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Hepatocardiorenal syndrome in liver cirrhosis:Recognition of a new entity?

World Journal of Gastroenterology 2024年第2期30卷 128-136页

作者： Henry H L Wu Amina Rakisheva Arvind Ponnusamy Rajkumar Chinnadurai Renal Research Kolling Institute of Medical ResearchRoyal North Shore Hospital&The University of SydneySt.Leonards(Sydney)2065New South WalesAustralia Department of Cardiology City Cardiological CenterAlmaty 050000Kazakhstan Department of Renal Medicine Royal Preston HospitalPreston PR29HTUnited Kingdom Donal O’Donoghue Renal Research centre&Department of Renal Medicine Northern Care Alliance National Health Service Foundation TrustSalford M68HDUnited Kingdom

Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this *** the absence of established heart disease,cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney *** is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological *** the clinical description of these potential cardiac-related complications of the liver,the role of the heart has traditionally been an overlooked aspect of circulatory dysfunction in *** from a physiological sense,temporality(prior onset)of cardiorenal interactions in HRS and positive effects stemming from portosystemic shunting demonstrated an important role of the heart in the development and progression of kidney dysfunction in cirrhotic *** this review,we discuss current concepts surrounding how the heart may influence the development and progression of HRS,and the role of systemic inflammation and endothelial dysfunction causing circulatory dysfunction within this *** temporality of heart and kidney dysfunction in HRS will be *** a subgroup of patients who receive portosystemic shunting,the dynamics of cardiorenal interactions following treatment is *** research to determine the unknowns in this topic is anticipated,hopefully to further clarify the intricacies surrounding the liver-heart-kidney connection and improve strategies for management.

关键词： Hepatorenal syndrome Cardiorenal syndrome Cirrhosis Cardiac dysfunction Circulatory dysfunction

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Post-transplant immunosuppression and COVID-19:From a double whammy to a mixed blessing

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World Journal of transplantation 2020年第9期10卷 267-276页

作者： Ashwin Rammohan The Institute of liver disease and transplantation Dr.Rela Institute and Medical CentreChennai 600044India

The coronavirus pandemic(COVID-19)has had an unprecedented effect on various disease processes and their ***-19 is likely to have a complex pathophysiological interplay with the post-transplant patients;one affecting the clinical course and outcome of the *** the absence of validated data from trials,there is strong dependence on experience based on previous similar epidemics(SARS/MERS),and from consensus based on expert *** the fact that our knowledge is rapidly evolving with time,there still is relatively limited objective data on the effect of COVID-19 on the human *** questions remain unanswered,one of which involves the management of immunosuppression in the post-transplant recipient during this *** core tenet of which continues to be that of establishing an equipoise between infection and *** review summarises the current knowledge on immune interactions of the virus,the immunomodulatory effects that may be at play,and its relation to the art of immunosuppression.

关键词： COVID-19 Post-transplant immunosuppression Immunity Review

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Dynamic phenotypic heterogeneity and the evolution of multiple RNA subtypes in hepatocellular carcinoma:the PLANET study

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National Science Review 2022年第3期9卷 96-109页

作者： Weiwei Zhai Hannah Lai Neslihan Arife Kaya Jianbin Chen Hechuan Yang Bingxin Lu Jia Qi Lim Siming Ma Sin Chi Chew Khi Pin Chua Jacob Josiah Santiago Alvarez Pauline Jieqi Chen Mei Mei Chang Lingyan Wu Brian K.P.Goh Alexander Yaw-Fui Chung Chung Yip Chan Peng Chung Cheow Ser Yee Lee Juinn Huar Kam Alfred Wei-Chieh Kow Iyer Shridhar Ganpathi Rawisak Chanwat Jidapa Thammasiri Boon Koon Yoong Diana Bee-Lan Ong Vanessa H.de Villa Rouchelle D.Dela Cruz Tracy Jiezhen Loh Wei Keat Wan Zeng Zeng Anders Jacobsen Skanderup Yin Huei Pang Krishnakumar Madhavan Tony Kiat-Hon Lim Glenn Bonney Wei Qiang Leow Valerie Chew Yock Young Dan Wai Leong Tam Han Chong Toh Roger Sik-Yin Foo Pierce Kah-Hoe Chow Genome Institute of Singapore Agency for Science Technology and Research Key Laboratory of Zoological Systematics and Evolution Institute of Zoology Chinese Academy of Sciences Center for Excellence in Animal Evolution and Genetics Chinese Academy of Sciences School of Biological Sciences Nanyang Technological University Division of Biosciences Faculty of Life Sciences Division of Surgery and Surgical Oncology National Cancer Centre Department of Hepato-Pancreato-Biliary and transplant Surgery Singapore General Hospital Division of Hepatobiliary and Pancreatic Surgery Department of Surgery University Surgical Cluster National University Health System Hepato-Pancreato-Biliary Surgery Unit Department of Surgery National Cancer Institute Division of Pathology National Cancer Institute Department of Surgery Faculty of Medicine University of Malaya Department of Surgery and Center for liver disease management and transplantation The Medical City 13. Department of Laboratories The Medical City Department of Pathology Singapore General Hospital Institute for Infocomm Research ASTAR Department of Pathology National University Health System Translational Immunology Institute (TII) Sing Health Duke-NUS Academic Medical Centre Division of Gastroenterology and Hepatology University Medicine Cluster National University Hospital Department of Biochemistry Yong Loo Lin School of Medicine National University of Singapore Cancer Science Institute of Singapore National University of Singapore Division of medical Oncology National Cancer Center Singapore Cardiovascular Research Institute National University of Singapore National University Healthcare System Singhealth-Duke-NUS Academic Surgery Program Duke-NUS Graduate Medical School Institute of Molecular and Cell Biology Agency for Science Technology and Research

