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Serious drug-induced liver disease secondary to ezetimibe

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World Journal of Gastroenterology 2008年第32期14卷 5098-5099页

作者： José Castellote Javier Ariza Rosa Rota Anna Girbau Xavier Xiol Hepatology and liver transplant unit IdibellHospital Universitario de Bellvitge

Ezetimibe is the f irst member of a new family of lipid- lowering drugs that inhibits uptake of dietary and bili- ary cholesterol. It was approved by the FDA in 2002 for hypercholesterolemia alone or in combination with statins. Its use has been spreading over the last years. Ezetimibe was considered a safe drug. We report a case of a woman who developed a serious hepatocellular drug-induced liver disease after 4 mo therapy with 10 mg daily of ezetimibe. After withdrawal of the drug, the patient recovered slowly. Ezetimibe may produce seri- ous toxic hepatitis and prompt withdrawal is mandatory in case of a signif icant abnormality in liver testing after beginning or during treatment with ezetimibe.

关键词： Ezetimibe Hepatitis Drug-induced liverdisease

liver decompensation after rapid weight loss from semaglutide in a patient with non-alcoholic steatohepatitis -associated cirrhosis

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World Journal of Gastroenterology 2023年第47期29卷 6165-6167页

作者： Matthew Peverelle Jonathan Ng James Peverelle Ryan D.Hirsch Adam Testro liver transplant unit Austin HealthMelbourne 3084Australia liver transplant unit Austin HealthHeidelberg 3084VictoriaAustralia

There is rapidly increasing uptake of GLP-1 (glucagon-like peptide-1) agonistssuch as semaglutide worldwide for weight loss and management of non-alcoholicsteatohepatitis (NASH). remains a paucity of safety data in the vulnerable NASHcirrhotic population. We report herein the first documented case of liver decompensationand need for liver transplant waitlisting in a patient with NASHcirrhosistreated with semaglutide. Rapid weight loss led to the development ofascites and hepatic encephalopathy and an increase in the patients Model forEndstage liver Disease-Na (MELD-Na) score from 11 to 22. Aggressive nutritionalsupplementation was commenced and the semaglutide was stopped. Overthe following months she regained her weight and her liver recompensated andher MELD-Na decreased to 13, allowing her to be delisted from the transplantwaitlist. This case serves as a cautionary tale to clinicians using semaglutide in thecirrhotic population and highlights the need for more safety data in this patientgroup.

关键词： Semaglutide Non-alcoholic steatohepatitis Cirrhosis Non-alcoholic steatohepatitis cirrhosis Glucagon-like peptide 1 agonists Weight loss

Solid,non-skin,post-liver transplant tumors:Key role oflifestyle and immunosuppression management

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World Journal of Gastroenterology 2016年第1期22卷 427-434页

作者： Christophe Carenco Stéphanie Faure JoséUrsic-Bedoya Astrid Herrero Georges Philippe Pageaux liver transplant unit CHRU Montpellier34090 MontpellierFrance

liver transplantation has been the treatment of choice for end-stage liver disease since *** has emerged as a major long-term cause of death for liver transplant *** retrospective studies that have explored standardized incidence ratio have reported increased rates of solid organ cancers postliver transplantation;some have also studied risk *** transplantation results in a two to five-fold mean increase in the rate of solid organ *** of head and neck,lung,esophageal,cervical cancers and Kaposi’s sarcoma is high,but risk of colorectal cancer is not clearly *** appears to be no excess risk of developing breast or prostate *** risk factors such as viral infection and tobacco consumption,and personal risk factors such as obesity play a key role,but recent data also implicate the role of calcineurin inhibitors,whose cumulative and dose-dependent effects on cell metabolism might play a direct role in *** this paper,we review the results of studies assessing the incidence of non-skin solid tumors in order to understand the mechanisms underlying solid cancers in post-liver transplant patients and,ultimately,discuss how to prevent these *** protocol changes,including a calcineurin inhibitor-free regimen,combined with dietary guidelines and smoking cessation,are theoretically the best preventive measures.

