Andrej Potthoff

Hannover Medical School, Hanover, Lower Saxony, Germany

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Publications (57)212.67 Total impact

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    ABSTRACT: Fine needle aspiration (FNA) is a sensitive and specific method (95%), often helpful in characterizing suspected liver lesions. It is appropriate to distinguish between primary and secondary liver neoplasia. Moreover, in most cases, the use of cell block preparations of small specimens allows immunocytochemical evaluation to determine the nature of the primary tumour. In a retrospective study at Hannover Medical School (MHH) from 1998 to 2012 (14 years), 4,136 sonographically guided FNAs were performed. The patients provided consent and the study protocol was approved by the local ethics committee. There were 39.6% malignant and 57.5% benign lesions in the liver, while 2.8% of the cases were undetermined. FNA was non-representative in 1.1% of the cases. The diagnostic utility of highly differentiated hepatocellular carcinoma (HCC; G1) remains difficult; cell bridges with cell atypia are pathognomonic for diagnosis. Ancillary techniques and immunocytochemical investigations will increase the sensitivity and specificity, particularly by using the cell block technique.
    Oncology reports. 10/2014;
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    ABSTRACT: Background Acoustic radiation force impulse imaging is used to assess stages of liver fibrosis. The aim of our study was to evaluate liver stiffness changes in patients with biliary obstruction with or without sclerosing cholangitis after biliary drainage. Methods A total of 71 patients were enrolled in this prospective study (cohort N = 51, control group N = 20); 51 patients with obstructive cholestasis, indicated for endoscopic retrograde cholangiography, received stiffness measurement by acoustic radiation force impulse imaging before and 1–2 days after endoscopic retrograde cholangiography. Seventeen patients with obstructive cholestasis had primary or secondary sclerosing cholangitis. Forty one patients had a follow-up acoustic radiation force impulse imaging measurement after 3.0 ± 9.31 weeks. Results In all patients with obstructive cholestasis, stiffness decreased significantly after biliary drainage (p < 0.001). The main decrease was observed within 2 days after endoscopic retrograde cholangiography (1.92–1.57 m/s, p < 0.001) and correlated with the decrease of bilirubin and alkaline phosphatase (p = 0.04 and p = 0.002, respectively). In patients with sclerosing cholangitis, the initial decrease of stiffness after biliary drainage was weaker than in those without (2.1–1.85 m/s vs. 1.81–1.43 m/s, p = 0.016). Conclusion Acoustic radiation force impulse imaging elastography shows that liver stiffness is increased by biliary obstruction, and decreases after endoscopic retrograde cholangiography irrespective of the aetiology. In patients with sclerosing cholangitis the reduction in stiffness after biliary drainage is impaired.
    Digestive and Liver Disease 01/2014; · 3.16 Impact Factor
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    ABSTRACT: Abstract Objective. Abdominal tuberculosis (TB) is a relatively rare disease in most of Europe and the typical clinical and sonographic findings in this setting have not been studied. We aimed to define sonographic findings that should alert an examiner to the possibility of abdominal TB in a low endemic region. Methods. Case records of 17 patients with proven (n = 11) or highly likely (n = 6) abdominal TB detected in the gastrointestinal ultrasound unit at a German tertiary care center in 2003-2013 were analyzed retrospectively. Findings were compared with reported series from high-prevalence regions. Results. While 76% of patients had an immigrant background, only 35% had a condition associated with immunosuppression. Lymphadenopathy was present in all cases of abdominal TB, while it was absent in 28% of patients from a control group with proven abdominal sarcoidosis. Moreover, retroperitoneal lymphadenopathy was significantly more common in TB. Other findings in patients with abdominal TB in descending order of frequency were ascites, altered hepatic texture, splenomegaly, splenic lesions, peritoneal thickening, intestinal wall lesions, hepatic lesions and hepatomegaly. 76% of abdominal TB patients had 2 or more pathological findings. Conclusions. Multiple pathological intra-abdominal findings including lymphadenopathy should alert the examiner to the possibility of abdominal TB.
