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Management of concomitant hepatocellular carcinoma and chronic hepatitis C: a review

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Hepatoma Research 2019年第7期5卷 47-59页

作者： Elizabeth Harrod Carlos Moctezuma-Velazquez Ahmet Gurakar Aftab Ala Douglas Dieterich behnam saberi Icahn School of Medicine at Mount Sinai Division of Liver DiseasesNew YorkNY 10029USA Royal Surrey County Hospital NHS Foundation Trust Dept of Gastroenterology and HepatologyGuildfordSurrey 571122UK University of Surrey Dept of Clinical and Experimental and MedicineGuildfordSurrey GU27XHUK Johns Hopkins University School of Medicine Division of Gastroenterology and Hepatology-Transplant HepatologyBaltimoreMD 21287USA

Our comprehensive review focuses on the treatment of hepatitis C virus in the context of hepatocellular carcinoma and vice versa,highlighting the ongoing complexity of this clinical *** remain multiple unanswered questions when considering the management of these complex patients and,with a rapidly-changing treatment landscape for both chronic hepatitis C and hepatocellular carcinoma,these questions are only going to *** timing,interactions and the impact of one disease condition on the other are vitally important,though guidance generally remains non-specific,suggesting that we make these decisions on a case-by-case *** focus on the current evidence for managing these cases,depending on disease stage and treatment type.

关键词： Hepatocellular carcinoma liver cancer hepatitis C virus direct-acting antiviral agents

Influence of vitamin D on liver fibrosis in chronic hepatitis C: A systematic review and meta-analysis of the pooled clinical trials data

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World Journal of Hepatology 2017年第5期9卷 278-287页

作者： Alia S Dadabhai behnam saberi Katie Lobner Russell T Shinohara Gerard E Mullin Division of Gastroenterology and Hepatology the Johns Hopkins University School of Medicine Department of Biostatistics and Epide-miology Perelman School of Medicine University of Pennsylvania

AIM To investigate the relationship between vitamin D and liver fibrosis in hepatitis C-monoinfected or hepatitis C virus(HCV)-human immunodeficiency virus(HIV) coinfected patients. METHODS Pertinent studies were located by a library literature search in PubM ed/Embase/Cochrane/Scopus/LILACS by two individual reviewers. Inclusion criteria:(1) studies with patients with HCV or co-infected HCV/HIV;(2) studies with patients ≥ 18 years old;(3) studies that evaluated liver fibrosis stage, only based on liver biopsy; and(4) studies that reported serum or plasma 25(OH)D levels. Studies that included pediatric patients, other etiologies of liver disease, or did not use liver biopsy for fibrosis evaluation, or studies with inadequate data were excluded. Estimated measures of association reported in the literature, as well as corresponding measures of uncertainty, were recorded and corresponding odds ratios with 95%CI were included in a meta-analysis. RESULTS The pooled data of this systematic review showed that 9 of the 12 studies correlated advanced liver disease defined as a Metavir value of F3/4 with 25(OH) D level insufficiency. The meta-analysis indicated a significant association across *** Low vitamin D status is common in chronic Hepatitis C patients and is associated with advanced liver fibrosis.

关键词： Vitamin D Liver fibrosis Hepatitis C virus Chronic hepatitis C

Current Management of Alcoholic Hepatitis and Future Therapies

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Journal of Clinical and Translational Hepatology 2016年第2期4卷 113-122页

作者： behnam saberi Alia S.Dadabhai Yoon-Young Jang Ahmet Gurakar Esteban Mezey Division of Gastroenterology and Hepatology The Johns Hopkins University School of MedicineBaltimoreMDUSA Department of Oncology The Johns Hopkins University School of MedicineBaltimoreMDUSA

Alcohol is one of the most common etiologies of liver disease,and alcoholic liver disease overall is the second most common indication for liver transplantation in the United *** encompasses a spectrum of disease,including fatty liver disease,alcoholic hepatitis (AH),and alcoholic *** can range from mild to severe disease,with severe disease being defined as:Discriminant Function (DF) ≥ 32,or Model for End-stage Liver Disease (MELD) ≥ 21,or presence of hepatic *** of the mild disease consists mainly of abstinence and supportive *** AH is associated with significant ***,there is no ideal medical treatment for this *** alcohol cessation,corticosteroids have been used with conflicting results and are associated with an inherent risk of *** steroids have shown short term benefit when compared to placebo,but they have no obvious long term *** does not improve survival in patients with severe AH and is no longer recommended based on the results of the STOPAH (Steroid Or Pentoxifylline for Alcoholic Hepatitis) ***-tumor necrosis factor (TNF) agents are associated with increased risk of life threatening infections and ***,early stage trials are underway,mainly targeting novel pathways based on disease pathogenesis,including modulation of innate immune system,inhibition of gut-liver axis and cell death pathways,and activation of transcription factor farnesyl X receptor (FXR).Future treatment may lie in human induced pluripotent stem cell (iPSC)technology,which is currently under investigation for the study of pathogenesis,drug discovery,and stem cell *** transplantation has been reported with good results in highly selected patients but is controversial due to limited organ Suppply.