关键词： liver transplantation Tumors Calcineurininhibitors Immunosuppression Risk factors Tacrolimus Review Incidence

Outflow reconstruction with arterial patch in domino liver transplantation: a new technical option

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 551-554页

作者： Laura Lladó Emilio Ramos Sofia De LaSerna Joan Fabregat liver transplant unit Hospital Universitari de Bellvitge

Domino liver transplantation（LT）, using livers from familial amyloidotic polyneuropathy（FAP） patients, is a well described technique useful to expand donor pool. One of the main difficulties of this type of LT arises from the necessity to share the vascular pedicles between the graft and the donor. The most important challenge resides in restoring a proper hepatic venous outflow in the FAP-liver *** is specially challenging when using the piggy-back technique, because the hepatic stumps may be too short. To overcome this issue, surgeons explored several techniques using different types of venous grafts. We describe a new technical option by using an arterial graft from the deceased donor. By using both iliac arteries a long graft is created and sutured as needed to the hepatic vein stump. We describe herein this new technique employed in a domino liver recipient who underwent retransplantation for ischemic cholangitis. The procedure was performed using the piggy-back technique; the venous stump of the FAP liver was reconstructed with the arterial graft. The patient had uneventful postoperative and mid-term hepatic function, and anastomosis was patent 24 months after LT.

关键词： liver transplantation technique graft hepatic vein iliac artery

Role of inflammation and infection in the pathogenesis of human acute liver failure: clinical implications for monitoring and therapy

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World Journal of Gastroenterology 2016年第26期22卷 5958-5970页

作者： Mhairi C Donnelly Peter C Hayes Kenneth J Simpson Department of Hepatology and Scottish liver transplant unit Royal Infirmary of Edinburgh

Acute liver failure is a rare and devastating clinical condition. At present, emergency liver transplantation is the only life-saving therapy in advanced cases, yet the feasibility of transplantation is affected by the presence of systemic inflammation, infection and resultant multiorgan failure. The importance of immune dysregulation and acquisition of infection in the pathogenesis of acute liver failure and its associated complications is now recognised. In this review we discuss current thinking regarding the role of infection and inflammation in the pathogenesis of and outcome in human acute liver failure, the implications for the management of such patients and suggest directions for future research.

关键词： Inflammation Neuroinflammation Acute liver failure Biomarker Infection

Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent

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World Journal of Gastroenterology 2003年第10期9卷 2377-2378页

作者： Rakesh Rai John Rose Derek Manas Hepatobiliary Surgery and liver transplant unit Freeman HospitalNewcastleUK Department of Interventional Radiology Freeman HospitalNewcastleUK Hepatobiliary Surgery and liver transplant unit.Freeman Hospital.newcastle.UK

AIM: To highlight the fatal complication caused by expanding biliary stents and the importance of avoiding use of expanding stent in potentially curable ***: Arteriobiliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudoaneurysm causing arteriobiliary fistula and presenting as severe malena and cholangitis, in a patient with a mesh metal biliary stent. The patient had lymphoma causing bile duct ***: Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolisation of the pseudo aneurysm successfully controlled the ***: Bleeding from the pseudo aneurysm of the hepatic artery can be fatal. Mesh metal stents in biliary tree can cause this complication as demonstrated in this *** mesh metal stent insertion should be avoided in potentially benign or in curable conditions. Difficulty in diagnosis and management is discussed along with the review of the literature.

关键词： Aneurysm, False Biliary Fistula Female Hemobilia Hemorrhage Humans Middle Aged Stents

COVID-19 in liver transplant Recipients-A Series with Successful Recovery

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Journal of Clinical and Translational Hepatology 2020年第4期8卷 467-473页

作者： Ashok Choudhury Golamari Srinivasa Reddy Shantan Venishetty Viniyendra Pamecha Saggere Muralikrishna Shasthry Arvind Tomar Lalita Gauri Mitra Venkata Siva Tez Prasad Rajendra Prasad Mathur Debajyoti Bhattacharya Shiv Kumar Sarin Department of Hepatology and liver transplant Institute of Liver and Biliary SciencesNew DelhiIndia Department of HPB Surgery and liver transplant Institute of Liver and Biliary SciencesNew DelhiIndia Department of Pulmonary Medicine Institute of Liver and Biliary SciencesNew DelhiIndia Department of Critical Care Medicine Institute of Liver and Biliary SciencesNew DelhiIndia Department of Nephrology Institute of Liver and Biliary SciencesNew DelhiIndia

