Journal of Clinical and Experimental Hepatology最新文献

{"title":"Hepatocellular Carcinoma: Molecular Diagnosis and Perspectives for Therapy","authors":"","doi":"10.1016/j.jceh.2024.102413","DOIUrl":"10.1016/j.jceh.2024.102413","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Stratification of Patients with Metabolic Dysfunction-associated Steatotic Liver Disease: Steatohepatitis, Fibrosis, and Hepatocellular Carcinoma","authors":"","doi":"10.1016/j.jceh.2024.102415","DOIUrl":"10.1016/j.jceh.2024.102415","url":null,"abstract":"<div><div>The metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is increasing globally, creating a growing public health concern. Metabolic disorders such as central obesity, dyslipidemia, hypertension, and hyperglycemia are intimately related to MASLD. Advanced hepatic fibrosis is the main predictor of morbidity, liver-related complications, and deaths. Various noninvasive scoring systems are used to practice acceptable general population screening and diagnose patients with MASLD. Unfortunately, as of right now, no single diagnostic test is thought to be reliable enough to diagnose and monitor MASLD patients. Liver biopsy remains the gold standard for diagnosing metabolic dysfunction-associated steatohepatitis (MASH) (with or without fibrosis), impacting the prognosis and survival of patients with MASLD.</div><div>Moreover, it is anticipated that MASLD is a risk factor for hepatocellular carcinoma (HCC) development, and several risk factors for MASLD occurrence are also linked to the development of HCC. Identifying patients with a risk of developing MASH, fibrosis, and HCC is more challenging; there is limited evidence on utilizing available noninvasive methods for these purposes. This review discusses the tools and steps of risk stratification in MASLD patients, providing data to guide the utilization of various diagnostic and scoring tools, focusing on the latest techniques to non-invasively detect patients at risk of developing MASH, fibrosis, and HCC.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Vascular Complications Between Living-donor and Deceased-donor Liver Transplantation – A Systematic Review and Meta-analysis","authors":"","doi":"10.1016/j.jceh.2024.102414","DOIUrl":"10.1016/j.jceh.2024.102414","url":null,"abstract":"<div><h3>Background</h3><div>Vascular complications commonly cause graft loss and morbidity after liver transplantation (LT). Comparative data on the risk of vascular complications are limited. Hence, the present meta-analysis was conducted to analyze the difference in vascular complications between living-donor LT (LDLT) and deceased-donor LT (DDLT).</div></div><div><h3>Methods</h3><div>A literature search of three databases was conducted for studies comparing the incidence of vascular complications with LDLT and DDLT. The event rates and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model.</div></div><div><h3>Results</h3><div>A total of 20 studies were included in the final analysis. There was no difference in the incidence of overall vascular complications (9.3%, 95% CI: 6.6–12.0 vs. 8.5%, 95% CI: 5.6–11.4) between LDLT and DDLT with OR 0.94 (95% CI: 0.73–1.21) (15 studies).There was a higher incidence of vascular complications with LDLT in older studies (published before 2013) but not in new studies. When comparing the individual complications, LDLT was associated with a higher incidence of hepatic artery thrombosis (HAT) (3.8%, 95% CI: 2.4–5.2 vs. 1.6%, 95% CI: 1.1–2.2)with OR 2.20 (95% CI: 1.53–3.17) (14 studies)and a significantly lower incidence of intra-abdominal bleeding(4.8%, 95% CI: 3.3–6.2 vs. 7.9%, 95% CI: 5.0–10.7) with OR 0.64 (95% CI: 0.47–0.87) (11 studies). However, there was no difference in the incidence (2.1%, 95% CI: 0.5–3.8 vs. 1.0%, 95% CI: 0.1–1.9) of portal vein thrombosis between LDLT and DDLT with OR 1.85 (95% CI: 0.82–4.18) (6 studies).</div></div><div><h3>Conclusion</h3><div>Despite a comparable risk of vascular complications between LDLT and DDLT, LDLT was associated with a higher risk of HAT and a lower risk of intraprocedural bleeding. Further studies are required to analyze the effect of donor-recipient characteristics and surgical techniques on the risk of vascular complications.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex Reconstruction of Right-Lobe Grafts on the Bench: Portal Vein, Anterior Sector Hepatic Veins, Inferior Hepatic Veins and Multiple Bile Ducts","authors":"","doi":"10.1016/j.jceh.2024.102411","DOIUrl":"10.1016/j.jceh.2024.102411","url":null,"abstract":"<div><div>Living donor liver transplantation (LDLT) employing right-lobe (RL) grafts has become indispensable amid limited deceased donor graft availability. RL grafts, while smaller, offer outcomes comparable with deceased donor grafts, prompting a surge in global RL LDLT. However, bench surgery in LDLT requires meticulous preparation to minimize warm ischaemia time and ensure optimal inflow and outflow reconstruction. This review combines an analysis of existing literature with a discussion of our technique, emphasizing the intricacies of RL graft bench reconstruction.