Liver international: official journal of the International Association for the Study of the Liver (Liver Int)

Publisher: International Association for the Study of the Liver, Wiley

Journal description

The general aim of Liver International is to promote all aspects of the science of hepatology from basic research to applied clinical studies. It is an international Journal providing a forum for the publication of high quality original research in hepatology. It provides an essential resource for all professionals concerned with normal and abnormal structure and function in the liver and its constituent cells and is intended for clinicians and basic scientists involved in the multi-disciplinary field of hepatology. It includes studies of pathobiology from experimental models and human material. Liver International welcomes articles from all fields of hepatology, which may be published as original articles, rapid communications, reviews, and letters to the Editor. Case reports will be accepted if the clinical problem is studied in detail and of sufficient interest in a wider context. Papers are normally evaluated by a peer review process involving at least two independent reviewers. Within the scope of the Journal, articles will be accepted on the basis of scientific quality, originality and up-to-date relevance.

Current impact factor: 4.85

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 4.85
2013 Impact Factor 4.412
2012 Impact Factor 3.87
2011 Impact Factor 3.824
2010 Impact Factor 3.84
2009 Impact Factor 2.987
2008 Impact Factor 2.908
2007 Impact Factor 2.559
2006 Impact Factor 2.344
2005 Impact Factor 1.766
2004 Impact Factor 1.227
2003 Impact Factor

Impact factor over time

Impact factor

Additional details

5-year impact 4.48
Cited half-life 4.10
Immediacy index 1.30
Eigenfactor 0.02
Article influence 1.34
Website Liver International website
Other titles Liver international (Online)
ISSN 1478-3231
OCLC 52034063
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • On author's personal website, institutional repositories, arXiv, AgEcon, PhilPapers, PubMed Central, RePEc or Social Science Research Network
    • Author's pre-print may not be updated with Publisher's Version/PDF
    • Author's pre-print must acknowledge acceptance for publication
    • Non-Commercial
    • Publisher's version/PDF cannot be used
    • Publisher source must be acknowledged with citation
    • Must link to publisher version with set statement (see policy)
    • If OnlineOpen is available, BBSRC, EPSRC, MRC, NERC and STFC authors, may self-archive after 12 months
    • If OnlineOpen is available, AHRC and ESRC authors, may self-archive after 24 months
    • Publisher last contacted on 07/08/2014
    • This policy is an exception to the default policies of 'Wiley'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Nodular regenerative hyperplasia (NRH) is a rare histological disorder associated with a wide variety of systemic diseases. Aims: We aimed 1) to report the prevalence of NRH in a database of liver biopsies (LBs) and the frequency of portal hypertension (PHT) at diagnosis, and (2) to investigate whether associated diseases and/or specific histological lesions, including abnormalities of the microvasculature, were related to PHT. Methods: Patients with a histological diagnosis of NRH, referred by 7 clinical departments, were retrospectively selected. Clinical, biological, radiological, hemodynamic and endoscopic data at diagnosis were recorded. LBs were reassessed for microvascular abnormalities. Results: NRH was diagnosed in 4.4% of LBs (n=159, male: 52%, mean age: 54). Among patients referred for unexplained liver enzyme abnormalities, 15% had NRH. PHT was present at diagnosis in 45 patients (38%), including 13 with portal thrombosis; 65% of patients had an associated disorder. Obliteration of portal vein branches, observed in the LBs of 17 patients (11%), was significantly associated with PHT (p=0.02). Periportal angiomatosis, observed in 101 patients (63%), was associated with the absence of PHT (p<10(-4) ). Conclusion: We suggest that NRH is a frequent histological lesion in the setting of unexplained liver enzyme abnormalities. PHT is present at the time of diagnosis in 1/3 of patients regardless of the presence of associated disease. The frequency of periportal angiomatosis in NRH without obliteration of portal vein branches, and its association with the absence of PHT suggest that obstructive portal venopathy would not represent the most frequent mechanism involved in NRH. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12974