    Scandinavian Journal of Gastroenterology 12/2013; · 2.33 Impact Factor
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    ABSTRACT: BACKGROUND: Early treatment of acute hepatitis C virus (HCV) infection with interferon alfa monotherapy is very effective, with cure rates of greater than 85%. However, spontaneous clearance of HCV occurs in 10-50% of cases. We aimed to assess an alternative treatment strategy of delayed antiviral therapy in patients who do not eliminate the virus spontaneously compared with immediate treatment. METHODS: In our open-label phase 3 non-inferiority trial, we enrolled adults (≥18 years) with acute hepatitis C but no HIV or hepatitis B co-infection at 72 centres in Germany. We randomly allocated patients with symptomatic acute hepatitis C (1:1) to receive immediate pegylated interferon alfa-2b treatment for 24 weeks or delayed treatment with pegylated interferon alfa-2b plus ribavirin (for 24 weeks) starting 12 weeks after randomisation if HCV RNA remained positive. We used a computer-generated randomisation sequence and block sizes of eight, stratified by bilirubin concentration. We assigned all asymptomatic patients to immediate treatment with pegylated interferon alfa-2b for 24 weeks. The primary endpoint was sustained HCV RNA negativity in all randomly allocated participants who completed screening (intention-to-treat analysis), with a non-inferiority margin of 10%. For the primary analysis, we calculated the virological response of patients in the immediate and delayed treatment groups and an absolute risk difference stratified by bilirubin status. The trial was stopped early on advice from the study advisory committee because of slow recruitment of participants. This study is registered, number ISRCTN88729946. FINDINGS: Between April, 2004, and February, 2010, we recruited 107 symptomatic and 25 asymptomatic patients. 37 (67%) of 55 symptomatic patients randomly allocated to receive immediate treatment and 28 (54%) of 52 symptomatic patients randomly allocated to receive delayed treatment had a sustained virological response (difference 13·7%, 95% CI -4·6 to 32·0; p=0·071). 18 (72%) of 25 asymptomatic patients had a sustained virological response. 22 (42%) of 52 symptomatic patients allocated to receive delayed treatment did not complete follow-up compared with 20 (25%) of 80 symptomatic or asymptomatic patients assigned immediate treatment (p=0·037). 11 symptomatic patients (21%) assigned delayed treatment had spontaneous HCV clearance. 14 patients who received delayed pegylated interferon alfa-2b plus ribavirin treatment and completed follow-up achieved sustained virological response. INTERPRETATION: Delayed treatment is effective although not of equal efficacy to immediate treatment; coupled with the rate of spontaneous clearance it can reduce unnecessary treatment in closely monitored populations. Immediate treatment seems preferable in populations where loss to follow-up is great. FUNDING: German Network of Competence on Viral Hepatitis (HepNet, funded by the German Federal Ministry of Education and Research, grants 01KI0102, 01KI0401, and 01KI0601), MSD, Schering-Plough.
    The Lancet Infectious Diseases 03/2013; · 19.97 Impact Factor
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    ABSTRACT: BACKGROUND: Acoustic Radiation Force Impulse Imaging (ARFI) is an innovative elastography for staging of liver fibrosis. We evaluated the diagnostic accuracy of different probes to perform ARFI at different insertion depths. METHODS: In a prospective study, 89 chronic HCV infected patients underwent ARFI elastography using both available probes (c-ARFI: C4-1-MHz; l-ARFI: L9-4 MHz) in comparison to Fibroscan(®). Variability of ARFI elastography at different insertion depths was systematically evaluated in 39 patients (44%). According to Fibroscan(®) elastography, 32 patients (36%) presented with liver cirrhosis, 23 patients (26%) had significant fibrosis and 34 patients (38%) had no significant fibrosis. RESULTS: Mean propagation velocity with c-ARFI was 1.70±0.67m/s and 1.91±0.87m/s with l-ARFI. Results of both probes were correlated to each other (p<0.001; r=0.70) and to Fibroscan(®) (p<0.001, r=0.82 and 0.84, respectively). In patients with significant fibrosis or with cirrhosis, mean values by l-ARFI were significantly higher than by c-ARFI (p<0.001). For detection of liver cirrhosis, AUROC was 0.97 for c-ARFI (cut-off level 1.72m/s) and 0.90 for l-ARFI (cut-off 2.04m/s). Correlation coefficients of c-ARFI with Fibroscan(®) were highest at an insertion depth of 5-6cm (r=0.882 and 0.864, respectively, p<0.001) and at 3-4cm for l-ARFI (r=0.850 and 0.838, respectively, p<0.001). CONCLUSIONS: ARFI elastography with the linear and with the convex probes showed comparable validity and accuracy in the estimation of liver stiffness. The linear probe gave higher ARFI values. The most accurate insertion depth was 5-6cm for c-ARFI and 3-4cm for l-ARFI indicating that measurements should not be performed close to the liver capsule.
