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Current and future perspectives on acute-on-chronic liver failure: Challenges of transplantation, machine perfusion, and beyond

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World Journal of Gastroenterology 2022年第48期28卷 6922-6934页

作者： bianca della guardia Amanda P C S Boteon Celso E L Matielo Guilherme Felga Yuri L Boteon Liver Unit Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Instituto Israelita de Ensino e Pesquisa Albert Einstein Faculdade Israelita de Ciências da Saúde Albert EinsteinSão Paulo 05652-900Brazil

Acute-on-chronic liver failure(ACLF)is a syndrome that occurs in patients with chronic liver disease and is characterized by acute decompensation,organ failure and high short-term *** due to the lack of universal diagnostic criteria,the actual ACLF prevalence remains unclear;nevertheless,it is expected to be a highly prevalent condition *** transplantation is an effective protective measure for selected ACLF *** liver transplantation,diagnosing and treating precipitant events and providing supportive treatment for organ failures are currently the cornerstone of ACLF *** new clinical specific therapies have been researched,more studies are necessary to assess safety and ***,future ACLF management strategies must consider measures to improve access to liver transplantation because the time window for this life-saving therapy is frequently ***,an urgent and global discussion about allocation and prioritization for transplantation in critically ill ACLF patients is needed because there is evidence suggesting that the current model may not portray their waitlist *** addition,while donor organ quality is meant to be a prognostic factor in the ACLF setting,recent evidence suggests that machine perfusion of the liver may be a safe tool to improve the donor organ pool and expedite liver transplantation in this scenario.

关键词： Acute-on-chronic liver failure Liver cirrhosis Liver transplantation Machine perfusion Hypothermic oxygenated machine perfusion

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Exercise training as an intervention for frailty in cirrhotic patients on the liver transplant waiting list:A systematic review

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World Journal of Hepatology 2023年第10期15卷 1153-1163页

作者： Thais Mellato Loschi Melline D T A Baccan bianca della guardia Paulo N Martins Amanda P C S Boteon Yuri L Boteon Transplant Centre Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Instituto Israelita de Ensino e Pesquisa Albert Einstein Faculdade Israelita de Ciências da Saúde Albert EinsteinSão Paulo 05652-900Brazil Department of Surgery Transplant DivisionUniversity of Massachusetts Medical SchoolWorcesterMA 01655United States

BACKGROUND The existing literature suggests that exercise for cirrhotic patients is safe and favours significant improvement to their physical ***,exercise training for this population and how to deliver activities,especially in severe stages of the disease and while waiting for a liver transplant(LT),remain *** To review the existing exercise prescriptions for cirrhotic patients on the waiting list for LT,their results for frailty evolution and their effect on clinical *** A systematic review was performed following the Preferred Reporting Review and Meta-Analysis guidelines and searching the PubMed,MEDLINE,and Scopus *** keyword“liver transplant”was used in combination with the free terms“frailty”and“exercise”for the literature *** studies that evaluated the effect of a regular training program,independent of supervision or the duration or intensity of physical exercise,in cirrhotic patients on the waiting list for LT were *** data on safe physical activity prescriptions following Frequency,Intensity,Time,and Type recommendations were extracted and *** Nine articles met the inclusion criteria for this *** instruments for frailty assessment were used,frequently in *** studies prescribed physical activity for patients,one in-person and four to be performed remotely and *** remaining four studies only used a self-report instrument to assess the level of physical *** reported adverse events related to exercise *** exercise frequency mainly varied from daily to a minimum of twice per *** intensity depended on frailty and included increasing levels of *** type of exercise was predominantly a combination of aerobic and resistance *** duration of exercise varied from 4 to 12 *** articles evaluated the effect of the exercise program on clinical outcomes,reporting a reduction in 90-d readmission rates post-tran

关键词： End-stage liver disease Liver transplant Frailty Exercise Rehabilitation Sarcopenia

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Update on the management and treatment of viral hepatitis

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World Journal of Gastroenterology 2021年第23期27卷 3249-3261页

作者： Patricia Holanda Almeida Celso E L Matielo Lilian A Curvelo Rodrigo A Rocco Guilherme Felga bianca della guardia Yuri L Boteon Liver Unit Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Instituto Israelita de Ensino e Pesquisa Albert Einstein Faculdade Israelita de Ciências da Saúde Albert EinsteinSão Paulo 05652-900Brazil

This review aims to summarize the current evidence on the treatment of viral hepatitis,focusing on its clinical ***,future treatment options and areas of potential research interest are *** and Scopus databases were searched for primary studies published within the last ten *** included hepatitis A virus,hepatitis B virus(HBV),hepatitis C virus,hepatitis D virus(HDV),hepatitis E virus,and *** reported in the studies were summarized,tabulated,and *** advances in viral hepatitis treatment were accomplished,such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A,hepatitis B,and hepatitis E *** that cure hepatitis B,going beyond viral suppression,are so far unavailable;however,targeted antiviral drugs against HBV(immunomodulatory therapies and gene silencing technologies)are promising approaches to eradicating the ***,high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health *** development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B,albeit further investigation is *** therapeutic options targeting HDV life cycle are currently under clinical investigation.

关键词： Viral hepatitis Hepatitis A virus Hepatitis B virus Hepatitis C virus Hepatitis D virus Hepatitis E virus

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