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    ABSTRACT: In a recent issue of this journal, Fernandes et al(1) reported on functional hepatocellular regeneration in elderly patients undergoing hepatectomy. They used (99m) Tc-mebrofinin HBS to quantify liver function before and after surgery and concluded that functional regeneration is already present at postoperative day 5. However, the study has in our view several limitations. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12973
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    ABSTRACT: Background: Idiopathic non-cirrhotic portal hypertension (INCPH) is a rare life-threatening liver disease that lacks a specific diagnostic test being frequently misdiagnosed as cryptogenic cirrhosis. Preliminary data from our group identified a plasma metabolomic profile able to differentiate INCPH from patients with cirrhosis (CH) and healthy volunteers (HV). However, the untargeted methodology applied was unable to identify all the specific metabolites, hampering the possibility of building-up diagnostic models. This study applies a wide-coverage of previously identified metabolites through a high-throughput metabolomics technology, evaluating if there is a metabolomic profile that allows a non-invasive diagnosis of INCPH. Methods: We included 34 patients with INCPH, 34 with CH and 34 HV. We performed a targeted metabolomic analysis of serum samples using UPLC-MS. The best combination of a set of specific metabolites was obtained using stepwise logistic regression (LR) and recursive partitioning analysis (RPA). Results: After internal cross-validation, LR analysis identified a subset of 5-metabolites that clearly differentiate INCPH patients from CH and HV (average corrected optimism AUROC = 0.8871 [0.838 - 0.924]). Using high and low cut-off values the model has an excellent capacity to respectively diagnose or exclude INCPH. The RPA analysis strategy used the 3-metabolites signature differentiating INCPH from CH and the 2-metabolites signature differentiating INCPH from HV. A decision tree applying sequentially these metabolic profiles diagnosed 88% of INCPH patients. Conclusions: Different metabolomic profiles allow the diagnosis of INCPH with high specificity and sensibility and may represent excellent clinical tools for its diagnosis avoiding multiple and invasive tests. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12972
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    ABSTRACT: Background and aims: The severity of acute viral hepatitis, which may be caused by several distinct viruses, varies among individual patients. In rare cases severe hepatic injury with sudden loss of liver function may occur, which is clinically indicated by the occurrence of coagulopathy or encephalopathy. Since the molecular mechanisms of this liver injury are largely unknown, we investigated extracellular micro RNA (miRNA) profiles in 54 patients acutely infected with one of four different hepatotropic viruses, in order to identify those miRNAs which indicate severe viral hepatitis associated with coagulopathy. Methods: First, the profile of miRNAs was extensively analyzed using a microarray-based approach in highly characterized 24 patients, matched in terms of sex, age and level of liver enzymes, as well as in 3 healthy controls. The cohort included samples from 18 patients with moderate and 6 individuals with severe hepatitis, indicated by abnormal prothrombin time and higher alanine aminotransferase and bilirubin levels. miRNAs found to upregulated in severe hepatitis were then quantified by Real Time PCR in the expanded cohort of 54 patients RESULTS: Comprehensive microarray-based miRNA profiling identified upregulation of mir-106a, mir-122 and mir197 in patients with severe acute viral hepatitis with coagulopathy, as compared to patients who did not develop coagulopathy. mir-106a, mir-122 and mir-197 were then proven to be significantly upregulated in patients with severe acute viral hepatitis by quantitative real-time PCR (p<0.01, Mann Whitney U-test). Conclusions: mir-106a, mir-122 and mir-197 could be potential markers for severe acute viral hepatitis associated with coagulopathy. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12961
