Digestive and Liver Disease最新文献

{"title":"Author's Reply: “Dairy-Rich diets: A promising strategy for reducing the risk of metabolic liver disease”","authors":"Jong Hee Lee , Yu-Jin Kwon","doi":"10.1016/j.dld.2024.11.022","DOIUrl":"10.1016/j.dld.2024.11.022","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Page 643"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of graft-to-recipient weight ratio on early systemic inflammatory response syndrome risk following pediatric liver transplantation","authors":"Alaita Fatima Bakhtiari ,&nbsp;Aqsa Sabir","doi":"10.1016/j.dld.2024.11.015","DOIUrl":"10.1016/j.dld.2024.11.015","url":null,"abstract":"<div><div>None</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 647-648"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's reply: “Impact of graft-to-recipient weight ratio on early systemic inflammatory response syndrome risk following pediatric liver transplantation”","authors":"Junshan Long ,&nbsp;Chunqiang Dong","doi":"10.1016/j.dld.2024.12.006","DOIUrl":"10.1016/j.dld.2024.12.006","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 649-650"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Bulevirtide monotherapy in patients with HDV-related compensated cirrhosis: effectiveness, safety and clinical outcomes from the retrospective multicenter european study (Save-D)","authors":"E. Degasperi ,&nbsp;M.P. Anolli ,&nbsp;M. Jachs ,&nbsp;T. Reiberger ,&nbsp;V. De Ledinghen ,&nbsp;S. Metivier ,&nbsp;G. D'Offizi ,&nbsp;F. di Maria ,&nbsp;C. Schramm ,&nbsp;H. Schmidt ,&nbsp;C. Zöllner ,&nbsp;F. Tacke ,&nbsp;C. Dietz-Fricke ,&nbsp;H. Wedemeyer ,&nbsp;M. Papatheodoridi ,&nbsp;G. Papatheodoridis ,&nbsp;I. Carey ,&nbsp;K. Agarwal ,&nbsp;F. Van Bömmel ,&nbsp;M.R. Brunetto ,&nbsp;P. Lampertico","doi":"10.1016/j.dld.2025.01.093","DOIUrl":"10.1016/j.dld.2025.01.093","url":null,"abstract":"<div><h3>Background</h3><div>Bulevirtide (BLV) has been approved by EMA for treatment of compensated chronic hepatitis D virus (HDV) infection, however, long-term real-life effectiveness and safety data in large cohorts of HDV patients with cirrhosis treated beyond week 48 are lacking.</div></div><div><h3>Methods</h3><div>Consecutive HDV patients with cirrhosis starting BLV 2 mg/day sc since September 2019 were included in a retrospective multicenter real-life European study (SAVE-D). Virological (HDV-RNA undetectable or ≥2-log decline <em>vs.</em> baseline), biochemical (ALT &lt;40 U/L), combined response (biochemical + virological), adverse events and liver-related outcomes were assessed.</div></div><div><h3>Results</h3><div>244 patients treated with BLV monotherapy up to 120 weeks [median follow-up: 92 (range 24-120) weeks] were included: age 49 years, 61% men, ALT 80 U/L, LSM 18.3 kPa, platelets 94 × 10³/mm³, 95% CPT score A, 54% with varices, 10% HIV-positive, 15% with a history of ascites, 6% with active HCC, 92% on NUC. Baseline HDV-RNA and HBsAg levels were 5.4 (4.1-6.5) log IU/mL and 3.8 (3.4-4.1) log IU/mL. Virological, biochemical and combined responses at W48, W96, W120 were 64%, 71%, and 74%, 58%, 63%, 59% and 43%, 51%, 49%, respectively. HDV RNA undetectability was achieved by 27%, 40%, and 41%. Baseline HDV-RNA &lt;5 LogIU/mL was the only predictor of HDV-RNA undetectability at week 48. AST, GGT, albumin, IgG and LSM values significantly improved during treatment. Bile acids significantly increased but only 11% of patients reported mild and transient pruritus. The W120 cumulative incidences of de-novo HCC and decompensation were 6.1% (95% CI 3-9%) and 3.3% (95% CI 1-6%), respectively. 18 patients underwent liver transplantation (HCC n=15; decompensation n=3), 8 patients died due to BLV-unrelated causes.