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Hepatitis C Screening: Barriers to Linkage to Care

Journal of Clinical and Translational Hepatology 2019年第3期7卷 226-231页

作者： Sammy Saab Youssef PChallita Lisa MNajarian Rong Guo Satvir SSaggi gina choi Departments of Surgery University of California at Los AngelesLos AngelesCAUSA Departments of Medicine University of California at Los AngelesLos AngelesCAUSA Departments of Medicine Statistics Core University of California at Los AngelesLos AngelesCAUSA

Background andAims:Hepatitis C(HCV)is a medical and public health concern.Once infected individuals are identified,management includes not only education but also the use of antiviral therapy.Although screening for HCV is readily available,barriers exist which prevent assessment and treatment in individuals potentially infected with HCV.Methods:This is a retrospective study of patients screened for HCV within the University of California,Los Angeles Health Care System between February 22 and July 9,2018.We defined linkage to care as:1)confirmatory HCV RNA test after screening HCV antibody test found a positive result;and 2)follow-up appointment for treatment was established with a specialist.Demographic and baseline laboratory values were collected.Factors potentially associated with prohibiting linkage of care were evaluated.Results:During the study period,17,512 individuals were screened for HCV.A total of 238(1.35%)were found to have detectable HCV antibodies.Of the individuals with detectable HCV antibodies,48(20%)did not undergo confirmatory testing with viral levels.Of the 190 individuals who underwent further testing,70 patients were noted to be viremic.Among them,17 of the 70(24%)were not linked to a specialist for further care.Younger patients(p=0.02)and people who inject drugs(p=0.02)were less likely to be referred for specialty care.Conclusions:The results of our study highlight that younger patients and people who inject drugs are less likely to be referred to specialty care for HCV treatment.Efforts are needed to engage these populations.

关键词： Hepatitis C Screening Linkage

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Clinical Food Addiction Is Not Associated with Development of Metabolic Complications in Liver Transplant Recipients

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Journal of Clinical and Translational Hepatology 2017年第4期5卷 335-342页

作者： Sammy Saab Cameron Sikavi Melissa Jimenez Matthew Viramontes Ruby Allen Youssef Challita Michelle Mai Negin Esmailzadeh Jonathan Grotts gina choi Francisco Durazo Mohamed El-Kabany Steven-Huy Han Elisa Moreno Departments of Medicine the University of California at Los AngelesLos AngelesCAUSA Departments of Surgery the University of California at Los AngelesLos AngelesCAUSA Departments of Psychiatry the University of California at Los AngelesLos AngelesCAUSA

Background and Aims:Given the increased risk of posttransplant metabolic syndrome(PTMS;defined by hypertension,diabetes mellitus and hyperlipidemia),we aimed to identify the potential role of food addiction in the development of metabolic complications in the post-liver transplant population.Methods:Inclusion criteria included adult liver transplant recipients followed at our institution between June 2016 and November 2016.Participants were administered a demographic survey as well as the Yale Food Assessment Scale 2.0,a 35-item questionnaire used to assess frequency of food addiction in accordance with the DSM-V guidelines of substance use disorders.Demographic and clinical data were collected.Results:Our study included 236 liver transplant recipients(139 males,97 females).The median(interquartile range[IQR])BMI of participants was 26.8 kg/m2(24.2,30.4),and median(IQR)time since transplantation was 50.9 months(19.6,119.8).The prevalence rates of hypertension,hypercholesterolemia and diabetes mellitus were 54.7%,25.0%and 27.1%,respectively.Twelve participants(5.1%)were found to have a diagnosis of food addiction.A diagnosis of food misuse was made in 94(39.8%)of the transplant recipients.Conclusions:Our findings are consistent with prior data that indicate high prevalence of metabolic complications among liver transplant recipients.Food addiction was not predictive of metabolic complications within this population.Nevertheless,we found that this population was at high risk of demonstrating symptoms of food misuse,and they were not likely to appreciate the risks of pathologic patterns of eating.Given the increasing risk of cardiovascular morbidity and mortality in this population,efforts should be made to identify risk factors for the development of PTMS.

