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

2016 Impact Factor Available summer 2017
2014 / 2015 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
Year

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

Wiley

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    • 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: Portal vein thrombosis (PVT) is frequently observed in cirrhosis and may be a clinically important complication. In vitro assays for endogenous thrombin potential (ETP) demonstrated that in cirrhosis plasma has intrinsic resistance to the anti-coagulant action of thrombomodulin (TM-R). This study retrospectively explores the association of TM-R with de novo PVT and its clinical impact on cirrhosis. Methods: Fifty-three patients with cirrhosis were tested for ETP-ratio with/without thrombomodulin. Clinical, endoscopic variables, presence/absence of PVT by Doppler-US and/or CT examination were collected at baseline and up to 4 years from baseline. The de novo PVT was the primary clinical end-point. Portal hypertension (PHT)-related complications and transplantation free-survival were secondary end-points. ETP-ratio higher than the 95°percentile of the distribution in 173 healthy controls defined TM-R. Results: During 48 months of follow-up, 11 patients developed de novo PVT, with preference for the 36 patients with TM-R after adjusting for Child-Pugh class (HR:7.675; 90%CI:1.323-44.536;p=0.017). Seventeen patients experienced PHT-related complications, 23 either died or underwent liver transplantation. PHT complications and transplantation free-survival were associated with TM-R, but were independently predicted by Child Pugh class, only. Same results were obtained by considering the MELD score. Conclusions: Owing to PVT results from the pro-coagulant imbalance occurring in patients with advanced cirrhosis, TM-R might serve as a predictor and could possibly be a biological mediator of adverse outcome in patients with advanced cirrhosis. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Approximately 350 million people worldwide are chronically infected with hepatitis B virus (HBV), representing a significant public health challenge. Nucleos/tide analogues (NUCs) and interferon alpha (IFNα), the current standard of care for chronic infection, aim at preventing progression of the disease to cirrhosis, hepatocellular carcinoma (HCC) and death. However, in contrast to the case of hepatitis C virus infection, in which novel antiviral drugs cure the vast majority of treated patients, in regards to HBV, cure is rare due to the unusual persistence of viral DNA in the form of covalently closed circular DNA (cccDNA) within the nucleus of infected cells. Available therapies for HBV require lifelong treatment and surveillance, as reactivation frequently occurs following medication cessation and the occurrence of HCC is decreased but not eliminated, even after years of successful viral suppression. Progress has been made in the development of new therapeutics, and it is likely that only a combination of immune modulators, inhibitors of gene expression and replication and cccDNA-targeting drugs will eradicate chronic infection. This review aims to summarize the state of the art in HBV drug research highlighting those agents with the greatest potential for success based on in vitro as well as on data from clinical studies. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background and aims: The significance of bile duct injury and ductular reaction in biopsies from autoimmune hepatitis patients is not clear. We aim to establish the prevalence and clinical relevance of both phenomena in autoimmune hepatitis. Methods: Cases of newly diagnosed, untreated autoimmune hepatitis without overlap syndrome were selected. Pretreatment and follow up biopsies were scored for inflammation, fibrosis, bile ductal injury and ductular reaction. Results: Thirty-five cases were studied of whom 14 cases had follow up biopsies. Bile duct injury was present in 29 cases (83%), mostly in a PBC-like pattern and was not correlated to demographic or laboratory findings. Ductular reaction, observed in 25 of 35 cases (71%) using conventional histology and in 30 of 32 cases (94%) using immunohistochemistry, was correlated to portal and lobular inflammation, interface hepatitis and centrilobular necrosis as well as bile duct injury and fibrosis. In 11 of 14 cases (79%) ductular reaction remained present on posttreatment biopsy whereas bile duct injury persisted in 6 of 14 (43%) of cases. Conclusions: Bile duct injury and ductular reaction are very common in newly diagnosed autoimmune hepatitis and cannot be predicted biochemically. Bile duct injury may subside in the majority of treated AIH cases while DR tends to persist during follow up. These findings show that the two phenomena are part of the spectrum of AIH with dissimilar responses to treatment and do not necessarily point towards an overlap syndrome. Persistence of ductular reaction after treatment supports the notion that it represents a regenerative response. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background & aims: To investigate the differences in mechanical effects and ablation zone between radiofrequency (RF) ablation with and without Sonazoid uptake in an in vivo rabbit liver model. Methods: Our study was approved by the Institutional Animal Care and Use Committee. Twenty-five rabbits were randomly allotted to one of five ablation durations (i.e., 1, 2, 3, 6, and 12 min). For each rabbit, RF ablation was performed twice, before and 10 min after Sonazoid administration (i.e. control group vs. Sonazoid group) using a 1-cm internally-cooled electrode (40W) equipped with a parallelly-fixed pressure-monitoring device. During ablation, a "popping" sound was perceived and recorded along with tissue pressure changes and RF ablation parameters. Then, the ablation volume and microscopic changes were compared. Results: Popping sounds were more frequently perceived in the control group (21/25 vs. 1/25, P<0.001). The time to first pressure peak was shorter in the Sonazoid group (22.3±1.1s vs. 46.3±4.4s, P<0.001) with similar pressures (39.8±4.2 mmHg vs. 35.6±4.1 mmHg, P=0.350). Time to first roll-off and mean power output were significantly less in the Sonazoid group (17.6±1.2s vs. 71.2±8.2s, P<0.001; 9.4±0.3 W vs. 12.8±0.5 W, P<0.001). Consequently, the Sonazoid group had lower total energy and ablation volumes for all durations. Microscopically, the control group showed larger confluent disruptions, whereas the Sonazoid group showed many smaller disruptions scattered throughout the ablation zones. Conclusions: RF ablation after Sonazoid uptake induces a smaller ablation zone than conventional RF ablation. However, it appears to ablate the liver tissue with less mechanical effects. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background & aims: IL15 is an essential cytokine in both innate and adaptive immune response against HCV infection. The aim was to analyze whether IL15 rs10833 is associated with liver disease severity and response to pegylated-interferon-alpha plus ribavirin (pegIFN-alpha/RBV) therapy in human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients. Methods: A retrospective study was performed in 315 patients who started pegIFN-alpha/RBV therapy. Liver fibrosis stage was characterized in 286 patients. IL15 rs10833 and IL28B rs12980275 were genotyped by GoldenGate.The primary outcomes were: a) advanced liver fibrosis evaluated by liver biopsy (F3-F4) or transient elastography (liver stiffness values ≥9.5 Kpa); b) sustained virological response (SVR). The secondary outcome variable was the levels of serum biomarkers of inflammation. Results: Patients with rs10833 AA genotype had increased odds of having advanced fibrosis (adjusted odds ratio (aOR)=2.30; p=0.019), particularly in males (aOR=2.24; p=0.040), patients with HCV-RNA <500,000 IU/mL (aOR=5.14; p=0.018) and patients with IL28B rs12980275 AG/GG genotypes (aOR=2.51; p=0.046). Moreover, rs10833 AA genotype was significantly associated with higher levels of HGF (adjusted arithmetic mean ratio (aAMR)=1.50; p=0.016), sICAM-1 (aAMR=1.57; p=0.025) and sVCAM-1 (aAMR=1.56; p=0.007). Finally, patients with rs10833 AA genotype had increased odds of achieving SVR (aOR=3.12; p=0.006), particularly in males (aOR=3.69; p=0.005), GT1/4 patients (aOR=3.59; p=0.006), patients with advanced fibrosis (aOR=4.64; p=0.021), HCV-RNA ≥500,000 IU/mL (aOR=3.92; p=0.007) and patients with IL28B rs12980275 AG/GG genotype (aOR=2.98; p=0.041). Conclusions: The presence of IL15 rs10833 AA genotype in HIV/HCV-coinfected patients was associated with advanced liver fibrosis, inflammation-related biomarkers and increased rates of SVR to pegIFN-alpha/RBV therapy. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: I read with great interest the recent issue of Liver International containing the proceedings of the Paris Hepatitis Conference (PHC) on the management of patients with viral hepatitis, particularly the editorial written by my colleague Patrick Marcellin (1). It is true that the introduction of direct-acting antiviral agents (DAAs) has considerably improved the treatment of chronic hepatitis C virus (HCV) infection, and that a new generation of these molecules will soon provide an efficacy close to 100%, making it possible to cure infections caused by HCV of all genotypes. However, can these new, highly efficient treatments really make HCV eradication a realistic objective? A recent Science article pointed out that only a minority (about 0.25%) of the 185 million chronic carriers of HCV worldwide are actually treated (2). This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background