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Strategies to reduce hepatitis C virus recurrence after liver transplantation

World Journal of Hepatology 2013年第5期5卷 237-250页

作者： Ruben Ciria mar.a pleguezuelo Shirin Elizabeth Khorsandi Diego Davila Abid Suddle Hector Vilca-Melendez Sebastian Rufian Manuel de la Mata Javier Briceo Pedro López Cillero Nigel Heaton Institute of Liver Studies King’s College HospitalLondon SE5 9RSUnited Kingdom Unit of Hepatology and Liver Transplantation University Hospital Reina Sofías/n 1400 CórdobaSpain Unit of Hepatobiliary Surgery and Liver Transplantation University Hospital Reina Sofías/n 1400 CórdobaSpain

Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graftoutcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients.

关键词： Hepatitis C virus Recurrence Liver Trans- plantation Outcomes

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Duodenal duplication cyst and pancreas divisum causing acute pancreatitis in an adult male

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World Journal of Gastrointestinal Endoscopy 2010年第9期2卷 318-320页

作者： Eduardo Redondo-Cerezo Julio pleguezuelo-Díaz Mercedes López de Hierro José F Macias-Sánchez Cristina Violo Ubia mar.a Del mar martín-Rodríguez Javier De TeresaGalván Endoscopy Unit Gastroenterology DepartmentHospital Universitario Virgen de las NievesAvenida de las Fuerzas Armadas 2Granada 18014Spain

Duodenal duplication cysts are rare congenital abnormalities which are more commonly diagnosed in infancy and ***,in rare cases,these lesions can remain asymptomatic until *** combination of duplication cyst and pancreas divisum is extremely rare and both conditions have been linked with acute recurrent *** present the case of a 37 years-old patient who presented with repeated episodes of acute *** means of magnetic resonance imaging and endoscopic ultrasonography we discovered a duplication cyst whose cavity received drainage from the dorsal *** opening the cyst cavity to the duodenal lumen with a needle knife the patient presented no further episodes in the clinical *** literature findings and therapeutic options for these abnormalities are discussed with regard to the presented case.

关键词： Duplication cyst Pancreas divisum Acute recurrent pancreatitis Endoscopic ultrasonography

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