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Ohio solid organ transplantation consortium criteria for liver transplantation in patients with alcoholic liver disease

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World Journal of Hepatology 2016年第27期8卷 1149-1154页

作者： Kaveh Hajifathalian Annette Humberson Mohamad A Hanouneh David S Barnes Zubin Arora nizar N zein Bijan Eghtesad Dympna Kelly Ibrahim A Hanouneh Department of Internal Medicine Cleveland Clinic Foundation Department of Transplant Social Work Cleveland Clinic Foundation Department of Gastroenterology and Hepatology Cleveland Clinic Foundation Department of General Surgery Cleveland Clinic Foundation

AIM To evaluate risk of recidivism on a case-by-case *** From our center's liver transplant program,we selected patients with alcoholic liver disease who were listed for transplant based on Ohio Solid Organ Transplantation Consortium(OSOTC) exception *** were considered to have either a low or medium risk of recidivism,and had at least one or three or more months of abstinence,*** were matched based on gender,age,and Model for End-Stage Liver Disease(MELD) score to controls with alcohol-induced cirrhosis from Organ Procurement and Transplant Network *** Thirty six patients with alcoholic liver disease were approved for listing based on OSOTC exception criteria and were matched to 72 *** patients(53%) with a median [Inter-quartile range(IQR)] MELD score of 24(13) received transplant and were followed for a median of 3.4 *** were matched to 38 controls with a median(IQR) MELD score of 25(9).At one and five years,cumulative survival rates(± standard error) were 90% ± 7% and 92% ± 5% and 73% ± 12% and 77% ± 8% in patients and controls,respectively(Log-rank test,P = 0.837).Four(21%) patients resumed drinking by last follow-up *** Compared to traditional criteria for assessment of risk of recidivism,a careful selection process with more flexibility to evaluate eligibility on a case-by-case basis can lead to similar survival rates after transplantation.

关键词： Alcohol-induced disorders Alcoholic liver cirrhosis Mortality Survival Liver transplantation

Metabolomics studies identify novel diagnostic and prognostic indicators in patients with alcoholic hepatitis

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World Journal of Hepatology 2016年第10期8卷 499-508页

作者： Mona Ascha Zeneng Wang Mustafa S Ascha Raed Dweik nizar N zein David Grove J Mark Brown Stephanie Marshall Rocio Lopez Ibrahim A Hanouneh Department of Gastroenterology and Hepatology Cleveland Clinic Department of Cellular and Molecular Medicine Cleveland Clinic Department of Pulmonary Allergy and Critical Care Medicine/Respiratory Institute Cleveland Clinic Department of Quantitative Health Science Cleveland Clinic Minnesota Gastroenterology Min- neapolis

AIM: To identify plasma analytes using metabolomics that correlate with the diagnosis and severity of liver disease in patients with alcoholic hepatitis(AH).METHODS: We prospectively recruited patients with cirrhosis from AH(n = 23) and those with cirrhosis with acute decompensation(AD) from etiologies other than alcohol(n = 25). We used mass spectrometry to identify 29 metabolic compounds in plasma samples from fasted subjects. A receiver operating characteristics analysis was performed to assess the utility of biomarkers in distinguishing acute AH from alcoholic cirrhosis. Logistic regression analysis was performed to build a predictive model for AH based on clinical characteristics. A survival analysis was used to construct Kaplan Meier curves evaluating transplant-free ***: A comparison of model for end-stage liver disease(MELD)-adjusted metabolomics levels between cirrhosis patients who had AD or AH showed that patients with AH had significantly higher levels of betaine, and lower creatinine, phenylalanine, homocitrulline, citrulline, tyrosine, octenoyl-carnitine, and symmetric dimethylarginine. When considering combined levels, betaine and citrulline were highly accurate predictors for differentiation between AH and AD(area under receiver operating characteristics curve = 0.84). The plasma levels of carnitine [0.54(0.18, 0.91); P = 0.005], homocitrulline [0.66(0.34, 0.99); P < 0.001] and pentanoyl-carnitine [0.53(0.16, 0.90); P = 0.007] correlated with MELD scores in patients diagnosed with AH. Increased levels of many biomarkers(carnitine P = 0.005, butyrobetaine P = 0.32, homocitrulline P = 0.002, leucine P = 0.027, valine P = 0.024, phenylalanine P = 0.037, tyrosine P = 0.012, acetyl-carnitine P = 0.006, propionyl-carnitine P = 0.03, butyryl-carnitine P = 0.03, trimethyl-lisine P = 0.034, pentanoyl-carnitine P = 0.03, hexanoyl-carnitine P = 0.026) were associated with increased mortality in patients with AH. CONCLUSION: Metabolomics plasma anal

关键词： Metabolomics Biomarkers Liver disease Model for end-stage liver disease Cirrhosis Alcoholic hepatitis Liver biopsy

Hepatitis C treatment with triple therapy in a patient with hemophilia A

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World Journal of Clinical Cases 2013年第3期1卷 106-107页

作者： Gurshawn Singh Reuben Sass Rayan Alamiry nizar zein Naim Alkhouri Department of Internal Medicine Cleveland Clinic FoundationClevelandOH 44195United States Digestive Disease Institute Cleveland Clinic FoundationClevelandOH 44195United States

