Journal of Clinical and Experimental Hepatology最新文献

{"title":"Enhancement Patterns of Malignant Gallbladder Masses at Multiphasic Contrast-enhanced CT: Associations With Clinicoradiopathological Features","authors":"Daneshwari Kalage ,&nbsp;Gurubasava Sajjana ,&nbsp;Swaroop Hegde ,&nbsp;Ajay Gulati ,&nbsp;Thakur D. Yadav ,&nbsp;Lileswar Kaman ,&nbsp;Santosh Irrinki ,&nbsp;Harjeet Singh ,&nbsp;Parikshaa Gupta ,&nbsp;Uma Nahar Saikia ,&nbsp;Ritambhra Nada ,&nbsp;Usha Dutta ,&nbsp;Pankaj Gupta","doi":"10.1016/j.jceh.2024.102377","DOIUrl":"10.1016/j.jceh.2024.102377","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the enhancement patterns of malignant gallbladder masses at multiphasic contrast-enhanced computed tomography (CECT) and their association with the clinicoradiopathological features.</p></div><div><h3>Material and methods</h3><p>In this retrospective study, consecutive patients with mass-forming gallbladder cancer (GBC) who underwent biphasic [hepatic arterial phase (HAP) and portal venous phase (PVP)] CECT between January 2019 and January 2023 were included. The enhancement patterns at CT scans were assessed independently by two radiologists blinded to the clinicopathological data. The masses were categorized into the typical group (hypoattenuation relative to normal liver in HAP) and the atypical group (isoenhancement or hyperenhancement in HAP). Enhancement patterns in PVP were also evaluated. The association between enhancement characteristics and the pathological grade and type, radiological aggressiveness (biliary/vascular involvement, lymph node, liver, and omental metastases), resectability, and overall survival was assessed.</p></div><div><h3>Results</h3><p>Sixty-five patients (41 females, mean age was 52.5 ± 17.6 years) were included in the study. On HAP images, eight lesions (12.3%) were hyperattenuating, nine (13.8%) were isoattenuating, and 48 (73.8%) were hypoattenuating. Of the 17 masses in the atypical group, 8 (47.1%) lesions showed washout, and 9 showed persistent enhancement (52.9%) in the PVP. Heterogeneous peripheral and central enhancement in HAP were significantly associated with lymph node metastases (<em>P</em> = 0.019). Enhancement pattern was not significantly associated with pathological grade/type, other radiological features, resectability, and overall survival.</p></div><div><h3>Conclusion</h3><p>Mass-forming GBC has variable enhancement. Heterogeneous HAP enhancement is associated with lymph node metastases.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839058","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":"Adverse Events and Outcomes of High-volume Plasma Exchange in 50 Acute Liver Failure Patients: A Monocentric Retrospective Real-world Study","authors":"Valentin Coirier ,&nbsp;Quentin Quelven ,&nbsp;Pauline Guillot ,&nbsp;Flora Delamaire ,&nbsp;Pauline Houssel-Debry ,&nbsp;Adel Maamar ,&nbsp;Benoît Painvin ,&nbsp;Arnaud Gacouin ,&nbsp;Mathieu Lesouhaitier ,&nbsp;Michel Rayar ,&nbsp;Isabelle Grulois ,&nbsp;Nicolas Terzi ,&nbsp;Jean-Marc Tadié ,&nbsp;Christophe Camus","doi":"10.1016/j.jceh.2024.101934","DOIUrl":"10.1016/j.jceh.2024.101934","url":null,"abstract":"<div><h3>Background and aims</h3><p>Acute liver failure (ALF) is a condition that mostly requires Intensive Care Unit (ICU) admission and sometimes necessitates emergency liver transplantation. High-volume plasma exchange (HVPE) may improve transplant-free survival (TFS) in ALF. Our study assessed complications of HVPE therapy and outcome in ALF patients.</p></div><div><h3>Methods</h3><p>We conducted a single-center retrospective study of all patients admitted to the ICU for ALF and who underwent HVPE between June 2016 and June 2021. The plasmapheresis technique used was centrifugation, and the volume exchanged was calculated as 15% of the ideal body weight. Dedicated staff prospectively collected clinical adverse effects, while biological data were retrospectively collected. The primary outcome was the rate of severe adverse effects (SAE, defined as severe manifestations of hypotension, allergy, metabolic disturbances or other life-threatening event) that occurred during HVPE sessions. Factors influencing day-21 TFS were also studied.