</div></div><div><h3>Conclusions</h3><div>BLV 2 mg/day monotherapy up to 120 weeks was safe and effective in patients with HDV-related cirrhosis. Virological and clinical responses continued to increase and only few patients experienced liver-related complications.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S48-S50"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world practice patterns on the use of terlipressin in patients with cirrhosis and acute kidney injury - results from the ICA-GLOBAL AKI study","authors":"S. Incicco ,&nbsp;A.T. MA ,&nbsp;A. Juanola ,&nbsp;K. Patidar ,&nbsp;A. Barone ,&nbsp;A. Kulkarni ,&nbsp;J.L. Pérez-Hernández ,&nbsp;B. Wentworth ,&nbsp;S. Asrani ,&nbsp;C. Alessandria ,&nbsp;N. Abdelaaty Abdelkader ,&nbsp;Y.J. Wong ,&nbsp;Q. Xie ,&nbsp;N.T. Pyrsopoulos ,&nbsp;S.E. Kim ,&nbsp;Y. Fouad ,&nbsp;A. Torre ,&nbsp;E. Cerda Reyes ,&nbsp;J. Diaz-Ferrer ,&nbsp;R. Maiwall ,&nbsp;S. Piano","doi":"10.1016/j.dld.2025.01.016","DOIUrl":"10.1016/j.dld.2025.01.016","url":null,"abstract":"<div><h3>Background</h3><div>Terlipressin is indicated for the treatment of HRS-AKI. However, real-world practice patterns on the use of terlipressin in AKI in general as well as outcomes in non HRS-AKI remain largely unknown.</div></div><div><h3>Method</h3><div>International prospective study including patients hospitalized for decompensated cirrhosis from July 2022 to May 2023. This was a subgroup analysis of patients who received terlipressin for AKI treatment. Primary outcome was absence of AKI resolution (return of serum creatinine to a value within 0.3 mg/dl of the baseline). Secondary outcomes were incidence of respiratory failure, and 28-day mortality.</div></div><div><h3>Results</h3><div>Among 1,456 patients with cirrhosis and AKI, 243 (17%) received terlipressin for AKI treatment. Terlipressin was predominantly administered in continuous infusion (75%) at a median maximum daily dose of 3 mg [IQR=2-4] and median duration of 5 days [IQR=3-8]. The AKI phenotype was HRS-AKI in 50%, ATN in 17%, hypovolemia-induced in 25%. Complete AKI resolution occurred in 49% of patients. Lack of AKI resolution was highest in ATN (71%), followed by HRS-AKI (49%). On multivariable analysis ATN was independently associated with lack of AKI resolution (OR 2.77; p=0.016) compared to HRS-AKI, along with AKI stage 3 and ACLF stages 2-3. <em>De novo</em> respiratory failure occurred in 20% of patients treated with terlipressin. No significant differences were found in albumin and terlipressin doses in patients who did and did not developed respiratory failure. Pneumonia (OR=8.29; p&lt;0.001) and lack of volume loss/hypovolemia before AKI (OR=2.70; p=0.029) were independent predictors of respiratory failure. On multivariable analysis, age, ATN, hospital-acquired AKI and MELD score were independent predictors of 28-day mortality.</div></div><div><h3>Conclusion</h3><div>Terlipressin is often used for treatment of AKI outside its primary indication of HRS-AKI. Since AKI response and clinical outcomes are very poor in ATN, terlipressin should be used with caution in this setting as its risks may outweigh benefits.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S9-S10"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somatic copy number alterations in circulating cell-free DNA as a predictive biomarker for hepatocellular carcinoma: insights from a proof-of-concept study","authors":"E. Pinto ,&nbsp;E. Lazzarini ,&nbsp;F. Pelizzaro ,&nbsp;M. Gambato ,&nbsp;L. Santarelli ,&nbsp;S. Potente ,&nbsp;P. Zanaga ,&nbsp;T. Zappitelli ,&nbsp;R. Cradin ,&nbsp;P. Burra ,&nbsp;F. Farinati ,&nbsp;C. Romualdi ,&nbsp;V. Tosello ,&nbsp;S. Indraccolo ,&nbsp;F.P. Russo","doi":"10.1016/j.dld.2025.01.070","DOIUrl":"10.1016/j.dld.2025.01.070","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Despite improvements in hepatocellular carcinoma (HCC) management, its prognosis remains poor. Diagnosis at advanced stages often precludes curative treatment options, and currently available biomarkers (e.g., alpha-fetoprotein (AFP)) offer limited utility in early diagnosis and prognostic stratification. Liquid biopsy has emerged as a promising tool for early HCC detection and prognostic evaluation, and the analysis of circulating cell-free DNA (ccfDNA) hold significant potential as a diagnostic tool. This proof-of-concept study aimed to investigate the potential role of tumor fraction (TF) within ccfDNA as a biomarker in HCC patients.