Search

Hepatitis C viral (HCV) treatment has rapidly advanced with the use of direct-acting antivirals (DAA), and many patients achieve sustained virological response (SVR). Although the risk of liver tumors is greatly reduced, there are still patients who achieve SVR but will progress to hepatocellular carcinoma (HCC). HCV infection is also a known risk for cholangiocellular carcinoma (CLC), although it is considered a relative infrequent liver malignancy. We report a series of five cases of CLC in patients that achieved SVR after HCV treatment with DAA. There were three women and two males with a median age of 62 years (range 49 to 77 years). Four patients had liver cirrhosis at the time of their HCV treatment. The interval from achieving SVR until CLC diagnosis varied, ranging from 4 to 36 months (median=12). Three patients presented with advanced disease and had extrahepatic spread at the time of their diagnosis. One patient had a resectable tumor, with no recurrence 4 years later. In one case, the tumor was initially considered an atypical HCC and was treated by radiofrequency ablation. Three years later, she was diagnosed with a large tumor recurrence that was demonstrated to be a CLC on liver biopsy. The last two patients were older males with HCV compensated cirrhosis diagnosed with CLC more than two years after achieving SVR. Palliative chemotherapy was started in both. Only a handful of CLC cases have been reported in HCV patients after SVR. Clinicians should take into account the possible development of an aggressive CLC. [ABSTRACT FROM AUTHOR]

AFP (alpha-fetoprotein) levels are increased during the development of HCC (hepatocellular carcinoma); nonetheless, it can also be produced by non-tumoral hepatocytes in conditions of high cell turnover. Our study aims to provide additional data regarding the causes of elevated AFP in patients with liver cirrhosis due to hepatitis C virus (HCV) infection. We conducted an observational prospective cohort study that included 2068 patients with compensated cirrhosis and chronic hepatitis C genotype 1b infection. The two main inclusion criteria were the presence of advanced liver fibrosis - Metavir stage F4 - diagnosed by FibroMax testing, Fibroscan or liver biopsy, and the presence of detectable HCV RNA in the serum. Plasmatic AFP levels were determined through the electrochemiluminescence method, with a standard value ranging from 0 to 7 ng/ml. All data were obtained from the Romanian National Health Agency. The average AFP serum levels in patients with compensated cirrhosis without HCC were 9.4 ng/ml (range 0.5 ÷ 406 ng/ml); 30.1% of patients had significantly increased levels of AFP (>15 ng/ml). High values of serum AFP in patients with compensated liver cirrhosis without HCC was correlated with more advanced age (p<0.001), severe necroinflammatory activity detected by FibroMax (p<0.001), severe NASH (p<0.001), severe steatosis (p<0.001), low platelets (p<0.001), increased values of AST and ALT (p<0.001). [ABSTRACT FROM AUTHOR]

Background and Aim. The number of patients with hepatocellular carcinoma (HCC) listed for liver transplant (LTx) has increased significantly and many of them are now receiving transarterial chemoembolization (TACE) to prevent disease progression. The aim of the study is to analyze the course of disease in patients with HCC who received TACE before LTx. Methods. Patients and tumor characteristics were compared between recipients who received TACE and those who did not. Kaplan-Meier method was used to compare patient survival. Results. Thirty-one patients treated with sequential TACE of a total of 63 patients with proven HCC that underwent LTx between 2013 and 2018 were included in the study. Altogether, 51 TACE procedures were accomplished (range 1-6). Twenty two patients (70.9%) received TACE with Lipiodol while the rest were treated with Debdox. Forty patients were within the Milano criteria and twelve patients (19.04%) had a complete response after TACE. Follow up duration was 72.3 months (62-114) and thirteen patients (20.6%) developed HCC recurrence after LTx. The recurrence free survival was 85.7 %, 69.6% and 58.9% at 1, 3 and 5 years, respectively. There was no significant difference in survival in patients that received TACE compared to those that did not (p=0.455). In the univariate analysis an AFP value greater than 100ng/mL, absence of tumor tissue at the time of LTx and a tumor within Milan criteria were found to be predictive factors for survival but only Milan criteria was significantly associated with survival in multivariate analysis (p=0.007; CI 95%: 0.1262 to 0.7266). Conclusion. TACE is an effective method for the therapy of the HCC before LTx in selected patients Milano criteria is the best predictive factor for survival in HCC patients undergoing liver transplant. [ABSTRACT FROM AUTHOR]

