1
|
Smith MK, Chow J, Huang R, Omar M, Ebadi M, Wong P, Huard G, Yoshida EM, Peretz D, Brahmania M, Montano-Loza AJ, Bhanji R. A224 COVID-19 INFECTION IN LIVER TRANSPLANT RECIPIENTS: CLINICAL FEATURES, HOSPITALIZATION, AND MORTALITY FROM A CANADIAN MULTICENTRE COHORT. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859339 DOI: 10.1093/jcag/gwab049.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic has brought significant challenges to clinicians caring for liver transplant (LT) recipients. Researchers have sought to better understand the risk and clinical outcomes of LT recipients infected with COVID-19 globally, however, there is a paucity of data from within Canada.
Aims
Our multi-center study aims to examine the characteristics and clinical outcomes of LT patients with COVID-19 in Canada.
Methods
We identified a retrospective cohort of adult LT recipients with RT-PCR confirmed COVID-19 from 7 Canadian tertiary care centers between March 2020 and June 2021. Demographic and clinical data were compiled by clinicians within those centers. We identified liver enzyme profile at the time of COVID-19 infection, immunosuppression type and post-infection adjustments, rate of hospitalization, ICU admission, mechanical ventilation, and death.
Results
A total of 49 patients with a history of LT and COVID-19 infection were identified. Twenty nine patients (59%) were male, the median time from LT was 66 months (1, 128) and the median age at COVID-19 infection was 59 years (52, 65). At COVID-19 diagnosis, the median ALT was 37 U/L (21, 41), AST U/L was 34 (20, 37), ALP U/L was 156 (88, 156), Total Bilirubin was 11 umol/L (7, 14), and INR was 1.1 (1.0, 1.1). The majority of patients (92%) were on tacrolimus monotherapy or a combination of tacrolimus and mycophenolate mofetil (MMF); median tacrolimus level at COVID-19 diagnosis was 5.3 ug/L (4.0, 8.1). Immunosuppression was modified in 8 (16%) patients post-infection; either the tacrolimus dose was reduced or MMF was held. One patient developed acute cellular rejection which recovered after re-initiation of the prior regimen. Eighteen patients (37%) required hospitalization, 6 (12%) were treated with dexamethasone, and 3 (6%) required ICU admission and mechanical ventilation. Four patients (8%) died due to complications of COVID-19. On univariate analysis, neither age, sex, co-morbidities nor duration post-transplant were associated with risk of hospitalization.
Conclusions
In our national retrospective study, approximately 40% of patients required hospitalization with a mortality rate of < 10%. Previous studies have shown proximity to LT as an independent factor for mortality with COVID-19; the median time from LT for our patients was 5 years, which may explain the lower mortality rate. Of note, the median tacrolimus levels were much lower in comparison to the target of 8–10 ug/L used in the first year post-transplant. As the landscape of COVID-19 changes with vaccination, evolving treatments, and increasing rates of variant transmission, additional studies are required to continue identifying trends in clinical outcomes.
Funding Agencies
None
Collapse
Affiliation(s)
- M K Smith
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - J Chow
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - R Huang
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - M Omar
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - M Ebadi
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - P Wong
- Gastroenterology, McGill University, Brossard, QC, Canada
| | - G Huard
- Liver diseases, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - D Peretz
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A J Montano-Loza
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - R Bhanji
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
2
|
Zhu J, Lim DR, James LJ, Yoshida EM, Peltekian KM. A212 LIVER TRANSPLANTATION FOR PRIMARY SCLEROSING CHOLANGITIS (PSC): EXPERIENCE FROM THE LAST THREE DECADES. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859213 DOI: 10.1093/jcag/gwab049.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In liver transplantation (LT) for PSC, pre-transplant colectomy may lower the risk of PSC recurrence (rPSC), and well-controlled or lack of IBD may protect against rPSC, however, these findings are not consistent across all studies. It is unknown whether recipient/donor sex plays a role in rPSC. Aims To study factors associated with PSC recurrence in the post-transplant population. Methods This is a retrospective study on adults who received an LT for PSC in Halifax NS from 1985 to 2020. Graft and patient outcomes are analyzed by logistic regression models. Results A total of 92 patients underwent deceased donor LT for PSC with a mean follow-up time of 9.2 yrs (SD 7.1). Fifty-three remain active in the program, 2 were lost to follow up and 37 died. The mean age at transplant was 43 (SD13, range 18.9–67.8). Seven patients had a second transplant. The five- and 10-year patient survival rate of the entire cohort was 78.7% and 66% respectively. In the active cohort, the prevalence of rPSC was 23.5% (12/51). Retransplantation for rPSC occurred in 8.3% (1/12). The prevalence of IBD was 82.4% (42/51), consisted of ulcerative pancolitis (64.7%, 33/51), ulcerative proctitis (3.9%), left-sided UC (2%) and Crohn’s disease (9.8%). Males are much more likely than females to undergo a colectomy at any time (OR 5.5, 95% CI 1.07–28.22, p 0.041). Refractory IBD was the predominant indication for a colectomy (10/16), followed by dysplasia or colon cancer (6/16). In the post-transplant period, 69% had stable IBD without therapy escalation, 11.9% were escalated to a biologic, 19% underwent a colectomy for active IBD symptoms. Pre-transplant colectomy negatively predicted rPSC, in this subgroup 0% (0/6) developed rPSC. Neither recipient sex (OR 1.14, 95% CI 0.26–5.0, p 0.86) or recipient age predicted the likelihood of rPSC. There was no association between donor sex on rPSC (OR 1.25, 95% CI 0.30–5.27, p 0.76). A trend towards increased rPSC was observed in male donors to female recipients versus female-to-female transplants (OR 6, 95% CI 0.33–107.42, p 0.224). Overall, having a post-transplant colectomy, subtotal or total, irrespective of timing, did not significantly impact rPSC (OR 0.389, 95% CI 0.09–1.66, p 0.20). Diagnosis of IBD was not associated with an increased risk of rPSC (OR 1.21, p 0.83). Conclusions Several factors were associated with rPSC after liver transplant in patients with PSC and IBD, pre-transplant colectomy was found to be protective, male donor to female recipient was a potential risk factor. It is important to study these factors in multi-centered cohorts to understand the pathogenesis of PSC. Pre-transplant total colectomy may be beneficial for several reasons, reducing rPSC, controlling IBD activities, and lowering dysplasia and colon cancer rates in the post-transplant population. Funding Agencies None
Collapse
Affiliation(s)
- J Zhu
- Dalhousie University, Halifax, NS, Canada
| | - D R Lim
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - L J James
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - K M Peltekian
- ATLANTIC HEPATOLOGY SERVICES INC, Halifax, NS, Canada
| |
Collapse
|
3
|
JAMES LJ, Kulai T, MCLEOD M, PELTEKIAN K, Yoshida EM, Zhu J. A213 OUTCOMES OF INCIDENTAL CHOLANGIOCARCINOMA IN LIVER TRANSPLANT PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Primary sclerosing cholangitis (PSC) is a predisposing factor for cholangiocarcinoma(CCA).Patients with CCA have poor outcomes post-transplant.Intrahepatic CCA is difficult to detect pre-operatively in cirrhosis.Few outcomes are reported among PSC transplant patients where CCA was incidental.
Aims
To determine the incidence of incidental CCA (iCCA) in PSC liver explants and the impact of iCCA on post-transplant survival for patients with PSC
Methods
This was a retrospective cohort study in which the medical records of PSC patients who underwent transplant at QEII Health Sciences Center in Halifax between January 1987 to March 2020 were reviewed. The incidence of iCCA was calculated. Survival analysis was performed to determine the mean time to survival among iCCA and non-iCCA groups
Results
A total of 94 patients were transplanted for PSC during the study period.The mean age was 43 years.Twenty-six percent were women and 74% were men.Three were iCCA, one hilar and two intrahepatic CCA. All iCCAs occurred prior to 2008.
All iCCA patients had contrast enhanced CT, ERCP with cholangiogram and MRI.Two of the ERCPs reported CBD related strictures and the brushings had no evidence of malignancy.CA19-9 level was measured in one and reported as normal.Contrast enhanced MRI was not available prior to 2007.
The PSC patients had 1, 5, and 10-year survival rates of 93.8%, 88.6% and 81.9% respectively.One patient required re-transplant for graft failure and died within 3 months post-transplant due to complications. In all other cases the cause of death was not identified.
Among patients with iCCA, two deaths were due to metastatic cholangiocarcinoma and the other due to surgical complication in the immediate post-transplant period. None survived beyond 2 years.
Conclusions
Observed PSC survival in this cohort was above national average in the same period.The 3 iCCA cases identified occurred before the availability of contrast enhanced MRI. Patients with iCCA and liver transplant had poor survival at 1 and 2 years.There were no iCCA identified after 2007.These findings suggest incidental cholangiocarcinoma was effectively reduced by the advent of high-resolution imaging modality, and improvements in pre-transplant screening, including tumor marker CA19-9 and stringent patient selection. Further study involving multiple centres is necessary to draw a definite conclusion.