关键词： Food addiction Liver transplant Metabolic complications

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Decrease of Alpha-fetoprotein in Patients with Cirrhosis Treated with Direct-acting Antivirals

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Journal of Clinical and Translational Hepatology 2017年第1期5卷 43-49页

作者： Kelvin Nguyen Melissa Jimenez Nima Moghadam Crystal Wu Alex Farid Jonathan Grotts David Elashoff gina choi Francisco A.Durazo Mohamed M.El-Kabany Steven-Huy B.Han Sammy Saab Departments of Medicine the University of California at Los AngelesLos AngelesCAUSA Departments of Surgery the University of California at Los AngelesLos AngelesCAUSA Departments of Biostatistics the University of California at Los AngelesLos AngelesCAUSA

Background and Aims:The lack of specificity has limited the role of serum alpha-fetoprotein(AFP)for hepatocellular carcinoma(HCC)screening among patients with cirrhosis related to hepatitis C virus(HCV)infection.We sought to examine whether AFP may decrease after achieving a sustained virological response(SVR)in patients with HCV-related cirrhosis.Methods:We performed a retrospective study of patients with HCV-related cirrhosis who were cured with direct-acting antiviral(DAA)therapy at the University of California,Los Angeles.Laboratory values,including serum AFP,were measured before and after completing the DAA treatment.Results:Fifty-six patients met the inclusion criteria,with median(interquartile range[IQR])age of 67(58-69)years and with 51.8%being male.All patients received DAA therapy without interferon.AFP decreased from median(IQR)7.2(4.2-13.4)ng/mL before DAAs to 4.2(2.7-6.3)ng/mL at the end of treatment and 4.2(2.9-6.8)ng/mL at 12 weeks after treatment(P<0.001).Model for end-stage liver disease(MELD),fibrosis-4(FIB4),and aspartate transaminase(AST)to platelet ratio index(APRI)scores at baseline were not significantly associated with AFP reduction.On multivariate analysis,platelet count,AST and total bilirubin at baseline were significantly correlated to AFP reduction(P=0.04,0.009 and 0.04,respectively).The higher the baseline AFP,the greater the reduction in AFP.There was no statistically significant correlation between baseline AFP and MELD,FIB4 or APRI scores.Conclusion:There was a significant decrease in AFP in patients with cirrhosis who achieved a SVR with DAAs.Given a reduction in AFP after DAA treatment,AFP should be further studied as a screening modality for HCC in patients with cirrhosis.

关键词： Hepatitis C Hepatocellular carcinoma Screening Direct-acting antivirals

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Elimination of Hepatitis C in Liver Transplant Recipients

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Journal of Clinical and Translational Hepatology 2018年第3期6卷 247-250页

作者： Sammy Saab Youssef Challita Phillip H.Chen Melissa A.Jimenez Alex D.Lee Elena G.Saab Timothy Ahn gina choi Francisco A.Durazo Mohamed M.El-Kabany Steven-Huy B.Han Jonathan Grotts Vatche G.Agopian Ronald W.Busuttil Department of Medicine University of California at Los AngelesLos AngelesCaliforniaUSA Department of Surgery at the University of California at Los Angeles Los AngelesCaliforniaUSA

Background and Aims:Recurrent hepatitis C(HCV)disease in liver transplant(LT)recipients is associated with significant morbidity and mortality.With the availability of noninterferon-based therapy,eliminating HCV may be achievable in LT recip-ients.Methods:We studied all consecutive recipients who underwent LT at the University of California Los Angeles be-tween January 2005 and June 2017.We collected data on date of transplant and last follow-up,as well as laboratory values.We also recorded type and timing of antiviral therapy relative to LT.Analyses were performed to assess the proportion of LT recipi-ents who are viremic after transplant.Results:Six hundred thirty-four patients underwent LTwith a diagnosis of HCV.There was a statistically significant trend for patients to be cured be-fore(pginal LT:5.5%(n=28/510)and 1.5%(n=2/124)respec-tively for study periods 2005 to 2013 and 2014 to 2016 respec-tively(p=0.011).Conclusions:The proportion of LTrecipients who are viremic has decreased over time.Eliminating HCV in LT recipients is feasible after the introduction of direct-acting agents.Curing HCV should translate to improved clinical out-comes in LT recipients who were transplanted for HCV infection with longer follow-up.Preliminary results suggest the de-creased need for transplant in the direct-acting agents era.

关键词： Hepatitis C Direct-acting agents Liver transplant Elimination

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Limited Knowledge of Acetaminophen in Patients with Liver Disease

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Journal of Clinical and Translational Hepatology 2016年第4期4卷 281-287页

作者： Sarnrny Saab Peter G.Konyn Matthew R.Viramontes Melissa A.Jimenez Jonathan F.Grotts Wally Hamidzadah Veronica P.Dang Negin L.Esmailzadeh gina choi Francisco A.Durazo Mohamed M.El-Kabany Steven-Huy B.Han Myron J.Tong Department of Medicine the University of California at Los Angeles Los Angeles CA USA Department of Surgery the University of California at Los Angeles Los Angeles CA USA Department of Surgery the University of California at Los Angeles Los Angeles CA USA Department of Biostatistics the University of California at Los Angeles Los Angeles CA USA Department of Surgery the University of California at Los Angeles Los Angeles CA USA California and Huntington Medical Research Institutes Pasadena CA USA

