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Eliminating viral hepatitis in children after liver transplants:How to reach the goal by 2030

World Journal of Gastroenterology 2022年第3期28卷 290-309页

作者： Palittiya Sintusek kessarin thanapirom Piyawat Komolmit Yong Poovorawan The Thai Pediatric Gastroenterology Hepatology and Immunology(TPGHAI)Research UnitChulalongkorn UniversityBangkok 10330Thailand Division of Gastroenterology Department of PediatricsFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand Division of Gastroenterology Department of MedicineLiver Fibrosis and Cirrhosis Research UnitFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Center of Excellence in Liver Diseases King Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand Center of Excellence in Clinical Virology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand

Viral hepatitis infections are a great burden in children who have received liver transplant.Hepatotropic viruses can cause liver inflammation that can develop into liver graft fibrosis and cirrhosis over the long term.Immunological reactions due to viral hepatitis infections are associated with or can mimic graft rejection,rendering the condition difficult to manage.Prevention strategies using vaccinations are agreeable to patients,safe,cost-effective and practical.Hence,strategies to eliminate viral hepatitis A and B focus mainly on immunization programmes for children who have received a liver transplant.Although a vaccine has been developed to prevent hepatitis C and E viruses,its use is not licensed worldwide.Consequently,eliminating hepatitis C and E viruses mainly involves early detection in children with suspected cases and effective treatment with antiviral therapy.Good hygiene and sanitation are also important to prevent hepatitis A and E infections.Donor blood products and liver grafts should be screened for hepatitis B,C and E in children who are undergoing liver transplantation.Future research on early detection of viral hepatitis infections should include molecular techniques for detecting hepatitis B and E.Moreover,novel antiviral drugs for eradicating viral hepatitis that are highly effective and safe are needed for children who have undergone liver transplantation.

关键词： Viral hepatitis Children Adolescent Liver transplantation Infection Elimination

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Validation of the albumin-bilirubin score for identifying decompensation risk in patients with compensated cirrhosis

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世界胃肠病学杂志:英文版 2023年第32期29卷 4873-4882页

作者： Huttakan Navadurong kessarin thanapirom Salisa Wejnaruemarn Thaninee Prasoppokakorn Roongruedee Chaiteerakij Piyawat Komolmit Sombat Treeprasertsuk Division of Gastroenterology Department of MedicineFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Department of Medicine Queen Savang Vadhana Memorial HospitalChonburi 20110Thailand

BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.AIM To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.METHODS One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020.A total of 113 patients(91.9%)had Child A cirrhosis with a median model for end-stage liver disease(MELD)score of less than 9.Baseline clinical and laboratory variables and decompensation events were collected.The ALBI score was calculated and validated to classify decompensation risk into low-,middle-,and high-risk groups using three ALBI grade ranges(ALBI grade 1:≤-2.60;grade 2:>-2.60 but≤-1.39;grade 3:>-1.39).Decompensation events were defined as ascites development,variceal bleeding,or grade 3 or 4 hepatic encephalopathy.RESULTS Among 123 cirrhotic patients enrolled,13.8%(n=17)developed decompensating events at a median time of 25[95%confidence interval(CI):17-31]mo.Median baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events[-2.768(-2.956 to-2.453)vs-2.007(-2.533 to-1.537);P=0.01].Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve(tAUC)of 0.86(95%CI:0.78-0.92),which was significantly better than that of ALBI-Fibrosis-4(ALBI-FIB4)score(tAUC=0.77),MELD score(tAUC=0.66),Child-Pugh score(tAUC=0.65),and FIB-4 score(tAUC=0.48)(P<0.05 for all).The 3-year cumulative incidence of decompensation was 3.1%,22.6%,and 50%in the low-,middle-,and high-risk groups,respectively(P<0.001).The odds ratio for decompensation in pat

关键词： Albumin-bilirubin score Compensated cirrhosis Hepatic decompensation risk

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Modified albumin-bilirubin predicted survival of unresectable hepatocellular carcinoma patients treated with immunotherapy

