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Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly

Hepatoma Research 2020年第6期6卷 41-57页

作者： Giovanni Marasco Antonio Colecchia Matteo Milandri Benedetta Rossini luigina vanessa alemanni Elton Dajti Federico Ravaioli Matteo Renzulli Rita Golfieri Davide Festi Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Unit of Gastroenterology Borgo Trento University Hospital of VeronaP.le Aristide Stefani 1Verona 37126Italy Radiology Unit Sant’Orsola Malpighi HospitalBologna 40138Italy

Post-hepatectomy liver failure(PHLF)is associated with great morbidity and mortality after resection of hepatocellular *** studies have underlined that advanced age could be a potential factor influencing post-operative complications and long-term *** the past,candidates for resection were based on the Child-Pugh classification,the predictive value of which was rather *** selection of patients undergoing resection in Western countries is based on the assessment of portal hypertension(PH),which is clinically assessed by measurement of the hepatic venous pressure gradient,an invasive and costly ***,there have been several attempts to identify the best non-invasive test(NIT)to accurately predict *** biochemical NITs for the prediction of PHLF are focused on evaluation of underlying liver cirrhosis and *** them,FIB-4,which also includes the patient's age,seems to have more robust supporting *** Europe and the USA.,the most tested and reliable NIT for predicting PHLF is the evaluation of liver stiffness measurement,which is also influenced by *** parameters are promising tools which are used only in specialized centers however,and when *** volume parameters,as well as contrast-enhanced data,demonstrate good accuracy in predicting *** this scenario,the evaluation of sarcopenia and bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly *** studies focused on parameters for the evaluation of PHLF in elderly patients are needed.

关键词： Post-hepatectomy liver failure liver resection elderly liver stiffness measurement indocyanine green retention test

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Non-invasive tests for the prediction of primary hepatocellular carcinoma

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World Journal of Gastroenterology 2020年第24期26卷 3326-3343页

作者： Giovanni Marasco Antonio Colecchia Giovanni Silva Benedetta Rossini Leonardo Henry Eusebi Federico Ravaioli Elton Dajti luigina vanessa alemanni Luigi Colecchia Matteo Renzulli Rita Golfieri Davide Festi Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Unit of Gastroenterology Borgo Trento University Hospital of VeronaVerona 37126Italy Radiology Unit Sant’Orsola Malpighi HospitalUniversity of BolognaBologna 40138Italy

Hepatocellular carcinoma(HCC)is one of the most common malignancies in the world and it is one of the main complications of cirrhosis and portal *** in the presence of a well-established follow-up protocol for cirrhotic patients,to date poor data are available on predictive markers for primary HCC occurrence in the setting of compensated advanced chronic liver disease patients(cACLD).The gold standard method to evaluate the prognosis of patients with cACLD,beyond liver fibrosis assessed with histology,is the measurement of the hepatic venous pressure gradient(HVPG).An HVPG≥10 mmHg has been related to an increased risk of HCC in cACLD ***,these methods are burdened by additional costs and risks for patients and are mostly available only in referral *** the last decade increasing research has focused on the evaluation of several,simple,non-invasive tests(NITs)as predictors of HCC *** reviewed the currently available literature on biochemical and ultrasound-based scores developed for the noninvasive evaluation of liver fibrosis and portal hypertension in predicting primary *** found that the most reliable methods to assess HCC risk were the liver stiffness measurement,the aspartate aminotransferase to platelet ratio index score and the fibrosis-4 *** promising NITs need further investigations and validation for different liver disease aetiologies.

关键词： Non-invasive test Fibrosis-4 index Hepatocellular carcinoma Liver stiffness measurement Spleen stiffness measurement Albi

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Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients

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World Journal of Hepatology 2018年第10期10卷 731-742页

作者： Federico Ravaioli Antonio Colecchia Elton Dajti Giovanni Marasco luigina vanessa alemanni Mariarosa Tamè Francesco Azzaroli Stefano Brillanti Giuseppe Mazzella Davide Festi Gastroenterology Unit Sant'Orsola-Malpighi University Hospital Department of Medical and Surgical Sciences (DIMEC) University of Bologna Unit of Gastroenterology Borgo Trento University Hospital

AIM To investigate changes in spleen stiffness measurements(SSMs) and other non-invasive tests(NITs) after treatment with direct-acting antivirals(DAAs) and identify predictors of SSM change after sustainedvirological response(SVR). METHODS We retrospectively analysed 146 advanced-chronic liver disease(ACLD) patients treated with DAA with available paired SSM at baseline and SVR24. Liver stiffness(LSM), spleen diameter(SD), platelet count(PLT) and liver stiffness-spleen diameter to platelet ratio score(LSPS) were also investigated. LSM ≥ 21 k Pa was used as a cut-off to rule-in clinically significant portal hypertension(CSPH). SSM reduction > 20% from baseline was defined as *** SSM significantly decreased at SVR24, in both patients with and without CSPH; in 44.8% of cases, SSM reduction was > 20%. LSPS significantly improved in the entire cohort at SVR24; SD and PLT changed significantly only in patients without CSPH. LSM significantly decreased in 65.7% of patients and also in 2/3 patients in whom SSM did not decrease. The independent predictor of decreased SSM was median relative change of LSM. CSPH persisted in 54.4% patients after SVR. Delta LSM and baseline SSM were independent factors associated with CSPH *** SSM and other NITs significantly decrease after SVR, although differently according to the patient's clinical condition. SSM faithfully reflects changes in portal hypertension and could represent a useful NIT for the follow-up of these patients.

关键词： Clinically significant portal hypertension Spleen stiffness measurement Advanced chronic liver disease Direct-acting antivirals Portal hypertension Hepatitis C Non-invasive test

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