51 research outputs found
Low fibrosis progression of recurrent hepatitis C in apolipoprotein E e4 carriers: relationship with the blood lipid profile
No full textBACKGROUND:
The histological outcome of chronic hepatitis C is better among carriers of the apolipoprotein E (ApoE) epsilon4 allele, for reasons unknown. The orthotopic liver transplantation (OLT) setting allows to separate the role played by liver-derived ApoE (graft) from ApoE of different origin (recipient). Patients and
METHODS:
Forty-six OLT recipients with recurrent hepatitis C were studied. Grafts and recipients were genotyped for ApoE. In a follow-up extending up to 4 years, the serum triglycerides-to-cholesterol ratio (T/C ratio) was measured 1 year after OLT, whereas fibrosis progression was assessed yearly and expressed as fibrosis units/month (FU/mo).
RESULTS:
A T/C ratio < or =0.75 was observed in 13/15 cases in which both donor and recipient were epsilon4 carriers, 10/19 cases in which epsilon4 alleles were of exclusive recipient's origin and 5/12 cases in which epsilon4 alleles were of exclusive donor's origin or absent (P<0.02). One year after OLT, a fibrosis progression < or =0.100 FU/mo was associated with a low T/C ratio (24/34 vs. 4/12, P<0.05). An Ishak staging score >2 was reached later by male recipients who were epsilon4 carriers (P<0.002).
CONCLUSIONS:
Recipient's carriage of ApoE epsilon4 affects fibrosis progression of recurrent hepatitis C through gender-specific mechanisms, associated with a peculiar, ApoE-associated, lipid profile
Early activation of interferon-stimulated genes in human liver allografts: relationship with acute rejection and histological outcome.
No full textBACKGROUND:
Innate immunity mechanisms have been shown to play a paramount role in organ transplantation. Our aim was to investigate the hypothesis that activation of the interferon system may affect clinically relevant outcomes, such as acute rejection and/or early fibrosis progression, after liver transplantation.
METHODS:
We studied 71 consecutive recipients (57 males; 25 with hepatitis C) who underwent two per protocol graft biopsies: the first, within 60 days after the transplant operation (median 24) and the second, after 1 year. The mRNA expression for five interferon-stimulated genes (Mx1, OAS2, PKR, IRF7A, IFI16) was measured on the first biopsy specimens. The main outcome measures were acute rejection during the first post-transplant year and fibrosis progression at the second biopsy.
RESULTS:
On multivariate analysis, the independent predictors of gene expression were hepatitis C (Mx1, OAS2, PKR and IFI16), donor age (IFI16) and recipient gender (IRF7A) (P < .05 for all). During the first post-transplant year, 19/71 patients (27%) had acute cellular rejection. At multivariate analysis, acute cellular rejection was independently predicted by high IRF7A mRNA expression. At the end of follow-up, 25 patients had some degree of fibrosis (F2 or higher in seven cases). On multivariate analysis, hepatitis C etiology, recipient age, and OAS2 overexpression were independent predictors of early fibrosis progression.
CONCLUSIONS:
In the early postoperative period of liver transplantation, interferon-stimulated gene activation is dependent on hepatitis C recurrence (the main factor responsible for early fibrosis progression) and donor age, and is related to the risk of acute cellular rejection
Recurrent and treatment-unresponsive spontaneous bacterial peritonitis worsens survival in decompensated liver cirrhosis
No full textBackground: Spontaneous bacterial peritonitis (SBP) remains a major complication of cirrhosis. However, the incidence and the real impact of SBP in determining patient survival rates remain unclear. This study aims to evaluate the incidence and risk factors for SBP development and the role of SBP in predicting transplant-free survival. Methods: Two hundred two consecutive patients underwent 492 paracenteses with biochemical and microbiological analysis of the ascitic fluid. When multiple paracenteses had been performed on a given patient, the first SBP-positive paracentesis or the first paracentesis conducted when none was diagnostic for SBP was included in the study. Results: SBP was detected in 28 of 202 (13.9%) patients; in 26 of 28 patients, the neutrophil count in the ascitic fluid was $250 cells/ml, and in 15 of 28 patients, the cultures were positive. Variables inde- pendently associated with SBP were as follows: a higher model of end-stage liver disease (MELD) score, the serum glucose value, elevated CRP serum levels, and higher potassium serum levels. Overall, the median (range) transplant-free survival was 289 (54–1253) days. One hundred (49.5%) patients died, whereas 35 patients (17.3%) underwent liver transplantation. Independent predictors of death or liver transplantation were a higher MELD score and the development of SBP, especially if it was antibiotic-resistant or recurrent SBP. Conclusion: The occurrence of SBP is associated with more severe liver dysfunction in conjunction with the presence of inflammation. Unlike the occurrence of SBP per se, failure of first-line antibiotic treatment and SBP recurrence appear to strongly influence the mortality rat