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    ABSTRACT: Background & aims: Hepatocellular carcinoma (HCC) is often associated with metastasis and recurrence leading to a poor prognosis. Therefore, development of novel treatment regimens is urgently needed to improve the survival of HCC patients. In this study, we aimed to investigate the in vitro and in vivo effects of anti-CD47 antibody alone and in combination with chemotherapy in HCC. Methods: In this study, we examined the functional effects of anti-CD47 antibody (B6H12) on cell proliferation, sphere formation, migration and invasion, chemosensitivity, macrophage-mediated phagocytosis, and tumorigenicity both in vitro and in vivo. The therapeutic efficacy of anti-CD47 antibody alone or in combination with doxorubicin was examined in patient-derived HCC xenograft. Results: Blocking CD47 with anti-CD47 monoclonal antibody (B6H12) at 10μg/mL could suppress self-renewal, tumorigenicity and migration and invasion abilities of MHCC-97L and Huh-7 cells. Interestingly, anti-CD47 antibody synergized the effect of HCC cells to chemotherapeutic drugs including doxorubicin and cisplatin. Blockade of CD47 by anti-CD47 antibody induced macrophage-mediated phagocytosis. Using a patient-derived HCC xenograft mouse model, we found that anti-CD47 antibody (400μg/mouse) in combination with doxorubicin (2mg/kg) exerted maximal effects on tumor suppression, as compared with doxorubicin and anti-CD47 antibody alone. Conclusions: Anti-CD47 antibody treatment could complement chemotherapy which may be a promising therapeutic strategy for the treatment of HCC patients. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12963
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    ABSTRACT: Background & aims: Clinical studies suggest that splenectomy improves liver function in liver cirrhotic patients, but the influence of splenectomy on stem cell transplantation is poorly understood. This study investigated the effect of splenectomy on stem cell infusion and elucidated its mechanism. Methods: Rat adipose tissue-derived mesenchymal stem cells were infused into liver cirrhosis rats with or without splenectomy, followed by assessment of the in vivo distribution of stem cells and pathological changes. Stromal cell-derived factor-1 and hepatocyte growth factor expression were also investigated in splenectomized liver cirrhosis patients and rats. Results: Splenectomy prior to cell infusion improved liver function and suppressed fibrosis progression more efficiently than cell infusion alone in the experimental cirrhosis model. Stromal cell-derived factor-1 and hepatocyte growth factor levels after splenectomy were increased in patients and rats. These upregulated cytokines significantly facilitated stem cell motility, migration and proliferation in vitro. C-X-C chemokine receptor type 4 neutralization weakened the promotion of cell migration by these cytokines. The infused cells integrated into liver fibrosis septa and participated in regeneration more efficiently in splenectomized rats. Direct co-culture with stem cells led to inhibition of hepatic stellate cell proliferation. In addition, hepatocyte growth factor induced hepatic stellate cell apoptosis via the c-jun N-terminal kinase-p53 pathway. Conclusions: Splenectomy prior to cell infusion enhanced the therapeutic effect of stem cells on liver cirrhosis, which involved upregulation of stromal cell-derived factor-1 and hepatocyte growth factor after splenectomy. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12962
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    ABSTRACT: Background: Antiviral drugs are safe and effective in the third trimester to prevent intrauterine transmission of hepatitis B virus, and are recommended for HBV infected gravid mothers (between weeks 28 and 32) with high viral load, followed by postnatal hepatitis B immunization in the newborn. We estimated the comparative efficacy of antiviral drugs for prevention of vertical transmission of HBV, through a network meta-analysis of clinical trials. Methods: We conducted a comprehensive search of MEDLINE, EMBASE and published proceedings from major liver meetings from January 1980 to November 2014. We conducted pair-wise meta-analyses and Bayesian framework using Markov chain Monte Carlo methods, combining direct and indirect evidence for any given pair of treatments. Results: Seventeen clinical trials involving 2,764 newborns of HBsAg seropositive mothers were eligible for analysis. There were no clinical trials involving Tenofovir or Entecavir. On pair-wise meta-analyses, Telbivudine (HR 0.12, 95% CI 0.04 to 0.37; I(2) = 0%), and Lamivudine (HR 0.40, 95% CI 0.24 to 0.65; I(2) = 0%), were more effective than placebo in reducing vertical transmission of HBV in high viremic HBeAg-positive chronic Hepatitis B Chinese patients. Sensitivity analyses limited to studies with HBeAg seropositive mothers revealed similar results. Conclusion: Based on a Bayesian network meta-analysis of clinical trials, combining direct and indirect treatment comparisons, Telbivudine appears to be more effective than Lamivudine for preventing vertical transmission of HBV infection. Trials assessing the efficacy of Tenofovir or Entecavir compared to placebo or other antiviral drugs are lacking. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12959