Funding Agencies
None
Collapse
Affiliation(s)
- L J JAMES
- GASTROENTEROLOGY, DALHOUSIE UNIVERSITY, Halifax, NS, Canada
| | - T Kulai
- GASTROENTEROLOGY, DALHOUSIE UNIVERSITY, Halifax, NS, Canada
| | - M MCLEOD
- GASTROENTEROLOGY, DALHOUSIE UNIVERSITY, Halifax, NS, Canada
| | - K PELTEKIAN
- GASTROENTEROLOGY, DALHOUSIE UNIVERSITY, Halifax, NS, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - J Zhu
- Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
4
|
Chahal D, Bedi HK, Marquez V, Yoshida EM, Ko H, Salh B. A208 PREDICTORS OF OUTCOMES IN PSC: RETROSPECTIVE ANALYSIS OF TWO TERTIARY CARE CENTERS IN BC. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Primary sclerosing cholangitis (PSC) is a chronic inflammatory disorder of the bile ducts. PSC can rapidly progress to cholangiocarcinoma and death. Many clinical features of PSC, as well as its relationship with diseases such as IBD, remain ill-defined. These features are important for disease modeling and clinical trial design.
Aims
To identify features of PSC that may aid in disease modeling and outcomes prediction.
Methods
Patients with a diagnosis of PSC with visits between 2012 and 2018 were identified and data were extracted. Survival analysis was performed, with time defined as time of PSC diagnosis to time at clinical endpoint. The clinical endpoint for survival analysis was defined as development of cholangiocarcinoma, liver transplantation or death. Univariate and multivariate Cox-regression was then performed.
Results
169 patients (99 male, 70 female) were identified. Of these, 102 (60.4%) had a diagnosis of IBD (84 UC). 138 were Caucasian, 9 East Asian, 9 South Asian and 13 Middle East. Mean age at PSC diagnosis was 39.3, IBD diagnosis 29.3 years. Mean time to next diagnosis in those with PSC-IBD was 7.7 years. Of those with PSC-IBD, IBD preceded the diagnosis of PSC in 69 (67.6%) patients. 22 (13.0%) had concurrent liver disease, including 14 AIH and 1 PBC overlap. In those with UC, disease was most often pancolitis (57.8%), with noticeable rate of backwash ileitis (23.3%). There were 26 patients with current or prior use of Infliximab, 14 with Humira, and 6 with Vedolizumab. 28 (16.6%) patients had a partial or total colectomy. 35 (20.7%) patients had diagnoses of cancer, including 16 cholangiocarcinoma, 2 gall bladder carcinoma, and 4 colorectal. 33 (19.5%) patients received liver transplant, and 31 (18.3%) died. Most frequent cause of death was cholangiocarcinoma (12, 38.7%). Univariate analysis identified increased age at PSC diagnosis, presence of IBD, increased age at IBD diagnosis, diagnosis of IBD prior to PSC, increased time from diagnosis of IBD to PSC, diagnosis of UC as opposed to Crohn’s, and lack of Infliximab use as significant predictors of our clinical endpoints (p<0.05). Multivariate analysis only identified increased age at PSC diagnosis, presence of IBD, and diagnosis of IBD prior to PSC as predictors.
Conclusions
PSC affects persons of various ethnic backgrounds. Diagnosis of IBD appears to precede PSC in most PSC-IBD cases, and the temporal relationship may impact outcomes, possibly due to delayed diagnosis of PSC. UC has a worse disease course than Crohn’s. Cholangiocarcinoma still accounts for a large burden of overall death in PSC, and strategies for early diagnosis should be explored. More studies are required to delineate the relationship between biologic use and PSC outcomes. The major limitation of our study is the smaller sample size that may have limited statistical power.
Funding Agencies
NoneNone
Collapse
Affiliation(s)
- D Chahal
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - H K Bedi
- Gastroenterology, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - V Marquez
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - H Ko
- Medicine, University of British Columbia, Vancouver, BC, Canada
| | - B Salh
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
5
|
Chahal D, Yoshida EM, Arbour L, Wallach J. A190 POST-PARTUM PRIMARY BILIARY CHOLANGITIS (PBC) AFTER RESOLUTION OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY (ICP) IN FIRST NATION’S PATIENTS OF BC: A CASE SERIES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
PBC is a progressive cholestatic disease characterized by destruction of intrahepatic bile ducts, peri-portal inflammation and fibrosis. PBC is the leading indication for liver transplantation in First Nations of British Columbia. Diagnosis of PBC during pregnancy is difficult due to clinical overlap with ICP and pregnancy induced immune tolerance (4–6). We present 3 cases of clinically diagnosed ICP in First Nations women who were later diagnosed with PBC post-partum.
Aims
To investigate the potential relationship between ICP and PBC in the First Nations community of BC.
Methods
Retrospective review of relevant cases.
Results
Case 1: A 27-year-old woman with history of ICP at 31 weeks during her 3rd pregnancy and family history of PBC presented with ursodiol and cholestyramine responsive pruritis and jaundice 20 weeks into her 4th pregnancy. Bilirubin was 103 µmol/L, ALP 371 IU/L, ANA and AMA negative. Symptoms and biochemistry remained in remission after delivery at 33 weeks. Discontinuation of medications led to recurrent pruritis 4 months later. Bilirubin was 6 µmol/L, ALP 272 IU/L, GGT 153 IU/L and ALT 204 IU/L. Liver biopsy was consistent with PBC, F1. Pruritis has now been refractory to ursodiol, cholestyramine and rifampin.
Case 2: A 30-year-old woman with history of ICP at 20 weeks during 2 prior pregnancies presented with ursodiol responsive pruritis 20 weeks into her 3rd pregnancy. Symptoms and biochemistry remained in remission after delivery at 35 weeks. Post-partum discontinuation of ursodiol led to recurrent pruritis 2 months later. ALP was 876 and AMA >1:640. Re-initiation of ursodiol improved symptoms and biochemical abnormalities.
Case 3: A 30-year-old woman with family history of PBC (mother) presented with ursodiol responsive pruritis and jaundice 20 weeks into her 4th pregnancy. Symptoms and biochemistry remained in remission after delivery at 37 weeks. Post-partum discontinuation of ursodiol led to recurrence jaundice 4 months later. Bilirubin was 68, ALP 1279, total cholesterol 7.72, IgM 18.98, ANA >1:640 and AMA 1:320. Jaundice and biochemical abnormalities persisted despite re-initiation of ursodiol. Obeticholic acid has been initiated.
Conclusions
First Nations communities of BC are disproportionately affected by PBC, due to both genetic and epigenetic phenomena. We present 3 patients who were diagnosed with ICP that resolved post-partum but with the subsequent development of PBC. The intrapartum cholestasis did not have clinical features of PBC during pregnancy. Although not previously reported, ICP may predispose to PBC in this specific community. It remains to be seen if there is a genetic association. Clinicians must remain suspicious of PBC during pregnancy in this population and ongoing monitoring in the post-partum period is paramount.
Funding Agencies
None
Collapse
Affiliation(s)
- D Chahal
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - L Arbour
- Medical Genetics, University of British Columbia, Victoria, BC, Canada
| | - J Wallach
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
6
|
Pearce ME, Jongbloed K, Demerais L, MacDonald H, Christian WM, Sharma R, Pick N, Yoshida EM, Spittal PM, Klein MB. "Another thing to live for": Supporting HCV treatment and cure among Indigenous people impacted by substance use in Canadian cities. Int J Drug Policy 2019; 74:52-61. [PMID: 31525640 DOI: 10.1016/j.drugpo.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/17/2019] [Accepted: 08/26/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Colonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care. METHODS Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization. RESULTS Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care. CONCLUSION There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.
Collapse
Affiliation(s)
- M E Pearce
- Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada.
| | - K Jongbloed
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - L Demerais
- Cree/Métis, Vancouver Native Health Society, 449 East Hastings Street, Vancouver, BC V6A 1P5, Canada
| | - H MacDonald
- Mamoo Naakiiwin, P.O. Box #573, Matheson, ON P0K 1N0, Canada
| | - W M Christian
- Splatsin Secwepemc Nation, 5775 Old Vernon Rd, Enderby, BC V0E 1V3, Canada.
| | - R Sharma
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada.
| | - N Pick
- Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; University of British Columbia Faculty of Medicine, Division of Infectious Diseases, 2733 Heather Street, Vancouver, BC, V5Z 3J5, Canada.
| | - E M Yoshida
- University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada; University of British Columbia Faculty of Medicine, Gastroenterology, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada.
| | - P M Spittal
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada.
| | - M B Klein
- Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine/Division of Infectious Diseases, McGill University Health Centre, 1001 Decarie Blvd, D02.4110, Montreal, QC, Canada.