    European journal of radiology 03/2013; · 2.65 Impact Factor
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    ABSTRACT: BACKGROUND: Nonparasitic splenic cysts are rare. Until now, surgical intervention has been the standard therapy of symptomatic splenic cysts. AIMS: We herein present a retrospective analysis of an approach using percutaneous ultrasound-guided fine needle aspiration and sclerotherapy. METHODS: Out of 88,151 ultrasound reports, we identified 138 patients who presented with splenic cysts. A single splenic cyst was found in 88% (mean size 28.9mm). Twelve patients underwent percutaneous therapy of symptomatic splenic cysts. They were younger, had larger splenic cysts and more often cyst internal echoes than the 126 untreated patients (all p<0.0001). RESULTS: Initial sclerotherapy was performed with polidocanol 1% in 9 patients and with NaCl 10% in 2 patients. One hemorrhagic cyst was only purged. Serious adverse events were not noted. Eight patients had to undergo 1-11 further percutaneous cyst therapies. 15 of these 30 reinterventions were cyst aspiration therapies, only, and 11 of them were sclerotherapies with NaCl 10%. Four patients were readmitted to hospital for cyst retreatment. After 57±43 months of follow-up, cyst size significantly decreased (p<0.0001). Only two patients had a complicated course of cyst therapy. CONCLUSIONS: Percutaneous ultrasound-guided sclerotherapy is a new approach for symptomatic splenic cysts. In most patients, cyst size and symptoms can be significantly reduced during one hospital stay.
    Digestive and Liver Disease 01/2013; · 3.16 Impact Factor
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    ABSTRACT: Biliary complications are significant source of morbidity after liver transplantation (LT). Cholangiography is the gold standard for diagnosis and specification of biliary complications. Detailed analyses of ultrasound (US) as a safe imaging method in this regard are still lacking. Therefore we analyzed systematically the diagnostic value of US in these patients. Retrospectively, 128 liver graft recipients and their clinical data were analyzed. All patients had a standardized US examination. The findings of US were compared to cholangiographic results in 42 patients. Following statistical analyses were performed: descriptive statistics, sensitivity, specificity, positive and negative predictive values (PPV, NPV). 42 patients had 54 different biliary complications (Anastomotic stenosis (AS) n = 33, ischemic type biliary lesions (ITBL) n = 18 and leakage n = 3). US detected n = 22/42 (52%) patients with biliary complications. The sensitivity, specificity, PPV and NPV of US were: 61%, 100%, 100%, 79% (95CI, 36-86%) for ITBL and 24%, 100, 100%, 31% (95CI, 9-46 %) for AS, respectively. US examination had no false positive rate. Therefore, it may be helpful as a first screening modality. But for the direct diagnosis of the biliary complication US is not sensitive enough.