</p></div><div><h3>Results</h3><p>One hundred twenty sessions were performed in 50 patients. The main etiology for ALF was paracetamol (52% of the patients). During the session, hemoglobin, platelet, transaminases, ammonia and bilirubin decreased, coagulation factors increased, and creatinine and lactate remained unchanged. At least one SAE was reported for 32 out of 120 sessions (26.7% [19%–35.5%], mostly severe alkalosis [24/117], hypotension [4/120] and hypocalcemia [4/119]). Arterial pH ≤ 7.43 following HVPE and paracetamol etiology were negatively and positively associated with day-21 TFS, respectively.</p></div><div><h3>Conclusion</h3><p>Severe adverse effects were frequent during HVPE performed for ALF, mainly severe alkalosis, hypotension and hypocalcemia. Post-HVPE, pH and paracetamol etiology were prognosis markers.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0973688324005917/pdfft?md5=a38b5d250518456b62b48b6bf6c02f36&pid=1-s2.0-S0973688324005917-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141714139","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":"Few Tregs are Not Enough: Acute Rejection of Living Donor Liver Transplant","authors":"Giuseppe Rusignuolo,&nbsp;Bertram Bengsch","doi":"10.1016/j.jceh.2024.102356","DOIUrl":"10.1016/j.jceh.2024.102356","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697123","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":"Living Donor Liver Transplantation for Hepatocellular Carcinoma","authors":"Prithiviraj Nabi,&nbsp;Ashwin Rammohan,&nbsp;Mohamed Rela","doi":"10.1016/j.jceh.2024.101933","DOIUrl":"10.1016/j.jceh.2024.101933","url":null,"abstract":"<div><p>Liver transplantation (LT) offers the best chance of cure for patients with hepatocellular carcinoma (HCC), as it addresses simultaneously the underlying disease and the tumour. The Milan criteria has been the standard for over 3 decades in selecting patients with HCC who will benefit from LT. While, early studies showed higher recurrence rates for HCC following living donor LT (LDLT), recent series, especially in the past decade have shown LDLT to have equal oncological outcomes as compared to deceased donor LT (DDLT) for HCC, even in patients beyond Milan criteria. Further, the intention to treat analysis data suggests that LDLT may actually provide a survival advantage. In the west, factors such as improved outcomes on par with DDLT, ability to time the LT etc., have led to a steadily increased number of LDLTs being performed for this indication. On the other hand, in the east, given its geo-socio-cultural idiosyncrasies, LDLT has always been the predominant form of LT for HCC, consequently resulting in an increased number of LDLTs being performed for this indication across the world. While LDLT in HCC has its distinctive advantages compared to DDLT, the double equipoise of balancing the donor risk with the recipient outcomes has to be considered while selecting patients for LDLT. There have been several advances including the application of downstaging therapies and the use of biological markers, which have further helped improve outcomes of LDLT for this indication. This review aims to provide an update on the current advances in the field of transplant oncology related to the practice of LDLT in HCC.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961749","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":"Changing the Dial on Pathogen Detection in SBP","authors":"Alastair O'Brien","doi":"10.1016/j.jceh.2024.101932","DOIUrl":"10.1016/j.jceh.2024.101932","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703213","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":"Role of Donor-derived Cell-free DNA In Predicting Short-term Allograft Health In Liver Transplant Recipients","authors":"Koustav Jana ,&nbsp;Ashwin Rammohan ,&nbsp;Avinash Ramani ,&nbsp;Bhavani Gunasekaran ,&nbsp;Mukul Vij ,&nbsp;Maharani Ramamoorthi ,&nbsp;Nivethitha Jayakanthan ,&nbsp;Ilankumaran Kaliamoorthy ,&nbsp;Agragesh Ramani ,&nbsp;Mohamed Rela","doi":"10.1016/j.jceh.2024.101477","DOIUrl":"10.1016/j.jceh.2024.101477","url":null,"abstract":"<div><h3>Background/Aims</h3><p>Predicting allograft dysfunction prior to clinical or biochemical evidence remains one of the challenges in transplantation, and a preclinical detection and early management of its cause allows for improved post-transplant outcomes. Donor-derived cell-free DNA (ddcfDNA) has been proposed as an important biomarker of allograft injury and has shown to predict dysfunction prior to any biochemical derangements. We aimed to investigate the diagnostic performance of ddcfDNA in detecting and differentiating the causes of early pre-biochemical detection of graft injury and in predicting the short-term outcomes of graft health using a patented protocol and proprietary set of single-nucleotide polymorphisms.