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Plasma Exchange in Hepatology: Indications, Techniques, and Practical Application","authors":"","doi":"10.1016/j.jceh.2024.102410","DOIUrl":"10.1016/j.jceh.2024.102410","url":null,"abstract":"<div><div>It is sobering that many liver failure patients die in the absence of liver transplantation (LT), and reducing its morbidity and mortality urgently needs more non-transplant treatment options. Among the several artificial liver support devices available, therapeutic plasma exchange (TPE) is the only one that improves survival in acute liver failure (ALF) patients. In many other disorders, data on survival benefits and successful bridging to transplant is encouraging. TPE removes the entire plasma, including damage-associated-molecular patterns, and replaces it with healthy donor fresh frozen plasma. In contrast, other artificial liver support systems (ALSS) correct the blood composition through dialysis techniques. TPE has become increasingly popular due to advances in apheresis techniques and a better understanding of its applicability in treating liver failure's pathophysiology. It provides metabolicdetoxification, and synthetic functions and modulates early innate immunity, fulfilling the role of ALSS. TPE is readily available in intensive care units, dialysis units, or blood banks and has enormous potential to improve survival outcomes. Hepatologists must take advantage of this treatment option by thoroughly understanding its most frequent indications and its rationale and techniques. This primer on TPE for liver clinicians covers its current clinical, technical, and practical applications, addresses the knowledge gaps, and provides future directions.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotational Thromboelastometry Reduces the Need for Preemptive Transfusion in Cirrhosis: A Randomized Controlled Trial (NCT:05698134)","authors":"","doi":"10.1016/j.jceh.2024.102409","DOIUrl":"10.1016/j.jceh.2024.102409","url":null,"abstract":"<div><h3>Backgrounds and aim</h3><div>Viscoelastic tests (VET) like rotational thromboelastometry (ROTEM) assess global hemostasis in cirrhosis. We aimed to assess whether ROTEM-guided blood product transfusion results in lower blood product requirements in patients with cirrhosis undergoing elective invasive procedures as compared to standard of care (SOC) based on conventional coagulation test (CCT).</div></div><div><h3>Methods</h3><div>In this open label randomized controlled trial, patients with cirrhosis and abnormal CCT who were undergoing an invasive procedure were randomized to receive blood products either by ROTEM-guidance or SOC. The primary outcome was the difference in blood products (fresh frozen plasma (FFP) or platelets) transfused between the groups. The secondary outcome was procedure-related bleeding or complications within 7 days of the procedure. The trial protocol is registered at <span><span>clinicaltrails.gov</span><svg><path></path></svg></span>; <span><span>NCT05698134</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>From August 2021 to January 2023, a total of 40 patients were recruited (ROTEM (n = 20) and SOC (n = 20)). The trial was terminated earlier during interim analyses due to compelling benefit in the ROTEM group after a scheduled interim analysis. The ROTEM group required substantially less blood transfusion than the SOC group (40% [8/20] vs 100% [20/20], <em>P</em> &lt; 0.001). The benefit was consistent across all types of blood product, including fresh frozen plasma (&lt;0.001) and pooled platelets (<em>P</em> = 0.046). No patients experienced clinically significant bleeding events. Transfusion-associated adverse events occurred in one patient (5%) in the SOC group (allergic reaction) and none in the ROTEM group (<em>P</em> = NS). The mortality in both groups at 30 and 90 days was similar.</div></div><div><h3>Conclusions</h3><div>Viscoelastic tests like ROTEM provide global assessment of hemostasis in patients with cirrhosis. Institution of ROTEM based transfusion strategy significantly reduces the need for blood product transfusion in patients with cirrhosis undergoing elective procedure without any increased risk of bleeding events.