| |
Collapse
|
7
|
Mitchell RA, Zhu J, Dahiya M, Hussaini T, Salh B, Yoshida EM. A60 PATIENT KNOWLEDGE-GAPS IN HEPATOTOXIC EFFECTS OF ACETAMINOPHEN FORMULATIONS. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R A Mitchell
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - J Zhu
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - M Dahiya
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - T Hussaini
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - B Salh
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
8
|
Lee JG, Yoshida EM, Ho F, Lowe C, Sum V, Kwan P. A190 SEROPREVALENCE OF HEPATITIS B VIRUS IN ASIAN CANADIANS WHO ARE UNAWARE OF THEIR HBV STATUS IN GREATER VANACOUVER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J G Lee
- University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - F Ho
- University of British Columbia, Vancouver, BC, Canada
| | - C Lowe
- University of British Columbia, Vancouver, BC, Canada
| | - V Sum
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - P Kwan
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
9
|
Hussaini T, Zhu J, Yoshida EM. Editorial: hepatocellular carcinoma as a consequence of hepatitis C direct-acting anti-virals-the great urban myth of hepatology. Aliment Pharmacol Ther 2018; 47:1418-1419. [PMID: 29676006 DOI: 10.1111/apt.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- T Hussaini
- The Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Vancouver General Hospital, Vancouver, BC, Canada
| | - J Zhu
- Vancouver General Hospital, Vancouver, BC, Canada.,Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Vancouver General Hospital, Vancouver, BC, Canada.,Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
10
|
Mitchell RA, Hussaini T, Yau A, Krajden M, Wright AJ, Scudamore C, Marquez V, Erb Z, Yoshida EM. A63 TRANSPLANTATION OF A LIVER ALLOGRAFT FROM A HEPATITIS C VIRUS (HCV) SEROPOSITIVE DONOR WITH PREVIOUS SUSTAINED VIROLOGIC RESPONSE TO AN UNINFECTED RECIPIENT SUFFERING STEROID REFRACTORY ACUTE GRAFT REJECTION WITH NO EVIDENCE OF HCV TRANSMISSION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R A Mitchell
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - T Hussaini
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - A Yau
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - M Krajden
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A J Wright
- Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - C Scudamore
- Division of General Surgery, University of British Columbia, Vancouver, BC, Canada
| | - V Marquez
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Z Erb
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
11
|
Aljudaibi B, Burak KW, Yoshida EM, Bilodeau M, Wong P, Benmassaoud A, Hussaini T, Thomas BS, Chen J, Teriaky A, Marotta P. A166 SOFOSBUVIR-BASED THERAPY IN THE PRE-LIVER TRANSPLANT SETTING: THE CANADIAN NATIONAL EXPERIENCE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Aljudaibi
- Gastroenterology, London Health Sciences Centre, London, ON, Canada
| | - K W Burak
- Liver Unit, Univ Calgary, Calgary, AB, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - M Bilodeau
- Liver Unit, CRCHUM, Montréal, QC, Canada
| | - P Wong
- Gastroenterology, McGill University, Brossard, QC, Canada
| | - A Benmassaoud
- McGill University Health Center, Montreal, QC, Canada
| | - T Hussaini
- University of British Columbia, Vancouver, BC, Canada
| | - B S Thomas
- Medicine, Western University, London, ON, Canada
| | - J Chen
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - A Teriaky
- Gastroenterology, London Health Sciences Centre, London, ON, Canada
| | - P Marotta
- London heatlh sciences Center, University of Western Ontario, London, ON, Canada
| |
Collapse
|
12
|
Janjua NZ, Islam N, Wong J, Yoshida EM, Ramji A, Samji H, Butt Z, Chong M, Alvarez M, Cook D, Tyndall M, Krajden M. A162 SHIFT IN DISPARITIES IN HCV TREATMENT FROM INTERFERON TO DAA ERA: A POPULATION BASED COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Z Janjua
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - N Islam
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - J Wong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - A Ramji
- Gastrointestinal Research Institute, Vancouver, BC, Canada
| | - H Samji
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Z Butt
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - M Chong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - M Alvarez
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - D Cook
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - M Tyndall
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - M Krajden
- BC Centre for Disease Control, Vancouver, BC, Canada
| |
Collapse
|
13
|
Yoshida EM, Fischer A, Mason A, Shah H, Peltekian KM, Hux M, Thiele SL, Borrelli R. A197 PREVALENCE OF PRIMARY BILIARY CHOLANGITIS IN CANADA: FIRST NATIONAL STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | | | - A Mason
- University of Alberta, Edmonton, AB, Canada
| | - H Shah
- University of Toronto, Toronto, ON, Canada
| | | | - M Hux
- QuintilesIMS, Toronto, ON, Canada
| | | | | |
Collapse
|
14
|
Affiliation(s)
- T Hussaini
- Department of Pharmacy, Vancouver General Hospital, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
15
|
Janjua NZ, Islam N, Wong J, Yoshida EM, Ramji A, Samji H, Butt ZA, Chong M, Cook D, Alvarez M, Darvishian M, Tyndall M, Krajden M. Shift in disparities in hepatitis C treatment from interferon to DAA era: A population-based cohort study. J Viral Hepat 2017; 24:624-630. [PMID: 28130810 DOI: 10.1111/jvh.12684] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/22/2016] [Indexed: 12/15/2022]
Abstract
We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.
Collapse
Affiliation(s)
- N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - N Islam
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - E M Yoshida
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Z A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - D Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - M Darvishian
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Tyndall
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
16
|
Thein HH, Qiao Y, Young SK, Zarin W, Yoshida EM, de Oliveira C, Earle CC. Trends in health care utilization and costs attributable to hepatocellular carcinoma, 2002-2009: a population-based cohort study. ACTA ACUST UNITED AC 2016; 23:e196-220. [PMID: 27330357 DOI: 10.3747/co.23.2956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The incidence of hepatocellular carcinoma (hcc) and the complexity of its diagnosis and treatment are increasing. We estimated trends in net health care utilization, costs of care attributable to hcc in Ontario, and rate ratios of resource use at various stages of care. METHODS This population-based retrospective cohort study identified hcc patients and non-cancer control subjects, and health care resource utilization between 2002 and 2009. Generalized estimating equations were then used to estimate net health care utilization (hcc patients vs. the matched control subjects) and net costs of care attributable to hcc. Generalized linear models were used to analyze rate ratios of resource use. RESULTS We identified 2832 hcc patients and 2808 matched control subjects. In comparison with the control subjects, hcc patients generally used a greater number of health care services. Overall, the mean net cost of care per 30 patient-days (2013 Canadian dollars) attributable to outpatient visits and hospitalizations was highest in the pre-diagnosis (1 year before diagnosis), initial (1st year after diagnosis), and end-of-life (last 6 months before death, short-term survivors) phases. Mean net homecare costs were highest in the end-of-life phase (long-term survivors). In the end-of-life phase (short-term survivors), mean net costs attributable to outpatient visits and total services significantly increased to $14,220 from $1,547 and to $33,121 from $14,450 (2008-2009 and 2002-2003 respectively). CONCLUSIONS In hcc, our study found increasing resource use and net costs of care, particularly in the end-of-life phase among short-term survivors. Our findings offer a basis for resource allocation decisions in the area of cancer prevention and control.
Collapse
Affiliation(s)
- H H Thein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON;; Ontario Institute for Cancer Research, Toronto, ON;; Institute for Clinical Evaluative Sciences, Toronto, ON
| | - Y Qiao
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - S K Young
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - W Zarin
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON
| | - E M Yoshida
- University of British Columbia, Division of Gastroenterology, Vancouver, BC
| | - C de Oliveira
- Institute for Clinical Evaluative Sciences, Toronto, ON;; Centre for Addiction and Mental Health, Toronto, ON;; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - C C Earle
- Ontario Institute for Cancer Research, Toronto, ON;; Institute for Clinical Evaluative Sciences, Toronto, ON;; Cancer Care Ontario, Toronto, ON
| |
Collapse
|
17
|
Foster GR, Ferenci P, Asselah T, Mantry P, Dufour JF, Bourlière M, Forton D, Maevskaya M, Wright D, Yoshida EM, García-Samaniego J, Oliveira C, Wright M, Warner N, Sha N, Quinson AM, Stern JO. Open-label study of faldaprevir plus peginterferon and ribavirin in hepatitis C virus genotype 1-infected patients who failed placebo plus peginterferon and ribavirin. J Viral Hepat 2016; 23:227-31. [PMID: 26572686 DOI: 10.1111/jvh.12485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/25/2015] [Indexed: 12/09/2022]
Abstract
Faldaprevir, a hepatitis C virus (HCV) NS3/4A protease inhibitor, was evaluated in HCV genotype 1-infected patients who failed peginterferon and ribavirin (PegIFN/RBV) treatment during one of three prior faldaprevir trials. Patients who received placebo plus PegIFN/RBV and had virological failure during a prior trial were enrolled and treated in two cohorts: prior relapsers (n = 43) and prior nonresponders (null responders, partial responders and patients with breakthrough; n = 75). Both cohorts received faldaprevir 240 mg once daily plus PegIFN/RBV for 24 weeks. Prior relapsers with early treatment success (ETS; HCV RNA <25 IU/mL detectable or undetectable at week 4 and <25 IU/mL undetectable at week 8) stopped treatment at week 24. Others received PegIFN/RBV through week 48. The primary efficacy endpoint was sustained virological response (HCV RNA <25 IU/mL undetectable) 12 weeks post treatment (SVR12). More prior nonresponders than prior relapsers had baseline HCV RNA ≥ 800,000 IU/mL (80% vs 58%) and a non-CC IL28B genotype (91% vs 70%). Rates of SVR12 (95% CI) were 95.3% (89.1, 100.0) among prior relapsers and 54.7% (43.4, 65.9) among prior nonresponders; corresponding ETS rates were 97.7% and 65.3%. Adverse events led to faldaprevir discontinuations in 3% of patients. The most common Division of AIDS Grade ≥ 2 adverse events were anaemia (13%), nausea (10%) and hyperbilirubinaemia (9%). In conclusion, faldaprevir plus PegIFN/RBV achieved clinically meaningful SVR12 rates in patients who failed PegIFN/RBV in a prior trial, with response rates higher among prior relapsers than among prior nonresponders. The adverse event profile was consistent with the known safety profile of faldaprevir.