</p></div><div><h3>Methods</h3><p>Blood samples were collected on defined postoperative days (1, 3, 7, and at 3 months) and were analysed through relatively economical patented protocol (Trunome™). Biopsy, biochemical tests, and clinical criteria were analysed between various subgroups.</p></div><div><h3>Results</h3><p>Of a total 50 patients, percentage ddcfDNA (%ddcfDNA) levels were significantly elevated in the rejection group (n = 8) as compared to that in the non-rejection group (n = 42; median elevation: 12.8% vs 4.3%, respectively), with a significant correlation (r = 0.92, <em>P</em> &lt; 0.0001). Area under the receiver operating characteristic curve (AUC-ROC) analysis revealed that the %ddcfDNA levels can predict graft health more precisely than the conventional liver function tests (AUC for %ddcfDNA: 0.86; <em>P</em> &lt; 0.001; AUC for aspartate transaminase 0.65, <em>P</em> = 0.08; AUC for alanine transaminase: 0.75, <em>P</em> &lt; 0.01). Moreover, %ddcfDNA levels (with a threshold of &gt;10.2%) on post-operative day 7 accurately predicted short-term (3 months) health status of the graft with 93.33% sensitivity, 94.44% specificity, 87.50% positive predictive value, 97.14% negative predictive value, and 94.12% accuracy.</p></div><div><h3>Conclusion</h3><p>A single-timepoint ddcfDNA on postoperative day 7 accurately predicts graft health and improves risk stratification in the short-term.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694804","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":"Portal Hypertension Due to TULP3-related Ciliopathy: First Report From the Asia–Pacific Region","authors":"Pramod Kumar,&nbsp;Rohit Maidur,&nbsp;Shiva K. Varakanahalli,&nbsp;Pradeep Krishna,&nbsp;V. Sandhya","doi":"10.1016/j.jceh.2024.101478","DOIUrl":"10.1016/j.jceh.2024.101478","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715515","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":"The Impact of Gender and Race on Outcomes for Hospitalized Hepatitis A Patients Stratified by Liver Disease Severity","authors":"David U. Lee ,&nbsp;Kuntal Bhowmick ,&nbsp;Mohammed R. Shaik ,&nbsp;Dabin Choi ,&nbsp;Gregory H. Fan ,&nbsp;Hannah Chou ,&nbsp;Aneesh Bahadur ,&nbsp;Ki J. Lee ,&nbsp;Harrison Chou ,&nbsp;Kimmy Schuster ,&nbsp;Sindhura Kolachana ,&nbsp;Daniel Jung ,&nbsp;Sophie Schellhammer ,&nbsp;Raffi Karagozian","doi":"10.1016/j.jceh.2024.101479","DOIUrl":"10.1016/j.jceh.2024.101479","url":null,"abstract":"<div><h3>Background</h3><p>The incidence of hepatitis A virus (HAV) infection is on the rise, with a minority of patients at risk for poor outcomes. This study investigates the prognostic impacts of race and gender on hospital outcomes among admitted HAV-infected patients.</p></div><div><h3>Methods</h3><p>Using the National Inpatient Sample from 2012 to 2017, patients admitted with HAV were selected and stratified by gender (male and female) and race (White, Black, Hispanic, Asian–Pacific Islander, Other). Propensity score-matching and statistical analysis were implemented with comparison to the controls (“Female” and “White”). Primary endpoints included mortality, length of stay (LOS), and hospitalization costs, while secondary endpoints consisted of hepatic-related medical complications such as ascites, hepatic encephalopathy, varices, and acute liver failure.