and aims: Published estimates of survival associated with mushroom (amatoxin)-induced acute liver failure (ALF) and injury (ALI) with and without liver transplant (LT) are highly variable. We aimed to determine the 21-day survival associated with amatoxin-induced ALI (A-ALI) and ALF (A-ALF) and review use of targeted therapies. Methods: Cohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014. Results: Of the 2224 subjects in the registry, 18 (0.8%) had A-ALF (n=13) or A-ALI (n=5). At admission, ALF patients had higher lactate levels (5.2 vs. 2.2 mmol/L, p=0.06) compared to ALI patients, but INR (2.8 vs. 2.2), bilirubin (87 vs. 26 μmol/L), and MELD scores (28 vs. 24) were similar (p >0.2 for all). Of the 13 patients with ALF, 6 survived without LT (46%), 5 survived with LT (39%), and 2 died without LT (15%). Of the 5 patients with ALI, 4 (80%) recovered and one (20%) survived post-LT. Comparing those who died/received LT (non-spontaneous survivors [NSS]) with spontaneous survivors (SS), N-acetylcysteine was used in nearly all patients (NSS 88% vs. SS 80%), whereas silibinin (25% vs. 50%), penicillin (50% vs. 25%), and nasobiliary drainage (0 vs. 10%) were used less frequently (p > 0.15 for all therapies). Conclusion: Patients with mushroom poisoning with ALI have favorable survival, while around half of those presenting with ALF may eventually require LT. Further study is needed to define optimal management (including the use of targeted therapies) to improve survival, particularly in the absence of LT. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
  • Maria Aguilar · Benny Liu · Edward W. Holt · Taft Bhuket · Robert J. Wong
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    ABSTRACT: Background & aims: The rising prevalence of obesity and diabetes mellitus (DM) among HCV patients contributes to concurrent nonalcoholic fatty liver disease (NAFLD). We aim to evaluate the impact of concurrent obesity or DM on waitlist survival and probability of LT among adults with chronic HCV awaiting LT. Methods: Using 2003-2013 United Network for Organ Sharing data, we evaluated the impact of obesity and DM among adults with chronic HCV awaiting LT: non-obese, non-DM vs. obese, non-DM (obese) vs. non-obese, DM (DM) vs. obese and DM. Overall LT waitlist survival and probability of receiving LT were evaluated using Kaplan Meier and multivariate logistic regression models. Results: From 2003-2013, there were 43,478 new LT waitlist registrants with chronic HCV (21.0% with HCC, 79% without HCC). Obesity was associated with lower probability of receiving LT (OR, 0.91; 95% CI, 0.85 - 0.97; p<0.01), and lower probability of waitlist mortality (OR, 0.80; 95% CI, 0.72-0.89; p<0.001) when compared to non-obese patients. DM among HCV patients did not impact probability of waitlist survival or receiving LT. When evaluating post-LT survival, compared to non-obese, non-DM patients, obese HCV patients had significantly lower post-LT mortality (HR 0.86; 95%CI, 0.81-0.92; p<0.001), whereas HCV patients with DM had significantly higher post-LT mortality (HR, 1.22; 95% CI, 1.12-1.33; p<0.001). Conclusion: Among adults with chronic HCV awaiting LT in the U.S., obesity is associated with lower probability of receiving LT, but did not impact waitlist survival. DM among chronic HCV patients did not impact waitlist survival or probability of LT. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background & aims: In Taiwan, patients with chronic hepatitis C virus (HCV) infection are currently treated with pegylated interferon-alpha plus ribavirin, but interferon-based regimens can be poorly tolerated, especially by those with advanced liver disease and the elderly. Sofosbuvir, an oral nucleotide analog inhibitor of HCV NS5B polymerase, is approved in Europe, the United States, and Japan for treating chronic HCV infection. This phase 3b study examined the efficacy and safety of sofosbuvir plus ribavirin in Taiwanese patients with chronic genotype 2 HCV infection ± compensated cirrhosis. Methods: In this multicenter, open-label, phase 3b (NCT02021643) study, 87 patients (n=43, treatment-naive; n=44, treatment-experienced) received 12 weeks of treatment with sofosbuvir plus weight-based ribavirin. The primary efficacy end point was the proportion of patients with sustained virologic response 12 weeks after treatment discontinuation (SVR12). Safety and pharmacokinetic data were also collected. Results: All 87 patients (100%; 95% confidence interval, 92-100%) achieved SVR12, including the 13 patients with compensated cirrhosis. The most common treatment-emergent adverse events (AEs) were insomnia (16%, 14/87) and upper respiratory tract infection (16%, 14/87). No grade 3 or grade 4 AE was reported. There was one serious AE (biliary colic), which was deemed unrelated to study treatment. Laboratory abnormalities other than ribavirin-related reductions in hemoglobin were uncommon. Conclusions: The results from this phase 3b study demonstrate that 12 weeks of treatment with the interferon-free regimen sofosbuvir plus ribavirin is effective and well tolerated in both treatment-naive and treatment-experienced Taiwanese patients with chronic genotype 2 HCV infection. