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Autoimmune Hepatitis Induced after Treatment of Syphilitic Hepatitis

Journal of Clinical and Translational Hepatology 2022年第1期10卷 174-177页

作者： Hasan Ali Taqi Rizvi mumtaz niazi Mark Galan Nikolaos Pyrsopoulos Department of Internal Medicine Rutgers University New Jersey Medical SchoolNewarkNJUSA Edward Via College of Osteopathic Medicine SpartanburgSCUSA Division of Gastroenterology and Hepatology Rutgers University New Jersey Medical SchoolNewarkNJUSA Department of Pathology Immunology and Laboratory MedicineRutgers University New Jersey Medical SchoolNewarkNJUSA

We present a unique case of biopsy-proven syphilitic hepa-titis which presented as severe acute liver injury with sig-nificant elevation in aminotransferases and bilirubin,and improved with antibiotic ***,the patient re-turned weeks after initial presentation with new-onset acute liver injury and had developed hypergammaglobulinemia,positive autoantibody titers,and repeat liver biopsy dem-onstrating interface hepatitis,supporting a diagnosis of autoimmune *** had an otherwise unrevealing etiologic workup,and responded to glucocorticoid *** believe that syphilitic hepatitis and its treatment sub-sequently triggered an immunogenic response,leading to autoimmune *** hepatitis is a chronic liver disease thought to manifest as a result of predisposing genetic factors in combination with environmental insults,especially hepatotropic *** is a sexually transmitted disease caused by Treponema pallidum that has been associated with autoimmunity and the develop-ment of *** propose that in the setting of syphilitic hepatitis,a molecular mimicry event resulting from structural similarities between *** and liver antigens,as well as impaired regulatory T-cell function,led to the breakdown of immune tolerance and the onset of au-toimmune *** support this hypothesis,further mo-lecular analyses and case series are necessary to determine if syphilitic hepatitis and its treatment are risk factors for the onset of autoimmune *** hepatitis should be considered early as the cause of acute liver injury in susceptible patients with risk factors for the disease,as prompt recognition and appropriate treatment may prevent progression of liver injury and result in improved outcomes.

关键词： Autoimmune hepatitis Syphilis Molecular mimicry

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Liver Transplantation Beyond Milan Criteria

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Journal of Clinical and Translational Hepatology 2020年第1期8卷 69-75页

作者： Vivek A Lingiah mumtaz niazi Raquel Olivo Flavio Paterno James V Guarrera Nikolaos T Pyrsopoulos Department of Medicine Division of Gastroenterology and HepatologyRutgers UniversityNew Jersey Medical SchoolNewarkNJUSA Department of Surgery Division of Liver Transplantation and Hepatobiliary SurgeryRutgers UniversityNew Jersey Medical SchoolNewarkNJUSA

Hepatocellular carcinoma(HCC)is one of the leading causes of cancer-related death worldwide,being the fifth most common cancer and the third most common cause of cancer-related *** incidence of HCC has been rising in the USA over the last 20 *** transplanta-tion is an optimal treatment option,as it eliminates HCC as well as the underlying liver *** Milan criteria(1 lesion greater than or equal to 2 cm and less than or equal to 5 cm,or up to 3 lesions,each greater than or equal to 1 cm and less than or equal to 3 cm)have been adopted by many transplant societies worldwide as the criteria to determine whether patients with HCC can move forward with liver ***,many believe that the Milan criteria may be too strict in regard to its size require-ments for *** has led to a number of expanded criteria for liver transplantation,concerning both overall size and number of lesions,as well as incorporation of other markers of tumor *** markers,such as alpha-fetoprotein,can also be used to follow treatment of HCC and possibly exclude patients from *** presenting beyond Milan criteria can also be down-staged with locore-gional *** response to locoregional therapy and longer wait times after locoregional therapy prior to transplant can serve as surrogate markers of tumor biology as well.

关键词： Hepatocellular carcinoma Liver transplantation Cancer staging Tumor burden Alpha-fetoprotein

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Hepatitis E in immunocompromised individuals

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World Journal of Hepatology 2022年第3期14卷 482-494页

作者： Konstantinos Damiris Mohamad Aghaie Meybodi mumtaz niazi Nikolaos Pyrsopoulos Department of Medicine Rutgers-New Jersey Medical SchoolNewarkNJ 07103United States Department of Medicine-Gastroenterology and Hepatology Rutgers-New Jersey Medical SchoolNewarkNJ 07103United States

