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  • 1
    Online Resource
    Online Resource
    Daclatasvir, Simeprevir and Ribavirin as a Promising Interferon-Free Triple Regimen for HCV Recurrence after Liver Transplant
    S. Karger AG ; 2015
    In:  Digestion Vol. 91, No. 4 ( 2015), p. 326-333
    Details
    In: Digestion, S. Karger AG, Vol. 91, No. 4 ( 2015), p. 326-333
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Recurrent hepatitis C infection after liver transplantation (LT) is associated with lower rates of graft and patient survival. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Here we describe the first use of daclatasvir, simeprevir, and ribavirin (RBV) as an all-oral triple regimen administered to 6 liver transplant recipients with recurrent hepatitis C, one with GT 1a and 5 with GT 1b. All patients were treated for 24 weeks. Trough levels of immunosuppression, laboratory measures, and potential adverse effects were closely monitored. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 For all patients, viral load became undetectable between treatment weeks 4 and 12. One patient experienced a viral breakthrough at the 10th week of treatment; this was associated with the selection of resistance-associated variants (D168Y in NS3 and & #x0394;P32 in NS5A). For the other 5 patients, end-of-treatment response and for 4 patients SVR24 was achieved. Viremia recurred in one patient 4 weeks after the end of treatment, which was again associated with the selection of resistance-associated variants (D168V in NS3 and & #x0394;P32 in NS5A). Clinical measures of liver function improved substantially for all patients. Adverse events were few and limited to moderate anemia caused by RBV. Importantly, adjustments to the immunosuppressant dosage were not required. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The described regimen appears to be safe and effective for liver transplant patients and will be a promising treatment regimen for post-LT patients.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000382075
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
    detail.hit.zdb_id: 1482218-0
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  • 2
    Online Resource
    Online Resource
    Does Ursodeoxycholic Acid Exert a Protective Effect on Liver Grafts in Orthotopic Liver Transplantation?
    S. Karger AG ; 2012
    In:  Digestion Vol. 86, No. 3 ( 2012), p. 206-207
    Details
    In: Digestion, S. Karger AG, Vol. 86, No. 3 ( 2012), p. 206-207
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000341746
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
    detail.hit.zdb_id: 1482218-0
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  • 3
    Online Resource
    Online Resource
    When and How to Treat HCV Infection with the New Antivirals before or after Liver Transplantation
    S. Karger AG ; 2016
    In:  Visceral Medicine Vol. 32, No. 4 ( 2016), p. 258-262
    Details
    In: Visceral Medicine, S. Karger AG, Vol. 32, No. 4 ( 2016), p. 258-262
    Abstract: Chronic hepatitis C virus (HCV) infection is one of the primary causes of hepatocellular carcinoma and liver transplantation (LT). Graft loss due to hepatitis C (HCV) recurrence is a serious problem after LT. Thus, the approval of interferon-free direct-acting antiviral (DAA) regimens has important implications in the LT setting. The findings of controlled trials have confirmed the safety and the excellent efficacy of most DAA combinations, and these findings have been confirmed by reports of high rates of sustained virologic response in the real-life setting. However, data from patients with decompensated cirrhosis who are on the LT waiting list are still scarce and, when available, suggest cautious consideration of whether HCV treatment before LT is beneficial in all cases. Progression of cirrhosis and refractory decompensation result in severely decreasing response rates, the risk of resistance, and reduced Model for End-Stage Liver Disease (MELD) scores despite clinical deterioration, making LT more difficult to achieve. On the other hand, treating HCV recurrence after LT is feasible with most of the available DAA combinations. Thus, an important topic of current debate is the establishment of predictors and conditions that can determine whether HCV treatment is best before or after LT. This review article comprehends and discusses recent data and challenges on the treatment of HCV infection in the liver transplant setting.
    Type of Medium: Online Resource
    ISSN: 2297-4725 , 2297-475X
    URL: Article
    DOI: 10.1159/000446976
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
    detail.hit.zdb_id: 2850734-4
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  • 4
    Online Resource
    Online Resource
    Glutamate Dehydrogenase and Alkaline Phosphatase as Very Early Predictors of Hepatocellular Carcinoma Recurrence after Liver Transplantation
    S. Karger AG ; 2015
    In:  Digestion Vol. 91, No. 2 ( 2015), p. 117-127
    Details
    In: Digestion, S. Karger AG, Vol. 91, No. 2 ( 2015), p. 117-127
    Abstract: Background: Although long-term survival rates for patients undergoing liver transplant (LT) for hepatocellular carcinoma (HCC) are good, the relatively high rate of tumor recurrence after LT necessitates the identification of biological parameters that supplement morphological predictors of recurrence. Method: From chart review we identified 175 patients who received liver transplantation due to HCC at our center between January 2000 and December 2013. We documented demographic and clinical data, as well as clinicopathological characteristics of the tumors, with a focus on liver values at the time of LT. Results: HCC recurred in 23% of LT patients. Most recurrences (59%) occurred within 12 months after LT; hardly any recurrence was detected later than 3 years after LT. Recurrence was positively correlated with tumor size, tumor stage and alpha-fetoprotein level (AFP), and it was most likely with certain causes of liver disease. Interestingly, tumor recurrence was independently predicted by serum levels of glutamate dehydrogenase (GLDH) and alkaline phosphatase (AP) at the time of LT. Conclusions: Because all HCC recurrence occurs within 36 months after LT, HCC detected more than 3 years after LT may be considered de novo. Liver values, with GLDH and AP being the most preponderant, serve as easy-to-assess biomarkers which contribute to predict the risk of tumor recurrence.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000370212
