103 results on '"Rajoriya N"'
Search Results
2. Editorial: complications of TIPSS – consolidation of a decade of experience
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Rajoriya, N. and Tripathi, D.
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- 2017
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3. A203 INCIDENCE AND PREDICTORS OF NON-HEPATIC CANCERS IN ALCOHOL RELATED LIVER DISEASE IN THE WALDO COHORT
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Hindi, Z, primary, Brahmania, M, additional, Arab, J, additional, Shi, N, additional, Rajoriya, N, additional, Aithal, G, additional, Allison, M, additional, Hagström, H, additional, Likhitsup, A, additional, McCune, A, additional, Masson, S, additional, and Parker, R, additional
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- 2022
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4. Outcomes of normothermic machine perfusion of liver grafts in repeat liver transplantation (NAPLES initiative)
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Hann, A., primary, Lembach, H., additional, Nutu, A., additional, Dassanayake, B., additional, Tillakaratne, S., additional, McKay, S. C., additional, Boteon, A. P. C. S., additional, Boteon, Y. L., additional, Mergental, H., additional, Murphy, N., additional, Bangash, M. N., additional, Neil, D. A. H., additional, Issac, J. L., additional, Javed, N., additional, Faulkner, T., additional, Bennet, D., additional, Moore, R., additional, Vasanth, S., additional, Subash, G., additional, Cuell, J., additional, Rao, R., additional, Cilliers, H., additional, Russel, S., additional, Haydon, G., additional, Mutimer, D., additional, Roberts, K. J., additional, Mirza, D. F., additional, Ferguson, J., additional, Bartlett, D., additional, Isaac, J. R., additional, Rajoriya, N., additional, Armstrong, M. J., additional, Hartog, H., additional, and Perera, M. T. P. R., additional
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- 2022
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5. A liver mass post-Fontan operation
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Rajoriya, N., Clift, P., Thorne, S., Hirschfield, G.M., and Ferguson, J.W.
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- 2014
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6. Liver Transplant for Porto-sinusoidal Vascular Disease: Long-term Outcome
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Magaz, M., primary, Giudicelli-Lett, H., additional, Rajoriya, N., additional, Fondevila, C., additional, Albillos, A., additional, Nevens, F., additional, Tripathi, D., additional, Rautou, P.-E., additional, and García-Pagán, J.C., additional
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- 2021
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7. Long-term follow-up of endoscopic Histoacryl glue injection for the management of gastric variceal bleeding
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Rajoriya, N., Forrest, E.H., Gray, J., Stuart, R.C., Carter, R.C., McKay, C.J., Gaya, D.R., Morris, A.J., and Stanley, A.J.
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- 2011
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8. An unusual cause of dyspepsia: oesophageal cavernous haemangioma
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Rajoriya, N., D’costa, H., Gupta, P., and Ellis, A. J.
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- 2010
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9. Immune-mediated and chronic inflammatory disease in people with sarcoidosis: disease associations in a large UK database
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Rajoriya, N, Wotton, C J, Yeates, D G R, Travis, S P L, and Goldacre, M J
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- 2009
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10. Gamma Delta T-lymphocytes in Hepatitis C and Chronic Liver Disease
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Rajoriya, N, Fergusson, JR, Leithead, JA, and Klenerman, P
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gamma delta T-lymphocytes ,γδ T-cells ,Immunology ,Review Article ,CD161 - Abstract
Discovered 30 years ago, gamma delta (γδ) T-lymphocytes remain an intriguing and enigmatic T-cell subset. Although in humans they comprise a small fraction of the total circulating T-lymphocyte pool, they represent an important T-cell subset in tissues such as the liver, with roles bridging the innate and adaptive immune systems. The associations of γδ T-lymphocytes with chronic liver disease have been explored - however, there remain conflicting data as to whether these T-cells are pathogenic or protective. In patients with some forms of liver disease, their expansion in the periphery and especially in the liver may indeed help pathogen clearance, while in other conditions their presence may, in contrast, contribute to disease progression. γδ T-cells can also express CD161, a C-type lectin, and such cells have been found to be involved in the pathogenesis of inflammatory disease. CD161+ T-cells of diverse subsets are known to be enriched in the livers of patients with chronic hepatitis C. This article serves to provide a review of the γδ T-cell population and its role in hepatitis C and other chronic liver diseases, and also explores a potential role of the CD161+ γδ T-cells in liver diseases.
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- 2016
11. CD161+ Gamma Delta T-cells in health and liver disease
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Rajoriya, N and Klenerman, P
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Immunology ,Medical sciences - Abstract
CD161 γδ T-cells have been implicated in the pathogenesis of Multiple Sclerosis however their role in health and chronic liver disease requires further exploration. In health, the majority of γδ T-cells expressed CD161 – a C-type lectin, and predominantly expressed the Vδ2 chain. The CD161+ γδ T-cells demonstrated a Th1-like pattern, expressing IFN-γ, TNF-α and Granzymes/Perforin when compared to the CD161- subset. The CD161+ γδ T-cells also expressed CCR6 and IL-18R thus also displaying a Th17-like pattern. These cells were also found in the lamina propria in the gut and rapidly expanded in the 1st few weeks of life in the periphery. On gene array analysis, there were 409 genes expressed on the CD161+ γδ T-cells when compared to their CD161-ve counterparts including those coding for β2 receptors, CCL20, Acetycholinesterase, CCR1 and IL-18R. A potential clinical correlation to cardiac diseases was found when the upregulated genes were analysed. When the CD161+ γδ and CD161+ αβ T-cell populations were compared via gene-array, an association with a risk variant for coeliac disease was found. Thus in health, CD161+ γδ T-cells are not only a distinct subset of T-cells (confirmed by a FACS approach and gene array methods), but also the expression of CD161 may be linked to common genetic signals downstream in cell processes and disease pathogenesis, irrespective of T-cell subset population. In chronic liver disease there was a significant reduction in the periphery of CD161+ γδ T-cells in patients with chronic Hepatitis C (HCV) and an increase in patients with Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis when compared with healthy individuals. The CD161+ γδ T-cells appeared to be of a different phenotype in HCV infection. There was no overall significant localisation into of CD161+ γδ T-cells patients with chronic liver disease or specifically in HCV infection. There was however a CD161+ γδ T-cell enrichment in the liver in patients with Non-Alcoholic Fatty Liver disease. The CD161+ γδ T-cells were also found in Hepatocellular Carcinoma tissue. Overall it appears the CD161+ γδ T-cells are indeed a unique subset, playing a distinct role in health, as part of an early innate response, but also potentially involved in disease pathogenesis.