Hepatitis E virus(HEV)originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United *** there are eight identified genotypes to date,genotype 1(HEV1),HEV2,HEV3,HEV4 are the most common to infect ***1 and HEV2 are most common in developing countries including Latina America,Africa and Asia,and are commonly transmitted through contaminated water supplies leading to regional *** contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked *** incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available *** majority of cases,HEV infection is a selflimiting hepatitis requiring only symptomatic ***,this is not the case in immunocompromised individuals,including those that have undergone solid organ or stem cell *** this subset of patients,chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and *** need for re-transplantation as a result of post-transplant hepatitis is of great *** addition,there have been many reported incidents of extrahepatic manifestations,for which the exact mechanisms remain to be *** cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies,while attempting to minimize the risk of organ *** treatment options include ribavirin,and pegylated interferon alpha in those who have demonstrated ribavirin *** investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health *** this concern,vaccination has been approved in Chin

关键词： Hepatitis E Hepatitis E virus Chronic hepatitis Acute hepatitis Immunocompromised Liver transplant

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Trends in hospitalization for alcoholic hepatitis from 2011 to 2017:A USA nationwide study

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World Journal of Gastroenterology 2022年第34期28卷 5036-5046页

作者： Ali Wakil Mujtaba Mohamed Zaid Tafesh mumtaz niazi Raquel Olivo Weiyi Xia Patricia Greenberg Nikolaos Pyrsopoulos Department of Gastroenterology and Hepatology Rutgers New Jersey Medical SchoolNewarkNJ 07103USA Department of Gastroenterology and Hepatology Marshall University HospitalHuntingtonWV 25701USA Department of Biostatistics&Epidemiology Rutgers School of Public HealthPiscatawayNJ 08854USA

BACKGROUND Severe alcoholic hepatitis(AH)is one of the most lethal manifestations of alcoholassociated liver *** light of the increase in alcohol consumption worldwide,the incidence of AH is on the rise,and data examining the trends of AH admission is *** To examine inpatient admission trends secondary to AH,along with their clinical outcomes and epidemiological *** The National Inpatient Sample(NIS)database was utilized,and data from 2011 to 2017 were *** included individuals aged≥21 years who were admitted with a primary or secondary diagnosis of AH using the International Classification of Diseases(ICD)-9 and its correspondent ICD-10 *** not related to alcohol was *** national estimates of inpatient admissions were obtained using sample weights provided by the *** AH-related hospitalization demonstrated a significant increase in the USA from 281506(0.7%of the total admission in 2011)to 324050(0.9%of the total admi-ssion in 2017).The median age was 54 *** most common age group was 45–65 years(range 57.8%–60.7%).The most common race was white(63.2%–66.4%),and patients were predominantly male(69.7%–71.2%).The primary healthcare payers were Medicare(29.4%–30.7%)and Medicaid(21.5%–32.5%).The most common geographical location was the Southern USA(33.6%–34.4%).Most patients were admitted to a tertiary care center(50.2%–62.3%)located in urban *** of AH in this inpatient sample was 5.3%in 2011 and 5.5%in *** most common mortality-associated risk factors were acute renal failure(59.6%–72.1%)and gastrointestinal hemorrhage(17.2%–20.3%).The total charges were noted to range between$25242.62 and$*** The number of AH inpatient hospitalizations significantly increased from 2011 to *** could have a substantial financial impact with increasing healthcare costs and ***-mortality remained the same.

关键词： Alcoholic hepatitis Cirrhosis Fatty liver disease Alcohol abuse

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An extended treatment protocol with pegylated interferon and ribavirin for hepatitis C recurrence after liver transplantation

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World Journal of Hepatology 2011年第7期3卷 198-204页

作者： Nikroo Hashemi Victor Araya Kashif Tufail Laxmi Thummalakunta Eyob Feyssa Ashaur Azhar mumtaz niazi Jorge Ortiz Division of Hepatology Center for Liver Disease and TransplantationAlbert Einstein Medical Center Division of Transplant Surgery Center for Liver Disease and TransplantationAlbert Einstein Medical Center

AIM: To evaluate the efflicacy and tolerability of an extended treatment protocol and to determine the predictors of sustained virological response (SVR) after liver transplantation (LT).METHODS: Between August 2005 and November 2008, patients with recurrent hepatitis C virus (HCV) after LT were selected for treatment if liver biopsy showed at least grade 2 inflammation and/or stage 2 flibrosis. All patients were to receive pegylated interferon (PEG)/regimens combining ribavirin (RBV) for an additional 48 wk after HCV ***: Extended protocol treatment was initiated in thirty patients. Overall, 73% had end of treatmentresponse and 60% had SVR. Nineteen patients completed treatment per protocol, of them, sixteen (84%) had end of treatment response, and fourteen (74%) achieved SVR. Both early virological response and 24-week virological response were individually associated with SVR but this association was not signif icant on multivariate analysis. Eleven patients (37%) discontinued therapy due to adverse effects. Cytopenias were the most common and most severe adverse effect, and required frquent growth factor use, dose adjustments and treatment cessations. The risk of rejection was not ***: Recurrent HCV after LT can be safely treated with extended virological responseguided therpy using PEG/RBV, but requires close monitoring for treatment-related adverse effects, particularly cytopenias.

