Canadian liver journal最新文献

{"title":"Risk Evaluation and Recipient Selection in Adult Liver Transplantation: A Mixed-Methods Survey.","authors":"Christian Vincelette, Philémon Mulongo, Jeanne-Marie Giard, Éva Amzallag, Adrienne Carr, Prosanto Chaudhury, Khaled Dajani, Réné Fugère, Nelson Gonzalez-Valencia, Alexandre Joosten, Stanislas Kandelman, Constantine Karvellas, Stuart A McCluskey, Timur Özelsel, Jeieung Park, Ève Simoneau, Helen Trottier, Michaël Chassé, François Martin Carrier","doi":"10.3138/canlivj-2023-0037","DOIUrl":"10.3138/canlivj-2023-0037","url":null,"abstract":"<p><strong>Background: </strong>Liver transplant (LT) is the definitive treatment for end-stage liver disease. Limited resources and important post-operative implications for recipients compel judicious risk stratification and patient selection. However, little is known about the factors influencing physicians' assessment regarding patient selection for LT and risk evaluation.</p><p><strong>Methods: </strong>We conducted a mixed-methods, cross-sectional survey involving Canadian hepatologists, anesthesiologists, LT surgeons, and French anesthesiologists. The survey contained quantitative questions and a vignette-based qualitative substudy about risk assessment and patient selection for LT. Descriptive statistics and qualitative content analyses were used.</p><p><strong>Results: </strong>We obtained answers from 129 physicians, and 63 participated in the qualitative substudy. We observed considerable variability in risk assessment prior to LT and identified many factors perceived to increase the risk of complications. Clinicians reported that the acceptable incidence of at least 1 severe post-operative complication for a LT program was 20% (95% CI: 20-30%). They identified the presence of any comorbidity as increasing the risk of different post-operative complications, especially acute kidney injury and cardiovascular complications. Frailty and functional disorders, severity of the liver disease, renal failure and cardiovascular comorbidities prior to LT emerged as important risk factors for post-operative morbidity. Most respondents were willing to pursue LT in patients with grade III acute-on-chronic liver failure but were less often willing to do so when faced with the uncertainty of a clinical example.</p><p><strong>Conclusions: </strong>Clinicians had a heterogeneous appraisal of the post-operative risk of complications following LT, as well as factors considered in risk assessment.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 3","pages":"352-367"},"PeriodicalIF":0.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661583","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":"Evolving trends in liver transplantation eligibility: A shift toward inclusivity for older adults at a Canadian Transplant Center.","authors":"Gabrielle Jutras, Genevieve Huard, Marc Bilodeau, Julien Bissonnette, Helene Castel, Jeanne-Marie Giard, Julian Hercun, Catherine Vincent, Bernard Willems, Philippe Willems, Jennifer C Lai","doi":"10.3138/canlivj-2024-0006","DOIUrl":"10.3138/canlivj-2024-0006","url":null,"abstract":"<p><strong>Background: </strong>The surge of end-stage liver disease among older individuals challenges traditional age-based criteria for liver transplantation (LT), historically capped at 65 years. Our Canadian center shifted away from using chronologic age as an absolute refusal criterion since 2019, enabling those aged 65 years and older to seek LT. This study aimed to investigate temporal trends in the transplant care cascade for patients aged 65 and older at our center, pre- and post-clinical shift.</p><p><strong>Methods: </strong>A retrospective study in a single Canadian transplant center reviewed LT referrals between 2015 and 2023, analyzing proportions of patients aged 65 and above at each stage. Specific intervals, 2015-2018 and 2019-2023, were defined for pre- and post-comparisons.