1,721,250 research outputs found
Hepatitis C virus infection. From clinical guidelines to clinical practice and personalization of cure
No full textAlthough clinical guidelines provide clear indications on the treatment of patients with chronic HCV related liver disease, there are still clinical situations in which clinicians experience and judgment remain essential in the proper patient management. These are mainly represented by antiviral therapy in patients with decompensated liver disease, especially if they are candidates for liver transplantation or with significant comorbidities and complex pharmacological therapies. Antiviral retreatment of patients who failed a regimen containing an NS5A protease inhibitor still appears to be a delicate context in which no solid recommendations are provided, especially in patients with HCV genotype 3 and decompensated cirrhosis. The follow-up of patients without cirrhosis who have obtained viral eradication is still controversial, in the absence of prospective clinical trials. With the advent of new drugs and shorter treatments in patients with mild liver disease, the subject of discussion and recommendations could become the evaluation of early HCV viral kinetics after the onset of treatment to decide in every patient when to stop antivirals
Special Issue “New Therapies of Liver Diseases”
Full text link: Medical and surgical treatments aimed at curing severe liver diseases and prolonging the survival of patients have improved dramatically in recent years [...]
Vaccination against SARS-CoV-2 in liver transplant recipients: The game is still long and the outcome is uncertain
No full textIncrease of Serum aú1-Acid Glycoprotein Despite the Decline of Liver Synthetic Function in Cirrhotics with Hepatocellular Carcinoma
No full textα,-Acid glycoprotein, an acute phase reactant synthesised by the liver, has been reported to be increased in neoplastic conditions and reduced in chronic liver disease. We measured serum aracid glycoprotein by a nephelometric method in 186 subjects (112 males, 74 females): 55 had mild chronic liver disease (chronic hepatitis and steatofibrosis), 45 cirrhosis, 38 hepatocellular carcinoma, 15 extra-hepatic malignant disease; 33 healthy subjects were used as controls. Analysis of variance demonstrated a significant variability among groups (F = 17.08, P = 0.0000). Higher concentrations of α1-acid glycoprotein were detected in malignant extra-hepatic disease than in all other groups (0.01); concentrations of α1-acid glycoprotein were higher in hepatocellular carcinoma than in cirrhosis (0.01). Multiple regression analysis by groups (dependent variable = αϊ-acid glycoprotein; group 1 = mild chronic liver disease + cirrhosis; group 2 = hepatocellular carcinoma) showed a significant correlation for both group 1 (r = 0.6264, F = 8.005, P = 0.0000) and group 2 (r = 0.8947, F = 13.643, P = 0.0000). The significant standardised regression coefficients were: cholinesterase, C-reactive protein, γ-glutamyltransferase and iron (negative) for regression upon group 1; C-reactive protein, α-antiproteinase, γ-glutamyltransferase, iron (negative) for regression upon group 2. A difference between the 2 regression equation coefficients was detected (F = 5.209, P = 0.0002). In conclusion, a raised aracid glycoprotein concentration was found in patients with malignancies, both hepatic and extra-hepatic; however, patients with hepatocellular carcinoma had a lower α1-acid glycoprotein concentration than patients with malignant extra-hepatic disease. In hepatocellular carcinoma, a good correlation existed between aracid glycoprotein and other serum indices of the acute phase response. In some patients with hepatocellular carcinoma, α1-acid glycoprotein was increased, despite the decrease of liver function. © 1993, Walter de Gruyter. All rights reserved
Challenges and future developments in liver transplantation
No full textLiver transplantation (LTLT) has become the treatment of choice for a wide range of liver diseases in both adult and pediatric patients. Until recently, the largest proportion of LTLT in adults, were performed in patients with hepatitis C (HCV) related cirrhosis. The recent availability of safe and effective direct antiviral agents to cure HCV infection in almost all patients whatever the HCV genotype and severity of liver disease, will reduce the need for LTLT in this category of recipients. Thus, it is presumed that in the next 1 to 2 decades HCV related liver disease will diminish substantially, whereas non-alcoholic steato-hepatitis (NAS H) will correspondingly escalate as an indication for LTLT. The greatest challenges facing LTLT remain the limited supply of donor organs, and the need for chronic immunosuppression, which represent the true obstacles to the greater application and durable success of the LTLT procedure. This review aimed to highlight, in different sections, the main open issues and future developments in LTLT. These will be focused to explore current and future strategies to maximize the use of limited organs, to offer an update on potential new approaches to immunosuppression and to imagine new indications for LTLT when the number of patients awaiting transplants for HCV related liver disease is reduced
Periodic clinical monitoring after liver transplantation
No full textDuring the last two decades, owing to advances in immunosuppressive pharmacotherapy, liver transplantation has been increasingly accepted by the medical community as an effective treatment for patients with end-stage liver disease. Successful transplantation of the liver, however, requires frequent monitoring. Most of the serious infectious complications and allograft dysfunction occur during the early post-transplantation period (i.e., first six months). Blood levels of cyclosporine or tacrolimus, the two major calcineurin inhibitors currently in use, need to be frequently checked. Drug dosage is adjusted in order to maintain target serum concentrations and the patients free of side-effects. In the time, the risk of acute allograft rejection decreases considerably, whereas the proportion of patients with fibrosis or cirrhosis increases, particularly among hepatitis C virus carriers. Graft loss may occur, secondary to recurrent disease or chronic rejection. Patients with well-functioning grafts may still be affected by significant comorbidities, such as hypertension, diabetes, obesity, hyperlipidemia and osteoporosis, which appear to be related to long-term immunosuppression. The incidence of lymphoma, skin and colorectal cancers in liver transplantation recipients exceeds those found in the general population and requires early detection. The principles of the management of medical problems after liver transplantation are a careful clinical assessment of the patient and a judicious use of laboratory tests, radiological evaluation and liver biopsy
New organ allocation criteria in liver transplantation
No full textSummary. The organ allocation modality in the liver transplant represents a fundamental step for the correct success of the transplantation procedure. The practical effects deriving from the adoption of the organ allocation models do not imply only clinical repercussions but also concern important ethical aspects. Alongside the general principles of fairness, justice and transparency, the organ allocation models should be aimed at providing for each patient who waits for an organ, the possibility of accessing it, preserving and maximizing the outcome of the transplant in terms of survival and quality of life. Balancing successfully the clinical and ethical aspects in an allocation model is particularly difficult and probably not completely feasible. In this brief review, the general principles governing the different models of organ allocation in liver transplantation are addressed. A particular description of the decision-making process that led to the sharing in Italy of a new allocation model based on the concept of the transplant benefit is illustrated. In this model we have tried to combine the two fundamental principles that for many years have guided the choice of allocation models, respectively based on the criteria of urgency and utility
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