关键词： Hepatitis C virus Liver transplantation Extended treatment protocol

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Liver transplant allocation policies and outcomes in United States: A comprehensive review

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World Journal of Methodology 2022年第1期12卷 32-42页

作者： Nyan L Latt mumtaz niazi Nikolaos T Pyrsopoulos Division of Gastroenterology and Hepatology Department of MedicineRutgers-New Jersey Medical SchoolNewarkNJ 07101-1709United States

Liver transplant allocation policies in the United States has evolved over 3 *** donor liver organs are matched,allocated and procured by the Organ Procurement and Transplantation Network which is administered by the United Network of Organ Sharing(UNOS),a not-for-profit organization governed by the United States human health *** reviewed the evolution of liver transplant allocation *** to 2002,UNOS used Child-Turcotte-Pugh score to list and stratify patients for liver transplantation(LT).After 2002,UNOS changed its allocation policy based on model for end-stage liver disease(MELD)*** serum sodium is the independent indicator of mortality risk in patients with chronic liver *** priority assignment of MELD-sodium score resulted in LT and prevented mortality on ***-Sodium score was implemented for liver allocation policy in *** to the current and most recent policy,livers from adult donors were matched first to the status 1A/1B patients located within the boundaries of the UNOS regions and donor-service areas(DSA).We reviewed the disadvantages of the DSA-based allocation policies and the advantages of the newest acuity circle allocation *** then reviewed the standard and non-standard indications for MELD exceptions and the decision-making process of the National Review Liver Review ***,we reviewed the liver transplant waitlist,donation and survival outcomes in the United States.

关键词： Liver transplant Allocation Distribution Waiting list Policies Acuity circles Transplant exceptions National Review Liver Review Board

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A Case Report of Alloimmune Hepatitis after Direct-acting Antiviral Treatment in a Liver Transplant Patient

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Journal of Clinical and Translational Hepatology 2020年第4期8卷 459-462页

作者： Catherine Choi Youssef Botros Jamil Shah Pei Xue Anja Jones Mark Galan Raquel Olivo mumtaz niazi Flavio Paterno James Guarrera Nikolaos T.Pyrsopoulos Department of Internal Medicine Rutgers New Jersey Medical SchoolNewarkNJUSA Division of Gastroenterology St.Joseph’s University Medical CenterPatersonNJUSA Division of Gastroenterology&Hepatology The Brooklyn Hospital CenterBrooklynNYUSA Rutgers New Jersey Medical School NewarkNJUSA Department of Pathology Immunology&Laboratory MedicineRutgers New Jersey Medical SchoolNewarkNJUSA Division of Gastroenterology&Hepatology Department of MedicineRutgers New Jersey Medical SchoolNewarkNJUSA Division of Liver Transplantation&Hepatobiliary Surgery Department of SurgeryRutgers New Jersey Medical SchoolNewarkNJUSA

Direct-acting antiviral (DAA) therapy is often well-tolerated, and adverse events from DAA therapy are uncommon. We report a case of a woman who underwent orthotopic liver transplant for chronic hepatitis C infection and later devel-oped alloimmune hepatitis shortly after starting DAA therapy for recurrent hepatitis C infection. The patient developed acute alloimmune hepatitis approximately 2 weeks after starting treatment with sofosbuvir, velpatasvir, and voxilap-revir. This case report proposes a dysregulation of immune surveillance due to the DAA stimulation of host immunity and rapid elimination of hepatitis C viral load as a precipitating factor for the alloimmune process, leading to alloimmune hepatitis in a post-transplant patient who starts on DAA.

关键词： Autoimmune hepatitis Hepatitis C Liver transplant

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Guillain-Barre syndrome associated with peginterferon alfa-2a for chronic hepatitis C: A case report

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World Journal of Hepatology 2010年第4期2卷 162-166页

作者： mumtaz A niazi Ashaur Azhar Kashif Tufail Eyob L Feyssa Stephen F Penny Marlene McGregory Victor Araya Jorge A Ortiz Center for Liver Disease and Transplantation Albert Einstein Healthcare Network Philadelphia PA 19141 United States Bay Health Medical Center Dover DE 19901 United States

The recommended therapy for chronic hepatitis C (CHC) infection is the combination of a Pegylated interferon and Ribavirin. Almost all such patients on combination therapy experience one or more adverse events during the course of treatment. Significant neurological side effects are rare. A few cases of Bell's Palsy, chronic inflammatory demyelinating polyneuropathy and even one case of acute demyelinating polyneuropathy with atypical features for Guillain-Barre syndrome (GBS) associated with Interferon therapy have been reported but no report of GBS with typical features has been published. We present a case report of typical GBS associated with Peginterferon alfa-2a and Ribavirin used for treatment of CHC infection.

关键词： Guillain-Barre syndrome Polyneuropathy Acute demyelinating polyneuropathy Pegylated interferon Chronic hepatitis C

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