1,721,039 research outputs found
Reply: Hepatic decompensation is the major driver of mortality in hepatocellular carcinoma patients treated with atezolizumab plus bevacizumab: The impact of successful antiviral treatment
No full textBiliary complications after liver transplantation: current perspectives and future strategies
No full textImportance: Liver transplantation (LT) is a life-saving therapy for patients with end-stage liver disease and with acute liver failure, and it is associated with excellent outcomes and survival rates at 1 and 5 years. The incidence of biliary complications (BCs) after LT is reported to range from 5% to 20%, most of them occurring in the first three months, although they can occur also several years after transplantation.Objective: The aim of this review is to summarize the available evidences on pathophysiology, risk factors, diagnosis and therapeutic management of BCs after LT.Evidence Review: a literature review was performed of papers on this topic focusing on risk factors, classifications, diagnosis and treatmentFindings: Principal risk factors include surgical techniques and donor's characteristics for biliary leakage and anastomotic biliary strictures and vascular alterations for nonanastomotic biliary strictures. MRCP is the gold standard both for intra- and extrahepatic BCs, while invasive cholangiography should be restricted for therapeutic uses or when MRCP is equivocal. About treatment, endoscopic techniques are the first line of treatment with success rates of 70-100%. The combined success rate of ERCP and PTBD overcome 90% of cases. Biliary leaks often resolve spontaneously, or with the positioning of a stent in ERCP for major bile leaksConclusions and Relevance: BCs influence morbidity and mortality after LT, therefore further evidences are needed to identify novel possible risk factors, to understand if an immunological status that could lead to their development exists and to compare the effectiveness of innovative surgical and machine perfusion techniques
Evaluating the risk-benefit ratio of immunotherapy according to liver-functional reserve in advanced HCC: the dark side of the moon
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Direct-acting antiviral agents and risk of hepatocellular carcinoma: is it still a clinical dilemma?
No full textDirect-acting antivirals (DAAs) revolutionised the treatment of chronic HCV-related disease achieving high rates of sustained virological response (SVR), also in more advanced patients, with a good safety profile and a proven positive effect on the reduction of risk of HCC occurrence. Nevertheless, patients with an history of successfully treated early HCC were initially excluded from pivotal trials. Although some initial retrospective studies, affected by several methodological issues, raised concerns regarding a possible harmful effect on the risk of HCC recurrence after antiviral therapy, more recent prospective
studies and meta-analyses provided evidence that risk of HCC recurrence after DAA therapy is similar, or even lower, than that observed in patients treated with interferon or in DAA-untreated controls. In the future, a meta-analyses of individual patient data would be necessary to definitively close this clinical debate, as well as prospective studies assessing ‘true endpoints’, such as overall survival
Evaluating the predictive performance of the elderly patient calculator TIPS score in a North American cohort
Full text linkTIPS is an effective intervention for the treatment of
portal hypertensive complications of cirrhosis, including
refractory ascites and variceal bleeding. However, TIPS
placement can precipitate HE and liver failure, requiring
liver transplantation. Risk stratification before candidate
selection is therefore critical to mitigate adverse
outcomes. Models like the Model for End-Stage Liver
Disease Sodium (MELD-Na) and the Freiburg index of
post-TIPS survival (FIPS) have been proposed to
estimate the risk of mortality post-TIPS.[1,2] Vizzutti
et al recently proposed 2 post-TIPS prediction tools for
overall patients [(overall elderly patients calculator TIPS
(ExPeCT)] and for patients Z 70 years of age (older
adult ExPeCT), using an Italian cohort.[3] Due to health
differences between Americans and Europeans, it is
unclear how well these models translate to North
American patients.[4] We aimed to evaluate the
performance of these post-TIPS mortality prediction
tools in a large North American cohort
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