</p><p><strong>Results: </strong>Among the 1,007 LT referrals, 11% (n = 110) were patients aged ≥65 years, with 74% (<i>n</i> = 81) of them being referred after 2019. From 2015 to 2023, older patient proportions increased at all stages of the transplant care cascade: referrals (7.4% to 12.6%), evaluations (7.6% to 11.4%), waitlisting (5.6% to 15.4%), and transplantations (5.8% to 17.5%). Post-clinical shift, the proportion of older patients referred nearly doubled (7.5% vs 13.7%; <i>p</i> < 0.05), with a similar increase in transplants (5.7% vs. 11.5%; <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Removing the age cap increased older patient engagement in the LT care cascade. This emphasizes the crucial role of actively promoting awareness of evolving LT eligibility criteria. Concerted efforts should focus on improving transplantation accessibility in older patients, ensuring age alone does not impede the process.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 3","pages":"345-351"},"PeriodicalIF":1.2,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661579","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":"Knowledge and wisdom in healthcare practice.","authors":"Kate P R Dunn, Bonnie Weasel Moccasin","doi":"10.3138/canlivj-2024-0011","DOIUrl":"https://doi.org/10.3138/canlivj-2024-0011","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 3","pages":"383-384"},"PeriodicalIF":0.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661582","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":"Fosfomycin-induced liver injury: A case report and literature review.","authors":"Kyrillos Faragalla, Daniel Cohen-Lyons, Nikoo Parvinnejad, Hanlin L Wang, Jimin Liu","doi":"10.3138/canlivj-2024-0001","DOIUrl":"10.3138/canlivj-2024-0001","url":null,"abstract":"<p><strong>Background: </strong>Fosfomycin is an antibiotic often used to treat urinary tract infections (UTIs) with only rare transient hepatotoxicity. We present a case of fosfomycin-induced liver injury and describe the histopathologic findings on biopsy.</p><p><strong>Methods: </strong>A 64-year-old female patient with no prior liver disease or risk factors was started on fosfomycin as prophylaxis for recurrent UTIs. Within a week of her first dose, she presented with fatigue, jaundice, and mixed liver enzyme elevation. Clinical workup for acute liver injury was unremarkable, and biopsy showed panacinar and portal necroinflammation with predominantly lymphocytic infiltrate and cholestasis, with no evidence of cirrhosis. This was thought to be likely related to fosfomycin exposure. Although liver enzymes trended down, bilirubin initially remained elevated. However, within 3 months the patient achieved clinical and biochemical recovery.</p><p><strong>Results: </strong>Only two other reports of fosfomycin-induced liver injury requiring biopsy were found. Both developed acute cholestatic hepatitis within days of exposure, and subsequent biopsy similarly showed lymphocytic necroinflammation. Although one patient initially developed acute liver failure, both recovered fully within a few months.</p><p><strong>Conclusion: </strong>Overall, these cases suggest potentially an idiosyncratic or immune-mediated liver toxicity of Fosfomycin, which is typically self-limited but may take months to fully resolve. Liver biopsy may be useful in confirming the diagnosis.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 3","pages":"377-382"},"PeriodicalIF":0.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661580","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":"In appreciation of service and sacrifice.","authors":"Eric M Yoshida","doi":"10.3138/canlivj-2024-0028","DOIUrl":"https://doi.org/10.3138/canlivj-2024-0028","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 3","pages":"323-324"},"PeriodicalIF":0.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661581","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":"Canadian Association for the Study of the Liver Single Topic Conference on Hepatitis B Virus: 'Progress toward hepatitis B elimination in Canada'.","authors":"Julian Hercun, Golasa Samadi Kochaksaraei, Simmone D'souza, Rachel Talavlikar, Jennifer Van Gennip, Carla Osiowy, Carla S Coffin, Harley Crowshoe","doi":"10.3138/canlivj-2024-0014","DOIUrl":"10.3138/canlivj-2024-0014","url":null,"abstract":"<p><p>Hepatitis B virus (HBV) infection affects >290 million people worldwide, including ∼250,000 Canadians, and it stands as a leading cause of end-stage liver disease and liver cancer. The World Health Assembly has set goals for HBV elimination by 2030, aiming for a >90% reduction in incidence and a 65% reduction in deaths compared to 2015. However, as of 2023, no countries were on track to achieve these targets. In Canada, challenges in HBV elimination persist