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Decompensated cirrhosis

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https://www.readbyqxmd.com/read/28107583/chronic-hepatitis-c-and-chronic-kidney-disease-advances-limitations-and-unchartered-territories
#1
Manuel Mendizabal, K Rajender Reddy
Over the past few years, treatment options for chronic hepatitis C virus (HCV) infection have evolved dramatically. The current approved interferon-free direct-acting antiviral (DAA) regimens have been shown to be safe and effective with sustained virologic response (SVR) rates of >90% in most patients. Unique issues yet remain such as the challenges in patients with impaired renal function or decompensated cirrhosis. Patients with stage 4-5 chronic kidney disease (CKD) have a higher prevalence of HCV infection compared with the general population...
January 20, 2017: Journal of Viral Hepatitis
https://www.readbyqxmd.com/read/28102906/filling-the-gap-between-clinical-trials-and-real-life-in-the-treatment-of-severe-hcv-recurrence-after-liver-transplantation
#2
Patrizia Burra, Alberto Zanetto
In this issue of Transplant International, Herzer et al. report the results obtained in a real-world European cohort of 87 patients with severe recurrent hepatitis C (HCV) after liver transplantation (LT), who were treated with a compassionate use of daclatasvir (DCV) plus registered sofosbuvir (SOF), with or without ribavirin (RBV). The vast majority of patients were HCV genotype 1, though the sample included a few with genotypes 3 and 4. It is noteworthy that 37/87 patients (42.5%) had cirrhosis (and 16/37 patients [43%] had Child-Pugh B/C decompensated cirrhosis)...
January 19, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28101791/strategies-to-reduce-30-day-readmissions-in-patients-with-cirrhosis
#3
REVIEW
Elliot B Tapper, Michael Volk
PURPOSE OF REVIEW: Approximately, one quarter of patients discharged after a hospitalization for decompensated cirrhosis will be readmitted within 30 days. These readmissions have been associated with increased morbidity and mortality, can be financially harmful to the health system, and may be partially preventable. This review summarizes the literature on readmissions, providing clinicians with tools for risk prediction and a taxonomy for preventative interventions. RECENT FINDINGS: Readmission strategies can be categorized according to complexity (simple versus complex) and specificity (focused versus broad)...
January 2017: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/28100019/a-randomized-trial-to-assess-whether-portal-pressure-guided-therapy-to-prevent-variceal-rebleeding-improves-survival-in-cirrhosis
#4
Càndid Villanueva, Isabel Graupera, Carles Aracil, Edilmar Alvarado, Josep Miñana, Ángela Puente, Virginia Hernandez-Gea, Alba Ardevol, Oana Pavel, Alan Colomo, Mar Concepción, María Poca, Xavier Torras, Josep M A Reñe, Carlos Guarner
: Monitoring the hemodynamic response of portal pressure to drug therapy accurately stratifies the risk of variceal rebleeding. We assessed whether guiding therapy with HVPG-monitoring may improve survival in the prevention of variceal rebleeding. Cirrhotic patients with controlled variceal bleeding were randomized to a HVPG-guided-therapy group (N= 84) or to a control group (N= 86). In both groups, HVPG and acute β-blocker response were evaluated at baseline and HVPG measurements were repeated at 2-4-weeks to determine chronic response...
January 18, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28090224/computerized-tomography-guided-paracentesis-an-effective-alternative-to-bedside-paracentesis
#5
Vinaya Gaduputi, Hassan Tariq, Chaitanya Chandrala, Sailaja Sakam, Naeem Abbas, Sridhar Chilimuri
BACKGROUND: Ascites remains the most common cause of hospitalization among patients with decompensated cirrhosis. Paracentesis is a relatively safe procedure with low complication rates. Computerized tomography (CT)-guided therapeutic paracentesis could be a safe and effective alternative to unaided or aided (ultrasonogram-guided) bedside paracentesis. In this retrospective study, we aimed to compare the efficacy, safety, and cost-effectiveness of CT-guided paracentesis with bedside paracentesis...