Intra-tumor heterogeneity(ITH) is a key challenge in cancer treatment, but previous studies have focused mainly on the genomic alterations without exploring phenotypic(transcriptomic and immune)heterogeneity. Using one of the largest prospective surgical cohorts for hepatocellular carcinoma(HCC)with multi-region sampling, we sequenced whole genomes and paired transcriptomes from 67 HCC patients(331 samples). We found that while genomic ITH was rather constant across stages, phenotypic ITH had a very different trajectory and quickly diversified in stage Ⅱ patients. Most strikingly, 30% of patients were found to contain more than one transcriptomic subtype within a single tumor. Such phenotypic ITH was found to be much more informative in predicting patient survival than genomic ITH and explains the poor efficacy of single-target systemic therapies in HCC. Taken together, we not only revealed an unprecedentedly dynamic landscape of phenotypic heterogeneity in HCC, but also highlighted the importance of studying phenotypic evolution across cancer types.

关键词： NADH oxidase H2O2 production oxidative phosphorylation

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Shifting perspectives in liver diseases after kidney transplantation

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World Journal of Hepatology 2023年第7期15卷 883-896页

作者： Iva Kosuta Ana Ostojic Ana Vujaklija Brajkovic Jaksa Babel Bojana Simunov Maja Sremac Anna Mrzljak Department of Intensive Care Medicine University Hospital Centre ZagrebZagreb 10000Croatia Department of Gastroenterology and Hepatology Liver Transplant CenterUniversity Hospital Centre ZagrebZagreb 10000Croatia School of Medicine University of ZagrebZagreb 10000Croatia Department of Nephrology University Hospital MerkurZagreb 10000Croatia

liver diseases after kidney transplantation range from mild biochemical abnormalities to severe hepatitis or *** causes are diverse and mainly associated with hepatotropic viruses,drug toxicity and metabolic *** the past decade,the aetiology of liver disease in kidney recipients has changed *** relates to the use of direct-acting antiviral agents against hepatitis C virus,the increasing availability of vaccination against hepatitis B and a better understanding of drug-induced *** addition,the emergence of the severe acute respiratory syndrome coronavirus 2 pandemic has brought new challenges to kidney *** review aims to provide healthcare professionals with a comprehensive understanding of recent advances in the management of liver complications in kidney recipients and to enable them to make informed decisions regarding the risks and impact of liver disease in this population.

关键词： Kidney transplantation Viral hepatitis Non-alcoholic fatty liver disease Drug-induced liver injury COVID-19

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Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures

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World Journal of transplantation 2024年第2期14卷 88-98页

作者： Chee Lim Jonathan Ng Babak Sarraf Rhys Vaughan Marios Efthymiou Leonardo Zorron Cheng Tao Pu Sujievvan Chandran Department of Gastroenterology and Hepatology Austin HealthMelbourne HeidelbergVIC 3084Australia Melbourne medical School The University of MelbourneMelbourne ParkvilleVIC 3052Australia

BACKGROUND Endoscopic management is the first-line therapy for post-liver-transplant anas-tomotic *** the optimal duration of treatment with plastic stents has been reported to be 8-12 months,data on safety and duration for metal stents in this setting is *** to limited access to endoscopic retrograde cholan-giopancreatography(ERCP)during the coronavirus disease 2019 pandemic in our centre,there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable *** was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic *** Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database *** admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical *** main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 *** efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for≤120 d or>120 *** During the study period,a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting *** 33 ERCPs,the stent was removed or exchanged on a 3-month *** pancreatitis,perfor-ations or deaths *** post-ERCP complications were similar between the 3-month(abdominal pain and intraductal migration)and 6-month(abdominal pain,septic shower and embedded stent)groups-6.1%vs 9.1%respectively,P=*** strictures resolved at the end of the stenting course,but the stenting course was variable from 3 to 22 *** recurrence rate for stenting courses lasting for up to 120 d was 71.4%and 21.4%for stenting courses of 121 d or over(P=0.03).There were 28 patients that were treated with a sin

