies index was 51.4 [IQR:27.3–70.1]. The lower establishment of HCV-related policies was observed in Ecuador (0.0), Honduras (6.6), and Costa Rica (9.8), while the highest performance was observed in Argentina (94.1), Colombia (94.7), and Canada (100)(Figure 1A). Fifteen (78.9%) countries have adopted a national strategic plan to eliminate HCV. Three (15.8%) countries have universal screening for HCV infection (Figure 1B). After a positive HCV serological test, 10 (52.6%) countries perform reflex testing to confirm HCV diagnosis using the same sample. However, only 7 (36.8%) countries have an alert system for the requesting physician. Twelve (63.2%) countries have a direct referral system for specialized care of HCV-positive cases. Universal access to direct-acting antivirals (DAAs) exists in 15 (78.9%) countries. Universal access to DAAs was not widely available in Cuba, Ecuador, Venezuela, and the United States. Seven (36.8%) countries have generic DAAs available. Only 3 (15.8%) countries performed a retrospective search for HCV-positive cases that could have been lost to follow-up.</p></div><div><h3>Conclusions</h3><p>Although most countries have adopted a national strategic plan to eliminate HCV, there are several issues and barriers to elimination in the Americas.</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268123003769/pdfft?md5=fdccb539e43091b204418b3e3e514f13&pid=1-s2.0-S1665268123003769-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975583","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}
Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2023.101243
Cárdenas Ramírez Bertha , Padilla-Machaca P. Martin , Cerrón Cabezas Carmen
Introduction and Objectives
In Peru the tuberculosis (TB) is an endemic infectious disease. This disease is a serious opportunistic infection in transplant recipients (LTRs) and has 20 to 74-fold increase in a chance of developing compared to the general population The prevalence of TB in (LTRs) is variable between regions. This study aims to describe the rate, clinics characteristics and mortality of TB in LTRs from a high-prevalence area.
Materials and Methods
We conducted a retrospective review of liver transplant recipients with tuberculosis diagnoses at Guillermo Almenara Hospital between Mach 2001 and March 2022.
Results
A total of 294 patients underwent LT during this period. 7 (2.3 %) adult patients were diagnosed with active TB. Mean age was 49 (32- 64) years; 5 (70 %) were males. Time interval from LT to TB diagnosis was 57 months (2-136) and 42 % had early tuberculosis (< 12 m). Three patients had disseminated TB and Four pulmonary involvement. 72 % received individualized treatment to avoid hepatotoxicity related to treatment, 28.5% had DILI with standard treatment. We found 28.5 % mortality no related to TB infections.
Conclusions
We observed a low rate of TB in LTRs (2.3%) from a high prevalence region. Most of our patients received individualized treatment.
{"title":"P- 56 TUBERCULOSIS IN LIVER TRANSPLANT RECIPIENTS: EXPERIENCE OF A SINGLE CENTER","authors":"Cárdenas Ramírez Bertha , Padilla-Machaca P. Martin , Cerrón Cabezas Carmen","doi":"10.1016/j.aohep.2023.101243","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101243","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>In Peru the tuberculosis (TB) is an endemic infectious disease. This disease is a serious opportunistic infection in transplant recipients (LTRs) and has 20 to 74-fold increase in a chance of developing compared to the general population The prevalence of TB in (LTRs) is variable between regions. This study aims to describe the rate, clinics characteristics and mortality of TB in LTRs from a high-prevalence area.</p></div><div><h3>Materials and Methods</h3><p>We conducted a retrospective review of liver transplant recipients with tuberculosis diagnoses at Guillermo Almenara Hospital between Mach 2001 and March 2022.</p></div><div><h3>Results</h3><p>A total of 294 patients underwent LT during this period. 7 (2.3 %) adult patients were diagnosed with active TB. Mean age was 49 (32- 64) years; 5 (70 %) were males. Time interval from LT to TB diagnosis was 57 months (2-136) and 42 % had early tuberculosis (< 12 m). Three patients had disseminated TB and Four pulmonary involvement. 72 % received individualized treatment to avoid hepatotoxicity related to treatment, 28.5% had DILI with standard treatment. We found 28.5 % mortality no related to TB infections.</p></div><div><h3>Conclusions</h3><p>We observed a low rate of TB in LTRs (2.3%) from a high prevalence region. Most of our patients received individualized treatment.</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268123003460/pdfft?md5=9236a87d717350831fefeed8fddcc801&pid=1-s2.0-S1665268123003460-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975590","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}
Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2023.101251
Rosana Solis , Mabel Mora , María Julieta Venturini , Fernando Battiston , Guadalupe Masci , Adrián Zapata , Laura Abojer , Martina Ribeky , Mariana Turturicci , Laura Figueras , Margarita Barris , Alejandra Gaiano , Valeria Silenzi , Andrea Conesa , Gloria Capellini , Mayra Moyano , MANUEL MENDIZABAL
Introduction and Objectives
The WHO proposed to eliminate viral hepatitis by the year 2030. To achieve this ambitious goal, we must evaluate the seroprevalence of these infections in different populations. This study aimed to estimate the seroprevalence of hepatitis B (HBV) and C (HCV) among pregnant women and mother-to-child transmission in a maternal hospital.