</div></div><div><h3>Method</h3><div>A total of 60 patients were recruited, including 13 with chronic liver disease (CLD), 24 with cirrhosis, and 23 with HCC. Plasma samples were collected, and ccfDNA was extracted for genomic analysis. TF was calculated by focusing on somatic copy number alterations (SCNAs) within the ccfDNA.</div></div><div><h3>Results</h3><div>In patients with CLD and cirrhosis (n = 37), circulating tumor DNA (ctDNA) was undetectable with the exception of one cirrhotic patient, who presented a significant TF (17 %) and displayed HCC shortly after. Conversely, 5 out of 22 HCC patients (21.7 %) exhibited detectable ctDNA, with TF levels ranging from 3.0 % to 32.6 %. Patients with higher TF levels were characterized by more aggressive disease features, including elevated AFP levels, larger tumor sizes, multiple tumor nodules, and advanced-stage disease.</div></div><div><h3>Conclusion</h3><div>Preliminary evidence from this study suggests that the analysis of TF, specifically through the detection of SCNAs, could serve as a promising non-invasive tool for the identification and evaluation of HCC. The innovative approach has the potential to significantly enhance early diagnosis and may also improve prognostic stratification in HCC patients.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Pages S36-S37"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Italian women: is liver fibrosis independent from menopause?","authors":"R. Chen ,&nbsp;A. Salamone ,&nbsp;C. Abbati ,&nbsp;R. Capelli ,&nbsp;E. Santangeli ,&nbsp;B. Stefanini ,&nbsp;M.G. Indre ,&nbsp;F. Ravaioli ,&nbsp;F. Piscaglia ,&nbsp;S. Ferri","doi":"10.1016/j.dld.2025.01.103","DOIUrl":"10.1016/j.dld.2025.01.103","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is an emerging health concern among women, with menopause influencing its onset and progression. This study aimed to explore the connection between menopause and liver fibrosis in MASLD.</div></div><div><h3>Method</h3><div>Between October 2014 and September 2024, 149 non-cirrhotic women were enrolled and underwent comprehensive evaluations, including physical activity and diet quality assessments (IPAQ and REAP-S scores). Significant liver fibrosis was defined as liver stiffness ≥ 7 kPa on 2D-elastography. Cardiovascular risk was assessed with ESC scores, and insulin resistance with TyG index.</div></div><div><h3>Results</h3><div>Of 149 women, 41 were pre-menopausal (median age 46, 17.1% fibrotic) and 108 post-menopausal (median age 61, 27.8% fibrotic). Fibrotic women were older (median age 64 vs. 56, p &lt; 0.001) and had higher rates of hypertension (64.9% vs. 43.8%, p = 0.026), type 2 diabetes (T2DM 40.5% vs. 16.1%, p = 0.002), and insulin resistance (TyG index: 4.9 vs. 4.7, p = 0.024). BMI, menopause status, age at menopause were similar between fibrotic and non-fibrotic women. Multivariate analysis revealed that age (OR 1.068, p = 0.002) and T2DM (OR 3.633, p = 0.004) were independently associated with fibrosis. Compared to non-fibrotic, fibrotic post-menopausal women had poorer diet quality (REAPS score: 26 vs. 31, p = 0.018), higher rates of hypertension (73.3% vs. 46.2%, p = 0.011) and T2DM (40% vs. 17.9%, p = 0.016), and a higher risk of CV events (11.1% vs. 6.1%, p &lt; 0.001). Multivariate analysis confirmed that hypertension (OR 2.959, p = 0.024) and T2DM (OR 2.752, p = 0.039) were independently associated with fibrosis in post-menopausal women.