Journal of Clinical and Experimental Hepatology最新文献

{"title":"Partial Splenic Artery Embolization for the Management of Symptomatic Hypersplenism in Portal Hypertension: Clinical Insights from a Case Series","authors":"Mayur Satai,&nbsp;Arun Vaidya,&nbsp;Krantikumar Rathod,&nbsp;Ankita Singh,&nbsp;Sidharth Harindranath,&nbsp;Biswa R. Patra,&nbsp;Akash Shukla","doi":"10.1016/j.jceh.2024.101435","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101435","url":null,"abstract":"<div><h3>Background and aims</h3><p>Partial splenic artery embolization (PSAE) is an alternative treatment modality for managing hypersplenism secondary to portal hypertension. We are presenting a case series of patients with portal hypertension who underwent PSAE for symptomatic hypersplenism.</p></div><div><h3>Methods</h3><p>We included patients with portal hypertension who underwent PSAE from January 2022 to December 2022. Patients' characteristics and procedure related complications were noted. Data were analyzed for improvement in the hematological parameters.</p></div><div><h3>Results</h3><p>A total of 11 (7 women, median age 34 [18–56] years) patients were included. Three patients were cirrhotic (hepatitis B-2, metabolic dysfunction–associated steatotic liver disease −1) and 8 were non-cirrhotic (extra-hepatic portal vein obstruction-5, Non cirrhotic portal fibrosis-3). Splenic artery aneurysm was concomitantly present in 5 cases. Technical success was achieved in all cases. Post embolization, hemoglobin, white blood cells and platelet counts improved at 4 weeks, 12 weeks and 24 weeks along with symptomatic improvement. All patients had post-embolization syndrome. One patient developed transient ascites and secondary bacterial peritonitis which was managed conservatively. One patient died due to splenic abscess and septicemia.</p></div><div><h3>Conclusion</h3><p>Although, hematological parameters and symptoms improve post procedure, PSAE is associated with major complications and should be performed judiciously in selected cases only. Graphical abstract is presented in Figure 1.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141097840","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":"Endoscopic Ultrasound Guided Radiofrequency Ablation for Caudate Lobe Hepatocellular Carcinoma: A New Paradigm in Endohepatology","authors":"Arka De ,&nbsp;Yogendra Kumar ,&nbsp;Arpit Shastri ,&nbsp;Chandragiri P. Ganesh ,&nbsp;Arwinder Singh ,&nbsp;Sahaj Rathi ,&nbsp;Sreedhara B. Chaluvashetty ,&nbsp;Ajay Duseja","doi":"10.1016/j.jceh.2024.101438","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101438","url":null,"abstract":"<div><p>Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a promising technique for treating small left hepatic lesions, particularly where ablation via percutaneous route is deemed to be technically difficult. Herein, we report a case of a 64-year-old cirrhotic patient with caudate lobe hepatocellular carcinoma (HCC) who underwent EUS-RFA, resulting in complete ablation of the tumor and also review the related literature.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140948448","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 Vein Reconstruction-trans Jugular Intrahepatic Portosystemic Shunt and Portal Vein Stenting in Patients With Extrahepatic Portal Vein Obstruction","authors":"Sayan Malakar ,&nbsp;Rajanikant R. Yadav ,&nbsp;Gaurav Pandey ,&nbsp;Praveer Rai ,&nbsp;Gurubasava Sajjan ,&nbsp;Anurag Mehndiratta ,&nbsp;Malla V.A. Gangadhar Rao ,&nbsp;S. Rakesh Kumar ,&nbsp;Dhruv Thakur ,&nbsp;Pritam Das ,&nbsp;Samir Mohindra ,&nbsp;Supriya Sharma","doi":"10.1016/j.jceh.2024.101437","DOIUrl":"10.1016/j.jceh.2024.101437","url":null,"abstract":"<div><p>Extrahepatic portal vein thrombosis (EHPVO) is an uncommon cause of portal hypertension. In the long term, patients may develop portal cavernoma cholangiopathy (PCC). Up to 30%–40% of patients with EHPVO may not have shuntable veins and are often difficult to manage surgically. Interventional treatment including portal vein recanalisation-trans jugular intrahepatic portosystemic shunt (PVRecan-TIPS) has been used for patients with EHPVO. However, PV reconstruction-trans jugular intrahepatic portosystemic shunt (PVRecon-TIPS) and portal vein stenting are novel techniques for managing such patients with EHPVO with non-shuntable venous anatomy. In contrast to PVRecan-TIPS, PV reconstruction-TIPS (PVRecon-TIPS) is performed through intrahepatic collaterals. Here we present six cases of PCC who presented with recurrent acute variceal bleeding (AVB) and or refractory biliary stricture. They did not have any shuntable veins. PVRecon-TIPS was performed for five patients whilst PV stenting was done in one. Amongst the six patients, one died of sepsis whilst one who developed hyponatremia and hepatic encephalopathy was salvaged with conservative management. Following the procedure, they were started on anti-coagulation. Decompression of cavernoma was documented in all other patients. Biliary changes improved completely in 40% of patients.