    Hepatitis Monthly 01/2013; 13(1):e6003. · 1.25 Impact Factor
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    ABSTRACT: Abstract Objective. Focal nodular hyperplasia (FNH) is a benign liver tumor considered to develop under the influence of estrogens. Whether women with known FNH are at higher risk of growth progression and complications during pregnancy is still controversially discussed. The authors investigated the growth pattern of FNH during pregnancy and possible related complications. Materials and methods. Twenty pregnant women with FNH were followed by the authors' center. Before pregnancy, diagnosis of FNH was usually established by contrast-enhanced ultrasound. During pregnancy, monitoring of FNH was performed by conventional ultrasound. Furthermore, a questionnaire was sent to all patients. Results. Patient's age ranged from 24 to 36 years. Mean size of FNH before pregnancy was 58.5 ± 22.7 mm. It did not vary significantly during pregnancy (fourth month of pregnancy: 58.1 ± 23.0 mm; after pregnancy: 55.5 ± 26.8 mm; -8%; n.s.). Only in three patients, growth of FNH by 18 ± 6% was observed, while FNH size remained constant in 7 patients and even declined by -11 ± 6% in 10 patients. There were no FNH-related complications. The questionnaire was sent back by 16 patients (80%). All responding patients took oral contraceptives in the past over a mean 12.4 ± 4.4 years. Previous pregnancies were reported by 38% of patients. FNH-related fears were expressed by 63% of patients, but no FNH-related complications or symptoms during pregnancy were noted. Conclusions. This study demonstrates that women with FNH are not at risk of significant growth progression or FNH-related complications. Pregnancy should not be discouraged in these patients but careful advice and guidance are necessary.
    Scandinavian Journal of Gastroenterology 10/2012; · 2.33 Impact Factor
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    ABSTRACT: The course of viral hepatitis shows wide interindividual differences, ranging from asymptomatic disease to liver failure. Only limited data on gender differences in patients undergoing liver transplantation (OLT) exist. We studied the gender distribution in patients who underwent liver transplantation for viral hepatitis. A retrospective analysis was performed on a cohort of 368 patients who underwent OLT for viral hepatitis-associated acute or chronic liver failure. In 96 of them, additional hepatocellular carcinoma (HCC) was present at transplantation. Gender ratios of the different hepatitis virus infections and in relation to HCC were evaluated. Significantly more males than females underwent OLT for chronic HBV. In contrast, patients after OLT for fulminant HBV were more frequently females. In patients transplanted for chronic HCV or HDV, no significant gender differences were found. However, men presented more frequently with HCC in both groups of chronic liver disease. There was a gender difference in HBV infection with more women developing fulminant hepatic failure in acute HBV while more men progressed to end-stage liver disease in chronic HBV. The role of gender in chronic HCV and HDV infection was less pronounced, except for a male predominance among patients with HCC.
    Zeitschrift für Gastroenterologie 08/2012; 50(8):760-5. · 1.41 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) uses several host factors to infect and replicate in human hepatocytes. Cyclophilin A (CypA) is required for viral replication, and CypA inhibitors are in development. We investigated the effects of nonsynonymous single nucleotide polymorphisms (SNPs) in the region of peptidyl-prolyl isomerase A (PPIA) that encodes CypA on HCV infection and replication of human hepatocytes. We used a combination of virologic, biochemical, and genetic approaches to investigate the effects of PPIA variants on HCV replication in cultured Huh-7.5 cells. We reduced levels of CypA in these cells using small hairpin RNAs (shRNAs). Using shRNAs, we showed that CypA was required for replication of HCV in Huh-7.5 cells and identified 3 SNPs in PPIA that protected cells from HCV entry or replication. Levels of HCV RNA were reduced 3-4 log in cells homozygous for the variant alleles; release of new particles was also reduced, but viral entry was not affected. The effects of the variant alleles were recessive and stronger for preventing replication of full-length HCV genomes than subgenomes. CypA inhibitors prevented replication of residual HCV in hepatocytes. The variants appeared to destabilize the CypA protein; the single amino acid changes led to rapid degradation of the protein. We identified variants in PPIA that destabilize its product, CypA, and prevent HCV infection and replication. These findings indicate mechanisms by which some cells might be resistant to HCV infection and that CypA is a good therapeutic target.