</div></div><div><h3>Conclusion</h3><div>T2DM drives liver fibrosis in both pre- and post-menopausal women, while hypertension is linked to fibrosis only in post-menopausal women, with diet quality posing additional challenges, particularly for post-menopausal women, possibly due to socioeconomic factors.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S56"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bulevirtide for patients with chronic Hepatitis D (CHD) in Italy: a multicenter prospective nationwide real-life study (D-Shield)","authors":"M.P. Anolli ,&nbsp;E. Degasperi ,&nbsp;G. D'Offizi ,&nbsp;A. Rianda ,&nbsp;A. Loglio ,&nbsp;M.O. Viganò ,&nbsp;A. Ciancio ,&nbsp;Y. Troshina ,&nbsp;M.R. Brunetto ,&nbsp;B. Coco ,&nbsp;S. Zaltron ,&nbsp;L. Turco ,&nbsp;L. Sarmati ,&nbsp;M. Milella ,&nbsp;P. Toniutto ,&nbsp;L. Marinaro ,&nbsp;F.P. Russo ,&nbsp;A. Gori ,&nbsp;I. Maida ,&nbsp;A. Federico ,&nbsp;P. Lampertico","doi":"10.1016/j.dld.2025.01.030","DOIUrl":"10.1016/j.dld.2025.01.030","url":null,"abstract":"<div><h3>Background</h3><div>Bulevirtide (BLV) has been available in Italy since May 2023 for patients with chronic hepatitis Delta (CHD), but no studies have addressed features of patients treated with BLV and their responses to treatment yet.</div></div><div><h3>Methods</h3><div>CHD patients starting BLV 2 mg/day as monotherapy or in combination with pegIFNα were included in a multicenter prospective real-life Italian study (D-SHIELD). Patients’ characteristics and treatment responses were assessed at baseline and trimonthly afterwards.</div></div><div><h3>Results</h3><div>369 patients from 36 centers were enrolled in this ongoing study. 99% received BLV 2 mg/day monotherapy: age 54 (28-82) years, 55% men, 76% cirrhotics, 96% on NUC therapy. Among cirrhotics, 39% had varices, 10% history of HCC, 10% of ascites, 3% of varices hemorrhage, 7% were decompensated. As of November 2024, 170 patients have completed 48 weeks of treatment. ALT declined: from 75 (16-1,074) U/I at baseline to 34 (7-198), 34 (7-236), and 32 (11-216) U/L at week 24, 32 and 48, respectively (p&lt;0,0001). HDV RNA declined from 5.3 (1.5-8.2) at baseline to 3.4 (0.3-7.3), 2.8 (0.2-7.2), and 2.5 (0.3-7.3) at week 24, 32 and 48, respectively (p&lt;0,0001). Virological, biochemical and combined responses were achieved by 42%, 65% and 31% of patients at week 24; 61%, 67% and 43% of patients at week 32, and by 64% 70% and 47% of patients at week 48. Among non-virological responders, 61%, 46% and 47% achieved a partial virological response (HDV RNA decline &gt;1 but &lt;2 Log IU/mL, compared to baseline) at week 24, 32, and 48. Moreover, 11%, 21% and 22% of patients achieved HDV RNA undetectable at week 24, 32 and 48, respectively.</div></div><div><h3>Conclusions</h3><div>D-SHIELD is the largest single country study on BLV treatment for CHD in Europe. Almost all patients started BLV as monotherapy. Virological, biochemical and combined responses at week 48 compared with previous retrospective studies.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 ","pages":"Page S17"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of magnetic resonance enterography for children with Crohn's disease: A multicenter, multireader study","authors":"Anastasiia Romanchuk ,&nbsp;Clarissa Valle ,&nbsp;Arianna Ghirardi ,&nbsp;Pietro Andrea Bonaffini ,&nbsp;Davide Ippolito ,&nbsp;Naire Sansotta ,&nbsp;Margherita Calia ,&nbsp;Giovanna Zuin ,&nbsp;Paolo Marra ,&nbsp;Lorenzo D'Antiga ,&nbsp;Lorenzo Norsa","doi":"10.1016/j.dld.2024.11.011","DOIUrl":"10.1016/j.dld.