Materials and Methods
We conducted an observational, prospective and consecutive study including pregnant women from San Isidro Maternal and Children Hospital whose births occurred between 05/01/2019 and 04/30/2021. In all patients HBsAg and anti-HCV were assessed during the 1st and 3rd trimester of pregnancy together with HIV. In the case of presenting HBsAg+, anti-HBcIgG was performed on the same sample followed by HBV-DNA PCR. In the case of presenting anti-HCV+, a confirmatory test was performed with PCR HCV-RNA. Neonates of HBsAg+ or HCV+ were follow-up for 3 years.
Results
2762 births were included during the period under study. Five (0.18%) HBsAg+ pregnant women were identified, median age was 25 years (range 17-36), of which only 1 had anti-HBcIgG+. Given the suspicion of chronic HBV and the delay in obtaining the HBV-DNA results, treatment with tenofovir was started. In successive controls, no chronic HBV infection was diagnosed in neonates. Anti-HCV+ was detected in 8 (0.29%) patients, with a median age of 29 years (range 19-38 years), of which only one patient presented detectable HCV-RNA, genotype 4. This patient had a diagnosis of HCV chronic prior to pregnancy and her son presented anti-HCV- at age 3. Finally, one patient with HBsAg+ and another with anti-HCV+, but negative viral loads presented HIV+.
Conclusions
The gestation period is an excellent opportunity to carry out health checks. During the studied period, the seroprevalence of HBsAg+ and anti-HCV+ was very low. These types of interventions are essential to achieve the objectives set by the WHO.
{"title":"O-1 SEROPREVALENCE AND MOTHER-TO-CHILD TRANSMISSION OF HEPATITIS B AND C VIRUSES AMONG PREGNANT WOMEN IN A MATERNAL AND CHILDREN HOSPITAL FROM THE PROVINCE OF BUENOS AIRES","authors":"Rosana Solis , Mabel Mora , María Julieta Venturini , Fernando Battiston , Guadalupe Masci , Adrián Zapata , Laura Abojer , Martina Ribeky , Mariana Turturicci , Laura Figueras , Margarita Barris , Alejandra Gaiano , Valeria Silenzi , Andrea Conesa , Gloria Capellini , Mayra Moyano , MANUEL MENDIZABAL","doi":"10.1016/j.aohep.2023.101251","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101251","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>The WHO proposed to eliminate viral hepatitis by the year 2030. To achieve this ambitious goal, we must evaluate the seroprevalence of these infections in different populations. This study aimed to estimate the seroprevalence of hepatitis B (HBV) and C (HCV) among pregnant women and mother-to-child transmission in a maternal hospital.</p></div><div><h3>Materials and Methods</h3><p>We conducted an observational, prospective and consecutive study including pregnant women from San Isidro Maternal and Children Hospital whose births occurred between 05/01/2019 and 04/30/2021. In all patients HBsAg and anti-HCV were assessed during the 1st and 3rd trimester of pregnancy together with HIV. In the case of presenting HBsAg+, anti-HBcIgG was performed on the same sample followed by HBV-DNA PCR. In the case of presenting anti-HCV+, a confirmatory test was performed with PCR HCV-RNA. Neonates of HBsAg+ or HCV+ were follow-up for 3 years.</p></div><div><h3>Results</h3><p>2762 births were included during the period under study. Five (0.18%) HBsAg+ pregnant women were identified, median age was 25 years (range 17-36), of which only 1 had anti-HBcIgG+. Given the suspicion of chronic HBV and the delay in obtaining the HBV-DNA results, treatment with tenofovir was started. In successive controls, no chronic HBV infection was diagnosed in neonates. Anti-HCV+ was detected in 8 (0.29%) patients, with a median age of 29 years (range 19-38 years), of which only one patient presented detectable HCV-RNA, genotype 4. This patient had a diagnosis of HCV chronic prior to pregnancy and her son presented anti-HCV- at age 3. Finally, one patient with HBsAg+ and another with anti-HCV+, but negative viral loads presented HIV+.</p></div><div><h3>Conclusions</h3><p>The gestation period is an excellent opportunity to carry out health checks. During the studied period, the seroprevalence of HBsAg+ and anti-HCV+ was very low. These types of interventions are essential to achieve the objectives set by the WHO.</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S166526812300354X/pdfft?md5=54771d08a9df93dc710c1e0abc495df4&pid=1-s2.0-S166526812300354X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975757","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}
Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2023.101192
Nikolaos Pyrsopoulos , Giovanni Perricone , Jasmohan S. Bajaj , Thierry Gustot , Thomas Reiberger , Mireia Torres , Peter Nelson , Javier Fernandez , Apache Study Investigators
Introduction and Objectives
Acute-on-chronic liver failure (ACLF) in cirrhotic patients is characterized by acute deterioration of liver function and severe organ injury with high short-term mortality. Liver transplantation is the only treatment to improve survival. A pilot study suggested that plasma exchange with human serum albumin 5% (PEA5%) as a replacement fluid is feasible and safe in ACLF patients and may improve organ function and survival. This study aimed to assess PE-A5% as a treatment for patients with ACLF in a pivotal study.