    Gastroenterology 05/2012; 143(2):439-47.e1. · 12.82 Impact Factor
  • A Potthoff, M J Gebel, K Rifai
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    ABSTRACT: Abdominal ultrasonography is an essential tool for physicians. In contrast to other imaging methods, ultrasound examination is a cost-effective real-time imaging method without radiation effects. As in all other imaging methods, abdominal ultrasound requires an experienced examiner and high quality equipment to maintain a high quality. Abdominal ultrasonography is at least equal to cross-sectional imaging methods in most clinical issues, e.g., in inflammatory bowel disease, vascular liver diseases, or real-time surveillance of interventions. The range of applications for ultrasound has been markedly expanded by using contrast-enhanced ultrasound to detect and characterize space occupying lesions or perfusion aberrations in- and outside the liver.Ultrasound-guided fine needle aspiration biopsy or drainage of space occupying lesions and pathological liquids are minimally invasive standard ultrasound-guided interventions. Ultrasound-based tumor therapy as well as sclerotherapy of symptomatic nonparasitic cysts of the liver, kidneys, or spleen are also performed. By being able to provide quantitatively reproducible measurement of tissue stiffness, ultrasonography has entered a new era. The development of mechanical elastography also promises a new form of tissue characterization.
    Der Internist 03/2012; 53(3):261-70. · 0.33 Impact Factor
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    ABSTRACT: A quantitative HCV core antigen (HCVcoreAg) immunoassay has been developed for the confirmation of viremia in patients with hepatitis C. We evaluated the correlation of HCV RNA and HCVcoreAg in different patient populations without HCV-specific treatment: HIV/HCV-coinfection, HBV/HCV-coinfection, and patients with end-stage renal disease. HCVcoreAg was quantified by a fully-automated immunoassay. Correlation of HCVcoreAg with HCV RNA was studied cross-sectionally in HIV/HCV- and HBV/HCV-coinfected patients, as well as before and after hemodialysis in patients with end-stage renal disease. A concordant positive or negative test result for both HCV RNA and HCVcoreAg was observed in 68 of 71 (96%), 55 of 57 (96%), and in 109 of 109 (100%) samples of patients with HIV- or HBV/HCV-coinfection, and patients undergoing hemodialysis, respectively. HCVcoreAg showed high correlation with HCV RNA in samples from HIV/HCV-coinfected patients and HCV-infected patients undergoing hemodialysis (r=0.97 and r=0.94, p<0.001). There was no overall correlation between HCVcoreAg and HCV RNA in HBV/HCV-coinfected individuals (r=0.04, p=0.822). Excluding patients with HCV RNA to HCVcoreAg ratios below 100 and above 10,000kIU/fmol led to improved correlation (r=0.53; p=0.02), but remained worse than for the other cohorts. Overall, HCV RNA to HCVcoreAg ratios did not differ significantly between the different patient populations, though variation tended to be higher in HBV/HCV-coinfected patients. Patients with lower HCV RNA levels tend to have lower HCV RNA/HCVcoreAg ratios. HCVcoreAg represents a reliable marker of viral replication showing a good correlation with HCV RNA in various patient populations, with some limitations in HBV/HCV-coinfection.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 12/2011; 53(2):110-5. · 3.12 Impact Factor
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    ABSTRACT: To date, the use of transient elastography has been limited to the liver. Acoustic radiation force impulse imaging (ARFI) is a new technology offering elastography of different tissues. Here, we present initial spleen elastography data and evaluate its influencing factors, especially portal hypertension. Elastography of the spleen and liver using the ARFI method was performed in 30 patients with portal hypertension, 70 patients with chronic liver disease without portal hypertension and 25 healthy controls. ARFI elastography of the spleen was feasible in 99% of patients and valid in 78%. The mean propagation velocity inside the spleen was 2.95 ± 0.60 m/sec, thus much higher than in the normal liver (< 1.10 m/sec). Spleen stiffness was higher in the patients with portal hypertension (p < 0.008) but did not correlate to spleen size. Spleen stiffness increased with patient age and liver stiffness (both p < 0.0001) as confirmed by multivariate analysis (R2 = 0.19, p < 0.01). In ROC analysis, spleen elastography was inferior to liver elastography for the detection of portal hypertension (area under the curve 0.68 vs. 0.90). The new ARFI method allows accurate elastography of the spleen. The stiffness of the normal spleen is much higher than that of the normal liver and increases with age. However, spleen elastography is inferior to liver elastography for the detection of portal hypertension.