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Paediatric Inflammatory Crohn's MRE Index (PICMI) is a multi-point index of intestinal inflammation (mucosal and transmural) for children with CD. The present study aims to assess whether PICMI at diagnosis may predict the course of CD and to test the inter-reader agreement.</div></div><div><h3>Methods</h3><div>CD children with <em>a</em> ≥ 1-year follow-up were retrospectively enrolled. Three radiologists calculated PICMI at diagnosis and association between PICMI and Paediatric Crohn's Disease Activity Index (PCDAI) and CD Endoscopic Index of Severity (CDEIS) was tested.</div></div><div><h3>Results</h3><div>68 children (median age 13 years IQR: 11–14) with CD with PICMI at diagnosis: remission 6 (8.8 %), mild 29 (42.6 %), moderate 24 (35.3 %), severe 9 (13.2 %), were enrolled. PICMI score significantly correlated with PCDAI at diagnosis (p: 0.036). Steroid-free remission at 1, 3 and 5 years was comparable between PICMI groups (p: 0.606). Higher PICMI at diagnosis was associated with higher biologic introduction at 1 year: incidence rate ratio IRR: 2.17 (1.09–4.42); <em>p</em> = 0.019, 3-year IRR: 2.12 (1.15–3.96); <em>p</em> = 0.011, and 5 years: 2.21 (1.20–4.08); <em>p</em> = 0.007.</div></div><div><h3>Conclusions</h3><div>PICMI score is a reliable and almost reproducible index to score activity in children with CD. Children with higher PICMI scores of disease activity at diagnosis required more biologic treatment to achieve comparable rates of steroid-free remission if compared with lower PICMI scores.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 624-629"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis E virus infection in immunosuppressed patients and its clinical manifestations","authors":"Paul Kupke ,&nbsp;Maximilian Kupke ,&nbsp;Stefan Borgmann ,&nbsp;Arne Kandulski ,&nbsp;Florian Hitzenbichler ,&nbsp;Josef Menzel ,&nbsp;Edward K. Geissler ,&nbsp;Hans J. Schlitt ,&nbsp;Jürgen J. Wenzel ,&nbsp;Jens M. Werner","doi":"10.1016/j.dld.2024.06.020","DOIUrl":"10.1016/j.dld.2024.06.020","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Hepatitis E virus (HEV) is a main cause of acute hepatitis globally. However, immunosuppressed patients regularly develop chronic courses. The aim of this study was to analyse the current status of HEV diagnostics, characterize clinical manifestations and identify risk factors for complicated HEV infections.</div></div><div><h3>Methods</h3><div>In this retrospective study at two large hospitals, 512 patients with borderline and positive anti-HEV-IgM and 94 patients with positive HEV-PCR between January 1999 and May 2023 were included.</div></div><div><h3>Results</h3><div>Detection by anti-HEV-IgM-ELISA led to a positive HEV-PCR in only 17.9 %. Amongst patients with positive HEV-PCR, 61 had underlying immunosuppression and 23 were patients after solid organ transplantation (SOT). All 13 patients with chronic HEV infections were immunosuppressed. Generally, immunosuppression led to higher HEV-RNA concentrations and a higher probability of receiving immediate treatment. However, all fulminant courses with liver failure happened in patients without immunosuppression. Immunocompetent patients showed symptoms more frequently and primarily had higher bilirubin levels indicating more severe liver damage. A risk factor for delayed or failed viral clearance after SOT was the administration of mTOR inhibitors.</div></div><div><h3>Conclusions</h3><div>Fulminant HEV infections happen primarily in immunocompetent patients. Nevertheless, immunosuppressed patients bear the risk of undetected, prolonged HEV infections, reflected by the rare occurrence of symptoms.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 378-384"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598887","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}