Materials and Methods
A phase 3, multicenter, randomized (1:1), controlled, parallel-group, open-label study (APACHE) compares standard medical treatment (SMT) + PE-A5% (treatment arm) to SMT alone (control arm). PE-A5% is performed using Albutein 5% (Grifols). Treatment schedule consists of two initial PE-A5% sessions on consecutive days followed by every other day PE-A5% (min-max 4-9 PE-A5%). Patients receive IVIG (200mg/kg) after every 2 PE-A5% to prevent hypogammaglobulinemia-associated infections, and FFP after each PE-A5% to prevent coagulopathy. Eligible patients are adult (18-79 years old), with ACLF-1b, ACLF-2, or ACLF-3a at admission or during hospitalization. Main exclusion criteria are patients with ACLF-1a or ACLF-3b, ACLF >10 days before randomization, septic shock requiring norepinephrine (>0.3µg/kg/min) or a second vasopressor, active infection, and severe respiratory failure.
Results
Target enrollment is 380 ACLF patients at high risk of hospital mortality. The primary efficacy endpoint is the 90-day overall survival. Secondary efficacy endpoints include 90-day transplant-free survival and 28-day overall survival. Main exploratory endpoints include overall and transplant-free survival at days 28 and 90, in-patient hospital and ICU stay, incidence of organ failures and ACLF course. Safety analyses include adverse events, vital signs, physical assessments, and laboratory tests.
Conclusions
APACHE will provide pivotal results on the efficacy and safety of PE-A5% as a treatment to improve survival in ACLF (NCT03702920;EudraCT:2016-001787-10).
{"title":"P-5 APACHE STUDY DESIGN TO EVALUATE THE EFFICACY AND SAFETY OF PLASMA EXCHANGE WITH HUMAN SERUM ALBUMIN 5% ON SHORT-TERM SURVIVAL IN PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE AT HIGH RISK OF HOSPITAL MORTALITY.","authors":"Nikolaos Pyrsopoulos , Giovanni Perricone , Jasmohan S. Bajaj , Thierry Gustot , Thomas Reiberger , Mireia Torres , Peter Nelson , Javier Fernandez , Apache Study Investigators","doi":"10.1016/j.aohep.2023.101192","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101192","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>Acute-on-chronic liver failure (ACLF) in cirrhotic patients is characterized by acute deterioration of liver function and severe organ injury with high short-term mortality. Liver transplantation is the only treatment to improve survival. A pilot study suggested that plasma exchange with human serum albumin 5% (PEA5%) as a replacement fluid is feasible and safe in ACLF patients and may improve organ function and survival. This study aimed to assess PE-A5% as a treatment for patients with ACLF in a pivotal study.</p></div><div><h3>Materials and Methods</h3><p>A phase 3, multicenter, randomized (1:1), controlled, parallel-group, open-label study (APACHE) compares standard medical treatment (SMT) + PE-A5% (treatment arm) to SMT alone (control arm). PE-A5% is performed using Albutein 5% (Grifols). Treatment schedule consists of two initial PE-A5% sessions on consecutive days followed by every other day PE-A5% (min-max 4-9 PE-A5%). Patients receive IVIG (200mg/kg) after every 2 PE-A5% to prevent hypogammaglobulinemia-associated infections, and FFP after each PE-A5% to prevent coagulopathy. Eligible patients are adult (18-79 years old), with ACLF-1b, ACLF-2, or ACLF-3a at admission or during hospitalization. Main exclusion criteria are patients with ACLF-1a or ACLF-3b, ACLF >10 days before randomization, septic shock requiring norepinephrine (>0.3µg/kg/min) or a second vasopressor, active infection, and severe respiratory failure.</p></div><div><h3>Results</h3><p>Target enrollment is 380 ACLF patients at high risk of hospital mortality. The primary efficacy endpoint is the 90-day overall survival. Secondary efficacy endpoints include 90-day transplant-free survival and 28-day overall survival. Main exploratory endpoints include overall and transplant-free survival at days 28 and 90, in-patient hospital and ICU stay, incidence of organ failures and ACLF course. Safety analyses include adverse events, vital signs, physical assessments, and laboratory tests.</p></div><div><h3>Conclusions</h3><p>APACHE will provide pivotal results on the efficacy and safety of PE-A5% as a treatment to improve survival in ACLF (NCT03702920;EudraCT:2016-001787-10).</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268123002958/pdfft?md5=8d6962308fbc79301a93d2eb15e3d679&pid=1-s2.0-S1665268123002958-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975824","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}
Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2023.101264
Facundo Maiorana , Magalí Neschuk , María Virginia Caronia , Adolfo Schneider , Georgina Veron , Pedro Dario Zapata , Fernando Javier Barreyro
Introduction and Objectives
The pathophysiology of NAFLD is only partially unrevealed; it is considered as a multifactorial disorder, attributed to multiple, parallel “hits,” both genetic and environmental. It has been described that the single nucleotide polymorphism at rs738409 in the PNPLA3 gene is strongly associated with hepatic steatosis and its progression. Conversely, H. pylori infection has been related to metabolic syndrome, type-2 diabetes mellitus, and dyslipidemia, which are known risk factors for NAFLD. However, the evaluation of Infection and the rs738409 polymorphism in the PNPLA3 gene has not been explored.