We report a case of successful treatment of chronic hepatitis C infection with telaprevir-based triple therapy in a patient with hemophilia A complicated by factor Ⅷ inhibitor. A twenty-two years old male with hereditary hemophilia A and high-titer factor Ⅷ inhibitor was taking maintenance doses of recombinant factor Ⅷ. He visited our clinic for treatment of his chronic hepatitis C with the newly instituted protease inhibitor based therapy. He was diagnosed with hepatitis C genotype 1a at one year of age. He was initiated on telaprevir, ribavirin and peg-interferon for treatment of hepatitis C and qualified for response-guided therapy. He completed treatment at 24 wk with minimal adverse effects. Notably, after 4 wk of hepatitis C treatment, his factor Ⅷ inhibitor screen was negative and the dose for recombinant factor Ⅷ decreased by half of the initial dosing before he was treated for hepatitis C. We suspect that suppressing hepatitis C may help decrease factor Ⅷ inhibitor level and the need for recombinant factor Ⅷ.

关键词： Hepatitis C virus Hemophilia FactorⅧ Telaprevir FactorⅧinhibitor Protease inhibitor

Alpha-1 antitrypsin deficiency and the risk of hepatocellular carcinoma in end-stage liver disease

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World Journal of Hepatology 2015年第10期7卷 1427-1432页

作者： Clara Antoury Rocio Lopez nizar zein James K Stoller Naim Alkhouri Department of Internal Medicine Cleveland Clinic Foundation Department of Quantitative Health Sciences Cleveland Clinic Foundation Department of Gastroenterology and Hepatology and Digestive Disease Institute Cleveland Clinic Foundation Departments of Pulmonary and Critical Care Respiratory Institute and Education InstituteCleveland Clinic Foundation

AIM:To evaluate the association between alpha-1 antitrypsin deficiency(A1ATD) and hepatocellular carcinoma(HCC) in patients with end-stage liver disease(ESLD).METHODS:Patients with cirrhosis and ESLD referred to the Cleveland Clinic Foundation for liver transplantation between 2003 and 2014 were included in the study(N = 675). ESLD was defined as having histological features of cirrhosis and/or radiological evidence of cirrhosis in the context of portal hypertension(ascites,variceal bleeding,thrombocytopenia,or hepatic encephalopathy). A1 ATD was diagnosed using phenotype characterization(MZ or ZZ),liver biopsy detection of PAS-positive diastaseresistant(PAS+) globules,or both. Patients with other causes of liver diseases such as hepatitis C virus(HCV),alcoholic liver disease and non-alcoholic steatohepatitis(NASH) or NASH were also included in the study. HCC was diagnosed by using imaging modalities,biopsy findings,or explanted liver inspection. Follow-up time was defined as the number of years from the diagnosis of cirrhosis to the diagnosis of hepatocellular carcinoma,or from the diagnosis of cirrhosis to the last follow up visit. The rate of HCC was assessed using time-tointerval analysis for interval censored ***:This study included 675 patients. 7% of subjects had A1ATD(n = 47). Out of all subjects who did not have A1 ATD,46% had HCV,17% had alcoholic liver disease,19% had NASH and 18% had another primary diagnosis. Of the 47 subjects with A1 ATD,15 had a primary diagnosis of A1ATD(PI*ZZ phenotype and PAS+ globules),8 had a PI*MZ phenotype alone,14 had PAS+ alone,and 10 had both the PI*MZ phenotype and PAS+. Median follow-up time was 3.4(25th,75 th percentiles:1,5.2) years. The overall rate of hepatocellular carcinoma in all subjects was 29%(n = 199). In the A1 ATD group,the incidence rate of HCC was 8.5% compared to 31% in the group of patients with other causes of cirrhosis(P = 0.001). Patients with ESLD due to A1 ATD had the lowest yearly cumulativ

关键词： Hepatocellular carcinoma Liver cirrhosis End-stage liver disease Hepatitis C virus Alpha-1antitrypsin deficiency

肝硬化进展的特性：丙型肝炎感染人群老龄化的意义

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传染病网络动态 2007年第12期 37-39页

作者： nizar N. zein MD 杨露绮（编译）

在发现丙型肝炎病毒（HCV）后的早几年，HCV在输血后肝炎中的主要作用以及暴露后所引起持续感染的趋势已得到广泛证实。经过这些早期观察后，医学科学界就HCV是否可能导致威胁生命的并发症或增加被感染宿主死亡率的问题进行大量的讨论... 详细信息

在发现丙型肝炎病毒（HCV）后的早几年，HCV在输血后肝炎中的主要作用以及暴露后所引起持续感染的趋势已得到广泛证实。经过这些早期观察后，医学科学界就HCV是否可能导致威胁生命的并发症或增加被感染宿主死亡率的问题进行大量的讨论。然而，令人注目的证据证明，HCV感染与肝硬化密切相关，而且可引起肝衰竭、肝细胞肝癌（HCC）的相关性并发症。随后一系列精心设计的研究提示，HCV感染病人的肝相关性死亡率有所上升。目前，已确定地认为HCV感染与实际发病率和死亡率有关，且代表着全球性的公共卫生问题。

关键词：丙型肝炎病毒感染人群肝硬化老龄化 HCV感染相关性并发症公共卫生问题输血后肝炎