关键词： liver transplantation Cholangiopancreatography Endoscopic retrograde Constriction Pathologic Self expandable metallic stents Bile duct diseases Cholestasis

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Risk factors for ribavirin treatment failure in Asian organ transplant recipients with chronic hepatitis E infection

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World Journal of Hepatology 2019年第6期11卷 553-561页

作者： En Xian Sarah Low Edhel Tripon Kieron Lim Poh Seng Tan How Cheng Low Yock Young Dan Yin Mei Lee Mark Muthiah Wai Mun Loo Calvin Jianyi Koh Wah Wah Phyo JunXiong Pang Seng Gee Lim Guan-Huei Lee Department of Medicine Ng Teng Fong General HospitalNational University Health SystemSingapore 609606Singapore centre for liver disease management and transplant of medical city Manila 1605Philippines Mount Elizabeth medical centre Singapore 228510Singapore Division of Gastroenterology and Hepatology National University Health SystemSingapore 119228Singapore Department of Medicine National University of SingaporeSingapore 119077Singapore centre for Infectious disease Epidemiology and Research National University of SingaporeSingapore 117549Singapore Department of Medicine Yong Loo Lin School of MedicineNational University of SingaporeSingapore 119228Singapore

BACKGROUND Hepatitis E virus(HEV)infection is a cause of chronic hepatitis in immunosuppressed *** virologic response rates to a 12-wk course of ribavirin therapy were reported to be>70%in the *** study describes the outcome of HEV treatment in a transplant center in *** To study the outcome of ribavirin treatment in a series of chronic HEV patients,and the cause of treatment *** We studied all of the transplant recipients who were diagnosed with HEV infection between 2012 to *** outcome of therapy and virologic relapse are monitored for three years after the end of *** Ten transplant recipients(4 liver,5 kidney,and 1 bone marrow transplantation)with positive HEV RNA were *** patients received at least 12 wk of ribavirin therapy,and the remaining patient resolved after reducing immunosuppression *** subjects had prolonged viremia that lasted more than one year,despite continuous ribavirin *** ribavirin-treated patients(44.4%)had HEV RNA relapse after achieving a virologic response by the end of *** overall failure rate is 66.7%.Being a kidney transplant recipient is the strongest risk factor for not achieving an initial sustained virologic response(0/5 treated,Chi-Square test,Ptransplant recipients had a higher rate of treatment failure due to higher immunosuppression requirements and adverse effects.

关键词： Toxicity Antiviral agents Hepatitis E virus Virus classification Systemic immunity Immune responses Persistent infection

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Foregut bypass *** bariatric procedures for nonalcoholic fatty liver disease:a meta-analysis of 3,355 individuals

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Hepatobiliary Surgery and Nutrition 2023年第5期12卷 658-670,I0001-I0003页

作者： Wen Hui Lim Snow Yunni Lin Cheng Han Ng Darren Jun Hao Tan Jieling Xiao Jie Ning Yong Phoebe Wen Lin Tay Nicholas Syn Yip Han Chin Kai En Chan Chin Meng Khoo Nicholas Chew Roger S.Y.Foo Asim Shabbir Eunice X.Tan Daniel Q.Huang Mazen Noureddin Arun J.Sanyal Mohammad Shadab Siddiqui Mark D.Muthiah Yong Loo Lin School of Medicine National University of SingaporeSingaporeSingapore Division of Endocrinology Department of MedicineNational University HospitalSingaporeSingapore Department of Cardiology National University Heart CentreNational University HospitalSingaporeSingapore Division of General Surgery(Upper Gastrointestinal Surgery) Department of SurgeryNational University HospitalSingaporeSingapore Division of Gastroenterology and Hepatology Department of MedicineNational University HospitalSingaporeSingapore National University centre for Organ transplantation National University Health SystemSingaporeSingapore Cedars-Sinai Fatty liver Program Division of Digestive and Liver DiseasesDepartment of MedicineComprehensive Transplant CenterCedars-Sinai Medical CentreLos AngelesCAUSA Division of Gastroenterology Hepatology and NutritionDepartment of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA

Background:Bariatric surgery represents an important treatment option for severely obese patients with nonalcoholic fatty liver disease(NAFLD).However,there remains inadequate data regarding the effects of different bariatric procedures on various NAFLD parameters,especially for histological ***,this meta-analysis aimed to compare the effects of restrictive bariatric procedures and foregut bypass on the metabolic,biochemical,and histological parameters for patients with ***:Medline and Embase were searched for articles relating to bariatric procedures and *** meta-analysis was conducted to compare efficacy of bariatric procedures ***-procedure with subgroup analysis to further compare restrictive against foregut bypass ***:Thirty-one articles involving 3,355 patients who underwent restrictive bariatric procedures(n=1,460)and foregut bypass(n=1,895)were *** foregut bypass(Pmanagement.