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- 2016
12. Palliative care access for hospitalized patients with end stage liver disease across the United States
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Rush, B., primary, Walley, K., additional, Celi, L.A., additional, Rajoriya, N., additional, and Brahmania, M., additional
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- 2017
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13. Editorial: complications of TIPSS - consolidation of a decade of experience
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Rajoriya, N., primary and Tripathi, D., additional
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- 2016
- Full Text
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14. PTH-156 Impact of BSG and BASL Liver Care Bundle Introduction on Clinical Practice: A University Hospital Experience: Abstract PTH-156 Table 1
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Shahid, S, primary, Cheung, V, additional, Meghji, H, additional, Rajoriya, N, additional, and MacFaul, G, additional
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- 2016
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15. Long-term follow-up of endoscopic Histoacryl glue injection for the management of gastric variceal bleeding
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Adrian J. Stanley, Carter Rc, Colin J. McKay, Daniel R. Gaya, Allan J. Morris, Ewan Forrest, Gray J, Rajoriya N, and Robert C. Stuart
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Endoscopic ultrasound ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Esophageal and Gastric Varices ,Gastroenterology ,Internal medicine ,Gastroscopy ,medicine ,Humans ,Hemostatic function ,Aged ,Varix ,medicine.diagnostic_test ,business.industry ,Stomach ,Hemostasis, Endoscopic ,General Medicine ,Gastric varices ,Enbucrilate ,Middle Aged ,medicine.disease ,Surgery ,Endoscopy ,medicine.anatomical_structure ,Treatment Outcome ,Female ,Varices ,business ,Gastrointestinal Hemorrhage ,Transjugular intrahepatic portosystemic shunt ,Follow-Up Studies - Abstract
Background: Variceal bleeding is an acute medical emergency with high mortality. Although less common than oesophageal variceal haemorrhage, gastric variceal bleeding is more severe and more difficult to control. The optimal therapy for gastric variceal bleeding remains unclear although endoscopic injection of N -Butyl-2-Cyanoacrylate (Histoacryl) glue is often used. However, its long-term efficacy is poorly described. We studied the immediate and long-term effects of Histoacryl glue injection as treatment for bleeding gastric varices in a large UK hospital. Method: Endoscopy records and case notes were used to identify patients receiving Histoacryl injection for gastric variceal bleeding over a 4-year period. Results: Thirty-one patients received Histoacryl for gastric variceal bleeding. Seventy-four per cent patients had alcohol-related liver disease and 61% of cirrhotics were Childs Pugh grade B or C. Fifty-eight per cent were actively bleeding during the procedure with 100% haemostasis rates achieved. Two patients developed pyrexia within 24 h of injection settling with antibiotics. No other complications were encountered. Mean overall follow-up was 35 months, with mean follow-up of survivors 57 months. Forty-eight per cent patients had endoscopic ultrasound assessment of varices during follow-up with no effect on rebleeding rates. Thirteen per cent required subsequent transjugular intrahepatic portosystemic shunt placement. Gastric variceal rebleeding rate was 10% at 1 year and 16% in total. One- and two-year mortality was 23% and 35%, respectively. Conclusion: Endoscopic injection of Histoacryl glue appears to be a safe and effective treatment for gastric variceal bleeding. Further data are required to compare it with other therapies in this situation.
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- 2010
16. A liver lesion in primary sclerosing cholangitis
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Biswas, S., primary, Rajoriya, N., additional, Wang, L. M., additional, and Collier, J., additional
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- 2015
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17. CD161 defines a transcriptional and functional phenotype across distinct human T cell lineages
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Fergusson, JR, Smith, KE, Fleming, VM, Rajoriya, N, Newell, EW, Simmons, R, Marchi, E, Björkander, S, Kang, YH, Swadling, L, Kurioka, A, Sahgal, N, Lockstone, H, Baban, D, Freeman, GJ, Sverremark-Ekström, E, Davis, MM, Davenport, MP, Venturi, V, Ussher, JE, Willberg, CB, Klenerman, P, Fergusson, JR, Smith, KE, Fleming, VM, Rajoriya, N, Newell, EW, Simmons, R, Marchi, E, Björkander, S, Kang, YH, Swadling, L, Kurioka, A, Sahgal, N, Lockstone, H, Baban, D, Freeman, GJ, Sverremark-Ekström, E, Davis, MM, Davenport, MP, Venturi, V, Ussher, JE, Willberg, CB, and Klenerman, P
- Abstract
The C-type lectin CD161 is expressed by a large proportion of human T lymphocytes of all lineages, including a population known as mucosal-associated invariant T (MAIT) cells. To understand whether different T cell subsets expressing CD161 have similar properties, we examined these populations in parallel using mass cytometry and mRNA microarray approaches. The analysis identified a conserved CD161++/ MAIT cell transcriptional signature enriched in CD161+CD8+ T cells, which can be extended to CD161+ CD4+ and CD161+TCRγδ+ T cells. Furthermore, this led to the identification of a shared innate-like, TCR-independent response to interleukin (IL)-12 plus IL-18 by different CD161-expressing T cell populations. This response was independent of regulation by CD161, which acted as a costimulatory molecule in the context of T cell receptor stimulation. Expression of CD161 hence identifies a transcriptional and functional phenotype, shared across human T lymphocytes and independent of both T cell receptor (TCR) expression and cell lineage.
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- 2014
18. FRI-013 - Palliative care access for hospitalized patients with end stage liver disease across the United States
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Rush, B., Walley, K., Celi, L.A., Rajoriya, N., and Brahmania, M.