Materials and Methods
this is a preliminary report of a prospective multicenter study from December 2020 to June 2021 in northeastern Argentina. 76 dyspeptic adult patients who fulfilled the ROME-IV criteria and underwent gastroscopy, of which 69 were included. The presence of H. pylori was determined by gastric histology. Biochemical and clinical parameters were recorded. NAFLD was defined by liver ultrasonography. The PNPLA3 gene was analyzed by PCR-RFLP in rs738409.
Results
The prevalence of NAFLD was 45% (31/69), with Hpyl+ 48% (17/36) and Hpyl- 42% (14/33) (p: ns). The variables significantly associated with NAFLD were BMI, dyslipidemia, Diabetes/prediabetes, presence of the G allele of PNPLA3, and the GG genotype. In the multivariate analysis, BMI (OR 1.63 95%CI 1.22-2.19) and the G-allele of PNPLA3 (OR 7.35 95%CI 1.34-40) were independently associated with NAFLD. When subjects with NAFLD were analyzed, the interaction between Hpyl and PNPLA3 allele-G was significantly associated with NAFLD (65%) and increased risk of liver fibrosis (FIB-4 > 1.3 41%).
Conclusions
the presence of NAFLD was associated with BMI and G-allele of PNPLA3. The combination of Hpyl infection and the G-allele of PNPLA3 were associated with NAFLD and risk of fibrosis (FIB-4)
{"title":"O-14 NON-ALCOHOLIC FATTY LIVER DISEASE IS INFLUENCED BY THE INTERACTION OF HELICOBACTER PYLORI INFECTION AND G-ALLELE OF PNPLA3","authors":"Facundo Maiorana , Magalí Neschuk , María Virginia Caronia , Adolfo Schneider , Georgina Veron , Pedro Dario Zapata , Fernando Javier Barreyro","doi":"10.1016/j.aohep.2023.101264","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101264","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>The pathophysiology of NAFLD is only partially unrevealed; it is considered as a multifactorial disorder, attributed to multiple, parallel “hits,” both genetic and environmental. It has been described that the single nucleotide polymorphism at rs738409 in the PNPLA3 gene is strongly associated with hepatic steatosis and its progression. Conversely, H. pylori infection has been related to metabolic syndrome, type-2 diabetes mellitus, and dyslipidemia, which are known risk factors for NAFLD. However, the evaluation of Infection and the rs738409 polymorphism in the PNPLA3 gene has not been explored.</p></div><div><h3>Materials and Methods</h3><p>this is a preliminary report of a prospective multicenter study from December 2020 to June 2021 in northeastern Argentina. 76 dyspeptic adult patients who fulfilled the ROME-IV criteria and underwent gastroscopy, of which 69 were included. The presence of H. pylori was determined by gastric histology. Biochemical and clinical parameters were recorded. NAFLD was defined by liver ultrasonography. The PNPLA3 gene was analyzed by PCR-RFLP in rs738409.</p></div><div><h3>Results</h3><p>The prevalence of NAFLD was 45% (31/69), with Hpyl+ 48% (17/36) and Hpyl- 42% (14/33) (p: ns). The variables significantly associated with NAFLD were BMI, dyslipidemia, Diabetes/prediabetes, presence of the G allele of PNPLA3, and the GG genotype. In the multivariate analysis, BMI (OR 1.63 95%CI 1.22-2.19) and the G-allele of PNPLA3 (OR 7.35 95%CI 1.34-40) were independently associated with NAFLD. When subjects with NAFLD were analyzed, the interaction between Hpyl and PNPLA3 allele-G was significantly associated with NAFLD (65%) and increased risk of liver fibrosis (FIB-4 > 1.3 41%).</p></div><div><h3>Conclusions</h3><p>the presence of NAFLD was associated with BMI and G-allele of PNPLA3. The combination of Hpyl infection and the G-allele of PNPLA3 were associated with NAFLD and risk of fibrosis (FIB-4)</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268123003678/pdfft?md5=e55b6625ec6f2bcee1f43c8ba135d167&pid=1-s2.0-S1665268123003678-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975831","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}
Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2023.101257
Paulo Bittencourt , Liana Codes , Adrian Gadano , Alejandra Villamil , Alfeu de Medeiros Fleck Jr , Álvaro Urzua , Debora Raquel Terrabuio , Eira Cerda , Graciela Elia Castro Narro , Ignacio Roca , John Abad González , Josefina Pages , Juan Carlos Restrepo Gutierrez , Leonardo de Lucca Schiavon , Mario Uribe , Martin Padilla , Norma Marlene Perez Figueroa , Pablo Coste Murillo , Raquel Stucchi , Ricardo Chong , Rodrigo Zapata
Introduction and Objectives
Little is known about current practice of liver transplantation (LT) in Latin American countries (LATAM). This study aimed to describe LT activity, immunosuppression protocols and policies regarding prophylaxis of cytomegalovirus (CMV) infection and hepatitis B virus (HBV) recurrence in different active LATAM centers.