关键词： Alcoholic hepatitis Corticosteroids Liver transplantation Induced pluripotent stem cell

Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax:A systematic review and cumulative meta-analysis

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World Journal of Hepatology 2015年第13期7卷 1797-1806页

作者： Ivo C Ditah Badr F Al Bawardy behnam saberi Chobufo Ditah Patrick S Kamath Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States Department of Medicine University of Yaoundé I Faculty of Medicine

AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt(TIPSS) in refractory hepatic hydrothorax(RHH) in a systematic review and cumulative ***:A comprehensive literature search was conducted on MEDLINE,EMBASE,and Pub Med covering the period from January 1970 to August *** authors independently selected and abstracted data from eligible *** were summarized using a random-effects *** was assessed using the I2 ***:Six studies involving a total of 198 patients were included in the *** mean(SD) age of patients was 56(1.8) *** patients(56.9%) had Child-Turcott-Pugh class C *** mean duration of follow-up was 10 mo(range,5.7-16 mo).Response to TIPSS was complete in 55.8%(95%CI:44.7%-66.9%),partial in 17.6%(95%CI:10.9%-24.2%),and absent in 21.2%(95%CI:14.2%-28.3%).The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mm *** incidence of TIPSS-related encephalopathy was 11.7%(95%CI:6.3%-17.2%),and the 45-d mortality was 17.7%(95%CI:11.34%-24.13%).CONCLUSION:TIPSS is associated with a clinically relevant response in *** should be considered early in these patients,given its poor prognosis.

关键词： Cirrhosis Portal hypertension Hepatichydrothorax Transjugular intrahepatic portosystemicstent shunt Meta-analysis

Vitamin D levels do not predict the stage of hepatic fibrosis in patients with non-alcoholic fatty liver disease: A PRISMA compliant systematic review and meta-analysis of pooled data

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World Journal of Hepatology 2018年第1期10卷 142-154页

作者： behnam saberi Alia S Dadabhai Julie Nanavati Lin Wang Russell T Shinohara Gerard E Mullin Division of Gastroenterology and Hepatology The Johns Hopkins University School of Medicine Division of Liver Diseases Icahn School of Medicine at Mount Sinai Welch Medical Library The Johns Hopkins University School of Medicine Department of Epidemiology Johns Hopkins-Bloomberg School of Public Health Department of Biostatistics Epidemiology and Informatics Perelman School of Medicine University of Pennsylvania

AIM To investigate the relationship between 25-hydroxyvitamin D [25(OH)D] levels and fibrosis stage in patients with non-alcoholic fatty liver disease(NAFLD).METHODS Two individual reviewers identified relevant studies using the Pub Med, EMBASE, Cochrane, and Scopus databases. Inclusion criteria were as follows:(1) Studies that evaluated adults with NAFLD and serum or plasma 25(OH)D levels; and(2) assessed fibrosis stage using liver biopsy. A rigorous analysis yielded six articles as having sufficient data to employ in evaluating the association of serum vitamin D levels in patients with NAFLD based on their liver fibrosis stage by histopathological analysis. The lead investigators of each of the six studies were contacted and the data were collected. To meta-analyze vitamin D levels in F0-F2 vs F3-F4 fibrosis, a random-effects meta-analysis fit using restricted maximum likelihood was applied. To examine trends across each stage of fibrosis with respect to vitamin D levels, a meta-regression was performed. P < 0.05 was considered statistically significant. RESULTS A total of 937 subjects from six studies were included in the final analysis to evaluate the association of serum vitamin D levels in patients with NAFLD based on their liver fibrosis stage by histopathological analysis. The lead investigators of each of the six studies were contacted and the data were collected. First, the investigators performed a meta-analysis to compare serum vitamin D levels in patients with NAFLD with stage F0-F2 compared to F3-F4, which did not show significance [meta-estimate of the pooled mean difference =-0.86, P = 0.08(-4.17, 2.46)]. A metaregression evaluation of serum vitamin 25(OH)D levels across the individual stages(F0-F4) of fibrosis did not show an association for the six included *** Low vitamin D status is not associated with higher stages of liver fibrosis in patients with NAFLD.