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- 2017
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19. PTU-055 A Comparison Of Radiological And Endoscopic Oesophageal Stent Placement In Malignancy
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Chapman, T, primary, Tyrell, H, additional, Al-Hassani, H, additional, Colcer, A, additional, Bruce, A, additional, Rajoriya, N, additional, Warakaulle, D, additional, Gorard, D, additional, and Sekhar, R, additional
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- 2014
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20. P950 NON-SELECTIVE BETA-BLOCKERS ARE ASSOCIATED WITH IMPROVED SURVIVAL IN PATIENTS WITH ASCITES LISTED FOR LIVER TRANSPLANTATION
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Leithead, J.A., primary, Rajoriya, N., additional, Gunson, B.K., additional, Tehami, N., additional, Tripathi, D., additional, and Ferguson, J.W., additional
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- 2014
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21. Factors determining effectiveness of interferons in managing hepatitis C: new targets and new approaches
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Rajoriya,N, Barnes,Ellie, Rajoriya,N, and Barnes,Ellie
- Abstract
N Rajoriya1, Eleanor Barnes1,21Department of Pathogen Research, Peter Medawar Building, South Parks Road, Oxford, UK; 2Oxford National Institute of Health Research Biomedical Research Centre, Oxford, UKAbstract: The hepatitis C virus now infects 170 million people worldwide. The majority of infected people develop viral persistence that may lead to increasing liver fibrosis, liver cirrhosis, and hepatocellular cancer. Interferon therapy has been the mainstay of treatment for hepatitis C since the discovery of the virus in 1989. The introduction of a pegylated form of interferon that increases the half-life of interferon, and the concurrent use of ribavirin has significantly improved the likelihood of achieving long-term viral eradication. HCV genotype and viral load remain major determinants of response to interferons. However, very recently, host genetic polymorphisms linked to interferon-λ3 have also been shown to play a crucial role in clinical outcome. A significant body of evidence now exists showing that the hepatitis C virus has developed multiple strategies to subvert both the production and the antiviral effects of interferons. This review explores these strategies, the factors that determine the effectiveness of interferon therapy, and highlights novel interferons in development. Ultimately, given the significant side effect profile of interferon therapy, and the emergence of small molecules and therapeutic vaccines that may inhibit viral replication, the aim will be to achieve viral eradication without interferon treatment.Keywords: hepatitis C virus, interferon, ribavirin, novel interferons, interferon-λ, pharmacodynamics
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- 2010
22. PWE-122 Parallel Tipss for the Management of Shunt Insufficiency in Patients with Complications of Portal Hypertension: A Tertiary Liver Unit 19 Year Experience
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Rajoriya, N, primary, Merzhat, H, additional, Mangat, K, additional, Oliff, S, additional, and Tripathi, D, additional
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- 2013
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23. 232 PARALLEL TIPSS FOR THE MANAGEMENT OF SHUNT INSUFFICIENCY IN PATIENTS WITH COMPLICATIONS OF PORTAL HYPERTENSION: A TERTIARY LIVER UNIT 19 YEAR EXPERIENCE
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Rajoriya, N., primary, Mehrzad, H., additional, Mangat, K., additional, Oliff, S., additional, and Tripathi, D., additional
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- 2013
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24. Long-term follow-up of endoscopic Histoacryl glue injection for the management of gastric variceal bleeding
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Rajoriya, N., primary, Forrest, E. H., additional, Gray, J., additional, Stuart, R. C., additional, Carter, R. C., additional, McKay, C. J., additional, Gaya, D. R., additional, Morris, A. J., additional, and Stanley, A. J., additional
- Published
- 2010
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25. 1145 LIVER FUNCTION TESTS ABNORMALITIES IN THE ICU SETTING: IS DOUBLING OF LFTS OF PROGNOSTIC OR CLINICAL RELEVANCE?
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Fallon, J., primary, Thakker, M., additional, Parke, T.J., additional, and Rajoriya, N., additional
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- 2010
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26. P34 The efficacy of clinical measurement and tailored proton pump inhibitor therapy in the management of extra-intestinal symptoms in GORD
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Rajoriya, N., primary, McIntosh, D., additional, MacKenzie, C., additional, Stanton, A., additional, McIvor, F., additional, Thomson, S., additional, Buchanan, C., additional, MacLaren, S., additional, Heading, R., additional, Bucknall, C., additional, and MacKenzie, J.F., additional
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- 2006
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27. P77 Hydrolic dilatation in the treatment of achalasia- a 5 year tertiary referral centre
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Rajoriya, N., primary, Crighton, J., additional, Thomson, S., additional, Buchanan, K., additional, Gillespie, R., additional, Heading, R., additional, and MacKenzie, J.F., additional
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- 2006
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28. Factors determining effectiveness of interferons in managing hepatitis C: new targets and new approaches.
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Rajoriya, N. and Barnes, Eleanor
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- 2010
29. Porto-sinusoidal vascular liver disorder with portal hypertension: Natural history and long-term outcome.
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Magaz M, Giudicelli-Lett H, Abraldes JG, Nicoară-Farcău O, Turon F, Rajoriya N, Goel A, Raymenants K, Hillaire S, Téllez L, Elkrief L, Procopet B, Orts L, Nery F, Shukla A, Larrue H, Degroote H, Aguilera V, Llop E, Turco L, Indulti F, Gioia S, Tosetti G, Bitto N, Becchetti C, Alvarado E, Roig C, Diaz R, Praktiknjo M, Konicek AL, Olivas P, Fortea JI, Masnou H, Puente Á, Ardèvol A, Navascués CA, Romero-Gutiérrez M, Scheiner B, Semmler G, Mandorfer M, Damião F, Baiges A, Ojeda A, Simón-Talero M, González-Alayón C, Díaz A, García-Criado Á, De Gottardi A, Hernández-Guerra M, Genescà J, Drilhon N, Noronha Ferreira C, Reiberger T, Rodríguez M, Morillas RM, Crespo J, Trebicka J, Bañares R, Villanueva C, Berzigotti A, Primignani M, La Mura V, Riggio O, Schepis F, Verhelst X, Calleja JL, Bureau C, Albillos A, Nevens F, Hernández-Gea V, Tripathi D, Rautou PE, and García-Pagán JC
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- Humans, Female, Middle Aged, Male, Retrospective Studies, Adult, Prognosis, Aged, Liver Transplantation statistics & numerical data, Liver Transplantation methods, Ascites etiology, Ascites diagnosis, Hepatic Encephalopathy etiology, Hepatic Encephalopathy epidemiology, Hepatic Encephalopathy diagnosis, Young Adult, Adolescent, Follow-Up Studies, Hypertension, Portal diagnosis, Hypertension, Portal complications
- Abstract
Background & Aims: Current knowledge of the natural history of patients with porto-sinusoidal vascular disorder (PSVD) is derived from small studies. The aim of the present study was to determine the natural history of PSVD and prognostic factors in a large multicenter cohort of patients., Methods: We performed a retrospective study on patients with PSVD and signs of portal hypertension (PH) prospectively registered in 27 centers., Results: A total of 587 patients were included, median age of 47 years and 38% were women. Four-hundred and one patients had an associated condition, which was graded as severe in 157. Median follow-up was 68 months. At diagnosis, 64% of patients were asymptomatic while 36% had a PH-related complication: PH-related bleeding in 112 patients, ascites in 117, and hepatic encephalopathy in 11. In those not presenting with bleeding, the incidence of first bleeding was 15% at 5 years, with a 5-year rebleeding rate of 18%. The 5-year cumulative incidence of new or worsening ascites was 18% and of developing portal vein thrombosis was 16%. Fifty (8.5%) patients received a liver transplantation and 109 (19%) died, including 55 non-liver-related deaths. Transplant-free survival was 97% and 83% at 1 and 5 years, respectively. Variables independently associated with transplant-free survival were age, ascites, serum bilirubin, albumin and creatinine levels at diagnosis and severe associated conditions. This allowed for the creation of a nomogram that accurately predicted prognosis., Conclusions: The prognosis of PSVD is strongly determined by the severity of the associated underlying conditions and parameters of liver and renal function., Impact and Implications: Porto-sinusoidal vascular liver disorder (PSVD) is a rare entity that usually affects young people, frequently causes severe complications of portal hypertension, and may reduce life expectancy. To date, there is scarce information regarding its clinical manifestations, natural history and prognostic factors. The present study, including the largest number of patients with PSVD reported so far, shows that overall, when managed at centers of expertise, the prognosis of patients with PSVD is good, with LT-free survival rates of 83% and 72% at 5 and 10 years, respectively. Presence and severity of an underlying associated condition, presence of ascites, age and bilirubin, albumin and creatinine levels were associated with poor prognosis. These results are important to know for hepatologists. A final model combining these parameters enabled development of a nomogram that predicts prognosis with good discrimination and calibration capacity and can be easily applied in clinical practice., (Copyright © 2024 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
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- 2025
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30. Circulating myeloid populations have prognostic utility in alcohol-related liver disease.