February 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28079670/impact-of-genetic-variation-in-the-vasopressin-1a-receptor-on-the-development-of-organ-failure-in-patients-admitted-for-acute-decompensation-of-liver-cirrhosis
#6
Annarein J C Kerbert, Jelte J Schaapman, Johan J van der Reijden, Àlex Amorós Navarro, Aiden McCormick, Bart van Hoek, Vicente Arroyo, Pere Ginès, Rajiv Jalan, Victor Vargas, Rudolf Stauber, Hein W Verspaget, Minneke J Coenraad
BACKGROUND: Vasopressin receptor-mediated vasoconstriction is considered to be involved in the pathogenesis of organ failure in acute-on-chronic liver failure (ACLF). PATIENTS AND METHODS: We studied the association between six single nucleotide polymorphisms (SNPs) of the vasopressin 1a receptor gene and the development of organ failure in 826 patients admitted for acute decompensation of liver cirrhosis (n=641) or ACLF (n=185). RESULTS: No associations were found for SNPs with the presence of circulatory or renal failure...
January 10, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28079269/ledipasvir-plus-sofosbuvir-as-salvage-therapy-for-hcv-genotype-1-failures-to-prior-ns5a-inhibitors-regimens
#7
Norio Akuta, Hitomi Sezaki, Fumitaka Suzuki, Shunichiro Fujiyama, Yusuke Kawamura, Tetsuya Hosaka, Masahiro Kobayashi, Mariko Kobayashi, Satoshi Saitoh, Yoshiyuki Suzuki, Yasuji Arase, Kenji Ikeda, Hiromitsu Kumada
There is little information on retreatment efficacy and predictors of the combination of ledipasvir and sofosbuvir (ledipasvir/sofosbuvir) for patients who fail to respond to NS5A inhibitors. NS5A resistance variants are known to persist for long periods after such treatment. Here, we evaluated 54 patients with chronic HCV genotype 1b infection, free of decompensated cirrhosis and hepatocellular carcinoma, for sustained virological response after 12 weeks (SVR12) of once-daily treatment with 90 mg ledipasvir and 400 mg sofosbuvir...
January 12, 2017: Journal of Medical Virology
https://www.readbyqxmd.com/read/28078736/investigation-of-underlying-comorbidities-as-risk-factors-for-symptomatic-human-hepatitis-e-virus-infection
#8
S Zhang, C Chen, J Peng, X Li, D Zhang, J Yan, Y Zhang, C Lu, J Xun, W Li, Y Ling, Y Huang, L Chen
BACKGROUND: Symptomatic Hepatitis E virus (HEV) infection occurs in few infected subjects, and the risk factors are not completely known. AIMS: To explore the risk factors for adverse clinical outcomes in acute HEV infections. METHODS: A large retrospective study was conducted. The baseline characteristics, clinical outcomes, and laboratory data of 512 acute HEV infection cases were analysed using logistic regression models. RESULTS: All patients exhibited autochthonous sporadic HEV infections, and most were elderly...
January 12, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28076451/survival-benefits-of-interferon-based-therapy-in-patients-with-recurrent-hepatitis-c-after-orthotopic-liver-transplantation
#9
L P Zanaga, A G Vigani, R N Angerami, A Giorgetti, C A F Escanhoela, E C Ataíde, I F S F Boin, R S B Stucchi
Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment can be used to prevent these detrimental outcomes. The aim of this study was to describe rates of hepatitis C recurrence and sustained virological response (SVR) to interferon-based treatment after OLT and its relationship to survival and progression of liver disease through retrospective analysis of medical records of 127 patients who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic hepatitis C between January 2002 and December 2013...
January 9, 2017: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/28073411/-effect-of-umbilical-cord-mesenchymal-stem-cell-transplantation-on-immune-function-and-prognosis-of-patients-with-decompensated-hepatitis-b-cirrhosis
#10
X Q Fang, J F Zhang, H Y Song, Z L Chen, J Dong, X Chen, J J Pan, B Liu, C X Chen
Objective: To investigate the effect of human umbilical cord mesenchymal stem cells (hUCMSCs) on the immune function and prognosis of patients with decompensated hepatitis B cirrhosis. Methods: A total of 65 patients with decompensated hepatitis B cirrhosis were divided into observation group and control group. The patients in the observation group were given intervention (via the proper hepatic artery or the portal vein) and intravenous infusion of 4×10(8) hUCMSCs in two doses, as well as the same basic treatment as in the control group...