</div></div><div><h3>Clinical trial number</h3><div><span><span>NCT05698134</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0973688324010764/pdfft?md5=90392388ab0c9eb69c225089353a4c21&pid=1-s2.0-S0973688324010764-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deceased Donor Program in India: Listing and Allocation Practices and the Legal Process With Respect to Liver Transplantation","authors":"","doi":"10.1016/j.jceh.2024.102408","DOIUrl":"10.1016/j.jceh.2024.102408","url":null,"abstract":"<div><div>India is the country with the third largest transplantation activity in the world but has one of the lowest deceased donation rates. The Transplantation of Human Organs Act was first enacted as law 29 years ago, its implementation has been non-uniform and growth in deceased donation has been slow and heterogenous. This review discusses the concept of brain death, ethics of deceased donation and organ allocation, Indian legislation in this area and the regulatory structure of the National Organ transplantation program. We also discuss current status of deceased donation and deceased donor liver transplantation in the country, identify variation in liver allocation policies across Indian states and identify areas of need and potential solutions.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0973688324010752/pdfft?md5=df5cd9679e94bf2603aa6068bd2155ad&pid=1-s2.0-S0973688324010752-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issue Highlights","authors":"","doi":"10.1016/S0973-6883(24)01071-5","DOIUrl":"10.1016/S0973-6883(24)01071-5","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving Global Etiology of Hepatocellular Carcinoma (HCC): Insights and Trends for 2024","authors":"","doi":"10.1016/j.jceh.2024.102406","DOIUrl":"10.1016/j.jceh.2024.102406","url":null,"abstract":"<div><p>The epidemiology of HCC is changing all over the world and the incidence of HCC is expected to continue increasing over the next 30 years. The changes are in the predisposing factors. Hepatitis B and hepatitis C as predisposing etiologies are decreasing while NAFLD/MAFLD is increasing. The increase in MAFLD is so great that despite the decrease in hepatitis B and C, the overall incidence of HCC is increasing. HCC in persons below the age of 20 years has distinct characteristics different from that of HCC in adults. The changing etiology of hepatocellular carcinoma has implications for the early detection, prevention, the stage of HCC at time of detection and in the treatment of HCC. The extent of these changes and their significance are discussed.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0973688324010739/pdfft?md5=1413b6d805486aa864e21c916b6ed2c7&pid=1-s2.0-S0973688324010739-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Plasma Exchange and Combining Therapies in Dengue-Associated Acute Liver Failure: A Systematic Review of Individual Cases","authors":"","doi":"10.1016/j.jceh.2024.102407","DOIUrl":"10.1016/j.jceh.2024.102407","url":null,"abstract":"<div><h3>Background/Aims</h3><p>Dengue-associated acute liver failure (ALF) poses a significant risk for mortality, especially in regions lacking access to liver transplantation. Although Plasma Exchange (PLEX) is recognized as a potential therapeutic intervention for dengue-associated ALF, data on its efficacy remain limited. This systematic review aimed to comprehensively examine the literature on PLEX and other combination therapies for dengue-associated ALF. It focused on assessing their effectiveness, safety profile, and potential implications for therapeutic interventions.</p></div><div><h3>Methods</h3><p>In this study, we conducted a systematic review to assess the efficacy and safety of PLEX and other combination therapies in patients with dengue-associated ALF. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were used to search the PubMed, Scopus, Embase, Ovid, and Google Scholar databases. Studies published in English between 2019 and May 2024 were included. The titles and abstracts were reviewed for discrepancies, and any differences were resolved through discussion.</p></div><div><h3>Results</h3><p>Among the 713 studies assessed for review, 9 met the eligibility criteria. Studies have demonstrated that PLEX, both alone and in combination with other therapies, such as continuous renal replacement therapy (CRRT), improves liver function, survival rates, and neurological outcomes in patients with dengue virus. Both high- and low-volume plasma exchanges were effective.</p></div><div><h3>Conclusion</h3><p>This systematic review highlights the beneficial role of PLEX and the potential benefits of combination therapies in the treatment of rare and severe forms of dengue-associated ALF. However, given the limited sample sizes and the necessity for well-designed studies, further investigations are needed to determine the optimal volume of PLEX and the efficacy of additional therapeutic strategies.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0973688324010740/pdfft?md5=9ff56b8668aab3b1774baa1860db7019&pid=1-s2.0-S0973688324010740-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}