We present the case of a previously healthy 62 year old man who developed primary non-Hodgkin lymphoma of the liver. Biopsy confirmed that it was a diffuse large anaplastic T-cell lymphoma of an extremely rare type. The diagnosis of this type of lesions is suggested by the presence of a hepatic mass without lymphadenopathy, splenomegaly or bone marrow involvement associated with normal tumor markers (carcinoembryonic antigen, alpha-fetoprotein and CA 19-9 levels). Histological examination of tissue is essential to confirm the diagnosis. Treatment options are surgical resection and/or chemotherapy but the rate of response to treatment varies widely. Some patients can achieve prolonged remission. [ABSTRACT FROM AUTHOR]

A 53 years-old male, diagnosed with ulcerative colitis and liver cirrhosis due to HCV infection, was hospitalized at the Gastroenterology Department for paraclinical workup, prior to inclusion on the liver transplantation waiting list. The patient was known with a gigantic arachnoid cyst and presented a transient ischemic attack one year prior, for which treatment with aspirin was initiated. Consequently, we performed a brain MRI examination, which disclosed a left-sided gigantic arachnoid cyst with mass effect, midline shift of 9 mm and subfalcine herniation. No focal neurologic deficits or signs of increased intracranial pressure were found on neurological examination. Following neurosurgical evaluation, the presence of the cyst was not deemed to be a contraindication for liver transplantation. [ABSTRACT FROM AUTHOR]

Introduction. Patients with end-stage liver diseases, included on the waiting list (WL) for liver transplant (LT) can develop complications that increase the morbidity and mortality, due to different risk factors. The aim was to evaluate different prognostic factors for mortality in patients included on the WL for LT. Materials and Methods. We performed a singlecenter retrospective cohort study from 1 January, 2018 to 31 December, 2022, in 120 patients included on the WL for LT. We analyzed the following prognostic factors: MELD, MELD Na, MELD 3.0, ALBI, occurrence of acute-on-chronic liver failure (ACLF) from grade 1 to 3, occurrence of liver cirrhosis complications, infections, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio, plateletto-lymphocyte ratio, using univariable and multivariable Cox proportional hazards models. Results. From 120 patients included, 63.3% were males, with a median age of 55 ± 11.55 years. The most frequent etiology of the liver disease was B + delta hepatitis viral infection in 35.8%, followed by alcoholic etiology in 35% of cases. 30.8% of patients had hepatocellular carcinoma. The median MELD Na score at the inclusion on the waiting list was 17 ±7.3. During the follow-up on the waiting list, 39.2% of patients had infectious complications, such as spontaneous bacterial peritonitis (SBP), pneumonia, urinary tract infections and cellulitis. The median waiting time for all patients was 300 ± 686 days. Liver transplant was performed in 66.7% of cases, and 22.5% patients died during follow-up. Univariate analysis demonstrated that the following factors were associated with higher death rates: presence of ACLF (p<0.0001), refractory ascites (p=0.012), acute kidney injury (p=0.0007), hepatic encephalopathy (p=0.0064), infectious complications (p=0.0077), higher MELD score (p=0.043), MELD Na score (p=0.0048) and MELD 3.0 (p=0.0053), higher NLR (p=0.0011). Multivariate analysis was performed and the presence of ACLF (p=0.0051) and a higher NLR (p=0.042) were found to be independent predictors for mortality. Conclusions. In patients included on the waiting list for liver transplant, occurrence of acute-on-chronic liver failure and neutrophil-to-lymphocyte ratio can be used as predictive factors for mortality. [ABSTRACT FROM AUTHOR]

Background & aims. In our country prospective studies to establish the prevalence of obesity and non-alcoholic fatty liver disease (NAFLD) are lacking. We prospectively assessed the prevalence and severity of NAFLD in a cohort of asymptomatic patients attending the national screening programme for colorectal cancer. Methods. Screening for NAFLD was performed using abdominal ultrasound and Fibroscan with CAP module. Also antropometric parameters, comorbidities like diabetes and arterial hypertension, and risk behaviours like smoking and alcohol consumption were evaluated Results. We screened 70 patients with FIT positive tests, attending for colonoscopy. The mean age was 60 ± 7.0 years, 48.5% were male, the mean BMI was 28.46 ± 4.54 kg/m2, and 37,1% were obese. The prevalence of NAFLD as evaluated as any degree of steatosis on Fibroscan with CAP module was 79.7% and the prevalence of severe steatosis was 26.6%. Significant fibrosis (F =2) was present in 13.8%. In a multivariable logistic analysis, the only factor associated with the presence of NAFLD was waist cirumference at high risk (>102 cm in men and >88 cm in women) Conclusion. The obesity and NAFLD incidence rate in asymptomatic general population is high and worrying. Abdominal obesity seems to be more predictable than BMI for the diagnosis of fatty liver. [ABSTRACT FROM AUTHOR]