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    ABSTRACT: Background and aims: There has been remarkable progress in the management of hepatocellular carcinoma (HCC) during the last several decades but its effect on the prognosis of HCC patient needs clarification. We analyzed the changes that affected prognosis of HCC patients diagnosed over two different eras. Methods: A retrospective study of 1318 patients diagnosed with HCC from 1986 to 2012 was conducted. Analysis was done according to two cohorts, cohort 1 (patients diagnosed with HCC from 1986 to 1992) and cohort 2 (patients diagnosed from 2006 to 2012). Results: Hepatitis B virus was the most common cause of liver disease for both cohorts (66.2% and 66.0%). The proportion of patients with Barcelona Clinic Liver Cancer stage 0/A was significantly lower in cohort 1 than in cohort 2 (14.4% vs. 39.5%, P<0.001). The proportions of patients diagnosed during surveillance and general health-check were significantly higher in cohort 2 than in cohort 1 (28.6% vs. 10.6% and 26.3% vs. 7.9%, respectively) while those diagnosed during symptomatic evaluation was significantly higher in cohort 1 than in cohort 2 (45.1 vs. 81.4%, P<0.001). Surgical resection rate was similar between the two cohorts (26.1% vs 26%) while the transcatheter arterial chemoembolization rate which was highest in cohort 1 (40.6%) was overtaken by radiofrequency ablation in cohort 2 (55%) at BCLC stage 0/A. Median survival duration in cohort 2 was significantly longer than cohort 1 (65.0 vs. 7.9 months, P<0.001). Conclusions: Implementation of national cancer surveillance and the advancement of treatment modalities have likely led to the early detection of HCC and improvements in prognosis over the last 20 years. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12960
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    ABSTRACT: Background and aims: Fatty liver is associated with alcohol habits and/or overweight-obesity. We challenged if some lifestyle feature are associated with fatty liver and, particularly, with non-alcoholic-fatty-liver-disease (NAFLD). Among them, sleep shortage due to nightlife habits and oversized fashion preferred clothing were assessed. This last consists of the fashion of clothing larger than normal and reflects attitude of social or age groups, conceivably indicating more global and widespread trend and behavior. Methods: We studied a group of 708 non-diabetic youngsters, 458 women and 250 men, aged between 15 and 35 years, 21.72±3.71 years, referred for minor digestive ailments to clinical assessment, ultrasound detection of fatty liver and nutritional counselling. Detail of the personal history regarding lifestyle, food intake frequency and alcohol intake, dietary and physical exercise profile, sleep duration and clothing habits were recorded. Results: The prevalence of NAFLD in this cohort of young person is 67/708 (9.4%). Even if quantitatively very low in both groups, the average alcohol intake, always below 20 g/day, is greater in the NAFLD subjects, g. 5.83±4.32, vs. normal liver subjects, g. 2.02±3.20.The number of meals/day and adherence to a Mediterranean diet profile are smaller in NAFLD subjects. By multiple linear regression, BMI, sedentary life, oversized clothing for the actual size, sleep shortage and lower frequency of daily food intake are associated with the presence of NAFLD. Conclusion: Onset and continuation of fatty liver disease, beyond food and exercise quantity and quality, with their effects on obesity, may be associated also with other aspects of lifestyle. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12957
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    ABSTRACT: Purpose: To examine the available literature and summarize what is known about chronic drug-induced liver injury. Methods: We reviewed PubMed/MEDLINE through March 2015. We developed a MEDLINE search strategy using PubMed medical subject heading terms chronic liver injury, hepatotoxicity, drug-induced liver injury, cirrhosis and chronic liver disease. We reviewed the reference list of included articles to identify articles missed in the database search. Findings: Chronic liver injury from drugs is more common than once thought with prevalence as high as 18% based on large national registries. Patients with cholestatic injury, age ≤ 65 years, and a long latency period (>365 days) are at increased risk. Of the most common drugs associated with drug-induced liver injury, antibiotics (amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, azithromycin) are most likely to cause chronic injury. The presence of autoantibodies is common with chronic DILI, however, it