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Khan R, Salman S, Harford L, Sheriff L, Hazeldine J, Rajoriya N, Newsome PN, and Lalor PF
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- Humans, Prognosis, Liver Cirrhosis complications, Leukocyte Count, Liver Diseases complications, Hepatitis, Alcoholic
- Abstract
Introduction: Alcohol-related liver disease (ARLD) accounts for over one third of all deaths from liver conditions, and mortality from alcohol-related liver disease has increased nearly five-fold over the last 30 years. Severe alcohol-related hepatitis almost always occurs in patients with a background of chronic liver disease with extensive fibrosis or cirrhosis, can precipitate 'acute on chronic' liver failure and has a high short-term mortality. Patients with alcohol-related liver disease have impaired immune responses, and increased susceptibility to infections, thus prompt diagnosis of infection and careful patient management is required. The identification of early and non-invasive diagnostic and prognostic biomarkers in ARLD remains an unresolved challenge. Easily calculated predictors of infection and mortality are required for use in patients who often exhibit variable symptoms and disease severity and may not always present in a specialized gastroenterology unit., Methods: We have used a simple haematological analyser to rapidly measure circulating myeloid cell parameters across the ARLD spectrum., Results and Discussion: We demonstrate for the first time that immature granulocyte (IG) counts correlate with markers of disease severity, and our data suggests that elevated counts are associated with increased short-term mortality and risk of infection. Other myeloid populations such as eosinophils and basophils also show promise. Thus IG count has the potential to serve alongside established markers such as neutrophil: lymphocyte ratio as a simply calculated predictor of mortality and risk of infectious complications in patients with alcohol-related hepatitis. This would allow identification of patients who may require more intensive management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Khan, Salman, Harford, Sheriff, Hazeldine, Rajoriya, Newsome and Lalor.)
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- 2024
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31. Duke Activity Status Index and Liver Frailty Index predict mortality in ambulatory patients with advanced chronic liver disease: A prospective, observational study.
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Williams FR, Quinlan J, Freer A, Morrison B, Sitch A, Hockey F, Klas N, Towey J, Perera TPR, Rajoriya N, Lord JM, and Armstrong MJ
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- Humans, Male, Female, Middle Aged, Prospective Studies, Frailty diagnosis, Frailty epidemiology, Liver Transplantation, Liver Diseases
- Abstract
Background: There remains a lack of consensus on how to assess functional exercise capacity and physical frailty in patients with advanced chronic liver disease (CLD) being assessed for liver transplantation (LT). Aim To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD., Aim: To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD., Methods: We recruited patients from outpatient clinics at University Hospitals Birmingham, UK (2018-2019). We prospectively collated the DASI and LFI to identify the prevalence of, respectively, functional capacity and physical frailty, and to evaluate their accuracy in predicting overall and pre-LT mortality., Results: We studied 307 patients (57% male; median age 54 years; UKELD 52). Median DASI score was 28.7 (IQR 16.2-50.2), mean LFI was 3.82 (SD = 0.72), and 81% were defined either 'pre-frail' or 'frail'. Female sex and hyponatraemia were significant independent predictors of both DASI and LFI. Age and encephalopathy were significant independent predictors of LFI, while BMI significantly predicted DASI. DASI and LFI were significantly related to overall (HR 0.97, p = 0.001 [DASI], HR 2.04, p = 0.001 [LFI]) and pre-LT mortality (HR 0.96, p = 0.02 [DASI], HR 1.94, p = 0.04 [LFI])., Conclusions: Poor functional exercise capacity and physical frailty are highly prevalent among ambulatory patients with CLD who are being assessed for LT. The DASI and LFI are simple, low-cost tools that predict overall and pre-LT mortality. Implementation of both should be considered in all outpatients with CLD to highlight those who may benefit from targeted nutritional and exercise interventions., (© 2023 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)
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- 2024
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32. Long-term outcomes (beyond 5 years) of liver transplant recipients-A transatlantic multicenter study.
- Author
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Palaniyappan N, Peach E, Pearce F, Dhaliwal A, Campos-Varela I, Cant MR, Dopazo C, Trotter J, Divani-Patel S, Hatta AAZ, Hopkins L, Testa G, Bilbao A, Kasmani Z, Faloon S, Mirza DF, Klintmalm GB, Bilbao I, Asrani SK, Rajoriya N, and Aravinthan AD
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Immunosuppression Therapy, Retrospective Studies, Spain epidemiology, Treatment Outcome, Cardiovascular Diseases etiology, Liver Transplantation adverse effects
- Abstract
The long-term (>5 y) outcomes following liver transplantation (LT) have not been extensively reported. The aim was to evaluate outcomes of LT recipients who have survived the first 5 years. A multicenter retrospective analysis of prospectively collected data from 3 high volume LT centers (Dallas-USA, Birmingham-UK, and Barcelona-Spain) was undertaken. All adult patients, who underwent LT since the inception of the program to December 31, 2010, and survived at least 5 years since their LT were included. Patient survival was the primary outcome. A total of 3682 patients who survived at least 5 years following LT (long-term survivors) were included. Overall, median age at LT was 52 years (IQR 44-58); 53.1% were males; and 84.6% were Caucasians. A total of 49.4% (n=1820) died during a follow-up period of 36,828 person-years (mean follow-up 10 y). A total of 80.2% (n=1460) of all deaths were premature deaths. Age-standardized all-cause mortality as compared to general population was 3 times higher for males and 5 times higher for females. On adjusted analysis, besides older recipients and older donors, predictors of long-term mortality were malignancy, cardiovascular disease, and dialysis. Implementation of strategies such as noninvasive cancer screening, minimizing immunosuppression, and intensive primary/secondary cardiovascular prevention could further improve survival., (Copyright © 2023 American Association for the Study of Liver Diseases.)
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- 2024
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33. Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group.