Collapse
Affiliation(s)
- G R Foster
- Department of Hepatology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - P Ferenci
- Department of Medicine III, University Hospital Vienna, Vienna, Austria
| | - T Asselah
- Service d'Hépatologie, AP-HP, University Paris-Diderot and INSERM U773, CRB3, Hôpital Beaujon, Clichy, France
| | - P Mantry
- Department of Hepatology, The Liver Institute at Methodist Dallas Medical Center, Dallas, TX, USA
| | - J-F Dufour
- Department of Hepatology, University Clinic for Visceral Surgery and Medicine and University of Bern, Bern, Switzerland
| | - M Bourlière
- Département d'Hépato-gastroentérologie, Hôpital Saint Joseph, Marseille, France
| | - D Forton
- Department of Gastroenterology and Hepatology, St George's Hospital, London, UK
| | - M Maevskaya
- Hepatology Department, First Moscow State Medical University, Moscow, Russia
| | - D Wright
- Central Texas Clinical Research, Austin, TX, USA
| | - E M Yoshida
- University of British Columbia, Vancouver, BC, Canada
| | - J García-Samaniego
- Liver Unit, Hospital Universitario La Paz/Carlos III CIBERehd, Madrid, Spain
| | - C Oliveira
- Department of Radiology, Hospital Infante D. Pedro, Aveiro, Portugal
| | - M Wright
- Wellcome Trust Clinical Research Facility, Southampton, UK
| | - N Warner
- Boehringer Ingelheim Ltd., Bracknell, UK
| | - N Sha
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - A-M Quinson
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - J O Stern
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| |
Collapse
|
18
|
Abstract
Over 100 000 solid organ transplants are performed worldwide each year and this has a significant impact on physical function and quality of life. However, the capacity for exercise in solid-organ recipients is reduced. Regular physical activity improves most of the indices of fitness in these patients but, with few exceptions, they do not reach the values seen in healthy controls. The reason for the 40-60% reduction in maximal exercise capacity is not clear; the disease process, need for life long immunosuppression and sedentary lifestyle all contribute. The interaction between exercise and immunosuppressing medication merits research as does the specifics of the exercise prescription for these patients. This paper reviews important features of this rapidly expanding group of patients and suggests clinical considerations in the application of exercise in this population.
Collapse
Affiliation(s)
- K-J L McKenzie
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - D C McKenzie
- Division of Sports Medicine and School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - E M Yoshida
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
19
|
Gordon SC, Yoshida EM, Lawitz EJ, Bacon BR, Sulkowski MS, Davis M, Poordad F, Bronowicki JP, Esteban R, Sniukiene V, Burroughs MH, Deng W, Dutko FJ, Brass CA, Albrecht JK, Rajender Reddy K. Adherence to assigned dosing regimen and sustained virological response among chronic hepatitis C genotype 1 patients treated with boceprevir plus peginterferon alfa-2b/ribavirin. Aliment Pharmacol Ther 2013; 38:16-27. [PMID: 23710734 DOI: 10.1111/apt.12342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 01/27/2013] [Accepted: 05/01/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adherence to therapeutic regimens affects the efficacy of peginterferon alfa (P) and ribavirin (R) therapy in patients with chronic hepatitis C virus genotype 1. AIM To determine if medication adherence impacts efficacy [sustained virological response (SVR)] with triple therapy that includes boceprevir (BOC) plus P/R. METHODS Adherence was determined in two Phase 3 clinical studies with BOC: SPRINT-2 (previously untreated patients) and RESPOND-2 (patients who failed previous therapy with P/R). Adherence to the assigned duration of the dosing regimen and adherence to the three times a day (t.d.s.) dosing interval of 7-9 h for BOC were assessed by the recording of data from patients' dosing diaries and by the amount of study drug dispensed and returned. RESULTS Most patients (63-71%) adhered to ≥80% of their assigned treatment duration and achieved SVR rates of 86-90%. In contrast, patients who adhered to <80% of their assigned treatment duration achieved SVR rates of 8-32% (P < 0.0001), particularly low in patients who failed previous therapy (SVR = 8-15%). Different rates of adherence (<60% to >80%) to the t.d.s. dosing interval (7-9 h) with BOC did not influence the SVR rates (SVR = 60-83%) with the exception of patients who failed previous treatment and adhered to <60% of the t.d.s. dosing interval with BOC (SVR = 48-50%; P = 0.005). CONCLUSIONS The achievement of an SVR is more dependent on adherence to the assigned duration of treatment than adherence to the t.d.s. dosing interval with boceprevir. Adherence to >60% of t.d.s. dosing with boceprevir is important in patients who failed previous therapy.
Collapse
Affiliation(s)
- S C Gordon
- Henry Ford Hospital, Detroit, MI 48202-2689, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Wang EHZ, Partovi N, Levy RD, Shapiro RJ, Yoshida EM, Greanya ED. Pneumocystis pneumonia in solid organ transplant recipients: not yet an infection of the past. Transpl Infect Dis 2012; 14:519-25. [PMID: 22571389 DOI: 10.1111/j.1399-3062.2012.00740.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 02/17/2012] [Accepted: 02/22/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at risk for Pneumocystis pneumonia (PCP), especially in the first year post transplant. Although trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis substantially decreases this risk, there is little data or consensus on optimal duration of prophylaxis. Consequently, there is lack of standardization of prophylaxis duration (3 months to lifelong, depending on organ group) in SOT programs. METHODS We performed a retrospective chart review of all cases of confirmed PCP, in adult kidney, pancreas, liver, and lung transplant recipients from 2001 to 2011 in our SOT program. RESULTS Of 1241 patients followed in our clinic (657 kidney, 44 kidney/pancreas, 436 liver, and 104 lung or heart/lung), a total of 14 PCP cases were identified in 2 kidney, 1 kidney/pancreas, 5 liver, 5 single lung, and 1 heart/lung transplant recipient. At the time of PCP diagnosis, immunosuppression in most cases consisted of prednisone, tacrolimus, and mycophenolate mofetil (79% of patients), and 53% had previously received TMP-SMX for prophylaxis. None were on PCP prophylaxis at the time of illness onset. PCP occurred early in all 5 liver transplant recipients and in 1 kidney transplant recipient, none of whom had ever received prophylaxis (17-204 days post transplant). Of those who had received 6 months of prophylaxis (1 kidney, 1 kidney/pancreas), PCP occurred at 846 and 4778 days, respectively. Late onset PCP occurred in lung recipients who had received 12 months of prophylaxis (lung 645-1414 days, heart/lung 1583 days post transplant). Five patients had experienced acute rejection and 6 patients had cytomegalovirus (CMV) viremia on average 59 and 204 days preceding PCP, respectively. Three deaths (1 liver, 2 lung) were thought to be directly related to complications of PCP. CONCLUSION Our experience with late PCP cases in lung transplant recipients receiving only 1 year of prophylaxis lends support to prolonged PCP prophylaxis in this group. Given the number of patients who had experienced an acute rejection episode or CMV disease preceding PCP in non-lung SOT recipients, consideration should be given to re-institution of PCP prophylaxis for a period of time after these events in kidney, kidney/pancreas, and liver transplant recipients.
