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Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction: A prospective study

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World Journal of Hepatology 2017年第27期9卷 1125-1132页

作者： Charlotte Nicolas Amelie Le Gouge Louis d’Alteroche Jean Ayoub Monica Georgescu Vincent Vidal denis castaing Jean-Pierre Cercueil Patrick Chevallier Jerome Roumy Herve Trillaud Louis Boyer Vincent Le Pennec Christophe Perret Bruno Giraudeau Jean-Marc Perarnau STIC-TIPS group Service d’Hepato-Gastroenterologie Hopital TrousseauCHRU Tours CIC CHRU de Tours INSERM United’echographie-doppler Hopital TrousseauCHRU Tours Service de Radiologie Hopital de la Timone Centre Hepato-Biliaire Hopital Paul Brousse Service de Radiologie CHRU Dijon Service d’Imagerie Medicale Diagnostique et interventionnelle Hopital de l’ArchetⅡNice Service de Radiologie et Echographie CHRU Poitiers Service d’Imagerie Medicale Hopital Saint Andre CHRU Bordeaux Service d’Imagerie viscerale et vasculaire CHRU Clermont Ferrand Service de Radiologie CHRU Caen Service de Radiologie CHRU Nantes 不详

AIM To prospectively evaluate the performance of Dopplerultrasonography(US) for the detection of transjugular intrahepatic portosystemic shunt(TIPS) dysfunction within a multicenter cohort of cirrhotic *** This study was conducted in 10 french teaching hospitals. After TIPS insertion, angiography and liver Doppler-US were carried out every six months to detect dysfunction(defined by a portosystemic gradient ≥ 12 mm Hg and/or a stent stenosis ≥ 50%). The association between ultrasonographic signs and dysfunction was studied by logistic random-effects models, and the diagnostic performance of each Doppler criterion was estimated by the bootstrap method. This study was approved by the ethics committee of *** Two hundred and eighteen pairs of examinations performed on 87 cirrhotic patients were analyzed. Variables significantly associated with dysfunction were: The speed of flow in the portal vein(P = 0.008), the reversal of flow in the right(P = 0.038) and left(P = 0.049) portal branch, the loss of modulation of portal flow by the right atrium(P = 0.0005), ascites(P = 0.001) and the overall impression of the operator(P = 0.0001). The diagnostic performances of these variables were low; sensitivity was < 58% and negative predictive value was < 73%. Therefore, dysfunction cannot be ruled out from Doppler-US. CONCLUSION The performance of Doppler-US for the detection of TIPS dysfunction is poor compared to angiography. New tools are needed to improve diagnosis of TIPS dysfunction.

关键词： Transjugular intrahepatic portosystemic shunt Dysfunction Doppler-ultrasonography

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Quality of life 10 years after liver transplantation:The impact of graft histology

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World Journal of Transplantation 2016年第4期6卷 703-711页

作者： Vincent Karam Mylène Sebagh Kinan Rifai Funda Yilmaz Prashant Bhangui Colette Danet Faouzi Saliba Didier Samuel denis castaing René Adam Cyrille Feray Centre Hépatobiliaire Assistance Publique-Hepitaux de Paris Université Paris-Sud H?pital Paul Brousse Department of Gastroenterology Hepatology and Endocrinology Hannover Medical School Department of Pathology Faculty of Medicine University of Ege Medanta Institute of Liver Transplantation and Regenerative Medicine INSERM U955 Institut Mondor de Recherche Biomédicale

AIM To evaluate the relationship between the state of transplanted liver graft and the recipient quality of life(QOL) of histologically proven lesions in a 10-year post liver transplantation(LT) cohort of patients. METHODS Seventy-two recipients with a functional first graft at 10 years post-LT underwent liver biopsy and completed a QOL questionnaire. Logistic regression analysis was used to explore associations between histological, clinical andQOL criteria. RESULTS Ten years after LT, fibrosis was detected in 53% of patients, and affected the general health perception, while ductopenia, present in 36%, affected the well-being(P = 0.05). Hepatic steatosis(HS) was present in 33% of patients and was associated with the worst QOL score on multiple domains. When compared to patients without HS, patients with HS had significantly higher incidence of fibrosis(P = 0.03), hepatitis C virus(HCV) infection(P = 0.007), and more patients had retired from their job(P = 0.03). Recurrent or de novo HCV-associated fibrosis and patient retirement as objective variables, and abdominal pain or discomfort and joint aches or pains as subjective variables, emerged as independent determinants of HS. CONCLUSION Long-term liver graft lesions, mainly HS presumably as a surrogate marker of HCV infection, may have a substantial impact on QOL 10 years after LT.