- Author
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Parker R, Allison M, Anderson S, Aspinall R, Bardell S, Bains V, Buchanan R, Corless L, Davidson I, Dundas P, Fernandez J, Forrest E, Forster E, Freshwater D, Gailer R, Goldin R, Hebditch V, Hood S, Jones A, Lavers V, Lindsay D, Maurice J, McDonagh J, Morgan S, Nurun T, Oldroyd C, Oxley E, Pannifex S, Parsons G, Phillips T, Rainford N, Rajoriya N, Richardson P, Ryan J, Sayer J, Smith M, Srivastava A, Stennett E, Towey J, Vaziri R, Webzell I, Wellstead A, Dhanda A, and Masson S
- Subjects
- Humans, Consensus, Public Opinion, Gastroenterology, Liver Diseases therapy
- Abstract
Objective: Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care., Design: A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives., Results: The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided., Conclusion: It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD., Competing Interests: Competing interests: RP: research support from NIHR and LEeds Hospital Charity. Consulting fees from Durect. Fees for speaking from Norgine Pharmaceuticals. Advisory board fees from Novo Nordisk. LC: consulting fees from Novo Nordisk relating to non-alcohol-related fatty liver disease. TP: research grant support from NIHR, Society for the Study of Addiction, Office of Police and Crime Commissioner. SMorgan: research support from NIHR. Consulting fees from Norgine Pharmaceuticals, Payment or honoraria from Sandoz UK and Dr Falk. LEadership roles with BRitish Society of Gastroenterology, Alcohol HEalth Alliance, Medical Council on Alcohol.These authors declare no conflicts of interest: SA, MA, RA, SB, VB, RB, ID, AD, PD, RGailer, EForrest, EForster, RGoldin, VH, AJ, VL, DL, JMcDonagh, JMaurice, SMasson, TN, EO, GP, NRajoriya, NRainford, PR, JR, JS, MS, AS, ES, JT, RV, IW and AW., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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34. Emergency retransplant for primary non-function of liver allograft.
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Halle-Smith JM, Hall LA, Hann A, Isaac JL, Murphy N, Roberts KJ, Rajoriya N, and Perera MTPR
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- Humans, Transplantation, Homologous, Allografts, Reoperation, Retrospective Studies, Graft Rejection, Liver, Graft Survival
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- 2023
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35. Liver Transplantation for Porto-sinusoidal Vascular Liver Disorder: Long-term Outcome.
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Magaz M, Giudicelli-Lett H, Nicoară-Farcău O, Rajoriya N, Goel A, Raymenants K, Hillaire S, Crespo G, Téllez L, Elkrief L, Fondevila C, Orts L, Nery F, Shukla A, Larrue H, Fundora Y, Degroote H, Aguilera V, LLop E, Turco L, Indulti F, Gioia S, Tosetti G, Bitto N, Becchetti C, Alvarado E, Roig C, Diaz R, Praktiknjo M, Konicek AL, Soy G, Olivas P, Fortea JI, Masnou H, Puente Á, Ardèvol A, Álvarez-Navascués C, Romero M, Scheiner B, Semmler G, Mandorfer M, Damião F, Baiges A, Turon F, Simón-Talero M, González-Alayón C, Díaz A, García-Criado Á, de Gottardi A, Reverter E, Blasi A, Genescà J, Roux O, Francoz C, Noronha Ferreira C, Reiberger T, Rodríguez M, Morillas RM, Crespo J, Trebicka J, Bañares R, Villanueva C, Berzigotti A, Primignani M, La Mura V, Riggio O, Schepis F, Procopet B, Verhelst X, Calleja JL, Bureau C, Albillos A, Nevens F, Hernández-Gea V, Tripathi D, Rautou PE, Durand F, and García-Pagán JC
- Subjects
- Humans, Creatinine, Neoplasm Recurrence, Local, Retrospective Studies, Liver Transplantation, Carcinoma, Hepatocellular, Vascular Diseases, Liver Neoplasms
- Abstract
Background: Porto-sinusoidal vascular liver disorder (PSVD) is a rare disease that occasionally requires liver transplantation (LT), despite usually presenting preserved liver function. There remains a paucity of data pertaining to LT in PSVD. The aim was to identify features associated with post-LT outcomes in PSVD., Methods: Retrospective multicentre study of 79 patients who received LT for PSVD., Results: Median post-LT follow-up was 37 (range 1-261) mo. Refractory ascites 24 (30%), hepatic encephalopathy 16 (20%), and hepatopulmonary syndrome 13 (16.3%) were the most frequent indications for LT. Hepatocellular carcinoma was the indication in only 2 patients. Twenty-four patients died, 7 due to liver and 17 to non-liver related causes. Post-LT survival was 82.2%, 80.7%, and 68.6% at 1, 2, and 5 y, respectively. Post-LT survival was significantly better in patients without (n = 58) than in those with a persistent severe PSVD-associated condition (n = 21). Pre-LT hyperbilirubinemia levels and creatinine >100 µmol/L were also independently associated with poor survival. Six patients (7.6%) required a second LT. Recurrence of PSVD was confirmed by liver biopsy in only 1 patient and in 3 further patients it was likely., Conclusions: LT in PSVD is associated with an acceptable outcome in the absence of associated severe conditions. However, persistence of a severe associated condition, pre-LT high bilirubin levels, or creatinine >100 µmol/L impact outcome, and these are features that should be considered when evaluating PSVD patients for LT. PSVD recurrence is possible after LT and needs to be explored, at least, in cases of posttransplant portal hypertension., Competing Interests: V.H.-G. received speaker fees from Gore. J.C.G.-P. advises for GORE, Cook, and Shionogi. The other authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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36. Extra-hepatic morbidity and mortality in alcohol-related liver disease: Systematic review and meta-analysis.
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Theodoreson MD, Aithal GP, Allison M, Brahmania M, Forrest E, Hagström H, Johansen S, Krag A, Likhitsup A, Masson S, McCune A, Rajoriya N, Thiele M, Rowe IA, and Parker R
- Subjects
- Humans, Morbidity, Cardiovascular Diseases, Liver Diseases, Fatty Liver, Alcoholic, Neoplasms, Liver Diseases, Alcoholic epidemiology
- Abstract
Background: Alcohol use increases the risk of many conditions in addition to liver disease; patients with alcohol-related liver disease (ALD) are therefore at risk from both extra-hepatic and hepatic disease., Aims: This review synthesises information about non-liver-related mortality in persons with ALD., Methods: A systematic literature review was performed to identify studies describing non-liver outcomes in ALD. Information about overall non-liver mortality was extracted from included studies and sub-categorised into major causes: cardiovascular disease (CVD), non-liver cancer and infection. Single-proportion meta-analysis was done to calculate incidence rates (events/1000 patient-years) and relative risks (RR) compared with control populations., Results: Thirty-seven studies describing 50 302 individuals with 155 820 patient-years of follow-up were included. Diabetes, CVD and obesity were highly prevalent amongst included patients (5.4%, 10.4% and 20.8% respectively). Outcomes varied across the spectrum of ALD: in alcohol-related fatty liver the rate of non-liver mortality was 43.4/1000 patient-years, whereas in alcoholic hepatitis the rate of non-liver mortality was 22.5/1000 patient-years. The risk of all studied outcomes was higher in ALD compared with control populations: The RR of death from CVD was 2.4 (1.6-3.8), from non-hepatic cancer 2.2 (1.6-2.9) and from infection 8.2 (4.7-14.3)., Conclusion: Persons with ALD are at high risk of death from non-liver causes such as cardiovascular disease and non-hepatic cancer., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2023
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37. Using global burden of hepatocellular cancer and liver cirrhosis as a driver to tackle preventable mortality and morbidity nationally and regionally.