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140767787","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":"Dental and ENT Evaluation Before Liver Transplantation","authors":"Rakesh K. Jagdish ,&nbsp;Preetam Chappity ,&nbsp;S. Lata","doi":"10.1016/j.jceh.2024.101431","DOIUrl":"10.1016/j.jceh.2024.101431","url":null,"abstract":"<div><p>The assessment of dental and ear, nose and throat (ENT) conditions holds significant importance in the pre-transplantation evaluation for individuals undergoing liver transplantation. This evaluation aims to address concerns related to dental and ENT issues both before and after liver transplantation. These concerns include the risk of sepsis, the impact of post-transplantation immunosuppression, the detection of existing malignancies, including oral potentially malignant disorders (OPMDs), and identifying any contraindications to the transplantation procedure. However, it is worth noting that there exists a notable absence of clear guidelines and protocols in the existing literature regarding this practice. Moreover, recent studies have presented conflicting results, and concerns have arisen regarding the cost-effectiveness of these evaluations. It is crucial to perform these investigations judiciously to avoid unnecessary testing burdens and delays in placing patients on waiting lists, particularly when considering live donor liver transplantation (LDLT) evaluations. A comprehensive examination of the oral and ENT regions, in conjunction with relevant laboratory tests, can play a pivotal role in identifying and managing oral and ENT diseases before the liver transplantation procedure. Timely recognition and treatment of potential issues are essential for minimizing perioperative morbidity and mortality. There is an evident need for prospective trials and studies to further explore and establish guidelines in the critical area of dental and ENT evaluation in liver transplantation recipients. Such research efforts would contribute significantly to enhancing our understanding and management of oral and ENT conditions in the pre-transplantation setting, ultimately improving patient care and outcomes.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756412","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":"A Case of First-line Atezolizumab Plus Bevacizumab Use in Recurrence of Combined Hepatocellular Cholangiocarcinoma After Surgical Resection","authors":"Gordon T. Moffat,&nbsp;Kai Duan,&nbsp;Jennifer J. Knox","doi":"10.1016/j.jceh.2024.101430","DOIUrl":"10.1016/j.jceh.2024.101430","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140797360","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":"Alterations in CD4+ T-cell Subsets in Living Donor Liver Transplantation Associated With Graft Rejection","authors":"Ankur Vagadiya ,&nbsp;Rashi Sehgal ,&nbsp;Nirupma Trehanpati ,&nbsp;Viniyendra Pamecha","doi":"10.1016/j.jceh.2024.101428","DOIUrl":"10.1016/j.jceh.2024.101428","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Regulatory T-cells (Tregs) play a key role in immune homeostasis after organ transplantation. However, the role of CD4⁺ T cell subsets in early acute rejection is still not well understood. Therefore, our aim was to determine changes in CD4⁺ T-cell subsets in living donor liver transplantation (LDLT).</p></div><div><h3>Methods</h3><p>LDLT patients were assessed for T-cell subsets, Tregs frequencies and their functionality by flow-cytometry at peri- and post-transplant in the span of 1 year.</p></div><div><h3>Results</h3><p>33 patients were followed up and 11 (33%) patients have developed early acute cellular rejection (ACR). At peri-transplant time point, MFI of Foxp3⁺ Tregs was significantly increased compared to HC (<em>P</em> = 0.04). However, CD4⁺CD25⁺Foxp3⁺/CD127^– Tregs numbers and IL-10, IL-17 and TGF-β secreting functional Tregs were significantly decreased at 3 months compared to peri-transplant (<em>P</em> = 0.003). But in patients with rejection, CD4⁺CD25⁺FOXP3⁺ and CD4⁺CD25⁺CD127⁻ Tregs were significantly decreased at day 3 compared to no rejection group (<em>P</em> = 0.048). Patients with rejection also showed significantly decreased numbers of IL-17 and TGF-β secreting CD4⁺CD25⁺FOXP3⁺ Tregs at peri-transplant time (<em>P</em> = 0.04, <em>P</em> = 0.03) compared to no rejection. Further, rejection group showed decreased terminally differentiated effector memory (TEMRA) at peri-transplant and day 7 (<em>P</em> = 0.048 and <em>P</em> = 0.01). Additionally, CD4⁺ central memory (CM) was decreased at peri-transplant (<em>P</em> = 0.05), 1 month (<em>P</em> = 0.04), and 3 to 6 month (<em>P</em> = 0.02).</p></div><div><h3>Interpretation and conclusion</h3><p>Tregs frequencies were significantly decreased in peri-TX in rejection patients. Further, decreased frequencies of CD4⁺ TEMRA and CD4⁺ CM at day 7 and 1 month were associated with rejection.