Background andAims:Unintentional acetaminophen overdose remains the leading cause of acute liver failure in the United States.Patients with underlying liver disease are at higher risk of poor outcomes from acetaminophen overdose.Limited knowledge of acetaminophen may be a preventable contributor to elevated rates of overdose and thus acute liver failure.The purpose of this study is to assess knowledge of acetaminophen dosing and presence of acetaminophen in common combination products in patients with liver disease.Methods:We performed a cross-sectional study of patients with liver disease at the Pfleger Liver Institute at the University of California,Los Angeles between June 2015 and August 2016.Patients completed a demographic questionnaire and an acetaminophen knowledge survey.Additional information was obtained from the medical record.Results:Of 401 patients with liver disease,30 (15.7%) were able to correctly identify that people without liver disease can safely take up to 4 g/day of acetaminophen.The majority of patients (79.9%-86.8%) did not know that Norco(R) (hydrocone/acetaminophen),Vicodin(R) (hydrocone/acetaminophen) and Percocet(R) (oxycodone/acetaminophen) contained acetaminophen.Only 45.3% of the patients knew that Tylenol(R) #3 contained acetaminophen.Conclusions:We conclude that patients with liver disease have critically low levels of knowledge of acetaminophen,putting them at risk both of acetaminophen overdose,as well as undermedication,and inadequate management of chronic pain.We recommend an increase in education efforts regarding acetaminophen dosage and its safety in the setting of liver disease.Increasing education for those at risk of low acetaminophen knowledge is essential to minimizing acetaminophen overdose rates and optimizing pain management.

关键词： Acetaminophen Pain management Cirrhosis

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Effectiveness of Ledipasvir/Sofosbuvir with / without Ribavarin in Liver Transplant Recipients with Hepatitis C

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Journal of Clinical and Translational Hepatology 2017年第2期5卷 101-108页

作者： Sammy Saab Justin Rheem Melissa A.Jimenez Tiffany M.Fong Michelle H.Mai Caterina A.Kachadoorian Negin L.Esmailzadeh Sherona N.Bau Susan Kang Samantha D.Ramirez Jonathan Grotts gina choi Francisco A.Durazo Mohammed M.El-Kabany Steven-Huy B.Han Ronald W.Busuttil Departments of Medicine at the University of California at Los Angeles Los Angeles California USA Departments of Surgery at the University of California at Los Angeles Los Angeles California USA Department of Medicine at Harbor-University of California at Los Angeles Medical Center Torrance California USA Departments of Surgery at the University of California at Los Angeles Los Angeles California USA Department of Biostatistics at the University of California at Los Angeles Los Angeles California USA

Background and Aims:Recurrent infection of hepatitis C virus (HCV) in liver transplant (LT) recipients is universal and associated with significant morbidity and mortality.Methods:We retrospectively evaluated the safety and efficacy of ledipasvir/sofosbuvir with and without ribavirin in LT recipients with recurrent genotype 1 hepatitis C.Results:Eighty-five LT recipients were treated for recurrent HCV with ledipasvir/sofosbuvirwith and without ribavirin for 12 or 24 weeks.The mean (± standard deviation [SD]) time from LT to treatment initiation was 68 (±71) months.The mean (± SD) age of the cohort was 63 (±8.6) years old.Most recipients were male (70%).Baseline alanine transaminase,total bilirubin,and HCV ribonucleic acid (RNA) values (± SD) were 76.8 (±126)mg/dL,0.8 (±1.3) U/L,and 8,010,421.9 (±12,420,985)IU/mL,respectively.Five of 43 recipients who were treated with ribavirin required drug cessation due to side effects,with 4 of those being anemia complications.No recipient discontinued the ledipasvir/sofosbuvir.Eighty-one percent of recipients had undetectable viral levels at 4 weeks after starting therapy,and all recipients had complete viral suppression at the end of therapy.The sustained viral response at 12 weeks after completion of therapy was 94%.Conclusion:Ledipasvir and sofosbuvir with and without ribavirin therapy is an effective and well-tolerated interferon-free treatment for recurrent HCV infection after LT.Anemia is not uncommon in LT recipients receiving ribavirin.