December 20, 2016: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/28070200/the-risk-of-hepatocellular-carcinoma-after-directly-acting-antivirals-for-hepatitis-c-virus-treatment-in-liver-transplanted-patients-is-it-real
#11
Alessio Strazzulla, Rosa Maria Rita Iemmolo, Ennio Carbone, Maria Concetta Postorino, Maria Mazzitelli, Mario De Santis, Fabrizio Di Benedetto, Costanza Maria Cristiani, Chiara Costa, Vincenzo Pisani, Carlo Torti
INTRODUCTION: Since directly acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) were introduced, conflicting data emerged about the risk of hepatocellular carcinoma (HCC) after interferon (IFN)-free treatments. We present a case of recurrent, extra-hepatic HCC in a liver-transplanted patient soon after successful treatment with DAAs, along with a short review of literature. CASE PRESENTATION: In 2010, a 53-year old man, affected by chronic HCV (genotype 1) infection and decompensated cirrhosis, underwent liver resection for HCC and subsequently received orthotopic liver transplantation...
November 2016: Hepatitis Monthly
https://www.readbyqxmd.com/read/28070093/current-status-and-issues-of-liver-transplantation-for-decompensated-liver-cirrhosis
#12
Toshimi Kaido, Shinji Uemoto
No abstract text is available yet for this article.
2017: Nihon Shokakibyo Gakkai Zasshi, the Japanese Journal of Gastro-enterology
https://www.readbyqxmd.com/read/28061762/the-effectiveness-of-daclatasvir-based-therapy-in-european-patients-with-chronic-hepatitis-c-and-advanced-liver-disease
#13
Jim Young, Nina Weis, Harald Hofer, William Irving, Ola Weiland, Emiliano Giostra, Juan Manuel Pascasio, Lluis Castells, Martin Prieto, Roelien Postema, Cinira Lefevre, David Evans, Heiner C Bucher, Jose Luis Calleja
BACKGROUND: There is limited evidence for the effectiveness of daclatasvir in patients whose hepatitis C threatens their life expectancy. The Named Patient Program in Europe included patients with advanced chronic hepatitis C, a life expectancy of less than 12 months and no other treatment options. METHODS: A retrospective multi-country cohort of patients with chronic hepatitis C who received daclatasvir as part of the Named Patient Program in Austria, Denmark, Spain, Sweden, Switzerland and the United Kingdom...
January 7, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28058019/clinical-features-of-acute-hepatitis-e-super-infections-on-chronic-hepatitis-b
#14
Chong Chen, Shu-Ye Zhang, Dan-Dan Zhang, Xin-Yan Li, Yu-Ling Zhang, Wei-Xia Li, Jing-Jing Yan, Min Wang, Jing-Na Xun, Chuan Lu, Yun Ling, Yu-Xian Huang, Liang Chen
AIM: To examine the clinical features and risk factors for adverse outcomes in chronic hepatitis B (CHB) superimposed with hepatitis E virus (HEV). METHODS: This retrospective cohort study included 228 patients with acute HEV infection (showing clinical acute hepatitis symptomology and positivity for anti-HEV immunoglobulin M) with underlying CHB (confirmed by positivity for hepatitis B surface antigen and/or hepatitis B virus (HBV) DNA over 6 mo) who had been admitted to the Shanghai Public Health Clinical Center, which represents the regional tertiary hospital for infectious diseases in Shanghai city, China...
December 21, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28054251/cirrhosis-and-liver-transplantation-in-patients-co-infected-with-hiv-and-hepatitis-b-or-c-an-observational-cohort-study
#15
Charlotte Warren-Gash, Kate Childs, Alicia Thornton, Sanjay Bhagani, Shirin Demma, Ankur Srivastava, Clifford Leen, Kosh Agarwal, Alison J Rodger, Caroline A Sabin
This study assessed the likelihood of referral for liver transplantation assessment in a prospective cohort of patients co-infected with HIV and hepatitis B or C with complications of cirrhosis. There were 141 co-infected patients from 11 UK centres with at least one complication of cirrhosis recorded (either decompensation or hepatocellular carcinoma) out of 772 identified with cirrhosis and/or HCC. Only 23 of these 141 (16.3%) were referred for liver transplantation assessment, even though referral is recommended for co-infected patients after the first decompensation episode...
