Evaluation of efficacy of liver transplantation in alcoholic cirrhosis using matched and simulated controls: 5-year survival

Background/Aims: Alcoholic cirrhosis is the most common cause of liver transplantation in US males. The limited number of donor livers calls for“prioritisation”, favouring those patients who will benefit most. The aim was to assess the efficacy of liver transplantation in patients with alcoholic cirrhosis.Methods: We compared the survival of 169 transplantedpatients with two conservatively treated control groups, one of 169 patients matched for prognostic factors (age, cirrhosis severity, bleeding history) and one of 169 simulated patients.Results: The probability of survival to 5 years in the transplanted group was 66% (95% confidence interval 58–74%) vs 52% (44–60; p=0.03) in the matched group and 54% (51–57; p=0.01) in the simulated controls. Transplantation was associated with survival (relative RISK=1.51; p=0.02), independently of risk score (risk=2.07; p<0.001), indication, period of inclusion, centre experience, and alcohol abstinence. Patients with severe disease (Pugh C11–15) benefited most in terms of 5-year survival: 58% (44–72) vs 31% (17–45; p=0.008) in the matched and 35% (30–40; p<0.001) in the simulated control groups. For patients at lower risk there was no significant difference.Conclusions: Liver transplantation increases the 5-year survival of patients with severe alcoholic cirrhosis. In patients at lower risk, efficacy of transplantation should be confirmed by longer follow-up or by randomised trial.     

Steroid withdrawal at day 14 after liver transplantation: a double-blind, placebo-controlled study.

Some clinical studies in liver transplantation have recently reported safety advantages and similar acute rejection rates with early steroid withdrawal. The aim of this study was to evaluate the efficacy and safety of an immunosuppressive regimen with steroid withdrawal at day 14. A multicenter, 1-year, comparative, double blind, placebo-controlled study was performed. Patients undergoing a first cadaveric liver transplantation were recruited and all received basiliximab + cyclosporine + intravenous methylprednisolone. Patients without severe postoperative complications were randomized at day 7 to receive a maintenance regimen with Neoral (cyclosporine) + prednisolone (group 1) or without steroids (Neoral + placebo; group 2), after a 7-day blinded oral steroid tapering period. A total of 174 patients were randomized at day 7 (group 1: n = 90; group 2: n = 84). The incidence of biopsy-confirmed and treated acute rejection at 6 months was 38.1% in group 2 vs. 24.4% in group 1 (P = .03) with a trend for a higher incidence of Grade II / III acute rejection (28.6% vs. 18.9%; P = .12). Changes from baseline were similar with regard to metabolic parameters (glycemia, total cholesterol, and triglycerides). A trend toward a better glucose tolerance was observed, as fewer patients received an antidiabetic treatment in the placebo group (2 vs. 10). In conclusion, this first double-blind, placebo-controlled study of steroid withdrawal at day 14 showed a higher incidence of acute rejection, only balanced by a trend of a lower need of antidiabetic treatment.     

Inhibition by tamoxifen of the effects of estradiol benzoate on lipid metabolism in female quail

The effect of estradiol (EB), tamoxifen (T), and estradiol + tamoxifen on the hepatic function and lipid metabolism in immature female quails was investigated. EB (0.02 mg/day/6 days) induced increases of relative liver weight, of serum cholesterol, bile acid and fatty acid levels, and of liver fatty acid level. Bile acid and fatty acid spectra were modified by this treatment. T alone (1 mg/day/6 days) had a meager effect on these parameters. If associated with EB it thoroughly inhibited the effects of that hormone.     

Pegylated interferon-α-based treatment for chronic hepatitis C in renal transplant recipients: an open pilot study

Treatment of hepatitis C in renal transplant recipients remains a controversial issue, as interferon therapy has been associated with a high risk of rejection and poor efficacy. We report here the use of pegylated interferon-α, alone or in combination with ribavirin, in renal transplant recipients with chronic hepatitis C. Eight renal transplant recipients with chronic hepatitis C were recruited. The mean delay between renal transplantation and antiviral therapy was 198.8 months. Sustained virological response was observed in four of out eight patients. Three patients with sustained virological response were genotype 2, one was genotype 1; fibrosis stages were F1 for one patient, F2 for 2, F3 for one. At baseline, renal dysfunction was moderate in seven patients and severe in one patient. No patient experienced rejection episodes during or after pegylated interferon-α therapy. One patient developed haemolytic uraemic syndrome, which eventually resulted in graft loss and return to dialysis. In conclusion, for renal transplant recipients treated with pegylated interferon-α-based therapy, we observed a low risk of renal dysfunction, acceptable tolerance and significant virological efficacy. This is therefore the first study to suggest that pegylated interferon-α could be proposed late after transplantation to renal transplant recipients.     

Syndrome de Budd-Chiari secondaire à une sarcoïdose : à propos d’un cas en 2011 au service des maladies de l’appareil digestif du CHU de Montpellier

Budd-Chiari syndrome is a rare complication of hepatic sarcoidosis. Today, there is no consensual argument that could explain the mechanism of this association. From 1978 to 2009, five cases have been published. Here we report a new observationThe patient of 33 years admitted for icteric cholestasis whose imaging tests showed a normal aspect’ rate with marked hypertrophy of the left lobe and of segment I of the liver, thrombosis supra-hepatic vein with a highly developed collateral network, and multiple and profound abdominal and mediastinal adenopathies; the anatomopathological examination showed characteristic images of sarcoidosis. The treatment with corticosteroids associated with antis vitamin K allowed a regression of the symptoms. To conclude we can affirm that although rare, sarcoidosis can be considered as one of the etiologies of Budd-Chiari syndrome as illustrated by our observation.     

RNA testing for the diagnosis of acute hepatitis A during the 2017 outbreak in France

Diagnostic of acute hepatitis A virus (HAV) infection is based on the detection of anti‐HAV IgM without testing for the pathogen itself. We evaluated the usefulness of HAV RNA testing for confirmation of acute hepatitis A and to provide indications about the level of HAV replication in HIV‐positive and HIV‐negative subjects during an unprecedented outbreak of HAV observed in France in 2017. HAV RNA was detected in 38 out of 41 (92.6%) subjects with a clinical diagnosis of acute hepatitis A, whereas nine cases tested positive for anti‐HAV IgM in whom the diagnosis of acute hepatitis A was not retained were found negative for HAV RNA. All subjects in the control group were also tested negative for HAV RNA. HAV viremia was correlated to ALT peak (r = .64; P < .0001). HIV‐infected patients have similar HAV RNA levels but were less likely to have prolonged international normalized ratio of prothrombin time when compared to the HIV‐uninfected group (P = .016), suggesting a less severe course of acute hepatitis. HAV RNA was detected in the serum of most of the patients with acute hepatitis A, indicating that the direct detection of HAV can be used to confirm hepatitis A in patients tested positive for anti‐HAV IgM antibodies. Nucleic acid tests should serve more broadly during the diagnosis workup of acute hepatitis A to improve the predictive values of HAV in vitro diagnostic tests and to confirm acute hepatitis A in patients tested positive with IgM with moderate or low S/CO values.