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World Journal of Gastrointestinal Oncology 2023年第10期15卷 1771-1783页

作者： Huttakan Navadurong Thaninee Prasoppokakorn Nanicha Siriwong Chonlada Phathong Nattaya Teeyapun Suebpong Tanasanvimon kessarin thanapirom Piyawat Komolmit Pisit Tangkijvanich Sombat Treeprasertsuk Roongruedee Chaiteerakij Department of Medicine Division of GastroenterologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand The Thai Red Cross Society Bangkok 10330Thailand Department of Medicine Division of OncologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence in Hepatitis and Liver Cancer Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology Division of GastroenterologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand

BACKGROUND Modified albumin-bilirubin(mALBI)grade has been established as a survival determinant in hepatocellular carcinoma(HCC)patients who receive locoregional and targeted therapies.AIM To investigate whether mALBI could predict survival in unresectable HCC(uHCC)patients who were treated with atezolizumab plus bevacizumab(AB).METHODS A single-center,retrospective cohort study enrolled uHCC patients who received AB treatment between September 2020 and April 2023 and were followed up until June 2023.An association between mALBI and patient survival was determined using Cox proportional hazards analysis.RESULTS Of the 83 patients,67 patients(80.7%)were male with the mean age of 60.6 years.Among them,22 patients(26.5%)were classified as Barcelona Clinic Liver Cancer B,and 61 patients(73.5%)were classified as Barcelona Clinic Liver Cancer C.Cirrhosis was present in 76 patients(91.6%),with 58 patients classified as Child-Turcotte-Pugh(CTP)A and 18 as CTP B.The median overall survival(OS)and progression-free survival were 13.0 mo[95%confidence interval(CI):5.2-20.8]and 9.0 mo(95%CI:5.0-13.0),respectively.The patients were divided into two groups based on mALBI grades:42 patients(50.6%)in the mALBI 1+2a group;and 41 patients(49.4%)in the mALBI 2b+3 group.During the median follow-up period of 7.0 mo,the mALBI 1+2a group exhibited significantly better survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 3.0 mo(95%CI:0.1-6.0,P<0.001).In a subgroup of patients with CTP A,the mALBI 1+2a group also showed significantly longer survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 6.0 mo(95%CI:3.4-8.6,P<0.001).In the multivariate analysis,both CTP class and mALBI grade were independently associated with survival,with adjusted hazard ratios(95%CI)of 2.63(1.19-5.78,P=0.020)and 3.90(1.71-8.90,P=0.001),respectively.CONCLUSION mALBI grades can determine survival of uHCC patients receiving AB treatment,particularly those who have mildly impaired liver function.This highlig

关键词： Unresectable hepatocellular carcinoma Atezolizumab plus bevacizumab Modified albumin-bilirubin grade Immunotherapy Liver function

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Non-alcoholic fatty liver disease (NAFLD) and the quest for effective treatments

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Hepatobiliary Surgery and Nutrition 2019年第1期8卷 77-79页

作者： kessarin thanapirom Emmanuel A.Tsochatzis UCL Institute for Liver and Digestive Health Royal Free Hospital and UCLLondonUK Division of Gastroenterology Department of MedicineFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThe Thai Red Cross SocietyBangkokThailand

Non-alcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease worldwide,affecting 24%of the population,and is impacting on global public health care with a considerable financial burden(1).NAFLD encompasses a wide disease spectrum ranging from simple steatosis to non-alcoholic steatohepatitis(NASH),fibrosis and cirrhosis.Patients with simple steatosis typically do not develop liver-related complications,whereas patients with NASH are at increased risk of hepatic and extra-hepatic mortality.Furthermore,NAFLD is associated with an increased risk of type 2 diabetes,cardiovascular disease and cancer(2).In addition,NASH is the second leading cause of cirrhosis in adult patients on the liver transplant waiting list in the United States(3,4).

关键词： NAFLD hepatic cirrhosis

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