Materials and Methods
A web-based survey with 20 questions regarding LT practice was sent to all members of ALEH LT SIG in December 2022.
Results
22 centers performing 35 [5-160] LT per year from Brazil (n=5), Argentina (n=4), Chile (n=4), Ecuador (n-2), Mexico (n=2), Colombia (n=1), Costa Rica (n=1), Peru (n=1), Dominican Republic (n=1) and Uruguay (n=1) answered the survey. Tacrolimus, mycophenolate and prednisone was the main immunosuppressive regimen employed by most (72%) centers and 81% of them referred basiliximab use for induction therapy in selected patients. Tailoring of immunosuppression was universally accepted, particularly in autoimmune hepatitis (AIH) (59%), hepatocellular carcinoma (54%) kidney dysfunction (77%) and primary biliary cirrhosis (33%). Weaning of corticosteroids at three, six and 12 months after LT was reported, respectively, by 41%, 36% and 23% of the centers, but policy for lifelong corticosteroid use in AIH-transplanted subjects was commonly observed (90%). Just four centers are currently performing protocol liver biopsies, while 18 of them are considering liver biopsy prior to steroid pulse therapy. HBIG and nucleos(t)ide analogs are used in most instances (73%) for HBV recurrence prevention, whereas CMV infection prophylaxis was shown to vary sharply across centers. Of note, all but two of them referred major changes in LT practice over the years due to economical restraints.
Conclusions
Compliance with standard of care recommendations for management of LT was reported by most centers. Heterogeneity in practices regarding HBV infection recurrence and CMV prophylaxis may reflect local financial restraints and point to the importance of developing ALEH guidelines to encourage LT activity in LATAM.
{"title":"O-7 CURRENT PRACTICE OF LIVER TRANSPLANTATION IN LATIN AMERICAN COUNTRIES: AN ALEH INTEREST GROUP SURVEY 2023","authors":"Paulo Bittencourt , Liana Codes , Adrian Gadano , Alejandra Villamil , Alfeu de Medeiros Fleck Jr , Álvaro Urzua , Debora Raquel Terrabuio , Eira Cerda , Graciela Elia Castro Narro , Ignacio Roca , John Abad González , Josefina Pages , Juan Carlos Restrepo Gutierrez , Leonardo de Lucca Schiavon , Mario Uribe , Martin Padilla , Norma Marlene Perez Figueroa , Pablo Coste Murillo , Raquel Stucchi , Ricardo Chong , Rodrigo Zapata","doi":"10.1016/j.aohep.2023.101257","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101257","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>Little is known about current practice of liver transplantation (LT) in Latin American countries (LATAM). This study aimed to describe LT activity, immunosuppression protocols and policies regarding prophylaxis of cytomegalovirus (CMV) infection and hepatitis B virus (HBV) recurrence in different active LATAM centers.</p></div><div><h3>Materials and Methods</h3><p>A web-based survey with 20 questions regarding LT practice was sent to all members of ALEH LT SIG in December 2022.</p></div><div><h3>Results</h3><p>22 centers performing 35 [5-160] LT per year from Brazil (n=5), Argentina (n=4), Chile (n=4), Ecuador (n-2), Mexico (n=2), Colombia (n=1), Costa Rica (n=1), Peru (n=1), Dominican Republic (n=1) and Uruguay (n=1) answered the survey. Tacrolimus, mycophenolate and prednisone was the main immunosuppressive regimen employed by most (72%) centers and 81% of them referred basiliximab use for induction therapy in selected patients. Tailoring of immunosuppression was universally accepted, particularly in autoimmune hepatitis (AIH) (59%), hepatocellular carcinoma (54%) kidney dysfunction (77%) and primary biliary cirrhosis (33%). Weaning of corticosteroids at three, six and 12 months after LT was reported, respectively, by 41%, 36% and 23% of the centers, but policy for lifelong corticosteroid use in AIH-transplanted subjects was commonly observed (90%). Just four centers are currently performing protocol liver biopsies, while 18 of them are considering liver biopsy prior to steroid pulse therapy. HBIG and nucleos(t)ide analogs are used in most instances (73%) for HBV recurrence prevention, whereas CMV infection prophylaxis was shown to vary sharply across centers. Of note, all but two of them referred major changes in LT practice over the years due to economical restraints.</p></div><div><h3>Conclusions</h3><p>Compliance with standard of care recommendations for management of LT was reported by most centers. Heterogeneity in practices regarding HBV infection recurrence and CMV prophylaxis may reflect local financial restraints and point to the importance of developing ALEH guidelines to encourage LT activity in LATAM.</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268123003605/pdfft?md5=06b19e255b799131e827c09eae2f0955&pid=1-s2.0-S1665268123003605-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975882","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}
Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2023.101258