Collapse
Affiliation(s)
- E H Z Wang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | |
Collapse
|
21
|
Patel K, Benhamou Y, Yoshida EM, Kaita KD, Zeuzem S, Torbenson M, Pulkstenis E, Subramanian GM, McHutchison JG. An independent and prospective comparison of two commercial fibrosis marker panels (HCV FibroSURE and FIBROSpect II) during albinterferon alfa-2b combination therapy for chronic hepatitis C. J Viral Hepat 2009; 16:178-86. [PMID: 19175870 DOI: 10.1111/j.1365-2893.2008.01062.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Noninvasive markers that accurately follow changes in fibrosis may provide alternatives to liver biopsy for assessment of histological endpoints of antiviral therapy in chronic hepatitis C (CHC). This study compared two commercially available serum marker panels (HCV FibroSURE and FIBROSpect II) during interferon-based therapy. Ninety-five interferon-naïve patients with genotype 1 CHC were enrolled in a phase 2b, active-controlled study of albinterferon alfa-2b/ribavirin for 48 weeks. Proprietary and simple biochemical marker panels were independently evaluated in serum before and during the study. Baseline liver biopsies were evaluated for METAVIR fibrosis by a single pathologist. Index scores were obtained for HCV FibroSURE (n = 84) and FIBROSpect II (n = 95); mean biopsy length: 17.8 +/- 8.0 mm. For detecting fibrosis stages 2-4 (prevalence 23% [22/95] and 21% [18/84]), HCV FibroSURE and FIBROSpect II indicated high sensitivity (1.00 and 0.95, respectively), lower but comparable specificity (0.61 and 0.66, respectively), and a good area under the receiver operating characteristic curve (0.89 and 0.90, respectively). Simple indices had high indeterminate rates (31-40%) at baseline. Patients with a sustained virological response had lower baseline scores than nonresponders, and reduced median percent changes in index scores for HCV FibroSURE (-20.0%vs 2.9%; P = 0.14) and FIBROS Spect II (-6.8%vs 18.4%; P = 0.05). The panels demonstrated comparable performance characteristics for differentiating mild from moderate-severe stage disease in CHC. Lower index scores at baseline that continue to decline likely reflect reduced fibrogenesis activity in patients with successful antiviral responses to therapy.
Collapse
Affiliation(s)
- K Patel
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC 27715, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Bain VG, Lee SS, Peltekian K, Yoshida EM, Deschênes M, Sherman M, Bailey R, Witt-Sullivan H, Balshaw R, Krajden M. Clinical trial: exposure to ribavirin predicts EVR and SVR in patients with HCV genotype 1 infection treated with peginterferon alpha-2a plus ribavirin. Aliment Pharmacol Ther 2008; 28:43-50. [PMID: 18397386 DOI: 10.1111/j.1365-2036.2008.03705.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND The impact of reduced drug exposure on outcomes in patients with chronic hepatitis C has not been determined in routine clinical practice. AIM To examine the impact of exposure to peginterferon alpha-2a and ribavirin on early virological response (EVR) and sustained virological response (SVR) in treatment-naive patients with HCV genotype 1 infection enrolled in a large expanded access programme. METHODS Eight hundred and ninety-one patients treated for 48 weeks with an initial ribavirin dose of 800 or 1000/1200 mg/day were evaluated. Ribavirin 1000 mg/day (<75 kg) or 1200 mg/day (>or=75 kg) and peginterferon alpha-2a 180 microg/week were considered optimal. The impact of reduced drug exposure (expressed as a percentage of optimal) on EVR and SVR was evaluated. RESULTS Mean ribavirin exposure in week 0-12 was 70% and 96% in patients assigned to ribavirin 800 and 1000/1200 mg/day, respectively. EVR and SVR rates were lower in patients assigned to ribavirin 800 than 1000/1200 mg/day (EVR, 75% vs. 84%, respectively, P < 0.001; SVR, 45% vs. 54%, respectively, P = 0.011). Furthermore, there was a strong correlation between achievement of EVR and SVR and ribavirin dose over the first 12 weeks expressed either as absolute dose or proportion of optimal dose received (P < 0.001 for both). CONCLUSIONS Ribavirin exposure to week 12 is significantly associated with EVR and SVR in genotype 1 patients. Maintenance of an optimal ribavirin dose is the most important modifiable factor during combination therapy for chronic hepatitis C.
Collapse
Affiliation(s)
- V G Bain
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Wiesinger HAR, Shah J, White A, Yoshida EM, Frohlich J, Sirrs S, Gill S, Byrne MF. Liver biochemistry abnormalities in a quaternary care lipid clinic database. Ann Hepatol 2008; 7:63-6. [PMID: 18376368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The metabolic syndrome and non-alcoholic fatty liver disease are increasing at alarming rates. AIMS To determine the effect of HMG-CoA reductase inhibitors (statins) on elevated liver enzymes in patients with hyperlipidemia. PATIENTS Patients with AST above 60 U/L prior to or during treatment with statin therapy at a quaternary care lipid clinic were reviewed. METHODS A retrospective analysis was conducted. Patients were separated into two groups: Group 1--elevated AST prior to statin therapy; and Group 2--elevated AST during statin therapy. RESULTS Forty six patients with one or more measurements of AST >60 U/L remained after exclusion criteria were applied. Ten of 13 (77%) group 1 patients had reduced AST levels after initiation of statin therapy. Thirty two of 33 patients (97%) in group 2 had transient AST elevations while on statin therapy; one patient had persistently elevated AST after initiation of treatment. There were no significant adverse events reported. CONCLUSION Use of HMG-CoA reductase inhibitors in patients with elevated AST resulted in normalization of AST levels. HMG-CoA reductase inhibitors were safe in patients with mildly elevated AST. This may translate to use of HMG-CoA reductase inhibitors in diseases such as non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.
Collapse
Affiliation(s)
- Holly A R Wiesinger
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Krygier DS, Harris AC, Yoshida EM. A case of recurrent pyogenic cholangitis. Dig Liver Dis 2008; 40:386. [PMID: 18083077 DOI: 10.1016/j.dld.2007.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 10/30/2007] [Accepted: 10/30/2007] [Indexed: 12/11/2022]
Affiliation(s)
- D S Krygier
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | | |
Collapse
|
25
|
Powis J, Peltekian KM, Lee SS, Sherman M, Bain VG, Cooper C, Krajden M, Deschenes M, Balshaw RF, Heathcote EJ, Yoshida EM. Exploring differences in response to treatment with peginterferon alpha 2a (40kD) and ribavirin in chronic hepatitis C between genotypes 2 and 3. J Viral Hepat 2008; 15:52-7. [PMID: 18088245 PMCID: PMC2229559 DOI: 10.1111/j.1365-2893.2007.00889.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic hepatitis C virus (HCV) infections with genotype 2 or 3 are associated with favourable sustained virologic response (SVR) rates. However, genotype 3 may respond less well. We reassessed all treatment-naive patients with genotype 2 and 3 participating in a large expanded-access, non-randomized, open-label trial, evaluating 180microg pegylated interferon (peg-IFN) alpha-2a (40kD) once weekly and 800 mg/day ribavirin for 24-48 weeks. Factors measured prior to initiation of antiviral therapy were considered in the multiple logistic regression model for predicting SVR. In total, 180 patients were analysed of which 72 (40%) were infected by genotype 2 and 108 (60%) genotype 3. The baseline characteristics between patients infected by genotype 2 or 3 were no different including the distribution of hepatic fibrosis stages by METAVIR score. Overall SVR was lower in those patients infected with genotype 3. The significant multivariate predictors of lack of SVR were hepatic fibrosis (P = 0.014) and genotype 3 (P = 0.030). The negative impact of cirrhosis (METAVIR score F4) on treatment response was more evident among subjects with genotype 3 than those with genotype 2 (P = 0.027). There is significant interaction between cirrhosis and genotype 3 leading to a poor antiviral response in such patients requiring an alternate management strategy. This finding should be confirmed in a larger population.
Collapse
Affiliation(s)
- J Powis
- Department of Medicine, University of TorontoToronto, ON
| | - K M Peltekian
- Department of Medicine, Dalhousie UniversityHalifax, NS
| | - S S Lee
- Department of Medicine, University of CalgaryCalgary, AB
| | - M Sherman
- Department of Medicine, University of TorontoToronto, ON
| | - V G Bain
- Department of Medicine, University of AlbertaEdmonton, AB
| | - C Cooper
- Department of Medicine, British Columbia Centre for Disease ControlVancouver, BC
| | - M Krajden
- Department of Medicine, British Columbia Centre for Disease ControlVancouver, BC
| | - M Deschenes
- Department of Medicine, University of British ColumbiaVancouver, BC, Canada
| | - R F Balshaw
- Department of Medicine, Syreon CorporationVancouver, BC
| | | | - E M Yoshida
- Department of Medicine, University of British ColumbiaVancouver, BC, Canada
| | | |
Collapse
|
26
|
Abstract
BACKGROUND Coffee is consumed by 50 percent of Americans every day. After oil, coffee is the second most valuable commodity in the world. In recent years a number of studies have suggested potential health risks associated with coffee consumption; however, the results are controversial. Whilst coffee has been reported to increase cardiovascular risk factors, other investigators have demonstrated its protective effects on diseases ranging from type 2 diabetes to Parkinson's disease. A number of investigators have focused their attention on the relationship between the consumption of coffee and liver disease. AIM To examine the published literature to date in an attempt to establish the presence of an hepatoprotective effect of coffee. METHODS Using PubMed, we identified published studies and review articles relating to the effect of coffee consumption on diseases of the liver. CONCLUSION A number of studies have reported the beneficial effects of coffee on abnormal liver biochemistry, cirrhosis and hepatocellular carcinoma. At the present time the mechanism of this effect remains unclear as does the ''dose'' required to achieve these benefits.