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Bhala N, Ferguson JW, Rajoriya N, and Newsome PN
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- Humans, Liver Cirrhosis complications, Morbidity, Liver Neoplasms epidemiology, Liver Neoplasms prevention & control, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular prevention & control
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- 2023
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38. Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery.
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Abbas N, Fallowfield J, Patch D, Stanley AJ, Mookerjee R, Tsochatzis E, Leithead JA, Hayes P, Chauhan A, Sharma V, Rajoriya N, Bach S, Faulkner T, and Tripathi D
- Abstract
As a result of the increasing incidence of cirrhosis in the UK, more patients with chronic liver disease are being considered for elective non-hepatic surgery. A historical reluctance to offer surgery to such patients stems from general perceptions of poor postoperative outcomes. While this is true for those with decompensated cirrhosis, selected patients with compensated early-stage cirrhosis can have good outcomes after careful risk assessment. Well-recognised risks include those of general anaesthesia, bleeding, infections, impaired wound healing, acute kidney injury and cardiovascular compromise. Intra-abdominal or cardiothoracic surgery are particularly high-risk interventions. Clinical assessment supplemented by blood tests, imaging, liver stiffness measurement, endoscopy and assessment of portal pressure (derived from the hepatic venous pressure gradient) can facilitate risk stratification. Traditional prognostic scoring systems including the Child-Turcotte-Pugh and Model for End-stage Liver Disease are helpful but may overestimate surgical risk. Specific prognostic scores like Mayo Risk Score, VOCAL-Penn and ADOPT-LC can add precision to risk assessment. Measures to mitigate risk include careful management of varices, nutritional optimisation and where possible addressing any ongoing aetiological drivers such as alcohol consumption. The role of portal decompression such as transjugular intrahepatic portosystemic shunting can be considered in selected high-risk patients, but further prospective study of this approach is required. It is of paramount importance that patients are discussed in a multidisciplinary forum, and that patients are carefully counselled about potential risks and benefits., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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39. Comparable Overall Survival in Patients with Hepatocellular Carcinoma Diagnosed within and outside a Surveillance Programme: The Potential Impact of Liver Cirrhosis.
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Faulkes RE, Rehman Z, Palanichamy S, Zakeri N, Coldham C, Dasari BVM, Perera MTPR, Rajoriya N, Shetty S, and Shah T
- Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer death, and its incidence is rising. Mortality from HCC is predicted to increase by 140% by 2035. Surveillance of high-risk patients with cirrhosis or chronic liver disease may be one means of reducing HCC mortality, but the level of supporting evidence for international guidelines is low/moderate. This study explores the real-world experience of HCC surveillance at a tertiary referral centre. Electronic patient records for all new HCCs diagnosed between August 2012 and December 2021 were retrospectively reviewed. Patient and tumour characteristics were evaluated, including the co-existence of chronic liver disease, cancer treatment and survival, and categorised according to HCC diagnosis within or outside a surveillance programme. Patients with HCC who presented through surveillance had smaller tumours diagnosed at an earlier stage, but this did not translate into improved overall survival. All patients in surveillance had chronic liver disease, including 91% ( n = 101) with cirrhosis, compared to 45% ( n = 29) in the non-surveillance cohort. We propose that the immune dysfunction associated with cirrhosis predisposes patients to a more aggressive tumour biology than the largely non-cirrhotic population in the non-surveillance group.
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- 2023
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40. Cirrhosis and non-hepatic surgery in 2023 - a precision medicine approach.
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Morris SM, Abbas N, Osei-Bordom DC, Bach SP, Tripathi D, and Rajoriya N
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- Humans, Prospective Studies, Liver Cirrhosis surgery, Fibrosis, Precision Medicine, Hypertension, Portal etiology, Hypertension, Portal surgery
- Abstract
Introduction: Patients with liver disease and portal hypertension frequently require surgery carrying high morbidity and mortality. Accurately estimating surgical risk remains challenging despite improved medical and surgical management., Areas Covered: This review aims to outline a comprehensive approach to preoperative assessment, appraise methods used to predict surgical risk, and provide an up-to-date overview of outcomes for patients with cirrhosis undergoing non-hepatic surgery., Expert Opinion: Robust preoperative, individually tailored, and precise risk assessment can reduce peri- and postoperative complications in patients with cirrhosis. Established prognostic scores aid stratification, providing an estimation of postoperative mortality, albeit with limitations. VOCAL-Penn Risk Score may provide greater precision than established liver severity scores. Amelioration of portal hypertension in advance of surgery may be considered, with prospective data demonstrating hepatic venous pressure gradient as a promising surrogate marker of postoperative outcomes. Morbidity and mortality vary between types of surgery with further studies required in patients with more advanced liver disease. Patient-specific considerations and practicing precision medicine may allow for improved postoperative outcomes.
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- 2023
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41. Protocol for a case-control prospective study to investigate the impact of He patic E ncephalopathy on N utritional Intake and S arcopenia status in patients with end-stage LIV er disease: HENS-LIV study.
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Towey J, Ngonadi C, Rajoriya N, Holt A, Greig C, and Armstrong MJ
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- Humans, Female, Animals, Prospective Studies, Hand Strength, Case-Control Studies, Chickens, Eating, Sarcopenia complications, Hepatic Encephalopathy, End Stage Liver Disease complications, Frailty complications, Frailty diagnosis
- Abstract
Introduction: Hepatic encephalopathy (HE) is a debilitating symptom of end-stage liver disease (ESLD), but there remains a paucity of evidence regarding its impact on nutritional status, nutritional intake, compliance with nutritional support and resultant muscle health and function. Malnutrition and sarcopenia are associated with increased morbidity and mortality in patients with ESLD. The aim of the current case-control study is to prospectively investigate the impact of HE on nutritional intake and sarcopenia status in patients with ESLD., Methods and Analysis: Patients with ESLD, with HE (n=10) and without HE (n=10) will be recruited at the outpatient liver unit, University Hospital Birmingham, UK. All patients will undergo clinical assessment at baseline and again at 6-8 weeks (in-line with their routine clinical follow-up), to assess the impact of HE on reported nutritional intake, nutritional status and sarcopenia/physical functional status. Standard medical, dietetic and home-based exercise physiotherapy care will continue for all participants as determined by their clinical team. Two methods of assessing nutritional intake will include the 24-hour food recall and 3-day food diaries. Assessment of sarcopenia status will be undertaken using anthropometry (mid-arm muscle circumference (MAMC)) and ultrasound imaging of the quadriceps muscle group. Markers of physical function (hand grip strength; chair rise time), frailty (Liver Frailty Index (LFI)), physical activity (accelerometery) and exercise capacity (Duke Activity Status Index (DASI)) will be assessed at both clinic visits., Ethics and Dissemination: The study is approved by Wales Research Ethics Committee 2 and Health Research Authority (REC reference: 21/WA/0216). Recruitment into the study commenced November 2021. The findings will be disseminated through peer-reviewed publications and international presentations., Trial Registration Number: RRK7156., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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42. Outcomes of incoming and outgoing second opinions from a UK liver transplant centre.