    Ultraschall in der Medizin 12/2011; 32 Suppl 2:E24-30. · 4.12 Impact Factor
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    ABSTRACT: Telomere shortening impairs liver regeneration in mice and is associated with cirrhosis formation in humans with chronic liver disease. In humans, telomerase mutations have been associated with familial diseases leading to bone marrow failure or lung fibrosis. It is currently unknown whether telomerase mutations associate with cirrhosis induced by chronic liver disease. The telomerase RNA component (TERC) and the telomerase reverse transcriptase (TERT) were sequenced in 1,121 individuals (521 patients with cirrhosis induced by chronic liver disease and 600 noncirrhosis controls). Telomere length was analyzed in patients carrying telomerase gene mutations. Functional defects of telomerase gene mutations were investigated in primary human fibroblasts and patient-derived lymphocytes. An increased incidence of telomerase mutations was detected in cirrhosis patients (allele frequency 0.017) compared to noncirrhosis controls (0.003, P value 0.0007; relative risk [RR] 1.859; 95% confidence interval [CI] 1.552-2.227). Cirrhosis patients with TERT mutations showed shortened telomeres in white blood cells compared to control patients. Cirrhosis-associated telomerase mutations led to reduced telomerase activity and defects in maintaining telomere length and the replicative potential of primary cells in culture. CONCLUSION: This study provides the first experimental evidence that telomerase gene mutations are present in patients developing cirrhosis as a consequence of chronic liver disease. These data support the concept that telomere shortening can represent a causal factor impairing liver regeneration and accelerating cirrhosis formation in response to chronic liver disease.
    Hepatology 05/2011; 53(5):1608-17. · 12.00 Impact Factor
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    ABSTRACT: Only 20% of patients with chronic hepatitis C (CHC) will develop cirrhosis, and fibrosis progression remains highly unpredictable. A recent genome-wide association study identified a genetic variant in the patatin-like phospholipase-3 (PNPLA3) gene (rs738409 C>G) associated with steatosis that was further demonstrated to influence severity of fibrosis in nonalcoholic fatty liver disease. The aim of this study was to assess the impact of this polymorphism on histological liver damage and response to antiviral therapy in CHC. We recruited 537 Caucasian CHC patients from three European centers (Brussels, Belgium [n = 229]; Hannover, Germany [n = 171]; Lyon, France [n = 137]); these patients were centrally genotyped for the PNPLA3 (rs738409 C>G) polymorphism. We studied the influence of rs738409 and other variants in the PNPLA3 region on steatosis and fibrosis assessed both in a cross-sectional and longitudinal manner. Seven other variants previously associated with fibrosis progression were included. Finally, we explored the impact of rs738409 on response to standard antiviral therapy using the interferon lambda 3 (IL28B) [rs12979860 C>T] variant both as a comparator and as a positive control. After adjustment for age, sex, body mass index, alcohol consumption, and diabetes, rs738409 mutant G allele homozygote carriers remained at higher risk for steatosis (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.08-6.03, P = 0.034), fibrosis (OR 3.13, 95% CI 1.50-6.51, P = 0.002), and fibrosis progression (OR 2.64, 95% CI 1.22-5.67, P = 0.013). Conversely, rs738409 was not independently associated with treatment failure (OR 1.07, 95% CI 0.46-2.49, P = 0.875) and did not influence clinical or biological variables. CONCLUSION: The PNPLA3 (rs738409 C>G) polymorphism favors steatosis and fibrosis progression in CHC. This polymorphism may represent a valuable genetic predictor and a potential therapeutic target in CHC liver damage.