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777726","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":"Case of Ectopic Variceal Bleed Managed With Percutaneous Transhepatic Portal Vein Recanalization","authors":"Tara P. Tripathy ,&nbsp;Ranjan K. Patel ,&nbsp;Aryamon Mukherjee ,&nbsp;Brahmadutta Pattanaik ,&nbsp;Hemant K. Nayak ,&nbsp;Sanjib Kar ,&nbsp;Manas K. Panigrahi","doi":"10.1016/j.jceh.2024.101429","DOIUrl":"10.1016/j.jceh.2024.101429","url":null,"abstract":"<div><p>A variety of complications and associated clinical presentations may be seen in patients with cirrhotic and non-cirrhotic portal hypertension. We present one such case of Upper GI hemorrhage from ectopic duodenal varices in a case of pre-hepatic portal hypertension due to Extrahepatic Portal Venous Obstruction (EHPVO). The case was managed successfully with endovascular Portal Vein Recanalization (PVR) and metallic stent deployment. With adequate technical success, improved symptoms, and laboratory parameters, the patient was discharged on long-term anticoagulation and interval follow-up.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764585","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":"Simultaneous Liver Kidney Transplantation in a Primary Type 2 Hyperoxaluria With Corrected TOF and Severe Cardiomyopathy: A Case Report","authors":"Navaneethan Subramanian ,&nbsp;Abhishek Yadav ,&nbsp;Jithin S. Kumar ,&nbsp;George P. Abraham","doi":"10.1016/j.jceh.2024.101425","DOIUrl":"10.1016/j.jceh.2024.101425","url":null,"abstract":"<div><h3>Background</h3><p>Primary type 2 hyperoxaluria is a very rare genetic disorder,^1,2 where in the progression to renal failure was assumed to be insidious and not very common.³ PH2 is due to deficient glyoxylate reductase/hydroxypyruvate reductase (GRHPR),^1,2 which was thought to have extra-hepatic production also.⁴ The progression to renal failure in these patient subgroups is well documented in the Literature and the role of SLK (simultaneous liver and kidney transplantation) has not been clearly established.⁸</p></div><div><h3>Method</h3><p>We present a case report of a young girl with PH2, who successfully underwent SLK, with evidence of reduction in the urine oxalate levels post SLK.</p></div><div><h3>Results</h3><p>PH2, though a rare genetic disease, has a proven potential to progress to chronic renal failure requiring transplantation, renal transplantation alone has not shown any benefit, these patients can be offered SLK as a primary treatment option, to improve the outcomes, this needs further validation with consensus and studies.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761796","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":"Challenges to Hepatitis C Virus Testing and Treatment in a Rural Setting of Lao People's Democratic Republic","authors":"Douangsamai Akkhasith,&nbsp;Somphou Sayasone,&nbsp;Anousin Homsana,&nbsp;Judith M. Hübschen,&nbsp;Siriphone Virachith,&nbsp;Antony P. Black,&nbsp;Phimpha Paboriboune","doi":"10.1016/j.jceh.2024.101426","DOIUrl":"10.1016/j.jceh.2024.101426","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140789650","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":"Hepatitis A Liver Failure in Children: Native Liver Survival Despite Poor Prognosis","authors":"Vipul Gautam ,&nbsp;Bikrant B. Lal ,&nbsp;Vikram Kumar ,&nbsp;Shaleen Agarwal ,&nbsp;Vikrant Sood ,&nbsp;Rajeev Khanna ,&nbsp;Seema Alam ,&nbsp;Subhash Gupta","doi":"10.1016/j.jceh.2024.101427","DOIUrl":"10.1016/j.jceh.2024.101427","url":null,"abstract":"<div><h3>Background</h3><p>Hepatitis A virus (HAV) infection is the commonest cause of pediatric acute liver failure (PALF) in developing countries. Literature has shown good outcomes of HAV-induced PALF as compared to other etiologies. The advanced critical care and use of extracorporeal liver assist devices (ELAD) have improved the survival with native liver in PALF and overall outcomes. Various liver transplant listing criteria have been proposed in PALF, however none of them is specific enough to predict the outcome. The timing of liver transplant in living donor setting has never been straightforward. Dynamic clinical and biochemical monitoring of the ALF child is the key to decide for LT.</p></div><div><h3>Cases</h3><p>Here we report three children with HAV-induced PALF presented with advanced hepatic encephalopathy (HE) and high international normalized ratio (INR &gt; 10). These children survived with native liver despite fulfilling the liver transplant criteria. The first child is a 14-year-old male who had peak INR of more than 10.2 and grade 3–4 HE with cerebral edema and acute kidney injury. He responded to medical management and CRRT as liver assist device. The second one is a 7-year-old male child who also recovered well with native liver despite advanced HE and INR of more than 10. Third child is a 16-year-old male who had peak INR of 12.6 and grade 2 HE. He received ELAD (Therapeutic plasma exchange and CRRT) and survived with native liver.</p></div><div><h3>Conclusion</h3><p>Children with HAV-induced PALF can recover with their native liver despite extremely poor prognostic markers like very high INR, ammonia and advanced HE.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775681","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}