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
    detail.hit.zdb_id: 1482218-0
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  • 5
    Online Resource
    Online Resource
    Steroid and Ursodesoxycholic Acid Combination Therapy in Severe Drug-Induced Liver Injury
    S. Karger AG ; 2011
    In:  Digestion Vol. 84, No. 1 ( 2011), p. 54-59
    Details
    In: Digestion, S. Karger AG, Vol. 84, No. 1 ( 2011), p. 54-59
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Drug-induced liver injury (DILI) is the leading cause of acute severe liver disease in Western countries. Treatment strategies for DILI are still not well defined. 〈 i 〉 Aim: 〈 /i 〉 We studied the safety and outcomes of steroid/ursodesoxycholic acid (UDCA) combination therapy in DILI patients. 〈 i 〉 Patients, Materials and Methods: 〈 /i 〉 15 consecutive patients with severe DILI were analyzed for clinical, biochemical and histological data. Nine patients were treated with a steroid step-down therapy with reduction of the daily dose over several weeks; 6 patients received a steroid pulse therapy for 3 days. UDCA was administered for several weeks in both groups. 〈 i 〉 Results: 〈 /i 〉 Patients without histological signs of preexistent liver damage (n = 10) showed the most favorable clinical course. Bilirubin and serum transaminases dropped to 〈 50% of peak values within 2 weeks, and normalized within 4–8 weeks. In contrast, patients with positive autoimmune antibodies (anti-nuclear antibodies and/or soluble liver antigen) and/or histological features of chronic hepatitis (n = 3) exhibited a slower reduction in bilirubin and serum transaminase levels. These patients were given immunosuppressants (steroids, azathioprine) for a further 6 months. 〈 i 〉 Conclusion: 〈 /i 〉 Treatment of severe DILI with corticosteroids (both pulse and step-down therapy) and UDCA appears to be safe, and leads to a more rapid reduction in bilirubin and transaminases after DILI.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000322298
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1482218-0
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  • 6
    Online Resource
    Online Resource
    Expression of Apoptosis- and Vitamin D Pathway-Related Genes in Hepatocellular Carcinoma
    S. Karger AG ; 2013
    In:  Digestion Vol. 87, No. 3 ( 2013), p. 176-181
    Details
    In: Digestion, S. Karger AG, Vol. 87, No. 3 ( 2013), p. 176-181
    Abstract: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and therapeutic options are scarce. As they might represent future targets for cancer therapy, the expression of apoptosis-related genes in HCC is of particular interest. In this pilot study, we further examined apoptosis-related genes in human HCC and also focused on vitamin D signaling as this might be a regulator of HCC cell apoptosis. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We employed tumor tissue and serum samples from 62 HCC patients as well as 62 healthy controls for these studies. Tissue and serum specimens were analyzed by quantitative RT-PCR, immunohistochemistry and ELISA. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In HCC patients the apoptosis marker M30 was found to be elevated and several pro-apoptotic (TRAIL, FasL and FasR) as well as anti-apoptotic genes (Mcl-1 and Bcl-2) were simultaneously upregulated in tumor tissue and especially tumor-surrounding tissue as compared to healthy control livers. Moreover, vitamin D serum levels were decreased in HCC patients whereas vitamin D receptor mRNA expression was increased in tumor tissue and tumor-surrounding tissue as compared to healthy livers. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 In human HCC, M30 serum levels are elevated indicating an increased cell turnover. Modulation of the vitamin D pathway might be a supportive, pro-apoptotic HCC therapy.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000348441
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482218-0
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  • 7
    Online Resource
    Online Resource
    Mini-Laparoscopy Is Superior in Detecting Liver Cirrhosis and Metastases in Liver Cancer: An Over 10-Year Experience in 1,788 Cases
    S. Karger AG ; 2014
    In:  Digestion Vol. 89, No. 2 ( 2014), p. 156-164
    Details
    In: Digestion, S. Karger AG, Vol. 89, No. 2 ( 2014), p. 156-164
    Abstract: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 Mini-laparoscopy has, since its first description in 1998, proven to be a valuable diagnostic method in liver diseases. We re-evaluated the significance of mini-laparoscopy for diagnosis and staging of liver disease and primary liver and bile duct cancer. 〈 b 〉 〈 i 〉 Patients and Methods: 〈 /i 〉 〈 /b 〉 1,788 consecutive patients who received a diagnostic mini-laparoscopy between 10/1998 and 06/2011 were included in this retrospective cohort study. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In chronic liver disease, cirrhosis was detected by mini-laparoscopy in 27% of cases. A comparison of microscopic versus macroscopic diagnosis of cirrhosis revealed a sampling error for histology alone of 21%. Macroscopic inspection of the liver surface contributed to the diagnosis of unknown liver diseases in approximately 38%. In patients with bile duct or liver cancer, mini-laparoscopy led to upstaging of the disease in 33 and 23%, respectively. Major complications (bowel perforation and delayed bleeding) occurred in 0.39% of cases. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Mini-laparoscopy is a valuable procedure with significant diagnostic impact in known and unknown inflammatory and malignant liver diseases. It can be safely performed even in patients with acute liver failure and severe coagulopathy and the diagnostic value does not differ from diagnostic laparoscopy performed with standard instruments.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000354829
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 1482218-0
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