due to the lack of a universal birth dose vaccine and interprovincial disparities in screening and care linkage. The Canadian Association for the Study of the Liver (CASL) and the Canadian Hepatitis B Network hosted the Inaugural Progress toward Hepatitis B Elimination Meeting in Calgary, Alberta, Canada (September 29, 2023 to October 1, 2023). This collaborative platform brought together national and international clinicians, laboratory providers, public health researchers, policymakers, and community-based organizations interested in HBV and hepatitis Delta virus (HDV) / HBV coinfection. The workshop was held during the National Day of Truth and Reconciliation (September 30, 2023) to commemorate the tragic legacy of residential schools in Canada, and it highlighted the need to promote meaningful reconciliation with Indigenous peoples. Key outcomes of the summit included establishing objectives for HBV elimination, advocating for adherence to global targets, universal screening and birth dose vaccination, equitable access to antiviral treatment across all provinces/territories, and addressing special populations. This overview highlights the presentations and emphasizes the importance of collaboration among stakeholders, public health agencies, and government entities to strive for HBV elimination in Canada.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 3","pages":"385-411"},"PeriodicalIF":0.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661578","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":"MAESTRO finally plays the music.","authors":"Natasha Chandok, Eric M Yoshida","doi":"10.3138/canlivj-2024-0013","DOIUrl":"10.3138/canlivj-2024-0013","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 2","pages":"255-256"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922636","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":"Factors associated with knowledge and awareness of Hepatitis B in individuals of Chinese descent: Results from a mass point of care testing and outreach campaign in Toronto, Canada.","authors":"Andrew B Mendlowitz, Erin Mandel, Camelia I Capraru, Bettina E Hansen, David Wong, Jordan J Feld, Harry LA Janssen, Mia J Biondi, Ambreen Arif, Colina Yim","doi":"10.3138/canlivj-2023-0015","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0015","url":null,"abstract":"<p><strong>Background: </strong>Migrants from hepatitis B virus (HBV) endemic regions are at high risk of having chronic infection. Despite this, HBV knowledge and awareness programming, and low-barrier screening methods such as point of care (POC) testing, among this group have yet to become routine.</p><p><strong>Methods: </strong>We conducted a mass HBV POC screening and knowledge and awareness campaign for individuals of Chinese descent in Toronto, Canada. POC screening was administered, then participants completed a knowledge questionnaire. Logistic regression identified associations between demographic factors and participants' level of HBV knowledge.</p><p><strong>Results: </strong>From 2015 to 2018, 33 outreach events resulted in 891 individuals completing testing and the knowledge questionnaire. Individuals averaged 64.4 years old. Most, 62% (<i>N</i> = 552), were female, and 73.6% (<i>N</i> = 656) have been in Canada for <30 years. The average questionnaire score was 70.7% correct, with 65.2% (<i>N</i> = 581) demonstrating a high level of HBV knowledge. Post-secondary education (OR: 2.19, 95% CI: 1.41, 3.39), income of $50,000 to <$75,000 (OR: 2.74, 95% CI: 1.39, 5.43), and having familial history of HBV (OR: 1.72, 95% CI: 1.06, 2.78) were associated with high knowledge. The observed prevalence of HBV was 1.5%, with 13 individuals testing positive on the POC test and confirmatory laboratory testing.</p><p><strong>Conclusions: </strong>Improving knowledge and awareness of HBV is critical to empowering people, especially migrants who experience barriers to care, to pursue vaccination, testing, and treatment. Combining knowledge outreach and POC test campaigns, enabled discussion and screening for HBV with large numbers of people, and can be tailored for optimal effectiveness for specific groups.