    Hepatology 04/2011; 54(1):60-9. · 12.00 Impact Factor
  • Journal of Hepatology 03/2011; 37(8). · 9.86 Impact Factor
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    ABSTRACT: Transient elastography is increasingly used for assessment of liver fibrosis. Acoustic radiation force impulse imaging (ARFI) is a new technology to perform liver elastography. We evaluated the clinical feasibility, validity and accuracy of the ARFI method and compared it to Fibroscan(®) and liver histology. Ultrasonographic elastography of the liver using ARFI was performed in 29 patients with liver cirrhosis, 70 patients with liver disease and 23 healthy controls. ARFI was feasible in all patients providing a mean propagation velocity of 1.65±0.93 m/s. ARFI results of the right and left liver lobes were comparable (p<0.001). In cirrhotic patients, ARFI gave significantly higher values than in the other patients (p<0.001). Rate of invalid measurements was lower in ARFI than in Fibroscan(®) (p<0.04). Both elastography methods were highly correlated to each other (p<0.001). Furthermore, ARFI correlated to histological grading of liver fibrosis (p<0.001) and to inflammatory activity (p<0.05). Liver steatosis had no statistical influence on ARFI results (p=0.2) in contrast to Fibroscan(®) (p<0.05). The new ultrasonographic method of ARFI elastography allows valid, accurate and flexible evaluation of liver stiffness. It seems more feasible in patients with liver cirrhosis than Fibroscan(®). ARFI elastography of the left liver lobe is also possible. Liver steatosis does not seem to influence ARFI elastography.
    Digestive and Liver Disease 03/2011; 43(6):491-7. · 3.16 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are common in haemodialysis units. Moreover, some studies reported seronegative cases of viral hepatitis. We and others have previously shown an HCV RNA decline during haemodialysis; however, limited data on HBV viraemia during haemodialysis are available. A total of 142 haemodialysis patients participated in this study, 11 were anti-HCV positive and 7 were HBsAg positive. HCV RNA and HBV DNA were determined in all patients irrespective of hepatitis serology. HBV DNA, HCV RNA, HBsAg and HCV core antigen (HCVcoreAg) were quantified repeatedly in anti-HCV- and HBsAg-positive patients before and after haemodialysis. No case of seronegative viral hepatitis could be identified. HCV RNA was detected in 9 of the 11 anti-HCV-positive patients, while HBV DNA tested positive in all 7 HBsAg-positive patients. A decrease of HCVcoreAg was observed during four dialysis sessions in 8/9 patients (-24.4 ± 22.7%, P < 0.001) parallelled by HCV RNA decline in most individuals (-10.1 ± 48.6%, P = 0.22). In contrast, HBV DNA and HBsAg declined only in 1/7 patients during all four independent measurements. The remaining six patients showed heterogeneous patterns of HBV DNA and HBsAg before and after haemodialysis without a significant change in mean HBV DNA and HBsAg levels (+14 ± 60.6% and -0.2 ± 25.3%, P > 0.05, respectively). HCVcoreAg correlated strongly with HCV RNA (r = 0.937; P < 0.001, n = 72), while there was no correlation between HBV DNA and HBsAg (r = -0.234; P = 0.131, n = 43). Seronegative viral hepatitis is rare in German maintenance haemodialysis patients. HCV RNA and HCVcoreAg decline during haemodialysis indicating a potential beneficial effect of haemodialysis during antiviral therapy of hepatitis C, which does not apply to HBV infection.
    Nephrology Dialysis Transplantation 01/2011; 26(8):2648-56. · 3.37 Impact Factor
  • Journal of Hepatology - J HEPATOL. 01/2011; 54.
  • Ultrasound in Medicine and Biology - ULTRASOUND MED BIOL. 01/2011; 37(8).

Publication Stats

389 Citations
212.67 Total Impact Points

Institutions

  • 2003–2014
    • Hannover Medical School
      • Department of Gastroenterology, Hepatology and Endocrinology
      Hanover, Lower Saxony, Germany
  • 2010
    • Université Libre de Bruxelles
      • Laboratory of Experimental Gastroenterology
      Brussels, BRU, Belgium