关键词： Bariatric surgery non-alcoholic fatty liver disease(NAFLD) obesity fibrosis endoscopy

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Critical Update on the Diagnosis and management of COVID-19 in Advanced Cirrhosis and liver transplant Recipients

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Journal of Clinical and Translational Hepatology 2021年第6期9卷 947-959页

作者： Cyriac Abby Philips Mohamed Rela Arvinder Singh Soin Subhash Gupta Sudhindran Surendran Philip Augustine Department of Clinical and Translational Hepatology and The Monarch liver Laboratory The Liver InstituteCenter of Ex-cellence in Gastrointestinal SciencesRajagiri HospitalAluvaKeralaIndia Institute of liver disease and liver Trans-plantation Dr.Rela Institute&Medical CentreBharath Institute of Higher Education and ResearchChennaiIndia In-stitute of liver transplantation and Regenerative Medicine MedantaThe MedicityGurgaonIndia Max centre for liver and Biliary Sciences Max Saket HospitalNew DelhiIndia Gastrointestinal Surgery and Solid Organ transplantation Amrita Institute of Medical Sciences and Research CentreAmrita Vishwa VidyapeethamKochiKeralaIndia Gastroen-terology and Advanced GI Endoscopy Center of Excellence in Gastrointestinal SciencesRajagiri HospitalAluvaKeralaIndia

The novel coronavirus disease 2019(COVID-19)pandemic has impacted health care worldwide,with specific patient populations,such as those with diabetes,cardiovascular disease,and chronic lung disease,at higher risk of infection and others at higher risk of disease *** with decompensated cirrhosis fall into the latter category and are a unique group that require specific treatment and management decisions because they can develop acute-on-chronic liver *** liver transplant recipients,the atypical immunity profile due to immunosuppression protects against downstream inflammatory responses triggered by *** exhaustive review discusses the outcomes associated with COVID-19 in patients with advanced cirrhosis and in liver transplant *** focus on the immunopathogenesis of COVID-19,its correlation with the pathogenesis of advanced liver disease,and the effect of immunosuppression in liver transplant recipients to provide insight into the outcomes of this unique patient population.

关键词： Coronavirus Cirrhosis Portal hypertension Acute-on-chronic liver failure Sepsis Hepatic encephalopathy Multiple-organ failure Critical care

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Collagen matrix scaffolds:Future perspectives for the management of chronic liver diseases

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World Journal of Clinical Cases 2023年第6期11卷 1224-1235页

作者： Moises Martinez-Castillo Itzel Altamirano-Mendoza Rafal Zielinski Waldemar Priebe Cristina Piña-Barba Gabriela Gutierrez-Reyes liver Pancreas and Motility LaboratoryUnit of Experimental MedicineSchool of MedicineUniversidad Nacional Autonoma de MexicoMexico City 06726Mexico CityMexico Department of Experimental Therapeutics The University of Texas MD Anderson Cancer CenterHoustonTX 77054United States Materials Research Institute Universidad Nacional Autónoma de MéxicoMexico City 06726Mexico CityMexico

Approximately 1.5 billion chronic liver disease(CLD)cases have been estimated worldwide,encompassing a wide range of liver damage ***,liver disease causes approximately 1.75 million deaths per *** is typically characterized by the silent and progressive deterioration of liver parenchyma due to an incessant inflammatory process,cell death,over deposition of extracellular matrix proteins,and dysregulated ***,these processes impair the correct function of this vital *** and liver cancer are the main complications of CLD,which accounts for 3.5%of all deaths *** transplantation is the optimal therapeutic option for advanced liver *** liver is one of the most common organs transplanted;however,only 10%of liver transplants are *** this context,regenerative medicine has made significant progress in the design of biomaterials,such as collagen matrix scaffolds,to address the limitations of organ transplantation(e.g.,low donation rates and biocompatibility).Thus,it remains crucial to continue with experimental and clinical studies to validate the use of collagen matrix scaffolds in liver disease.

关键词： liver Chronic liver disease Collagen matrix scaffold transplant management

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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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