January 4, 2017: Infection
https://www.readbyqxmd.com/read/28052635/special-populations-treating-hepatitis-c-in-patients-with-decompensated-cirrhosis-and-or-advanced-renal-impairment
#16
REVIEW
Marcus M Mücke, Victoria T Mücke, Christian M Lange, Stefan Zeuzem
Direct-acting antivirals have revolutionized the treatment of hepatitis C. Sustained virological response rates of at least 95% have become common in the general population. However, along with the ageing of the HCV population, physicians face a growing group of HCV-infected patients with advanced liver and/or renal impairment. The safety and efficacy of treatment remains a clinical challenge in these patients. This review focuses on the current state of knowledge and treatment regimens in patients with decompensated cirrhosis and severe renal impairment...
January 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28052623/prevention-and-treatment-of-variceal-haemorrhage-in-2017
#17
REVIEW
Felix Brunner, Annalisa Berzigotti, Jaime Bosch
Variceal haemorrhage is a major complication of portal hypertension that still causes high mortality in patients with cirrhosis. Improved knowledge of the pathophysiology of portal hypertension has recently led to a more comprehensive approach to prevent all the complications of this condition. Thus, optimal treatment of portal hypertension requires a strategy that takes into account the clinical stage of the disease and all the major variables that affect the risk of progression to the next stage and death...
January 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28052621/hepatitis-b-virus-long-term-impact-of-antiviral-therapy-nucleot-s-ide-analogues-nucs
#18
REVIEW
Glenda Grossi, Mauro Viganò, Alessandro Loglio, Pietro Lampertico
The goal of antiviral therapy is to improve the quality of life and survival of patients with chronic hepatitis B (CHB) by halting the progression to cirrhosis, end-stage liver disease or hepatocellular carcinoma (HCC), thus preventing anticipated liver-related death. Oral administration of potent and less resistance-prone nucleot(s)ide analogues (NUCs), such as entecavir (ETV) and tenofovir disoproxil fumarate (TDF) has become the most popular treatment strategy worldwide because of their excellent efficacy and safety profile as well as easy management confirmed in both registration trials and in clinical practice studies...
January 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28052618/the-future-of-liver-transplantation-for-viral-hepatitis
#19
REVIEW
François Durand, Claire Francoz
In hepatitis C virus (HCV)-infected patients, transplantation can be justified by decompensated cirrhosis, hepatocellular carcinoma (HCC) or both. During the last decade, HCV infection accounted for about 30% of the indications for transplantation in Europe and North America. Direct antiviral agents (DAAs) are highly effective at curing HCV, even in patients with end-stage cirrhosis. In the future, the incidence of HCV-related decompensated cirrhosis will continue to decrease. The incidence of HCC will also decrease, but a large cohort of patients with cirrhosis will still be at risk of developing HCC even after HCV has been cured...
January 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28051801/%C3%A2-utility-and-safety-of-tolvaptan-in-cirrhotic-patients-with-hyponatremia-a-prospective-cohort-study
#20
Ji-Dong Jia, Wen Xie, Hui-Guo Ding, Hua Mao, Yonggang Li, Xiaojin Wang, Jie-Fei Wang, Wei Lu, Cheng-Zhong Li, Yimin Mao, Gui-Qiang Wang, Yue-Qiu Gao, Bangmao Wang, Qin Zhang, Yan Ge, Vincent Wai-Sun Wong
:  Introduction and aim. Hyponatremia is common in patients with decompensated cirrhosis and is associated with increased mortality. Tolvaptan, a vasopressor V2 receptor antagonist, can increase free water excretion, but its efficacy and safety in cirrhotic patients remain unclear. MATERIAL AND METHODS: We studied the usage and safety of tolvaptan in cirrhotic patients in a real-life, non-randomized, multicenter prospective cohort study. Forty-nine cirrhotic patients with hyponatremia were treated with tolvaptan 15 mg daily, and 48 patients not treated with tolvaptan in the same period served as controls...
January 2017: Annals of Hepatology
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