The severe acute respiratory syndrome corona virus-2 (referred to as SARS-CoV-2) pandemic had a great impact on public life in general as well as on populations with pre-existing disease and co-morbidities. liver transplant and immunosuppressant medication predisposes to more severe disease and is often associated with poor outcome. The clinical features, disease course, treatment and process of modulating the immunosuppression is challenging. Here, we describe the clinical presentation, treatment and outcomes in six liver transplant recipients. Out of those six patients, three had mild, one had moderate and one had severe COVID-19, and one was asymptomatic. The immunosup-pression minimization or withdrawal was done based upon the clinical severity. Consideration of tocilizumab and/or convalescent plasma as well as antivirals i.e. remdesvir done in severe cases. The routine practice of prophylactic anti-coagulation, consideration of repurposed drugs (i.e. teico-planin and doxycycline), and watchful monitoring of asymptomatic recipients helped to achieve an uneventful recovery.

关键词： liver transplant COVID-19 SARS-CoV-2 liver injury Remdesivir Convalescent plasma

Retransplantation for graft failure in chronic hepatitis C infection: A good use of a scarce resource?

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World Journal of Gastroenterology 2010年第40期16卷 5070-5076页

作者： Ian A Rowe Kerri M Barber Rhiannon Birch Elinor Curnow James M Neuberger liver and Hepatobiliary unit University Hospital Birmingham NHS Trust Queen Elizabeth Hospital NHS Blood and transplant

AIM: To investigate the outcome of patients with hepatitis C virus (HCV) infection undergoing liver retransplantation. METHODS: Using the UK National Registry, patients undergoing liver transplantation for HCV-related liver disease were identified. Data on patient and graft characteristics, as well as transplant and graft survival were collected to determine the outcome of HCV patients undergoing retransplantation and in order to identify factors associated with transplant survival. RESULTS: Between March 1994 and December 2007, 944 adult patients were transplanted for HCV-related liver disease. At the end of follow-up, 617 of these patients were alive. In total, 194 (21%) patients had first graft failure and of these, 80 underwent liver retransplantation, including 34 patients where the first graft failed due to recurrent disease. For those transplanted for HCV-related disease, the 5-year graft survival in those retransplanted for recurrent HCV was 45% [95% confidence interval (CI): 24%-64%] compared with 80% (95% CI: 62%-90%) for those retransplanted for other indications (P = 0.01, log-rank test); the 5-year transplant survival after retransplantation was 43% (95% CI: 23%-62%) and 46% (95% CI: 31%-60%), respectively (P = 0.8, log-rank test). In univariate analysis of all patients retransplanted, no factor analyzed was significantly associated with transplant survival. CONCLUSION: Outcomes for retransplantation in patients with HCV infection approach agreed criteria for minimum transplant benefit. These data support selective liver retransplantation in patients with HCV infection.

关键词： Hepatitis C liver Recurrence Retransplantation Outcome

Role of “reduced-size” liver/bowel grafts in the “abdominal wall transplantation” era

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World Journal of Gastrointestinal Surgery 2017年第9期9卷 186-192页

作者： Augusto Lauro Anil vaidya liver and Multiorgan transplant unit St Orsola University Hospital Department of transplant Surgery Oxford University Hospital

The evolution of multi-visceral and isolated intestinal transplant techniques over the last 3 decades has highlighted the technical challenges related to the closure of the abdomen at the end of the *** key factors that contribute to this challenge include:(1) Volume/edema of donor graft;and(2) loss of abdominal domain in the *** being able to close the abdominal wall leads to a variety of complications and morbidity that range from complex ventral hernias to bowel *** the end of the 90's this challenge was overcome by graft reduction during the donor operation or bench table procedure(especially reducing liver and small intestine),as well as techniques to increase the volume of abdominal cavity by pre-operative expansion *** reports from a few groups have demonstrated the ability of transplanting a full-thickness,vascularized abdominal wall from the same ***,a spectrum of techniques have co-evolved with multivisceral and intestinal transplantation,ranging from graft reduction to enlarging the volume of the abdominal *** of these techniques are free from complications,however in large-volume centers the combinations of both(graft reduction and abdominal widening,sometimes used in the same patient) could decrease the adverse events related to recipient's closure,allowing a faster *** quest for a solution to this unique challenge has led to the proposal and implementation of innovative solutions to enlarge the abdominal cavity.

关键词： Abdominal wall transplant reduced-size graft combined liver-bowel transplantation