GENE POLYMORPHISM AT THE INTERLEUKIN 6 -174 G > C LOCUS AFFECTS THE OUTCOME OF CHRONIC HEPATITIS B
No full textONCE DAILY PROLONGED RELEASED (ADVAGRAF) VERSUS TWICE DAILY TACROLIMUS (PROGRAF) AS PRIMARY IMMUNOSUPPRESSION IN LIVER TRANSPLANTATION
No full textAn Essential Guide for Managing Post-Liver Transplant Patients: What Primary Care Physicians Should Know
No full textWith long-term survival after liver transplantation becoming the rule, care for medical problems arising over time in liver transplanted patients gained increasing importance. The most common causes of death occurring more than one year after liver transplantation are unrelated to liver diseases and facilitated by immunosuppressive treatments, such as malignancies, renal failure, cardiovascular, metabolic and infectious diseases. Recipients receive life-long follow-up care at transplant centers; however, the increasing number of liver transplanted patients is saturating the health care supply that transplant centers have to offer. Primary care physicians are increasingly exposed to liver transplanted patients even in the early periods after transplant and an understating of the most common risks and complications faced by these patients would enhance their care. This article reviews the long-term care of liver transplant recipients, emphasizing the key internal medicine-related issues that should be known by the primary care physicians. A specific section is devoted to implementing strategies to involve these physicians in the long-term follow-up of liver transplanted patients in close collaboration with transplant hepatologists
Vitamin D and the risk of acute allograft rejection following human liver transplantation.
No full textBACKGROUND:
Vitamin D may act as an immune modulator in experimental and human organ transplantation, but these data are yet to be confirmed in human liver transplantation (LT).
AIM:
This study aimed to assess the relationship between acute liver allograft cellular rejection (ACR) and pretransplant serum vitamin D concentration or post-transplant vitamin D supplementation.
METHOD:
We studied 133 LT recipients who underwent two per protocol allograft biopsies in the early post-operative period, plus on-demand biopsies as clinically indicated. ACR estimate was given according to the Banff scheme in biopsies obtained along two follow-up periods: (a) from the transplant operation to the end of the second month (0-2 months); (b) and from the third month to the end of the eighth month (3-8 months) post-LT.
RESULTS:
The median pretransplant serum 25-hydroxyvitamin D concentration was 12.5 ng/ml; 40 patients had concentrations < or =12.5 ng/ml, of whom six had < or =5.0 ng/ml. Seventy-nine recipients received oral vitamin D(3) supplementation to treat post-transplant osteoporosis. In the 0-2 months period, moderate-to-severe rejection episodes were independently associated with cytomegalovirus reactivation (P<0.005) and progressively lower pretransplant serum 25-hydroxyvitamin D concentrations (P<0.02). Early vitamin D(3) supplementation was independently associated with a lack of ACR (P<0.05).
CONCLUSIONS:
These results suggest that vitamin D may favour immune tolerance towards the liver allograft
Integrating Computer Vision based on YOLOv8 on Mobile Robot to Automate Inspections
No full textIntegrazione di algoritmi di visione artificiale per rendere robot mobili capaci di comprendere ciò che vedono e prendere delle decisioni. In particolare si è progettato e implementato un algoritmo di computer vision basato sul modello YOLOv8 per rendere il quadrupede SPOT di Boston Dynamics capace di determinare in real-time se nell'area ispezionata ci sono persone che indossano i dispositivi di protezione individuale (come ad esempio elmetti e giacche riflettenti). La soluzione proposta riguarda l' individuare all'interno di un flusso video la regione di interesse dove cercare il determinato dispositivo. Si sono utilizzati algorimi di object detection, human pose estimation e classification. Infine per rendere l'algoritmo robusto e completo per un caso d'uso reale, è stato implementato un algoritmo di tracking-by-detection, il DeepSORT, per identificare le stesse persone in più frame video
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