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Hepatitis C virus related cirrhosis decreased as indication to liver transplantation since the introduction of direct-acting antivirals: A single-center study

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World Journal of Gastroenterology 2018年第38期24卷 4403-4411页

作者： Alberto Ferrarese Giacomo Germani Martina Gambato Francesco paolo Russo Marco Senzolo Alberto Zanetto Sarah Shalaby Umberto Cillo Giacomo Zanus paolo angeli Patrizia Burra Multivisceral Transplant Unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Hepatobiliary Surgery and Liver Transplant Unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Internal Medicine Department of Medicine Padua University Hospital

AIM To evaluate waiting list(WL) registration and liver transplantation(LT) rates in patients with hepatitis C virus(HCV)-related cirrhosis since the introduction of direct-acting antivirals(DAAs).METHODS All adult patients with cirrhosis listed for LT at Padua University Hospital between 2006-2017 were retrospectively collected using a prospectivelyupdated database; patients with HCV-related cirrhosis were divided by indication for LT [dec-HCV vs HCV/hepatocellular carcinoma(HCC)] and into two interval times(2006-2013 and 2014-2017) according to the introduction of DAAs. For each patient, indications to LT, severity of liver dysfunction and the outcome in the WL were assessed and compared between the two different time periods. For patients receiving DAA-based regimens, the achievement of viral eradication and the outcome were also evaluated. RESULTS One thousand one hundred and ninty-four [male(M)/female(F): 925/269] patients were included. Considering the whole cohort, HCV-related cirrhosis was the main etiology at the time of WL registration(490/1194 patients, 41%). HCV-related cirrhosis significantly decreased as indication to WL registration after DAA introduction(from 43.3% in 2006-2013 to 37.2% in 2014-2017, P = 0.05), especially amongst decHCV(from 24.2% in 2006-2013 to 15.9% in 2014-2017, P = 0.007). Even HCV remained the most common indication to LT over time(289/666, 43.4%), there was a trend towards a decrease after DAAs introduction(from 46.3% in 2006-2013 to 39% in 2014-2017, P = 0.06). HCV patients(M/F: 43/11, mean age: 57.7 ± 8 years) who achieved viral eradication in the WL had better transplant-free survival(log-rank test P = 0.02) and delisting rate(P = 0.002) than untreated HCV patients. CONCLUSION Introduction of DAAs significantly reduced WL registrations for HCV related cirrhosis, especially in the setting of decompensated cirrhosis.

关键词： Liver transplantation Hepatitis C Cirrhosis Sustained virological response

Covert hepatic encephalopathy: Agreement and predictive validity of different indices

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World Journal of Gastroenterology 2014年第42期20卷 15756-15762页

作者： Sara Montagnese Esmeralda Balistreri Sami Schiff Michele De Rui paolo angeli Giacomo Zanus Umberto Cillo Giancarlo Bombonato Massimo Bolognesi David Sacerdoti Angelo Gatta Carlo Merkel Piero Amodio Department of Medicine University of Padova Department of Surgical Oncological and Gastroenterological Sciences University of Padova

AIM: To investigate the agreement and prognostic value of different measures of covert hepatic encephalopathy (CHE).

关键词： Hepatic encephalopathy Electroencephalography Psychometry Ammonia Liver cirrhosis

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关于老老年人降压治疗的争论

中华高血压杂志 2010年第12期18卷 1189-1191页

作者： Reboldi Gianpaolo Gentile Giorgio angeli Fabio Verdecchia paolo 王新航机构不详

在发达国家,80岁以上老年人,即＂老老年人＂的构成比明显增加,人口老龄化趋势日益加剧。由于收缩压随年龄增长而增加,故老老年人是高血压的高发人群。老老年高血压患者接受降压治疗是否获益,目前尚无定论。

关键词：降压治疗老年人老年高血压患者人口老龄化发达国家高发人群构成比收缩压

Does Cyclosporine Down Regulate IL-17 in Cardiac Allograft Vasculopathy?

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Open Journal of Organ Transplant Surgery 2013年第1期3卷 1-4页

作者： Nandini Nair Luciano Potena Sandeep Kumar Sudhiranjan Gupta Enrique Gongora Federica angeli paolo Romani Central Texas VA Health Care System/Texas A&M Health Science Center College of Medicine Temple USA Department of Cardiology Scott & White Healthcare/Texas A&M Health Science Center College of Medicine Temple USA Department of Cardiology University of Bologna Bologna Italy Division of Cardiothoracic Surgery Hahnemann University Hospital/Drexel University College of Medicine Philadelphia USA

Background: Cardiac Allograft Vasculopathy (CAV) is characterized by vascular inflammation and intimal proliferation which results in luminal stenosis and myocardial infarction. During vascular inflammation elaboration of several cytokines and differential expression of growth factors have been noted. CAV remains the major threat to long-term graft survival. CD4 and CD8 T-cell subsets play a significant role in the development of transplant rejection. Chronic transplant rejection often leads to development of CAV. A new CD4 effector cell subset that produces IL-17 (Th17) has been shown to be up-regulated in the murine system in the setting of CAV. This study assesses the level of IL-17 in cardiac transplant patients with and without CAV as compared to nontransplanted controls. Methods: Levels of IL-17, IL-6, MCP-1 were measured by ELISA in plasma of four nontransplanted controls, nine cardiac allograft recipients with CAV (HT-GVD) and eight post transplant subjects without a diagnosis of CAV (HT-No GVD). All post transplant patients were immune suppressed with cyclosporine. HT-GVD patients were 1-15 years post transplant while HT-No GVD subjects were 1 - 10 years post transplant. Results: IL-17, MCP-1 and IL-6 were significantly down regulated in HT-GVD subjects compared to the HT-No GVD subjects (p 0.001) but not significant between controls and HT-No GVD (p = ns). Conclusions: A decrease in IL-17 in HT-GVD subjects as compared to HT-No GVD in the presence of cyclosporine treatment could be a consequence of down regulation of IL-6. It is likely that cyclosporine differentially regulates pro inflammatory molecules in the setting of graft vascular disease.

关键词： Allograft CD4 and CD8 T-Cells Cardiac Allograft Vasculopathy IL-17 Luminal Stenosis