is not diagnostic nor is it specific to autoimmune-like drug-induced liver injury. Immunosuppressive therapy may be necessary for individual cases of autoimmune-like drug-induced liver injury where cessation of the drug alone does not result in resolution of injury, however, the lowest dose should be used for the shortest duration with careful attention to the development of side effects. The effectiveness of treament of cholestatic liver injury with corticosteroids or ursodiol remains unclear. Cases of drug-induced fatty liver, nodular regenerative hyperplasia and peliosis hepatitis are less common subtypes of chronic drug-induced liver injury that deserve special consideration. Conclusions: A high degree of clinical suspicion is required for the diagnosis of chronic drug-induced liver injury and should be suspected in any patient with liver associated enzyme abnormalities that persist out past six months of initial presentation. Treatment with drug removal and/or immunosuppressive therapy appears to be effective for the majority of cases. More study into pharmacogenomics and personalized medicine may aid in predicting which patients will go on to develop chronic drug-induced liver injury. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12958
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    ABSTRACT: Background and aims: Extracellular microRNAs (miRNAs) in serum and bile are currently under intense investigation for biomarker purposes in liver disease. However, the directions and pathways by which miRNAs are released from hepatic cells remains largely unknown. Here, we investigated the release of hepatocyte and cholangiocyte-derived miRNAs (HDmiRs and CDmiRs) into blood and bile during various (patho)physiological hepatic conditions. Methods: MiRNA release was analyzed using longitudinally collected tissue and paired bile and serum samples (n=124) that were obtained from liver transplant recipients during follow-up. Results: Cell-type specificity of HDmiRs and CDmiRs was confirmed in liver and common bile duct biopsies (P<0.001). Analysis of paired bile and serum samples showed up to 20-times higher miRNA-levels in bile compared to serum (P<0.0001). Fractionation of bile showed the majority of miRNAs being present in the unpelletable supernatant, where protein-conjunctions protect miRNAs against degradation (P<0.0001). During episodes of liver injury and histologically proven rejection in liver transplant recipients, relative HDmiR-levels in bile decreased while its levels in serum increased (P≤0.015). Simultaneously, relative CDmiR-levels in bile significantly increased, while their levels in serum decreased. Related to liver excretory function, a strong positive correlation was observed between HDmiR-122 levels and bilirubin excretion into bile (R=0.694, P<0.0001), whereas CDmiRs showed an inverse correlation (P<0.05). Conclusion: During impaired excretory function and injury, the liver shows polarized release of extracellular HDmiRs and CDmiRs. This sheds new light on the biology of hepatic miRNA release which is relevant for the interpretation of hepatic miRNAs as biomarkers. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12955
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    ABSTRACT: We read with great interest the recently published article by Dokmak et al. [1] “Will weight loss become a future treatment of hepatocellular adenoma in obese patients?” We agree that weight loss can be a promising strategy for the treatment of hepatocellular adenoma (HCA) in young females with obesity. However, we recently experienced a case of HCA that ruptured despite weight loss.A 29-year-old female was diagnosed with a large HCA (20 cm diameter) complicated by morbid obesity (body mass index 49 kg/m2).This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12968
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    ABSTRACT: All Societies, AASLD, EASL, APASL and JSH, identify patients with cirrhosis as a target population for surveillance, with minor differences for additional categories of patients, such as chronic hepatitis B and hepatitis C patients with advanced fibrosis. According to AASLD, liver disease related to metabolic diseases including diabetes and obesity is a recognized target of screening, since those conditions have been causally related to HCC. All societies endorse radiological non-invasive techniques as the mainstay for early diagnosis of HCC, but discrepancies exist between Societies on the utilization of contrast-enhanced ultrasound and utilization of serum markers for surveillance and diagnosis of HCC. The diagnostic algorithm of the international societies differ substantially in the anatomic paradigm of EASL and APASL which identify 1 cm size as the starting point for radiological diagnosis of HCC compared to APASL algorithm based on the dynamic pattern of contrast imaging, independently on tumor size. While strengthening prediction in individual patients is expected to improve cost-effectiveness ratios of screening, the benefits of pre-treatment patient stratification by clinical, histological and genetic scores remain uncertain and exclusion of patients with severe co-morbidities and advanced age is still debated.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12965