</p></div><div><h3>Results</h3><p>Females with compensated cirrhosis had increased odds of mortality (aOR 2.59, 95% CI: 1.14–5.91, <em>P</em> = 0.02). Otherwise, no other differences in mortality were detected between genders and races. Females had a shorter hospital LOS (aOR 0.97, 95% CI: 0.96–0.98, <em>P</em> &lt; 0.001), lower adjusted cost ($12,241 vs. $13,510, aOR 0.92, 95% CI: 0.92–0.92, <em>P</em> &lt; 0.001), lower odds of esophageal varices (aOR 0.74, 95% CI: 0.57–0.97, <em>P</em> = 0.03) and hepatic encephalopathy (aOR 0.67, 95% CI: 0.53–0.84, <em>P</em> &lt; 0.001) compared to males. Black patients exhibited higher LOS (aOR 1.06, 95% CI: 1.04–1.08, <em>P</em> &lt; 0.001) and adjusted costs ($13,392 vs $12,592, aOR 1.02, 95% CI: 1.02–1.03, <em>P</em> &lt; 0.001). Hispanic patients exhibited higher rates of esophageal varices (aOR 2.19, 95% CI: 1.28–3.76, <em>P</em> = 0.005) and adjusted costs ($14,202 vs. $12,381, aOR 1.07, 95% CI: 1.07–1.07, <em>P</em> &lt; 0.001), and Asian patients experienced higher adjusted costs ($18,426 vs. $13,137, aOR 1.10, 95% CI: 1.10–1.10, <em>P</em> &lt; 0.001) compared to White patients.</p></div><div><h3>Conclusion</h3><p>Various nuanced impacts of gender and race on hospitalization outcomes in HAV infection were observed, with only one subgroup analysis demonstrating a higher rate of mortality. Further research is warranted to better understand these findings and their implications.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0973688324001361/pdfft?md5=e73b8e3f7fd748463be079d6a926a3cd&pid=1-s2.0-S0973688324001361-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691506","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":"Characteristics of Hepatobiliary Fascioliasis and the Role of Endoscopic Retrograde Cholangiopancreatography in Management: A Single Center Experience","authors":"Ibrahim H. Bahcecioglu ,&nbsp;Ahmed Tawheed ,&nbsp;Nurettin Tunc ,&nbsp;Hakan Artas ,&nbsp;Ahmad Madkour ,&nbsp;Sedat Cicek ,&nbsp;Mehmet Yalniz","doi":"10.1016/j.jceh.2024.101476","DOIUrl":"10.1016/j.jceh.2024.101476","url":null,"abstract":"<div><h3>Background</h3><p>Hepatobiliary fascioliasis has two phases, each requiring specific management approaches. Triclabendazole has been widely effective in treating the two phases of clinical fascioliasis and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary phase. We aimed to characterize presentations of hepatobiliary fascioliasis and highlight the role of ERCP in management.</p></div><div><h3>Subjects and methods</h3><p>This retrospective cohort includes patients diagnosed with clinical hepatobiliary fascioliasis between January 2013 and December 2022. Demographic data, clinical presentation, laboratory and radiological investigations, treatment, and endoscopy reports were collected from the records of 62 participants. Patients were divided into two groups: acute hepatic and chronic biliary phases.</p></div><div><h3>Results</h3><p>Thirty-six patients were in the biliary phase, and 26 were in the hepatic phase. All patients were from rural areas, and females were predominant (76%). Hypereosinophilia was detected in 92% of acute cases and 58% of chronic biliary cases. In chronic biliary cases, the levels of liver biochemicals, including alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and bilirubin, were higher at levels of 189 ± 76, 127 ± 47, 268 ± 77, and 2.4 ± 0.7 respectively, compared to acute hepatic cases, 35.6 ± 8.2, 32.7 ± 4.3, 69.2 ± 45.45, and 0.58 ± 0.01. The corresponding <em>P</em>-values were 0.003, 0.001, &lt;0.001, and &lt;0.001, respectively. Triclabendazole effectively cured 93.5% of patients and was used in combination with ERCP in biliary-phase cases where the fluke was extracted from the biliary system in 34 patients (94.4%). Three patients (8.8%) were diagnosed with post-ERCP pancreatitis. None of the patients experienced bleeding, perforation, or required biliary stenting.</p></div><div><h3>Conclusion</h3><p>Clinical fascioliasis could manifest in acute hepatic or chronic biliary phases. Hypereosinophilia was more evident in the hepatic phases, while ALT, AST, GGT, and bilirubin were higher in the biliary phase. Triclabendazole is effective in the hepatic phase and when combined with ERCP in the biliary phase. ERCP is highly effective for relieving obstruction and treating biliary fascioliasis.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636537","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":"Issue Highlights","authors":"","doi":"10.1016/S0973-6883(24)00120-8","DOIUrl":"https://doi.org/10.1016/S0973-6883(24)00120-8","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141487606","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}