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Liver transplant in primary sclerosing cholangitis:Current trends and future directions

World Journal of Hepatology 2023年第8期15卷 939-953页

作者： Yash R Shah Natalia Nombera-Aznaran David Guevara-Lazo Ernesto Calderon-Martinez Angad Tiwari srilakshmidevi kanumilli Purva Shah Bhanu Siva Mohan Pinnam Hassam Ali Dushyant Singh Dahiya Department of Internal Medicine Trinity Health OaklandPontiacMI 48341United States Faculty of Medicine Universidad Peruana Cayetano HerediaLima 15102Peru Department of Internal Medicine Universidad Nacional Autonoma de MexicoCiudad De Mexico 04510Mexico Department of Internal Medicine Maharani Laxmi Bai Medical CollegeJhansi 284001India Department of Internal Medicine GSL Medical CollegeRajamahendravaram 533296India Department of Postgraduate Education Harvard Medical SchoolBostonMA 02115United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Division of Gastroenterology Hepatology and MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States

Primary sclerosing cholangitis(PSC)is a chronic and progressive immunemediated cholangiopathy causing biliary tree inflammation and scarring,leading to liver cirrhosis and end-stage liver *** of PSC is challenging due to its nonspecific symptoms and overlap with other liver *** the rising incidence of PSC,there is no proven medical therapy that can alter the natural history of the *** liver transplantation(LT)is the most effective approach for managing advanced liver disease caused by PSC,post-transplantation recurrence of PSC remains a ***,ongoing research aims to develop better therapies for PSC,and continued efforts are necessary to improve outcomes for patients with *** article provides an overview of PSC’s pathogenesis,clinical presentation,and management options,including LT trends and future *** also highlights the need for improved therapeutic options and ethical considerations in providing equitable access to LT for patients with ***,the impact of liver transplant on the quality of life and psychological outcomes of patients with PSC is *** research into PSC’s pathogenesis and post-transplant recurrence is crucial for improved understanding of the disease and more effective treatment options.

关键词： Primary sclerosing cholangitis Liver transplantation Management Psychosocial outcomes Pathogenesis

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Role of fecal microbiota transplant in management of hepatic encephalopathy: Current trends and future directions

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World Journal of Hepatology 2024年第1期16卷 17-32页

作者： Yash R Shah Hassam Ali Angad Tiwari David Guevara-Lazo Natalia Nombera-Aznaran Bhanu Siva Mohan Pinnam Manesh Kumar Gangwani Harishankar Gopakumar Amir H Sohail srilakshmidevi kanumilli Ernesto Calderon-Martinez Geetha Krishnamoorthy Nimish Thakral Dushyant Singh Dahiya Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Maharani Laxmi Bai Medical CollegeJhansi 284001India Faculty of Medicine Universidad Peruana Cayetano HerediaLima 15102Peru Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Gastroenterology and Hepatology University of Illinois College of Medicine at PeoriaPeoriaIL 61605United States Department of Surgery University of New MexicoAlbuquerqueNM 87106United States Department of Internal Medicine GSL Medical CollegeRajamahendravaram 533296India Department of Internal Medicine Universidad Nacional Autonoma de MexicoCiudad De Mexico 04510Mexico Department of Digestive Diseases and Nutrition University of KentuckyLexingtonKY 40536United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States

Fecal microbiota transplantation(FMT)offers a potential treatment avenue for hepatic encephalopathy(HE)by leveraging beneficial bacterial displacement to restore a balanced gut *** prevalence of HE varies with liver disease severity and *** pathogenesis involves ammonia toxicity,gut-brain communication disruption,and *** aims to restore gut microbiota balance,addressing these ***'s efficacy has been explored in various conditions,including *** suggest that FMT can modulate gut microbiota,reduce ammonia levels,and alleviate *** has shown promise in alcohol-associated,hepatitis B and C-associated,and non-alcoholic fatty liver *** include improved liver function,cognitive function,and the slowing of disease ***,larger,controlled studies are needed to validate its effectiveness in these *** have shown cognitive improvements through FMT,with potential benefits in cirrhotic ***,trials have demonstrated reduced serious adverse events and cognitive enhancements in FMT arms compared to the standard of *** evidence is promising,challenges remain:Limited patient numbers,varied dosages,administration routes,and donor *** large-scale,controlled trials are essential to establish standardized guidelines and ensure FMT's clinical applications and *** FMT holds potential for HE management,ongoing research is needed to address these challenges,optimize protocols,and expand its availability as a therapeutic option for diverse hepatic conditions.

关键词： Hepatic encephalopathy Fecal microbiota transplant Cognitive impairment Liver cirrhosis Chronic liver disease

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