Collapse
Affiliation(s)
- I S H Cadden
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | |
Collapse
|
27
|
Apiratpracha W, Chung HV, Ali JA, Bashir K, Yoshida EM, Singh RS. Peritoneal dialysis after orthotopic liver transplant surgery. Perit Dial Int 2007; 27:99-100. [PMID: 17179523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
|
28
|
Wang CS, Ko HH, Yoshida EM, Marra CA, Richardson K. Interferon-based combination anti-viral therapy for hepatitis C virus after liver transplantation: a review and quantitative analysis. Am J Transplant 2006. [PMID: 16827859 DOI: 10.1111/j.1365-2893.2008.01019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is universal. However, the efficacy, tolerability and safety of combination interferon and ribavirin (IFN-RIB) or peginterferon and ribavirin (PEG-RIB) anti-viral therapies post-LT are uncertain. We performed a comprehensive search of major medical databases (1980-2005) and conference proceedings (1996-2005). The main outcome measure was sustained virological response (SVR, undetectable HCV RNA) at 6 months. Summary estimates were calculated using random-effects models. Twenty-seven IFN-RIB and 21 PEG-RIB studies were included. IFN-RIB was associated with a pooled SVR rate of 24% (95% CI, 20-27%), while PEG-RIB was associated with an SVR rate of 27% (23-31%). Pooled discontinuation rates were 24% (21-27%) with IFN-RIB and 26% (20-32%) with PEG-RIB. The pooled rate of acute graft rejection was 2% (1-3%) with IFN-RIB and 5% (3-7%) with PEG-RIB. IFN-RIB and PEG-RIB therapies in HCV infection post-LT were associated with similar but overall low SVR and were poorly tolerated. The rate of acute rejection was small. The therapeutic advantage of PEG-RIB therapy observed in non-transplant chronic HCV infection appears to be attenuated post-LT. Clinical trials are needed to evaluate reasons for this post-transplant therapeutic disadvantage and to find strategies to ameliorate them.
Collapse
Affiliation(s)
- C S Wang
- Department of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | |
Collapse
|
29
|
Sherman M, Yoshida EM, Deschenes M, Krajden M, Bain VG, Peltekian K, Anderson F, Kaita K, Simonyi S, Balshaw R, Lee SS. Peginterferon alfa-2a (40KD) plus ribavirin in chronic hepatitis C patients who failed previous interferon therapy. Gut 2006; 55:1631-8. [PMID: 16709661 PMCID: PMC1860092 DOI: 10.1136/gut.2005.083113] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The management of patients with chronic hepatitis C who have relapsed or failed to respond to interferon based therapies is an important issue facing hepatologists. AIMS We evaluated the efficacy and safety of peginterferon alfa-2a (40KD) plus ribavirin in this population by conducting a multicentre open label study. PATIENTS Data from adults with detectable serum hepatitis C virus (HCV) RNA who had not responded or had relapsed after previous conventional interferon or conventional interferon/ribavirin combination therapy were analysed. METHODS Patients were retreated with peginterferon alfa-2a (40KD) 180 microg/week plus ribavirin 800 mg/day for 24 or 48 weeks at the investigators' discretion. The study was conceived before the optimal dose of ribavirin (1000/1200 mg/day) for patients with genotype 1 was known. The primary endpoint was sustained virological response (SVR), defined as undetectable HCV RNA (<50 IU/ml) after 24 weeks of follow up. The analysis was conducted by intention to treat. RESULTS A total of 312 patients (212 non-responders, 100 relapsers) were included. Of these, 28 patients were treated for 24 weeks and 284 for 48 weeks. Baseline characteristics between non-responders and relapsers were similar although more non-responders had genotype 1 infection (87% v 69%). Overall SVR rates were 23% (48/212) for non-responders and 41% (41/100) for relapsers. When data were analysed by genotype, SVR rates were 24% (61/253) in genotype 1 and 47% (28/59) in genotype 2/3. CONCLUSIONS These results in a large patient cohort demonstrate that it is possible to cure a proportion of previous non-responders and relapsers by retreating with peginterferon alfa-2a (40KD) plus ribavirin.
Collapse
Affiliation(s)
- M Sherman
- Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, M5G 2C4 Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
The risk of an abnormal liver test in 813 patients with multiple sclerosis or clinically isolated syndrome enrolled in placebo arms of clinical trials was greater than expected for alanine aminotransferase (ALT) (relative risk [RR] 3.7; 95% CI: 2.3 to 6.0) and aspartate aminotransferase (AST) (RR 2.2; 95% CI: 1.3 to 3.6), although not alkaline phosphatase (AP) or total bilirubin, at first presentation. Abnormal test results were associated with higher body mass index (ALT only), male gender (ALT only), and a relapsing-remitting (vs secondary-progressive) course (ALT and AST only).
Collapse
Affiliation(s)
- H Tremlett
- Faculty of Medicine, Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | |
Collapse
|
31
|
Wang CS, Ko HH, Yoshida EM, Marra CA, Richardson K. Interferon-based combination anti-viral therapy for hepatitis C virus after liver transplantation: a review and quantitative analysis. Am J Transplant 2006; 6:1586-99. [PMID: 16827859 DOI: 10.1111/j.1600-6143.2006.01362.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is universal. However, the efficacy, tolerability and safety of combination interferon and ribavirin (IFN-RIB) or peginterferon and ribavirin (PEG-RIB) anti-viral therapies post-LT are uncertain. We performed a comprehensive search of major medical databases (1980-2005) and conference proceedings (1996-2005). The main outcome measure was sustained virological response (SVR, undetectable HCV RNA) at 6 months. Summary estimates were calculated using random-effects models. Twenty-seven IFN-RIB and 21 PEG-RIB studies were included. IFN-RIB was associated with a pooled SVR rate of 24% (95% CI, 20-27%), while PEG-RIB was associated with an SVR rate of 27% (23-31%). Pooled discontinuation rates were 24% (21-27%) with IFN-RIB and 26% (20-32%) with PEG-RIB. The pooled rate of acute graft rejection was 2% (1-3%) with IFN-RIB and 5% (3-7%) with PEG-RIB. IFN-RIB and PEG-RIB therapies in HCV infection post-LT were associated with similar but overall low SVR and were poorly tolerated. The rate of acute rejection was small. The therapeutic advantage of PEG-RIB therapy observed in non-transplant chronic HCV infection appears to be attenuated post-LT. Clinical trials are needed to evaluate reasons for this post-transplant therapeutic disadvantage and to find strategies to ameliorate them.
Collapse
Affiliation(s)
- C S Wang
- Department of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | |
Collapse
|
32
|
Lee SS, Bain VG, Peltekian K, Krajden M, Yoshida EM, Deschenes M, Heathcote J, Bailey RJ, Simonyi S, Sherman M. Treating chronic hepatitis C with pegylated interferon alfa-2a (40 KD) and ribavirin in clinical practice. Aliment Pharmacol Ther 2006; 23:397-408. [PMID: 16422999 DOI: 10.1111/j.1365-2036.2006.02748.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pegylated interferon alfa-2a (40 KD) plus ribavirin therapy induces sustained virological response rates up to 63% in randomized-controlled trials. AIM To conduct a prospective open-label programme to examine the efficacy and safety of this therapy in routine clinical practice. METHODS Treatment-naive patients with chronic hepatitis C received, at the discretion of the investigator, pegylated interferon alfa-2a 180 microg/week + ribavirin 800 mg/day for 24 or 48 weeks. In total, 508 patients were enrolled [334 non-cirrhotic; 174 cirrhotic (defined as stage F3 and F4)]. RESULTS In genotype 1 patients treated for 48 weeks, sustained virological response rates were 41% in non-cirrhotics and 34% in cirrhotics. Sustained virological response rates in genotype 2 or 3 non-cirrhotics were 79% (24 weeks) and 72% (48 weeks). Corresponding values for cirrhotic genotype 2/3 were 66% and 44%. The negative predictive value of an early virological response at week 12 was 94%. Predictive factors for sustained virological response on multivariate analysis were genotype (2/3 vs. 1), low viral load and degree of fibrosis. Rates of serious adverse events (<or=5%) and adverse events inducing withdrawal (<or=8%) were comparable with the phase III trials. CONCLUSION Efficacy and safety of pegylated interferon alfa-2a + ribavirin in clinical practice is comparable with results of randomized-controlled trials.
Collapse
Affiliation(s)
- S S Lee
- Liver Unit, University of Calgary, Calgary, AB, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ho SGF, Phillips AJ, Browne RFJ, Munk PL, Legiehn GM, Yoshida EM, Davis JE, Chung SW, Scudamore CH. Recurrent hepatocellular carcinoma after liver transplantation mimicking post-transplantation lymphoproliferative disorder. Australas Radiol 2005; 49:315-8. [PMID: 16026439 DOI: 10.1111/j.1440-1673.2005.01449.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Approximately 5% of patients with end-stage cirrhosis undergoing orthotopic liver transplantation have occult hepatocellular carcinoma. Careful follow up is required to detect recurrent tumour, and knowledge of the patterns of recurrence may avoid diagnostic confusion with other malignancies, such as post-transplantation lymphoproliferative disorder. This case report illustrates an unusual presentation of recurrent hepatocellular carcinoma in a 56-year-old man presenting with a para-aortic soft tissue mass, thought clinically and radiologically to represent lymphoma or post-transplantation lymphoproliferative disorder. This case demonstrates that recurrent hepatocellular carcinoma can present late after transplantation as retroperitoneal lymphadenopathy, and should alert physicians and radiologists to be aware of the radiological appearances of recurrence and of the need for early biopsy to avoid diagnostic confusion with other malignancies.