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    ABSTRACT: It only recently dawned on us that obesity is even a bigger threat to our liver health than alcohol although those enjoying culinary delights often both overeat and drink. We have learnt that the metabolic syndrome (MetS) develops particularly in those obese subjects, who deposit excess fat in the liver. In this type of NAFLD (‘Obese/Metabolic NAFLD’), insulin does not normally inhibit the production of glucose or VLDL from the liver.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12970
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    ABSTRACT: With great interest, I read the article titled “The impact of nonalcoholic fatty liver disease on incident type 2 diabetes mellitus in non-overweight individuals” by Fukuda et al.(1) The authors reported that non-overweight participants with nonalcoholic fatty liver disease (NAFLD) might have a greater risk of type 2 diabetes mellitus (T2DM) than overweight participants without NAFLD in Japan. However, there were some issues that deserve further comments in assessing this relationship.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12971
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    ABSTRACT: Thanks for giving us the opportunity to respond to Testino et al's letter ‘Fibrosis progression in patients treated for hepatitis C recurrence’. We agree with the authors of the letter that metabolic syndrome and steatosis likely impact therapeutic response to hepatitis C therapy. But the question raised in the letter is specific to the four patients reported in our paper (1) who achieved SVR but still experienced fibrosis progression as noted in post treatment biopsies, with no clear explanation We have described in our paper that three of the four patients had moderate to severe steatosis noted on the biopsy but all of them only had mild inflammation (grade 1 of 3).This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12969
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    ABSTRACT: Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. onservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is however the ultimate treatment.
    Liver international: official journal of the International Association for the Study of the Liver 09/2015; DOI:10.1111/liv.12956
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    ABSTRACT: Prednisolone is the first-line therapy for severe alcoholic hepatitis (AH). Patients with severe alcoholic hepatitis often develop severe infections that negatively impact short-term prognosis. We performed this meta-analysis to assess the effect of corticosteroids on the occurrence of and mortality from infections in patients with severe alcoholic hepatitis. Randomized controlled trials examining the use of corticosteroids in severe alcoholic hepatitis and reporting data on infection rates and mortality were included. Random effects model was used to pool the data comparing arms with and without steroids for the occurrence of infection, 28-d mortality, and cause specific mortality. Of 1,062 patients (528 steroids treated) without infection at baseline from 12 studies, infection was reported in 213 (113 steroids treated) patients without differences comparing arms with and without steroids (OR: 0.98; CI: 0.49-1.94). However, frequency was higher for occurrence of fungal infections among steroid treated patients (8 of 528 vs. 1 of 534; P=0.02). Steroids provided mortality benefit at 28 days (OR: 0.55; CI: 0.34-0.90) mainly for liver failure related death (OR: 0.46; CI: 0.24-0.87) without differences on mortality from infection (OR: 1.19; CI: 0.38-3.73) or gastrointestinal bleeding (OR: 0.90; CI: 0.43-1.87). Three of nine patients with fungal infections died, all in corticosteroid arm. Corticosteroids do not increase occurrence of or mortality from bacterial infections in patients with severe alcoholic hepatitis. Further studies are needed to develop strategies of reducing the risk of fungal infection with use of steroids for patients with severe alcoholic hepatitis. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 08/2015; DOI:10.1111/liv.12939