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 1","pages":"28-39"},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178586","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":"Decoding hepatorenal tyrosinemia type 1: Unraveling the impact of early detection, NTBC, and the role of liver transplantation.","authors":"Mohit Kehar, Moinak Sen Sarma, Jayendra Seetharaman, Carolina Jimenez Rivera, Pranesh Chakraborty","doi":"10.3138/canlivj-2023-0018","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0018","url":null,"abstract":"<p><p>Hepatorenal tyrosinemia type 1 (HT-1) is a rare autosomal recessive disease that results from a deficiency of fumaryl acetoacetate hydrolase (FAH), a critical enzyme in the catabolic pathway for tyrosine. This leads to the accumulation of toxic metabolites such as fumaryl and maleylacetoacetate, which can damage the liver, kidneys, and nervous system. The discovery of 2-[2-nitro-4-trifluoromethylbenzoyl]-1,3-cyclohexanedione (NTBC or nitisinone) has significantly improved the management of HT-1, particularly when initiated before the onset of symptoms. Therefore, newborn screening for HT-1 is essential for timely diagnosis and prompt treatment. The analysis of succinyl acetone (SA) in dried blood spots of newborns followed by quantification of SA in blood or urine for high-risk neonates has excellent sensitivity and specificity for the diagnosis of HT-1. NTBC combined with dietary therapy, if initiated early, can provide liver transplant (LT) free survival and reduce the risk of hepatocellular carcinoma (HCC). Patients failing medical treatment (eg, due to non-adherence), and who develop acute liver failure (ALF), have HCC or evidence of histologically proven dysplastic liver nodule(s), or experience poor quality of life secondary to severe dietary restrictions are currently indicated for LT. Children with HT-1 require frequent monitoring of liver and renal function to assess disease progression and treatment compliance. They are also at risk of long-term neurocognitive impairment, which highlights the need for neurocognitive assessment and therapy.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 1","pages":"54-63"},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178583","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":"Effects of silymarin use on liver enzymes and metabolic factors in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis.","authors":"Adnan Malik, Muhammad Malik, Shahbaz Qureshi","doi":"10.3138/canlivj-2023-0021","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0021","url":null,"abstract":"<p><strong>Background: </strong>Fatty liver disease comprises a wide range of related liver disorders affecting mainly people who drink no or minimal amounts of alcohol. Silymarin is a member of the <i>Carduus marianum</i> family that has been used for centuries to treat different diseases. There is little evidence supporting its efficacy in humans.</p><p><strong>Objectives: </strong>To evaluate the effects of Silymarin in patients with non alcoholic fatty liver disease (NAFLD) or recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Methods: </strong>We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant clinical trials assessing the use of silymarin in patients with NAFLD. A risk of bias assessment was performed using Cochrane's risk of bias tool. We included the following outcomes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transferase (GGT), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) (mg/dL), degree of fibrosis resolution, low-density lipoprotein (LDL), and HOMA-IR. We analyzed continuous data using mean difference (MD) and relative 95% confidence interval (CI).</p><p><strong>Results: </strong>We included nine clinical trials. We found that silymarin significantly reduced the levels of ALT (MD= -17.12 [-28.81, -4.43]), (P < 0.004), AST (MD= -12.56 [-19.02, -6.10]), (P < 0.0001) and TG (MD = -22.60 [-23.83, -21.38]) (<i>p</i> < 0.00001). It also improved HDL (MD= 2.13 [1.60, 2.66]), (P < 0.01)). There was no significant difference regarding GGT (P=o.07), TC (P= 0.52), LDL (P= 0.06), HOMA-IR (P= 0.06) and BMI (p=0.1).One study reported significant improvement in the degree of fibrosis (P = 0.023).</p><p><strong>Conclusion: </strong>Silymarin treatment significantly reduces biochemical and transaminase levels in patients with MASLD.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 1","pages":"40-53"},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178584","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}