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substantial hepatic necrosis is prognostic in fulminant liver failure

World Journal of Gastroenterology 2017年第23期23卷 4303-4310页

作者： Paul Ndekwe marwan s ghabril Yong Zang steven A Mann Oscar W Cummings Jingmei Lin Department of Pathology and Laboratory Medicine Indiana University School of Medicine Department of Internal Medicine Division of Gastroenterology and HepatologyIndiana University School of Medicine Department of Biostatistics Indiana University School of Medicine

To evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient ***-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation. The patients were grouped based on the etiology of hepatic necrosis. Each of the etiology groups were then further stratified according to whether or not they had received a liver transplant post-index biopsy, and whether or not the patient *** core tissue length ranged from 5 to 44 mm with an average of 23 mm. Causes of necrosis included 14 autoimmune hepatitis, 10 drug induced liver injury (DILI), 9 hepatitis virus infection, and 4 unknown origin. Among them, 11 showed submassive (26%-75% of the parenchymal volume) and 26 massive (76%-100%) necrosis. Transplant-free survival was worse in patients with a higher extent of necrosis (40%, 71.4% and 100% in groups with necrosis of 76%-100%, 51%-75% and 26%-50%, respectively). Additionally, transplant-free survival rates were 66.7%, 57.1%, and 25.0% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively. Even after liver transplantation, the survival rate in patients as a result of viral hepatitis remained the lowest (80%, 100%, and 40% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively).CONCLUsIONAdequate liver biopsy with more than 75% necrosis is associated with significant transplant-free mortality that is critical in predicting survival.

关键词： submassive necrosis Massive necrosis Fulminant liver failure Liver transplantation Biopsy Histopathology

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Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis: A meta-analysis

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World Journal of Hepatology 2015年第27期7卷 2774-2780页

作者： Jonathan G stine Puja M shah scott L Cornella sean R Rudnick marwan s ghabril George J stukenborg Patrick G Northup Division of Gastroenterology and Hepatology University of Virginia Department of surgery University of Virginia Department of Medicine University of Virginia Division of Gastroenterology and Hepatology Indiana University Department of Public Health science University of Virginia

AIM: To determine the clinical impact of portal vein thrombosis in terms of both mortality and hepatic decompensations(variceal hemorrhage, ascites, portosystemic encephalopathy) in adult patients with ***: We identified original articles reported through February 2015 in MEDLINE, scopus, science Citation Index, AMED, the Cochrane Library, and relevant examples available in the grey literature. Two independent reviewers screened all citations for inclusion criteria and extracted summary data. Random effects odds ratios were calculated to obtain aggregate estimates of effect size across included studies, with 95%***: A total of 226 citations were identified and reviewed, and 3 studies with 2436 participants were included in the meta-analysis of summary effect. Patients with portal vein thrombosis had an increased risk of mortality(OR = 1.62, 95%CI: 1.11-2.36, P = 0.01). Portal vein thrombosis was associated with an increased risk of ascites(OR = 2.52, 95%CI: 1.63-3.89, P s insufficient data available to determine the pooled effect on other markers of decompensation including gastroesophageal variceal bleeding or hepatic encephalopathy. CONCLUsION: Portal vein thrombosis appears to increase mortality and ascites, however, the relatively small number of included studies limits more generalizable conclusions. More trials with a direct comparison group are needed.

关键词： Hepatology Coagulopathy Liver Ascites Hepatic ence

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Incidence, risk factors and outcomes of de novo malignancies post liver transplantation

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World Journal of Hepatology 2016年第12期8卷 533-544页

作者： Pavan Kedar Mukthinuthalapati Raghavender Gotur marwan ghabrilmarwan ghabril Division of Gastroenterology and Hepatology Indiana University School of Medicine

Liver transplantation(LT) is associated with a 2 to7 fold higher, age and gender adjusted, risk of de novo malignancy. The overall incidence of de novo malignancy post LT ranges from 2.2% to 26%, and 5 and 10 years incidence rates are estimated at 10% to 14.6% and 20% to 32%, respectively. The main risk factors for de novo malignancy include immunosuppression with impaired immunosurveillance, and a number of patient factors which include; age, latent oncogenic viral infections, tobacco and alcohol use history, and underlying liver disease. The most common cancers after LT are non-melanoma skin cancers, accounting for approximately 37% of de novo malignancies, with a noted increase in the ratio of squamous to basal cell cancers. While these types of skin cancer do not impact patient survival, post-transplant lymphoproliferative disorders and solid organ cancer, accounting for 25% and 48% of malignancies, are associated with increased mortality. Patients developing these types of cancer are diagnosed at more advanced stages, and their cancers behave more aggressively compared with the general population. Patients undergoing LT for primary sclerosing cholangitis(particularly with inflammatory bowel disease) and alcoholic liver disease have high rates of malignancies compared with patients undergoing LT for other indications. These populations are at particular risk for gastrointestinal and aerodigestive cancers respectively. Counseling smoking cessation, skin protection from sun exposure and routine clinical follow-up are the current approach in practice. There are no standardized surveillance protocol, but available data suggests that regimented surveillance strategies are needed and capable of yielding cancer diagnosis at earlier stages with better resulting survival. Evidence-based strategies are needed to guide optimal surveillance and safe minimization of immunosuppression.

关键词： Liver transplant Immunosuppression Risk Outcomes Malignancy

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