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background & aims: Interferon and ribavirin-free regimens to treat chronic hepatitis C infection in patients with end-stage renal disease are not approved and represent an area of unmet clinical need. We report our experience on the safety and efficacy of sofosbuvir/simeprevir and sofosbuvir/ledipasvir therapy in patients on hemodialysis. Methods: Patients with chronic HCV infection on hemodialysis were included in this study. Patients were started on either sofosbuvir/simeprevir or sofosbuvir/ledipasvir. Routine clinical and laboratory data were collected at baseline and during treatment. The primary outcome was sustained virologic response at week 12 (SVR12). Results: Eight patients with mean age 56.8 ± 20 years were included in the study. Seven were treatment naïve and one was a prior null responder to interferon-based therapy. Four patients were started on sofosbuvir/simeprevir and four on sofosbuvir/ledipasvir for 12 weeks. Therapy was well tolerated overall with nausea/vomiting, pruritus, headache and a 2g/dl drop in hemoglobin developing in one patient each. No patient discontinued therapy due to side effects. Comparison of labs at baseline and nadir levels during treatment revealed no significant change in hemoglobin (10.8±2.4 g/dL vs 10.3±1.6 g/dL), platelet count (198±164 k/uL vs184.5±162/uL) and bilirubin (0.3±0.4 mg/dL vs 0.25±0.15 mg/dl). 8/8 patients had undetectable HCV RNA at the end of treatment. One patient was lost to follow up and the remaining seven achieved SVR12. Conclusion: Full dose sofosbuvir/simeprevir or sofosbuvir/ledipasvir therapy for HCV-infected patients with end stage renal disease was well-tolerated with no discontinuation due to side effects and no significant adverse events. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background & aim: With restricted numbers of available organs futility in liver transplantation has to be avoided. The concept of dynamic changes in MELD score (DeltaMELD) has previously been shown to be a simple tool to identify patients with the greatest risk of death after transplantation. Aim was to validate this concept with the Eurotransplant (ET) database. Methods: A retrospective registry analysis was performed on all patients listed for liver transplantation within ET between 2006 and 2011. Patients <18 years of age, acute liver failure, malignancy and patients listed for re-transplantation were excluded. Influence of MELD at listing (MELDon), MELD at transplantation (MELDoff), DeltaMELD, age, sex, underlying disease and time on the waiting list on overall survival after liver transplantation were evaluated. Results: A total of 16821 patients were listed for oLT, 8096 met the inclusion criteria. Age, MELD on and DeltaMELD showed significant influence on survival on the waiting list. Age and DeltaMELD showed influence on survival after liver transplantation, with DeltaMELD>10 showing a 1.6 fold increased risk of death. Conclusion: The concept of DeltaMELD was validated in a large, prospective data set. It provides a simple tool to identify patients with increased risk of death after liver transplantation and might help improve longterm results. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background: A major challenge in the management of nonalcoholic fatty liver disease (NAFLD) is to identify patients with nonalcoholic steatohepatitis (NASH) and early liver fibrosis. The progression of NAFLD is accompanied by distinctive changes in very low density lipoprotein (VLDL), a lipoprotein particle produced exclusively in the liver. Herein, we sought to determine the characteristics of VLDL profiles associated with NASH and liver fibrosis. Methods: We evaluated VLDL profiles of128 patients from a single center NAFLD registry, and examined VLDL size, total and subclass VLDL concentrations in relation to NAFLD activity score (NAS), steatohepatitis and liver fibrosis as determined by liver biopsy. Results: A near linear relationship was observed between mean VLDL particle size and NAFLD activity score (NAS). In multivariate models, VLDL particle size was significantly associated with both NAS and NASH, after adjustment for BMI and diabetes. A decrease in small VLDL particle concentration was associated with more advanced liver fibrosis. In receiver operative characteristic analyses, mean VLDL size performed similarly to cytokeratin 18 in predicting NASH, whereas small VLDL particle concentration had similar performance to NAFLD fibrosis score in predicting stage 2 or above liver fibrosis. Conclusions: The increase in mean VLDL size in NASH and decrease in small VLDL particle concentration in liver fibrosis likely reflect the changes in the number and state of hepatocytes associated with NASH and fibrosis. In addition to its value in risk stratification of cardiovascular diseases, circulating VLDL profile may provide information for the staging of NAFLD disease severity. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background: Patients with acute liver failure have high rates of infections, likely from defects in immune function. Whether infections are independently associated with poor outcomes is unclear. We hypothesized that patients with acute liver injury who developed infections were at increased risk of adverse outcomes. Methods: We conducted a retrospective analysis of 150 critically ill adult patients admitted with acute liver dysfunction at a single academic institution between 2005 and 2011. We excluded patients with immunocompromised states, patients with chronic liver disease, and patients who died or were discharged within 48 hours of admission. Our primary endpoint was a 30-day event-free survival, with events defined as either death or liver transplantation. Our secondary endpoint was length of stay. Univariate and multivariate analyses were performed to determine associations between presence of infection and our primary and secondary endpoints. Results: Of our cohort of 150 patients, 62 (41%) were infected, and 88 (59%) were not infected. Of the infected patients, 45% died or underwent transplantation, compared to 22% for the non-infected patients (p=0.003). Univariate and multivariate analyses demonstrated that infections in patients with acute liver dysfunction was an independent predictor of poor outcome (i.e., death or transplantation). Additionally, specific types of infection, including pneumonia, independently led to a 48% increase in length of stay (p=0.002). Conclusions: Infections in patients with acute liver dysfunction are associated with increased risk of death or transplant and increased hospital length of stay. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Lheureux et al. [1] reported, in their interesting matched case-control study focusing on betalactamin's PK/PD, that cirrhotic patients were more up than non cirrhotic patients to display excessive serum betalactamins concentrations when treated with piperacillin/tazobactam and meropenem. This was explained by both a decrease in renal clearance and an increase in distribution volume of those drugs. In this study, the excessive drug concentrations were likely responsible for neurological worsening: indeed, among the 20 cirrhotic patients experiencing neurological worsening, 60% displayed excessive serum drug concentrations while treated with standard recommended dosage. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: We read the article by Lee et al., in which pretreatment platelet count was found as a reliable marker to predict extrahepatic metastasis of early stage hepatocellular carcinomas (HCC) following curative treatment, and the cirrhotic thrombocytopenia was found to contribute to relatively low metastasis incidence of HCC compared to many other cancers [1]. Although this study brings a new perspective on relationship between thrombocytopenia and extrahepatic metastasis of HCC, prognostic importance of this relationship is not discussed enough. Therefore, we would like to share our thoughts and contributions to the original study in a few stages. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background & aims: Indocyanine green retention test (ICG-r15) is a non-invasive marker of functional hepatic reserve. Among patients with compensated cirrhosis, ICG-r15 correlates to the degree of portal hypertension (PH); however, its prognostic relationship with the occurrence of decompensation events still requires clarification. Methods: ICG-r15 was prospectively measured in 154 patients with compensated cirrhosis. Patients with hepatocellular carcinoma (HCC), Child-Pugh B-C, MELD>15, bilirubin>2mg/dL, INR>1.5 or portal vein thrombosis were excluded. All patients underwent laboratory tests, upper endoscopy and hepatic venous pressure gradient (HVPG). Decompensation, development of HCC, liver transplant and death were recorded and analyzed through competing risk analysis. Results: The study group was composed of one hundred and thirty four patients who were followed for a median of 39 months. During follow-up, 46 patients (34.3%) developed liver decompensation. Hepatocellular carcinoma occurred in 18 patients and two patients died from non-liver related causes. The 1-, 2- and 3-year cumulative incidences of decompensation were 9.7%, 28.4% and 33.4%, respectively. Patients with ICG-r15<10% did not experience any decompensation events during follow-up, while the 3-year cumulative incidence of decompensation of patients with ICG-r15 between 10% and 22.9% was 29.2% and that of patients with ICG-r15 ≥23% was 70.0% (p<0.001). ICG-r15 gave the lowest pseudo-log-likelihood value, in comparison to esophageal varices present, MELD, low platelet count and HVPG. Conclusions: ICG-r15 appears to be strictly related to liver decompensation, longitudinally confirming the preliminary findings of its correlation with PH among patients with compensated liver cirrhosis, and can be used for patient prognostication. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Nosocomial spontaneous bacterial peritonitis (N-SBP) is frequently caused by multi drug resistant (MDR) bacteria. Recently Solà E., Solé C. and Ginès P. have suggested piperacillin/tazobactam or meropenem ± glycopeptide as initial empirical antibiotic therapy (EAT) [1]. The spectrum of causative agents of N-SBP has changed in Europe. Although Gram-negative bacteria were the main infectious agents a few decades ago, and are still reported to be so in the most recent reviews [1], Gram-positive cocci are now predominant. Enterococci are isolated in about a quarter of the cases and these infections appear to be significantly associated with poor patient survival. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background & aims: Eradication of hepatitis C virus (HCV) by interferon (IFN)-based therapy has been reported to reduce all-cause mortality rates in patients with chronic HCV infection. However, the impact of HCV eradication on non-liver-related mortality including the causes of death has not been sufficiently investigated in patients with chronic HCV infection. Methods: We enrolled 2743 patients with chronic HCV infection. Causes of death, incidence of hepatocellular carcinoma (HCC), and all-cause mortality including non-liver-related diseases, were analyzed. Results: Of these 2743 patients, 587 achieved sustained virological response (SVR) (eradication of HCV) by IFN-based therapy (IFN-SVR), 475 did not (without HCV eradication) (IFN-non-SVR), or 1681 did not receive IFN-based therapy (non-IFN patients) (Cohort 1); of these, 309 were selected from IFN-SVR and non-IFN groups using propensity score matching (Cohort 2).The median follow-up duration was 11.4 years. In Cohort 1 patients, mortality rates from non-liver-related diseases were 71.0% (22/31) in IFN-SVR patients, 34.9% (37/106) in IFN-non-SVR patients, and 50.0% (248/496) in non-IFN patients, respectively. In Cohort 2 patients, mortality rates from non-liver-related diseases were 72.2% (13/18) in IFN-SVR patients and 46.8% (29/62) in non-IFN patients, respectively. The eradication of HCV reduced all-cause mortality (hazard ratio (HR), 0.265; 95% confidence interval (CI), 0.058-0.380) including non-liver-related mortality (HR, 0.439; 95% CI, 0.231-0.834), and the incidence of HCC (HR, 0.275; 95% CI, 0.156-0.448). Conclusions: Eradication of HCV reduced not only liver-related mortality but also non-liver-related mortality in patients with chronic HCV. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Background: The current standard-of-care for treatment of HCV genotype 2 (GT-2) patients is the combination of sofosbuvir (SOF) with weight-based ribavirin (RBV). Patients with HCV GT-2 infection and ribavirin contraindications require the use of SOF plus NS5A inhibitor daclatasvir (DCV) which is not reimbursed everywhere. Methods: We conducted an open-label observational, prospective study on a subgroup of GT-2 patients either naïve or treatment experienced (TE) with contraindications to the use of RBV. Patients with cirrhosis of Child-Pugh-Turcotte (CPT) class A and B, or advanced fibrosis with co-morbidities were included. They were assigned to receive 12 or 24 weeks of SOF/DCV. The primary end point of the study was sustained virological response (SVR) defined as HCV RNA levels <12 IU/ml, 12 weeks post-treatment. Results: Out of 106 patients with GT-2 who received treatment at our Unit from July 2014 to June 2015, 20 (18.8%) whose treatment could not be deferred, were ribavirin intolerant; 19 received SOF/DCV combination for 12 or 24 weeks. The majority was male, 58% had cirrhosis, 58% were TE. All treated patients achieved SVR regardless of treatment duration. The most common adverse events (AEs) were fatigue, headache and nausea. No discontinuations due to AEs were observed. Two patients had oesophageal bleeding but continued treatment and achieved SVR; one patient developed HCC 12 weeks post-treatment, but remained HCV RNA undetectable. Conclusions: This study supports the use of SOF/DCV for 12 in non cirrhotics, or 24 weeks in cirrhotic GT-2 patients who cannot tolerate RBV, including those with decompensated disease. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Liver international: official journal of the International Association for the Study of the Liver