Collapse
Affiliation(s)
- S G F Ho
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Cowie SE, Yoshida EM, Ryan AG, Chung SW, Buczkowski AK, Ho SG, Erb SR, Steinbrecher UP, Scudamore CH. Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor. Transpl Int 2004; 17:379-83. [PMID: 15349723 DOI: 10.1007/s00147-004-0727-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Revised: 11/14/2003] [Accepted: 03/09/2004] [Indexed: 10/26/2022]
Abstract
We report the case of an ultimately successful liver transplant recipient whose post-transplant course was complicated by the early development of multiple abscesses in the graft. Post-transplant cholangiography identified multiple shear injuries to the second and third order intrahepatic bile ducts, originating from blunt trauma to the donor liver. Treatment was non-operative following recent reports of the successful management of intrahepatic bile duct injury in the stable trauma patient. This discussion adds to the limited literature available on the transplantation of injured donor livers, despite this being a relatively common practice. Further experience is needed in determining the appropriate criteria for the use of traumatized donor livers. Cholangiography carried out on the back table may help to determine if such injured livers are suitable for transplantation.
Collapse
Affiliation(s)
- S E Cowie
- Department of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Cowie SE, Yoshida EM, Ryan AG, Chung SW, Buczkowski AK, Ho SG, Erb SR, Steinbrecher UP, Scudamore CH. Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor. Transpl Int 2004. [DOI: 10.1111/j.1432-2277.2004.tb00458.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
Sirrs S, Yoshida EM, Wong L, Erb SR, Chung SW, Steinbrecher UP, Scudamore CH, Hartnett C, Lillquist Y, Davidson A. Orthotopic liver transplantation in a patient with carbamyl phosphate synthetase deficiency and cystic fibrosis. Paediatr Child Health 2003; 8:497-8. [PMID: 20019934 DOI: 10.1093/pch/8.8.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 15-year-old female with carbamyl phosphate synthetase deficiency, cystic fibrosis, and cystic fibrosis-related diabetes underwent orthotopic cadaveric liver transplantation. Metabolic control was maintained during the procedure with nutritional support and the use of intravenous sodium phenylacetate and benzoate. Her postoperative course was complicated by seizures and a transient decline in her pulmonary function tests, which returned to preoperative levels within one year of the transplant. Now, four years post-transplant, her quality of life has dramatically improved. There are only four Canadian centres with paediatric liver transplantation programs. However, expert medical care for adults with inborn error of metabolism is even more limited, suggesting that access to adult medical care is one of the many factors to be considered when liver transplantation is contemplated for patients with metabolically unstable conditions.
Collapse
Affiliation(s)
- S Sirrs
- Department of Medicine, Division of Endocrinology
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Yoshida EM, Wong SGM. SEN virus. A clinical review. MINERVA GASTROENTERO 2002; 48:73-9. [PMID: 16489298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
SEN-V is a newly discovered single-stranded DNA virus that is distantly related to TT virus. Eight genotypes of SEN-V, designated SEN-V: A to H, have been identified although it has been suggested that genotypes SEN-V: H & C as well as SEN-V: D & F be combined. SEN-V is clearly transmitted via transfusion of blood products and parenteral contact. It appears to have a world-wide distribution as it has been isolated in every country that has been studied including remote communities. Interest in SEN-V arises from initial reports that two SEN-V genotypes, SEN-V: D & H, were associated with post-transfusion non-A, non-E hepatitis. The focus of investigations of SEN-V and liver disease has been exclusively with these two genotypes. Although one study documented a clear temporal relation between post-transfusion SEN-V infection and NANE hepatitis, and found that over 90% of a small cluster of NANE hepatitis cases were associated with SEN-V, it is also clear that the majority of patients who acquire SEN-V do not suffer hepatitis. Furthermore, other studies have failed to find a significant difference in prevalence between SEN-V and etiologically known vs cryptogenic acute or chronic liver disease, cryptogenic hepatoma vs HBV & HCV-associated hepatoma and post-liver transplant biochemical abnormalities. Despite the fact that there is no consensus that SEN-V is a cause of liver disease, it does appear to be responsive to interferon-based therapy.
Collapse
Affiliation(s)
- E M Yoshida
- Department of Medicine, University of British Columbia, British Columbia Transplant Society, Vancouver, BC, Canada
| | | |
Collapse
|
38
|
Affiliation(s)
- E C McKevitt
- Dept. of Surgery, University of British Columbia, Vancouver, Canada
| | | | | | | |
Collapse
|
39
|
Yoshida EM. Is there an association between SEN virus and liver disease? Reviewing the evidence. Can Commun Dis Rep 2002; 28:53-60. [PMID: 11939087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- E M Yoshida
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
40
|
Northcott KA, Yoshida EM, Steinbrecher UP. Primary protein-losing enteropathy in anti-double-stranded DNA disease: the initial and sole clinical manifestation of occult systemic lupus erythematosus? J Clin Gastroenterol 2001; 33:340-1. [PMID: 11588554 DOI: 10.1097/00004836-200110000-00019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hypoalbuminemia and generalized edema is a common clinical problem and the etiology is usually clear: cirrhosis, nephrotic syndrome, primary gastrointestinal disorders, malnutrition, etc. We present a 23-year-old previously healthy woman of Korean background who presented with generalized edema and a serum albumin of 9 g/L (normal, 35-45 g/L). Intensive investigations failed to reveal liver, renal, or inflammatory gastrointestinal mucosal disease. The antinuclear antibody was positive at a titer of 1:80, and extractable nuclear antigens were positive for SSA/anti-Ro. Anti-double-stranded DNA was markedly elevated at 4.6 kU/L (normal, 0-2.0 kU/L). A technetium 99M-labeled albumin study revealed a protein-losing enteropathy, despite normal histologic full-thickness jejunal biopsies. A diagnosis of occult systemic lupus erythematosus resulting in increased intestinal vascular permeability was made. The hypoalbuminemia remained in long-term remission after the initiation of induction and maintenance immunosuppression.
Collapse
Affiliation(s)
- K A Northcott
- Department of Medicine, the University of British Columbia, Vancouver, British Columbia, Canada
| | | | | |
Collapse
|
41
|
Abstract
BACKGROUND Recipients of heart, lung, and kidney transplants have impaired peak exercise performance (peak Vo2 40% to 60% predicted, reduced anaerobic threshold [AT]) without evidence of ventilatory or cardiac limitations. The aim of this study was to determine whether similar exercise impairment occurs in liver transplant recipients. METHODS We studied eight healthy liver transplant recipients (age 42+/-9 [SD] years, 6 male, 31+/-13 months posttransplant). Immunosuppression included FK506 or cyclosporine, azathioprine or mycophenolate mofetil, and prednisone. Subjects underwent lung function testing and cardiopulmonary exercise testing on a cycle ergometer. RESULTS Peak exercise oxygen consumption (Vo2) was 22+/-8 ml/min/kg (66+/-20% predicted maximum). No subject demonstrated exercise desaturation or ventilatory limitation (peak minute ventilation 55+/-8% predicted maximum voluntary ventilation). Peak heart rate was 87+/-8% of predicted maximum. Early AT was evident (1.2+/-0.34 L/min, 48+/-11% predicted Vo2max). CONCLUSIONS Liver transplant recipients exhibit impaired peak exercise performance similar to that observed after other solid organ transplants, possibly as a result of chronic deconditioning or myopathy related to immunosuppressive medications.
Collapse
Affiliation(s)
- A L Stephenson
- Respiratory Division, Vancouver General Hospital, 2775 Heather Street, Vancouver, BC, Canada, V5Z 3J5
| | | | | | | | | |
Collapse
|
42
|
Pruthi J, Medkiff KA, Esrason KT, Donovan JA, Yoshida EM, Erb SR, Steinbrecher UP, Fong TL. Analysis of causes of death in liver transplant recipients who survived more than 3 years. Liver Transpl 2001; 7:811-5. [PMID: 11552217 DOI: 10.1053/jlts.2001.27084] [Citation(s) in RCA: 234] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Few studies have examined causes of death in long-term survivors of orthotopic liver transplantation (OLT). We reviewed causes of death among 299 adult liver transplant recipients who survived more than 3 years after OLT at 2 centers. Thirty-eight of the 299 patients subsequently died. Nonhepatic causes accounted for 22 of 38 late deaths (58%). Death caused by malignancies occurred in 9 patients between 3.3 and 8.0 years after OLT. Eight patients died of cardiovascular complications. The 6 patients who died of myocardial infarction had risk factors for coronary artery disease. Hepatic failure caused by recurrent liver disease or chronic rejection accounted for 16 of 38 late deaths (42%). These 16 patients were younger than patients who died of nonhepatic complications (mean ages, 50.7 v 62.1 years; P =.001). However, the mean interval between OLT and death was similar among patients who died of nonhepatic versus hepatic causes. Nine patients had recurrent liver disease leading to death, and 8 of 9 patients had recurrent chronic hepatitis C virus (HCV) infection. Chronic rejection resulting in graft failure and death occurred in 7 patients. In summary, de novo malignancies and cardiovascular complications accounted for more than half the late deaths. Patients who died of nonhepatic causes were significantly older than patients who died of hepatic causes. Chronic rejection and recurrent HCV infection accounted for the majority of hepatic causes of death. With longer follow-up, graft failure resulting from recurrent HCV infection will become the major cause of death in late survivors.