关键词： Vitamin D 25-hydroxyvitamin D Liver fibrosis Meta-analysis Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis

Regional and National Trends of Adult Living Donor Liver Transplantation in the United States Over the Last Two Decades

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Journal of Clinical and Translational Hepatology 2022年第5期10卷 814-824页

作者： Saleh A.Alqahtani Ahmet Gurakar Hani Tamim Thomas D.Schiano Alan Bonder Zachary Fricker Marwan Kazimi Devin E.Eckhoff Michael P.Curry behnam saberi Johns Hopkins University Division of Gastroenterology and HepatologyBaltimoreMDUSA American University of Beirut Department of Internal MedicineBeirutLebanon Icahn School of Medicine at Mount Sinai Division of Liver DiseasesNew YorkNYUSA Beth Israel Deaconess Medical Center Harvard Medical SchoolBostonMAUSA

Background and Aims:Liver organ shortage remains a major health burden in the US,with more patients being waitlisted than the number of liver transplants(LTs)*** study investigated US national and regional trends in living donor LT(LDLT)and identified factors associated with recipient ***:We retrospectively analyzed LDLT recipients and donors from the United Network Organ Sharing/Organ Procurement Transplant Network database from 1998 until 2019 for clinical characteristics,demographic differences,and survival *** and regional trends in LDLT,recipient outcomes,and predictors of survival were ***:Of the 223,571 candidates listed for an LT,57.5%received an organ,of which only 4.2%were *** adult LDLTs first peaked at 412 in 2001 but experienced a significant decline to 168 by *** then gradually increased to 445 in *** 2 had the highest LDLT numbers(n=919),while region 1 had the highest proportion(11.1%).Overall,post-LT mortality was 21.4%among LDLT ***-LDLT survival rates after 1-,5-,and 10-years were 92%,87%,and 70%,*** analysis(2004–2019)showed that patients undergoing LDLT in recent years had lower mortality than in earlier years(hazard ratio=0.81,95%confidence interval=0.75–0.88).Conclusions:Following a substantial decline after a peak in 2001,the number of adult LDLTs steadily increased from 2011 to ***,LDLTs still constitute the minority of the transplant pool in the *** policies to increase the use of LDLTs,particularly in regions of high organ demand,should be implemented.

关键词： Living donor Liver transplantation Survival UNOS Organ demand

Recurrence of hepatocellular carcinoma following deceased donor liver transplantation:case series

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Hepatoma Research 2020年第3期6卷 31-40页

作者： Cem Simsek Amy Kim Michelle Ma Nilay Danis Merve Gurakar Andrew M.Cameron Benjamin Philosophe Jacqueline Garonzik-Wang Shane Ottmann Ahmet Gurakar behnam saberi Johns Hopkins University School of Medicine Division of Gastroenterology and Hepatology-Transplant HepatologyBaltimoreMD 21205USA Johns Hopkins University Bloomberg School of Public Health BaltimoreMD 21205USA Johns Hopkins University School of Medicine Division of Transplant SurgeryBaltimoreMD 21205USA

Aim:We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma ***:We reviewed the data for 26 patients who had tumor recurrence after deceased donor liver transplant for hepatocellular carcinoma at the Johns Hopkins Hospital from January 2005 to December ***:In total,88%of recipients were *** mean age was 59 *** explant,poor differentiation was detected in 43%,while 73%had microvascular ***,62%were diagnosed to be outside of Milan *** of these,15%met the criteria for ***(77%)patients had pre-transplant alpha fetoprotein levels≥20 ng/*** 54%of patients,the location of hepatocellular carcinoma(HCC)recurrence was extrahepatic,followed by intrahepatic in 31%and both intra-and extrahepatic in 15%.The post-transplant tumor recurrence was diagnosed at a mean of 427 days(range 34-1502).Fifty percent of HCC recurrences were diagnosed within one year following liver ***(77%)patients received treatment for their recurrent HCC:external radiation(n=10),surgical resections(n=8;brain 4,spine 2,bone 1,and Whipple surgery 1),sorafenib(n=7),locoregional therapy(n=5).Overall,24 out of 26(92%)recipients died within four years after the ***:HCC recurrence after liver transplant is *** than fifty percent of HCC recurrences following liver transplant are *** better recipient selection for liver transplant,the curative options are limited in recurrent cases and associated with extremely poor outcomes.

关键词： Hepatocellular carcinoma liver transplant liver resection locoregional therapy