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Parente A, Boyd A, Mahgoub S, Morris S, Webb K, Neuberger J, Armstrong MJ, and Rajoriya N
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- Humans, Liver, Referral and Consultation, United Kingdom epidemiology, Liver Transplantation adverse effects, Transplants
- Abstract
Objective: Second transplant centre opinions (STCOs) for patients declined for liver transplantation are infrequent. We aimed to identify STCOs outcomes from a tertiary transplant centre., Design: Referrals between 2012 and 2020 to Birmingham Unit were reviewed. Incoming: all referrals from out-of-region centres were collated. Outgoing: patients not listed in Birmingham were reviewed to identify referrals for STCOs to the other UK centres (A-F)., Results: 2535 patients were assessed for liver transplantation during the study period. Incoming: among 1751 referrals, 23 STCOs (17 unit A, 3 unit B, 1 unit C, 1 unit D and 1 unit E) were provided by Birmingham. Of the STCOs, 13/23 (57%) patients remained unsuitable for transplantation. Therefore, 10/23 (43%) underwent a second liver transplant assessment, of whom five (50%) were still deemed unsuitable, three (30%) listed (one transplanted) and two (20%) died preassessment. Outgoing: among 426 patients not listed, eight (1.8%) patients were referred for STCO (4 unit E, 2 unit B, 1 unit D, 1 unit A). Three (38%) were listed, two (25%) were assessed and declined, two (25%) were unsuitable for assessment and one (12.5%) died while waiting. Combining incoming and outgoing Birmingham STCOs (n=31), six (19%) of STCOs were listed in a second centre., Conclusion: Second transplant centre opinions are rare with the majority still deemed unsuitable for liver transplantation. This highlights potential resource implications especially when undergoing a full second formal assessment. A streamlined STCO process with sharing of investigations and use of telemedicine in appropriate patients may allow for greater transparency, quicker decision making and less use of labour-intensive resources., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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43. Acute-on-chronic liver failure (ACLF) in 2022: have novel treatment paradigms already arrived?
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Abbas N, Rajoriya N, Elsharkawy AM, and Chauhan A
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- Humans, Inflammation complications, Liver Cirrhosis complications, Prognosis, Syndrome, Acute-On-Chronic Liver Failure diagnosis, Acute-On-Chronic Liver Failure epidemiology, Acute-On-Chronic Liver Failure therapy, Liver Transplantation adverse effects
- Abstract
Introduction: Acute-on-chronic failure (ACLF) is a recognized syndrome in patients with chronic liver disease and is characterized by acute decompensation, organ failure(s), and a high short-term mortality. ACLF is often triggered by ongoing alcohol consumption, gastrointestinal bleeding and/or infections, and is pathophysiologically characterized by uncontrolled systemic inflammation coupled with paradoxical immunoparesis. Patients with ACLF require prompt and early recognition. Management requires extensive utilization of clinical resources often including escalation to intensive care., Areas Covered: Currently, there are no specific targeted treatments for established ACLF, and management revolves around treating underlying precipitants and providing organ support. In this article, we review the epidemiology and pathophysiology of ACLF and summarize recent advances in management strategies of this syndrome, focusing specifically on novel emerging therapies., Expert Commentary: ACLF is a challenging condition with rapid clinical course, high short-term mortality and varying clinical phenotypes. Management of ACLF is broadly focused on supportive care often in an intensive care setting with liver transplantation proving to be an increasingly relevant and effective rescue therapy. This disease has clear pathogenesis and epidemiological burden, thus distinguishing it from decompensated cirrhosis; there is clear clinical need for the development of specific and nuanced therapies to treat this condition.
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- 2022
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44. Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document.
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Macken L, Corrigan M, Prentice W, Finlay F, McDonagh J, Rajoriya N, Salmon C, Donnelly M, Evans C, Ganai B, Bedlington J, Steer S, Wright M, Hudson B, and Verma S
- Abstract
Palliative care remains suboptimal in advanced cirrhosis, in part relating to a lack of evidence-based interventions. Ascites remains the most common cirrhosis complication resulting in hospitalisation. Many patients with refractory ascites are not candidates for liver transplantation or transjugular intrahepatic portosystemic shunt, and therefore, require recurrent palliative large volume paracentesis in hospital. We review the available evidence on use of palliative long-term abdominal drains in cirrhosis. Pending results of a national trial (REDUCe 2) and consistent with recently published national and American guidance, long-term abdominal drains cannot be regarded as standard of care in advanced cirrhosis. They should instead be considered only on a case-by-case basis, pending definitive evidence. This manuscript provides consensus to help standardise use of long-term abdominal drains in cirrhosis including patient selection and community management. Our ultimate aim remains to improve palliative care for this under researched and vulnerable cohort., Competing Interests: Competing interests: SV: Rocket Medical plc provided the LTAD free of cost for the REDUCe trial. They were not involved in data collection or preparation of manuscript and nor will they be claiming any intellectual property based on the trial., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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45. Assessment of Deceased Brain Dead Donor Liver Grafts via Normothermic Machine Perfusion: Lactate Clearance Time Threshold Can Be Safely Extended to 6 Hours.
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Hann A, Lembach H, Nutu A, Mergental H, Isaac JL, Isaac JR, Oo YH, Armstrong MJ, Rajoriya N, Afford S, Bartlett D, Mirza DF, Hartog H, and Perera MTPR
- Subjects
- Brain Death, Humans, Lactic Acid, Liver surgery, Living Donors, Organ Preservation, Perfusion adverse effects, Liver Transplantation adverse effects
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- 2022
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46. Portal decompression with transjugular intrahepatic portosystemic shunt prior to nonhepatic surgery: a single-center case series.
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Goel A, Khanna A, Mehrzad H, Bach S, Karkhanis S, Kamran U, Morgan J, Rajoriya N, and Tripathi D
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- Adult, Aged, Child, Child, Preschool, Decompression, Humans, Middle Aged, Retrospective Studies, Treatment Outcome, Hepatic Encephalopathy etiology, Hepatic Encephalopathy prevention & control, Portasystemic Shunt, Transjugular Intrahepatic adverse effects
- Abstract
Background and Aims: Cirrhosis increases perioperative and postoperative mortality in nonhepatic surgery. Transjugular intrahepatic portosystemic shunt (TIPSS), by reducing portal pressure, may reduce intraoperative bleeding and postoperative decompensation. We report our experience of prophylactic TIPSS in nonhepatic surgery., Methods: Patients who underwent prophylactic TIPSS before nonhepatic surgery were identified from database with retrospective data collection via an e-patient record system. Primary outcome was discharged without hepatic decompensation after a planned surgery., Results: Twenty-one patients [age (median, range): 55, 33-76 years, Child's score: 6, 5-9] who underwent prophylactic TIPSS before nonhepatic surgery over a period of 9 years were included. All patients underwent successful TIPSS with a reduction in portal pressure gradient from 21.5 (11-35) to 16 (7-25) mmHg (P < 0.001). Immediate post-TIPSS complications were seen in 7 (33%) patients including hepatic encephalopathy in four. Eighteen patients (86%) underwent planned surgical intervention. Significant postoperative complications included hepatic encephalopathy (3), sepsis (2) and bleed (1). Two patients died postoperatively with multi-organ failure. The primary outcome was achieved in 12 (57%) patients. Post-TIPSS portal pressure gradient was significantly higher in patients with the adverse primary outcome. Over a follow-up period of 11 (1-78) months; 1-, 6- and 12-months' survival was 90, 80 and 76%, respectively., Conclusion: Prophylactic TIPSS is associated with complications in up to one-third of patients, with 57% achieving the primary outcome. Careful patient selection in a multidisciplinary team setting is essential. Multicentre studies are necessary before the universal recommendation of prophylactic TIPSS., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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47. COVID-19: Effect on gastroenterology and hepatology service provision and training: Lessons learnt and planning for the future.