Claudia Maccali, Aline L Chagas, Lisa Rc Saud, Regiane Ssm Alencar, Michele Sg Gouvea, Joyce Mks Etto, Isabel V Pereira, Arthur In Oliveira, Jose T Stefano, Rafael Sn Pinheiro, Wellington Andraus, Paulo Herman, Luiz Ac D'albuquerque, Mario G Pessoa, Claudia P Oliveira
Introduction and Objectives
The PNPLA3 rs738409 C>G polymorphism has been associated with hepatocellular carcinoma (HCC) and liver cirrhosis regardless of the etiology, although the association was stronger with non-viral etiologies. However, the influence of PNPLA3 polymorphism on Hepatitis C Virus (HCV) and whether this polymorphism could be a risk factor for HCV-related HCC is not well defined. We aimed to evaluate the influence of the PNPLA3 rs738409 C>G polymorphism on the risk of HCC occurrence in HCV patients in Brazil.
Materials and Methods
This study included 90 patients with HCV-related cirrhosis and HCC who underwent liver transplantation or resection at a tertiary center in Brazil and 111 patients non-HCC with HCV-related cirrhosis, as the control group. The rs738409 polymorphism was detected in the DNA extracted from patients' blood samples using the TaqMan assay. All clinical data were collected using the Research Electronic Data Capture (REDCap) tool. The statistical analyses were performed using Jamovi software version 2.3.23.
Results
In the HCV+HCC group there was a higher proportion of male gender (79.1% vs. 45.9%, p<0.001), history of alcoholism (80.5% vs. 22.5%, p<0.001) and smoking (68.9% vs. 25.2%, p<0.001), however there was no statistical difference in age (p=0.519) and BMI (p=0.403) between both groups. The genotype frequencies of the rs738409 polymorphism in the HCV+HCC group was CC 41,2% CC and CG/GG 58,8% vs. controls CC 49,5% and CG/GG 50,5%. The presence of the G allele was not an independent factor associated with the risk of HCC occurrence (r=0,199, p=0.53).
Conclusions
Even in an admixed population such as the Brazilian, there was no association between the PNPLA3 rs738409 C>G polymorphism and the risk of developing HCV-related HCC, as previously shown in published studies in caucasian and oriental population.
{"title":"O- 8 PNPLA3 RS738409 C>G POLYMORPHISM IMPACT ON HCV-RELATED HCC DEVELOPMENT IN THE BRAZILIAN POPULATION: PRELIMINARY RESULTS","authors":"Claudia Maccali, Aline L Chagas, Lisa Rc Saud, Regiane Ssm Alencar, Michele Sg Gouvea, Joyce Mks Etto, Isabel V Pereira, Arthur In Oliveira, Jose T Stefano, Rafael Sn Pinheiro, Wellington Andraus, Paulo Herman, Luiz Ac D'albuquerque, Mario G Pessoa, Claudia P Oliveira","doi":"10.1016/j.aohep.2023.101258","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101258","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>The PNPLA3 rs738409 C>G polymorphism has been associated with hepatocellular carcinoma (HCC) and liver cirrhosis regardless of the etiology, although the association was stronger with non-viral etiologies. However, the influence of PNPLA3 polymorphism on Hepatitis C Virus (HCV) and whether this polymorphism could be a risk factor for HCV-related HCC is not well defined. We aimed to evaluate the influence of the PNPLA3 rs738409 C>G polymorphism on the risk of HCC occurrence in HCV patients in Brazil.</p></div><div><h3>Materials and Methods</h3><p>This study included 90 patients with HCV-related cirrhosis and HCC who underwent liver transplantation or resection at a tertiary center in Brazil and 111 patients non-HCC with HCV-related cirrhosis, as the control group. The rs738409 polymorphism was detected in the DNA extracted from patients' blood samples using the TaqMan assay. All clinical data were collected using the Research Electronic Data Capture (REDCap) tool. The statistical analyses were performed using Jamovi software version 2.3.23.</p></div><div><h3>Results</h3><p>In the HCV+HCC group there was a higher proportion of male gender (79.1% vs. 45.9%, p<0.001), history of alcoholism (80.5% vs. 22.5%, p<0.001) and smoking (68.9% vs. 25.2%, p<0.001), however there was no statistical difference in age (p=0.519) and BMI (p=0.403) between both groups. The genotype frequencies of the rs738409 polymorphism in the HCV+HCC group was CC 41,2% CC and CG/GG 58,8% vs. controls CC 49,5% and CG/GG 50,5%. The presence of the G allele was not an independent factor associated with the risk of HCC occurrence (r=0,199, p=0.53).</p></div><div><h3>Conclusions</h3><p>Even in an admixed population such as the Brazilian, there was no association between the PNPLA3 rs738409 C>G polymorphism and the risk of developing HCV-related HCC, as previously shown in published studies in caucasian and oriental population.</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268123003617/pdfft?md5=fa14c2415f76f336d699585f220f749e&pid=1-s2.0-S1665268123003617-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975883","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}
In COVID-19, liver alterations has multiple mechanisms. The objective of this study is to evaluate if raise in transaminases and bilirubin predicts death in COVID-19.