关键词： Liver transplantation Quality of life Liver biopsy Hepatic steatosis Liver fibrosis

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Predictive factors for survival and score application in liver retransplantation for hepatitis C recurrence

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World Journal of Gastroenterology 2016年第18期22卷 4547-4558页

作者： Alice Tung Wan Song Rodolphe Sobesky Carmen Vinaixa Jérome Dumortier Sylvie Radenne Francois Durand Yvon Calmus Géraldine Rousseau Marianne Latournerie Cyrille Feray Valérie Delvart Bruno Roche Stéphanie Haim-Boukobza Anne-Marie Roque-Afonso denis castaing Edson Abdala Luiz Augusto Carneiro D’Albuquerque Jean-Charles Duclos-Vallée Marina Berenguer Didier Samuel INSERM Unit 785 Villejuif 94800France Liver and Digestive Organ Transplantation Division Gastroenterology DepartmentUniversity of Sao Paulo Medical SchoolSao Paulo 05403-900Brazil Universite Paris-Sud Villejuif 94800France Liver Transplantation Laboratory LIM-37 Sao Paulo 01246-903Brazil AP-HP Hopital Paul Brousse Villejuif 94800France La Fe Hospital University of Valencia and CiberehdValencia 46026Spain Hopital Edouard Herriot Lyon 69003France Hopital Croix Rousse Lyon 69004France AP-HP Hopital Beaujon Clichy 92110France AP-HP Hopital St Antoine Paris 75011France AP-HP Hopital Salpetriere Paris 75013France CHU Pontchaillou Rennes 35000France AP-HP Hopital Henri Mondor Creteil 94010France Viral Hepatitis Laboratory LIM-47 Sao Paulo 01246-903Brazil

AIM: To identify risk factors associated with survival in patients retransplanted for hepatitis C virus(HCV) recurrence and to apply a survival score to this ***: We retrospectively identified 108 patients retransplanted for HCV recurrence in eight European liver transplantation centers(seven in France, one in Spain). Data collection comprised clinical and laboratory variables, including virological and antiviral treatment data. We then analyzed the factors associated with survival in this population. A recently published score that predicts survival in retransplantation in patients with hepatitis C was applied. Because there are currently no uniform recommendations regarding selection of the best candidates for retransplantation in this setting, we also described the clinical characteristics of 164 patients not retransplanted, with F3, F4, or fibrosing cholestatic hepatitis(FCH) post-first graft presenting with hepatic decompensation. RESULTS: Overall retransplantation patient survival rates were 55%, 47%, and 43% at 3, 5, and 10 years, respectively. Patients who were retransplanted for advanced cirrhosis had survival rates of 59%, 52%, and 49% at 3, 5, and 10 years, while those retransplanted for FCH had survival rates of 34%, 29%, and 11%, respectively. Under multivariate analysis, and adjusting for the center effect and the occurrence of FCH, factors associated with better survival after retransplantation were: negative HCV viremia before retransplantation, antiviral therapy after retransplantation, non-genotype 1, a Model for End-stage Liver Disease(MELD) score < 25 when replaced on the waiting list, and a retransplantation donor age < 60 years. Although the numbers were small, in the context of the new antivirals era, we showed that outcomes in patientswho underwent retransplantation with undetectable HCV viremia did not depend on donor age and MELD score. The Andrés score was applied to 102 patients for whom all score variables were available,

关键词： Antivirals Hepatitis C Mortality Prognosis Retransplantation Risk factors

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