- Author
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Anjum MR, Chalmers J, Hamid R, and Rajoriya N
- Subjects
- Delivery of Health Care, Humans, Pandemics, SARS-CoV-2, COVID-19, Gastroenterology
- Abstract
In late 2019, reports arose of a new respiratory disease in China, identified as a novel coronavirus, severe acute respiratory syndrome coronavirus 2. The World Health Organisation named the disease caused by the virus 'coronavirus disease 2019 (COVID-19)'. It was declared a pandemic in early 2020, after the disease rapidly spread across the world. COVID-19 has not only resulted in substantial morbidity and mortality but also significantly impacted healthcare service provision and training across all medical specialties with gastroenterology and Hepatology services being no exception. Internationally, most, if not all 'non-urgent' services have been placed on hold during surges of infections. As a result there have been delayed diagnoses, procedures, and surgeries which will undoubtedly result in increased morbidity and mortality. Outpatient services have been converted to remote consultations where possible in many countries. Trainees have been redeployed to help care for COVID-19 patients in other settings, resulting in disruption to their training - particularly endoscopy and outpatient clinics. This has led to significant anxiety amongst trainees, and risks prolongation of training. It is of the utmost importance to develop strategies that continue to support COVID-19-related service provision, whilst also supporting existing and future gastroenterology and Hepatology services and training. Changes to healthcare provision during the pandemic have generated new and improved frameworks of service and training delivery, which can be adopted in the post-COVID-19 world, leading to enhanced patient care., Competing Interests: Conflict-of-interest statement: All authors have no conflict of interests to declare., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2021
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48. Basiliximab With Delayed Tacrolimus Improves Short-Term Renal Outcomes Post-Liver Transplantation-a Real-World Experience.
- Author
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Boyd A, Brown A, Patel J, Nightingale P, Perera MTPR, Ferguson J, Neuberger J, and Rajoriya N
- Subjects
- Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Adrenal Cortex Hormones administration & dosage, Adult, Drug Therapy, Combination, Female, Graft Rejection epidemiology, Graft Survival drug effects, Humans, Immunosuppression Therapy methods, Incidence, Kidney drug effects, Liver Transplantation adverse effects, Male, Middle Aged, Mycophenolic Acid administration & dosage, Postoperative Complications epidemiology, Postoperative Complications etiology, Prospective Studies, Retrospective Studies, Treatment Outcome, Acute Kidney Injury prevention & control, Basiliximab administration & dosage, Immunosuppressive Agents administration & dosage, Postoperative Complications prevention & control, Tacrolimus administration & dosage
- Abstract
Background: Acute kidney injury (AKI) is common after liver transplantation (LT). Induction with interleukin-2 receptor antagonists is often used as a "renal-sparing" strategy. The aim of this study was to assess this approach in a real-world setting in an LT center., Methods: A retrospective cohort analysis of LTs between 2011 and 2018 was performed to assess the impact of a renal-sparing strategy using basiliximab in conjunction with mycophenolate mofetil and corticosteroids from day 0 post-LT along with delayed introduction of tacrolimus. This was compared with a group receiving tacrolimus, mycophenolate mofetil, and corticosteroids from the outset., Results: The renal-sparing regimen was associated with significantly lower incidence of all-stage AKI at day 7 post-LT (36% vs 55%, P = .006) and less decline in renal function at 3 months (39% vs 57%, P = .01). No further significant differences in renal outcomes were observed at other time points on follow-up to 1 year post-LT. There was no significant difference in the incidence of acute cellular rejection, inpatient length of stay or graft survival. The decision to adopt a renal-sparing regimen was predominantly made on a clinically reactive basis within the first 24 hours post-LT in 77%, and was preordained in 23%. Cost-effectiveness analysis did not find evidence of a significant cost saving when using a renal-sparing strategy., Conclusion: This study provides real-world analysis of the use of a renal-sparing immunosuppression regimen in LT. Although improvements in incidence of AKI in the short term were demonstrated, this did not translate to cost savings or improved renal outcomes after 3 months., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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49. Novel Use of Normothermic Machine Perfusion of the Liver: A Strategy to Mitigate Unexpected Clinical Events.
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Carvalheiro AP, McKay SC, Bartlett DC, Dronavalli VB, Thilekertane S, Dassanayake B, Kadam P, Boteon Y, Attard J, Rajoriya N, Trivedi P, Armstrong M, Moore R, Vasanth S, Bennett D, Murphy N, Singh H, Mirza DF, Rooney SJ, Ranasinghe AM, and Perera MTPR
- Subjects
- Adult, Humans, Male, Liver blood supply, Liver Transplantation methods, Organ Preservation methods, Perfusion methods
- Published
- 2020
- Full Text
- View/download PDF
50. Nutrition in alcohol-related liver disease: Physiopathology and management.
- Author
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Kamran U, Towey J, Khanna A, Chauhan A, Rajoriya N, and Holt A
- Subjects
- Humans, Liver Cirrhosis, Nutrition Assessment, Nutritional Status, Malnutrition etiology, Malnutrition therapy, Quality of Life
- Abstract
Malnutrition encompassing both macro- and micro-nutrient deficiency, remains one of the most frequent complications of alcohol-related liver disease (ArLD). Protein-energy malnutrition can cause significant complications including sarcopenia, frailty and immunodepression in cirrhotic patients. Malnutrition reduces patient's survival and negatively affects the quality of life of individuals with ArLD. Moreover, nutritional deficit increases the likelihood of hepatic decompensation in cirrhosis. Prompt recognition of at-risk individuals, early diagnosis and treatment of malnutrition remains a key component of ArLD management. In this review, we describe the pathophysiology of malnutrition in ArLD, review the screening tools available for nutritional assessment and discuss nutritional management strategies relevant to the different stages of ArLD, ranging from acute alcoholic hepatitis through to decompensated end stage liver disease., Competing Interests: Conflict-of-interest statement: No potential conflicts of interest. No financial support., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2020
- Full Text
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