Materials and Methods
Retrospective cohort study of adults hospitalized with COVID-19 and hypoxemia. The primary outcome was death of any cause with a multivariate independent model for ALT, AST and total bilirubin adjusted by age, diabetes mellitus, presence of fever, lymphocyte count, D dimer and lactate dehydrogenase.
Results
Data from 702 patients was collected. The mortality rate was 38%. In admission, 64% of patients had elevated ALT, 64% elevated AST and 8.3% elevated total bilirubin. AST rise level was independently associated with death (OR=1.06, 95% CI: 1.02-1.11 by every rise of 40 U/L, p-value=0.009). Total bilirubin also was independently associated with death (OR = 1.26, 95% CI: 1.08-1.47 for every rise in 1 mg/dl, p-value=0.003). Total bilirubin was also associated with ICU admission, mechanical ventilation and length of hospital stay. Results for ALT did not allow us to conclude an independent association with death. Age, fever and lymphocyte count nadir also was associated with death.
Conclusions
In patients with COVID-19 and hypoxemia, a rise in transaminases and bilirubin is frequent. AST and bilirubin predict mortality, so it is reasonable to measure them in admission. Progress must be made in including these markers in predictive models of mortality and clinical decision rules.
{"title":"P- 17 LIVER TESTS ABNORMALITIES AS PROGNOSTIC MARKERS OF DEATH IN PATIENTS HOSPITALISED BY COVID-19. A COHORT STUDY","authors":"Andrés Fernando Rodríguez , Sergio Mauricio Moreno , Camilo Andrés Duarte","doi":"10.1016/j.aohep.2023.101204","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101204","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>In COVID-19, liver alterations has multiple mechanisms. The objective of this study is to evaluate if raise in transaminases and bilirubin predicts death in COVID-19.</p></div><div><h3>Materials and Methods</h3><p>Retrospective cohort study of adults hospitalized with COVID-19 and hypoxemia. The primary outcome was death of any cause with a multivariate independent model for ALT, AST and total bilirubin adjusted by age, diabetes mellitus, presence of fever, lymphocyte count, D dimer and lactate dehydrogenase.</p></div><div><h3>Results</h3><p>Data from 702 patients was collected. The mortality rate was 38%. In admission, 64% of patients had elevated ALT, 64% elevated AST and 8.3% elevated total bilirubin. AST rise level was independently associated with death (OR=1.06, 95% CI: 1.02-1.11 by every rise of 40 U/L, p-value=0.009). Total bilirubin also was independently associated with death (OR = 1.26, 95% CI: 1.08-1.47 for every rise in 1 mg/dl, p-value=0.003). Total bilirubin was also associated with ICU admission, mechanical ventilation and length of hospital stay. Results for ALT did not allow us to conclude an independent association with death. Age, fever and lymphocyte count nadir also was associated with death.</p></div><div><h3>Conclusions</h3><p>In patients with COVID-19 and hypoxemia, a rise in transaminases and bilirubin is frequent. AST and bilirubin predict mortality, so it is reasonable to measure them in admission. Progress must be made in including these markers in predictive models of mortality and clinical decision rules.</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268123003071/pdfft?md5=0dea8409759f142262c304fe56b1da98&pid=1-s2.0-S1665268123003071-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975683","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}
Pub Date : 2024-02-01DOI: 10.1016/j.aohep.2023.101221
Kenia Orellana , Francisca Araya , Abraham Gajardo , Giselle Arévalo , Isabel Lagos , Jaime Poniachik , Juan Pablo Roblero
Introduction and Objectives
Sarcopenia is associated with worse outcomes in cirrhotic patients after liver transplant (LT). Recent studies have shown that tomographic assessment (TA) of sarcopenia is useful in cirrhosis. However, there is insufficient evidence regarding TA use in Latin American cirrhotic patients. This study aimed to describe the prevalence of sarcopenia by TA, associated factors, and outcomes in a cohort of patients undergoing LT.