Collapse
Affiliation(s)
- J Pruthi
- Division of Liver Transplantation, Southern California Permanente Medical Group, Los Angeles, CA, USA
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Wong SG, Yoshida EM. Liver enzymes as surrogate markers of hepatitis C histopathology--avoiding the liver biopsy needle? Can J Gastroenterol 2001; 15:629-30. [PMID: 11573108 DOI: 10.1155/2001/654720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A retrospective cohort study of 79 patients with chronic hepatitis C was performed to assess the predictive nature of various variables (age, sex, route of transmission, extent of steatosis, alcohol consumption and serum aminotransferase values), with the underlying hepatic histopathology. The newly modified Knodell histological activity index by Desmet et al (1), which separately scores the inflammation from the fibrosis on the liver biopsy, was used. Using stepwise multivariate logistic regression, it was discovered that serum aspartate aminotransferase (AST) values had a predictive relationship with overall histological activity (r=0.62), portal inflammation (r=0.58), piecemeal necrosis (r=0.61) and extent of hepatic fibrosis (r=0.64). Serum AST values correctly predicted the inflammatory grade in 63 of 79 (80%) patients, and the fibrosis stage in 50 of 79 (63%) patients - higher than the predictive values of ALT. Serum alanine aminotransferase (ALT) values did not correlate with the degree of histological inflammation (r=0.39) but did correlate mildly with the extent of hepatic fibrosis (r=0.51). There were no significant correlations of the other variables with histological inflammation or fibrosis.
Collapse
Affiliation(s)
- S G Wong
- University of British Columbia, Vancouver, British Columbia V5Z 4E3, Canada
| | | |
Collapse
|
44
|
Ramji A, Yoshida EM. Diabetes mellitus after liver transplantation: another extrahepatic manifestation of hepatitis C. Can J Gastroenterol 2001; 15:432. [PMID: 11493946 DOI: 10.1155/2001/428386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Ramji
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
45
|
Yoshida EM. Efficacy of lamivudine in decompensated cirrhosis secondary to hepatitis B: cautious optimism in the war not yet won. Can J Gastroenterol 2001; 15:433-4. [PMID: 11493947 DOI: 10.1155/2001/158543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- E M Yoshida
- University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
46
|
Abstract
A new DNA virus, referred to as SEN virus (SEN V), has been isolated and is associated with blood-product transfusion and possibly Non A to Non E hepatitis. We performed a cross-sectional analysis of SEN V in liver transplant recipients at our center. Polymerase chain reaction was used to test for 2 genotypes of SEN V (SEN V:C/H and SEN V:D) in 58 unselected patients. Comparisons were made between SEN V--positive and SEN V--negative groups in terms of age, time posttransplantation, indications for transplantation, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and cytomegalovirus and Epstein-Barr virus status. Thirty of 58 transplant recipients (51.7%) were SEN V positive; 15.5% were positive for SEN V:C/H, 24.1% for SEN:D, and 12.1% for both strains. No significant differences were found based on primary indication for transplantation, including hepatitis C virus (HCV). Of the 14 of 21 patients with HCV seropositivity and HCV reinfection, 79% were positive for SEN V (P =.02). There was no difference in the proportion of patients with abnormal serum ALT and/or AST levels. A trend for the SEN V--positive group to have a greater mean ALT level (82 v 41 U/L; P =.067) was attributable to the subgroup with HCV recurrence because there was no difference in mean ALT levels (34.9 v 34.5 U/L; P =.968) in non--HCV-infected transplant recipients. Even in the subgroup (n = 14) with recurrent HCV, there was no statistically significant difference in mean ALT levels (140 v 105 U/L; P =.665). Age and cytomegalovirus or Epstein-Barr virus status were not significantly different between the 2 groups, but a significant difference in posttransplantation time was noted (16.8 v 32 months; P =.021). We conclude that SEN V is common among liver transplant recipients but does not appear to cause graft dysfunction as an isolated agent. There is a suggestion that SEN V may be associated with HCV recurrence, but we did not detect biochemical differences attributable to SEN V.
Collapse
Affiliation(s)
- E M Yoshida
- Department of Medicine, University of British Columbia, British Columbia Transplant Society, Vancouver, BC
| | | | | | | | | |
Collapse
|
47
|
Yoshida EM, Rasmussen SL, Steinbrecher UP, Erb SR, Scudamore CH, Chung SW, Oger JJ, Hashimoto SA. Fulminant liver failure during interferon beta treatment of multiple sclerosis. Neurology 2001; 56:1416. [PMID: 11376205 DOI: 10.1212/wnl.56.10.1416] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E M Yoshida
- Department of Medicine, the University of British Columbia and the British Columbia Transplant Society, Vancouver, Canada
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Internal medicine residents at one school identified barriers to and predictors of publishing their research. Insufficient time was the key obstacle to completing research. Residents with previous research experience, senior residents, and men were more likely to publish.
Collapse
Affiliation(s)
- S Gill
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | |
Collapse
|
49
|
Partovi N, Guy MW, Ensom MH, Noble MA, Yoshida EM. A study of the pharmacokinetic profile of low-dose hepatitis B immune globulin in long-term liver transplant recipients for chronic hepatitis B infection. Am J Transplant 2001; 1:51-4. [PMID: 12095038 DOI: 10.1034/j.1600-6143.2001.010110.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Post-transplant protocols for hepatitis B (HBV) prophylaxis using high-dose intravenous hepatitis B immune globulin (10,000 IU) with or without lamivudine are commonly reported. Our centre has previously reported a low-dose intramuscular (i.m.) protocol and lamivudine with excellent results. There have been, however, no pharmacokinetic studies of i.m. hepatitis B immune globulin (HBIG) in this setting. The objective of this study was to determine the pharmacokinetic profile of i.m. HBIG in long-term post-liver-transplant recipients to determine a rational dosing protocol. Six stable liver transplant recipients receiving monthly i.m. HBIG injections for greater than one year were enrolled in this study. All patients had no detectable HBV DNA levels. HBIG titers (anti-HBs) were measured predose, then three times weekly for four weeks and then twice weekly until the serum HBIG titers were 100 IU/L or less. The pharmacokinetic parameters were calculated using noncompartment methods. The mean time to maximum concentration was 10.5 d (range 4-20 d) and the mean half-life was 20 d (range 13.5-23.5 d). Based on these pharmacokinetic parameters in stable long-term post-transplant patients, a rational dosing protocol was developed that allows for more appropriate utility of HBIG and improved patient convenience.
Collapse
Affiliation(s)
- N Partovi
- Vancouver Hospital and Health Sciences Centre, and Faculty of Pharmaceutical Sciences, University of British Columbia and the British Columbia Transplant Society, Canada
| | | | | | | | | |
Collapse
|
50
|
Yoshida EM, Ramji A, Erb SR, Davis JE, Steinbrecher UP, Sherlock CH, Scudamore CH, Chung SW, Williams M, Gutfreund KS. De novo acute hepatitis B infection in a previously vaccinated liver transplant recipient due to a strain of HBV with a Met 133 Thr mutation in the "a" determinant. Liver 2000; 20:411-4. [PMID: 11092260 DOI: 10.1034/j.1600-0676.2000.020005411.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED De novo HBV infection post-liver transplantation (LT) from an anti-HBc seropositive donor rarely presents as acute failure. We report a 42-year-old Caucasian female, HBsAg and anti-HBc seronegative, with primary biliary cirrhosis who received an allograft from a HBsAg negative, anti-HBc seropositive donor. The patient, previously vaccinated years pre-LT, was re-vaccinated against HBV and 1 year post-LT had an anti-HBs titre of 256 IU/l. Two years post-LT, elevated serum aminotransferases and worsening liver function with an INR of 2.0 developed. The HBsAg became positive, anti-HBs undetectable and serum HBV-DNA >2000 pg/ml by hybridisation assay. Liver biopsy revealed significant ballooning degeneration, piecemeal necrosis and positive immunostaining for HBsAg. Progressive liver failure developed followed by sepsis and terminal multi-organ failure. Subsequent analysis of the predominant HBV strain revealed mutations in the "a" determinant: Met 133 Thr (codon change ATG to ACG) and Asn 131 Thr. CONCLUSION ' Acute de novo HBV infection from an anti-HBc sero-positive donor may occur long after LT despite protective anti-HBs titres post-vaccination secondary to the emergence of "a" determinant mutated strains of HBV.
Collapse
Affiliation(s)
- E M Yoshida
- British Columbia Transplant Society and the Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|