关键词： Liver transplantation Immunosuppressant Hepatitis C Direct-acting agents Sustained viral response

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Curing Hepatitis C in Liver Transplant Recipients Is Associated with Changes in Immunosuppressant Use

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Journal of Clinical and Translational Hepatology 2016年第1期4卷 32-38页

作者： Sammy Saab Justin Rheem Melissa Jimenez Sherona Bau gina choi Francisco Durazo Mohammed El Kabany Steven Han Alexander Farid Naadir Jamal Jonathan Grotts David Elashoff Ronald W.Busuttil Departments of Medicine at the University of California at Los Angeles Los Angeles California USA Department of Surgery at the University of California at Los Angeles Los Angeles California USA Department of Medicine at Harbor-University of California at Los Angeles Medical Center Torrance California USA Departments of Medicine at the University of California at Los Angeles Los Angeles California USA Department of Surgery at the University of California at Los Angeles Los Angeles California USA Departments of Medicine at the University of California at Los Angeles Los Angeles California USA Department of Biostatistics at the University of California at Los Angeles Los Angeles California USA

Background and Aims:All-oral interlferon-free antivirals are highly effective in treating recurrent hepatitis C (HCV) infection in liver transplant (LT) recipients.The aim of the study was to assess immunosuppression needs after achieving a sustained viral response (SVR).Methods:We compared immunosuppression needs before and after achieving a SVR in adult LT recipients treated for recurrent HCV infection with alloral direct acting agents.Results:We identified 52 liver LT treated recipients who achieved a SVR.The median (25th and 75th percentile interquartile range [IQR]) age was 62 years (57.75,65).Most recipients received tacrolimus (TAC) for their immunosuppressant regimen.After achieving SVR,there was no statistically significant difference in daily dose of TAC unadjusted per weight (p > 0.05).However,there was a statistically significant decrease in daily dose of TAC adjusted per weight,serum levels of TAC,and the product of glomerular filtration rate and TAC.No statistically significant differences in cyclosporine unadjusted/adjusted per weight daily dose or serum levels were noted.Conclusions:Immunosuppression needs were increased for those patients treated with TAC but not cyclosporine.LT recipients prescribed TAC require close monitoring after treatment completion to avoid potential risk of acute rejection.

关键词： Liver transplantation Immunosuppressant Hepatitis C Direct acting agents

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A pilot study of radiologic measures of abdominal adiposity:weighty contributors to early pancreatic carcinogenesis worth evaluating?

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Cancer Biology & Medicine 2017年第1期14卷 66-73页

作者： Jennifer B.Permuth Jung W.choi Dung-Tsa Chen Kun Jiang gina DeNicola Jian-Nong Li Domenico Coppola Barbara A.Centeno Anthony Magliocco Yoganand Balagurunathan Nipun Merchant Jose G.Trevino Daniel Jeong Departments of Cancer Epidemiology Gastrointestinal Oncology Diagnostic Imaging and Interventional Radiology Biostatistics and Bioinformatics Anatomic Pathology Cancer Imaging and Metabolism Moffitt Cancer Center and Research InstituteTamPa 33612FLUSA Department of Surgery Sylvester Comprehensive Cancer Center at the University of Miami Miller School of MedicineMiami 33136FLUSA Department of Surgery Division of General SurgeryUniversity of Florida Health Sciences CenterGainesville 32611FLUSA

Objective:Intra-abdominal fat is a risk factor for pancreatic cancer(PC),but little is known about its contribution to PC precursors known as intraductal papillary mucinous neoplasms(IPMNs).Our goal was to evaluate quantitative radiologic measures of abdominal/visceral obesity as possible diagnostic markers of IPMN severity/pathology.Methods:In a cohort of 34 surgically-resected,pathologically-confirmed IPMNs(17 benign;17 malignant) with preoperative abdominal computed tomography(CT) images,we calculated body mass index(BMI) and four radiologic measures of obesity:total abdominal fat(TAF) area,visceral fat area(VFA),subcutaneous fat area(SFA),and visceral to subcutaneous fat ratio(V/S).Measures were compared between groups using Wilcoxon two-sample exact tests and other metrics.Results:Mean BMI for individuals with malignant IPMNs(28.9 kg/m^2) was higher than mean BMI for those with benign IPMNs(25.8 kg/m^2)(P=0.045).Mean VFA was higher for patients with malignant IPMNs(199.3 cm^2) compared to benign IPMNs(120.4cm^2),P=0.092.V/S was significantly higher(P=0.013) for patients with malignant versus benign IPMNs(1.25 vs.0.69 cm^2),especially among females.The accuracy,sensitivity,specificity,and positive and negative predictive value of V/S in predicting malignant IPMN pathology were 74%,71%,76%,75%,and 72%,respectively.Conclusions:Preliminary findings suggest measures of visceral fat from routine medical images may help predict IPMN pathology,acting as potential noninvasive diagnostic adjuncts for management and targets for intervention that may be more biologically-relevant than BMI.Further investigation of gender-specific associations in larger,prospective IPMN cohorts is warranted to validate and expand upon these observations.

关键词： Abdominal obesity pre-malignant lesions pancreatic cancer computed tomography

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