Materials and Methods
Retrospective cohort of cirrhotic patients underwent LT (March 2015 - August 2021) with available abdominal CT up to 6 months before surgery. Baseline characteristics were obtained from clinical charts. A radiologist performed TA of sarcopenia through muscle area measurement of psoas (PMA), paravertebral (PVMA), paraspinal (PSMA), and its respective indexes, with defined sarcopenia cut-offs according to previous literature. Length hospital stay (LoS) after LT and 1-year mortality were recorded. Descriptive statistics and regression models were used to report sarcopenia TA and its association with baseline characteristics and outcomes after LT.
Results
During the study period, 163 patients underwent LT, 59 of them met inclusion criteria. Median time between TA and LT was 30 days (IQR 7-65). Mean age was 55±11 years, 51% females, 36% non-alcoholic steatohepatitis, 21% hepatocellular carcinoma, median MELD score of 23 (IQR: 17-28). Prevalence of sarcopenia assessed by any tomographic index was 72% (65% PMA, 56% PMI, and 37% PSMI). The baselines characteristics associated with sarcopenia were age (OR = 1.061, p-value=0.034) and sex (all sarcopenic were males). One-year mortality was 19% (22% in sarcopenic vs. 12% in non-sarcopenic patients, OR=1.969, p-value=0.423). LoS was 26 days (IQR 15-101), being longer in survivors with sarcopenia (IRR = 1.706, p-value<0.001).
Conclusions
Sarcopenia is frequent in cirrhotic patients underwent LT (72%), being associated with older age and male sex. While sarcopenia in TA does not significantly increase mortality, it does prolong LoS in LT survivors.
{"title":"P- 34 TOMOGRAPHIC ASSESMENT OF SARCOPENIA IN CIRRHOTIC PATIENTS BEFORE LIVER TRASPLANT: PREVALENCE, ASSOCIATED FACTORS AND POST-SURGERY OUTCOMES IN A COHORT OF CHILEAN PATIENTS","authors":"Kenia Orellana , Francisca Araya , Abraham Gajardo , Giselle Arévalo , Isabel Lagos , Jaime Poniachik , Juan Pablo Roblero","doi":"10.1016/j.aohep.2023.101221","DOIUrl":"https://doi.org/10.1016/j.aohep.2023.101221","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>Sarcopenia is associated with worse outcomes in cirrhotic patients after liver transplant (LT). Recent studies have shown that tomographic assessment (TA) of sarcopenia is useful in cirrhosis. However, there is insufficient evidence regarding TA use in Latin American cirrhotic patients. This study aimed to describe the prevalence of sarcopenia by TA, associated factors, and outcomes in a cohort of patients undergoing LT.</p></div><div><h3>Materials and Methods</h3><p>Retrospective cohort of cirrhotic patients underwent LT (March 2015 - August 2021) with available abdominal CT up to 6 months before surgery. Baseline characteristics were obtained from clinical charts. A radiologist performed TA of sarcopenia through muscle area measurement of psoas (PMA), paravertebral (PVMA), paraspinal (PSMA), and its respective indexes, with defined sarcopenia cut-offs according to previous literature. Length hospital stay (LoS) after LT and 1-year mortality were recorded. Descriptive statistics and regression models were used to report sarcopenia TA and its association with baseline characteristics and outcomes after LT.</p></div><div><h3>Results</h3><p>During the study period, 163 patients underwent LT, 59 of them met inclusion criteria. Median time between TA and LT was 30 days (IQR 7-65). Mean age was 55±11 years, 51% females, 36% non-alcoholic steatohepatitis, 21% hepatocellular carcinoma, median MELD score of 23 (IQR: 17-28). Prevalence of sarcopenia assessed by any tomographic index was 72% (65% PMA, 56% PMI, and 37% PSMI). The baselines characteristics associated with sarcopenia were age (OR = 1.061, p-value=0.034) and sex (all sarcopenic were males). One-year mortality was 19% (22% in sarcopenic vs. 12% in non-sarcopenic patients, OR=1.969, p-value=0.423). LoS was 26 days (IQR 15-101), being longer in survivors with sarcopenia (IRR = 1.706, p-value<0.001).</p></div><div><h3>Conclusions</h3><p>Sarcopenia is frequent in cirrhotic patients underwent LT (72%), being associated with older age and male sex. While sarcopenia in TA does not significantly increase mortality, it does prolong LoS in LT survivors.</p></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1665268123003241/pdfft?md5=733e8d0b0e9db1bc55c54f1fa18d91ad&pid=1-s2.0-S1665268123003241-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975685","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号