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Li D, He Q, Yang H, Du Y, Yu K, Yang J, Tong X, Guo Y, Xu J, Qin L. Daily Dose of Bovine Lactoferrin Prevents Ethanol-Induced Liver Injury and Death in Male Mice by Regulating Hepatic Alcohol Metabolism and Modulating Gut Microbiota. Mol Nutr Food Res 2021; 65:e2100253. [PMID: 34331394 DOI: 10.1002/mnfr.202100253] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/22/2021] [Indexed: 11/10/2022]
Abstract
SCOPE Lactoferrin (Lf) possess a protective potential to liver, but whether it can prevent alcoholic liver injury (ALI) remains unclear. METHODS AND RESULTS Four groups of male C57BL/6J mice are fed with different diets, namely, AIN-93G diet for control (CON) and ethanol (EtOH) groups, and AIN-93G diet with 0.4% and 4% casein replaced by Lf for low-dose Lf (LLf) and high-dose Lf (HLf) groups, respectively. ALI is induced by giving 20% ethanol ad libitum combined with four "binges". Lf can remarkably decrease EtOH-induced mortality. Lf promotes aldehyde dehydrogenase-2 (ALDH2) expression and suppressing cytochrome P450 2E1 (CYP2E1) overexpression, resulting in the reduced hepatic superoxide and inflammation levels, which ultimately leads to the hepatic injury alleviation. However, HLf increases acetyl-CoA carboxylase and fatty acid synthase protein levels, which suggests that excessive intake may weaken the beneficial effects of Lf. Moreover, LLf increases the relative abundances of Akkermansia and Lactobacillus. Additionally, the study shows that Lf likely exerts action in its digestive product forms rather than intact Lf molecular in normal condition. CONCLUSION LLf can ameliorate ALI, which is associated with the regulation of hepatic alcohol metabolism and the modulation of gut microbiota. However, excessive Lf intake may result in a diminished benefit.
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Affiliation(s)
- Deming Li
- School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, Jiangsu, 215123, China
| | - Qian He
- School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, Jiangsu, 215123, China
| | - Huanhuan Yang
- School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, Jiangsu, 215123, China
| | - Yafang Du
- School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, Jiangsu, 215123, China
| | - Kangqing Yu
- Institute of Optics and Electronics, Chinese Academy of Science, Chengdu, Sichuan, 610209, China
| | - Jing Yang
- Department of Clinical Nutrition, The First Affiliated Hospital of Soochow University, Suzhou, 215123, China
| | - Xing Tong
- Laboratory Center, Medical College of Soochow University, Suzhou, 215123, China
| | - Yaxin Guo
- School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, Jiangsu, 215123, China
| | - Jiaying Xu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Soochow University, Suzhou, 215123, China
| | - Liqiang Qin
- School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, Jiangsu, 215123, China
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Grander C, Schaefer B, Schwärzler J, Grabherr F, de Graaf DM, Enrich B, Oberhuber G, Mayr L, Sangineto M, Jaschke N, Adolph TE, Effenberger M, Moschen AR, Dinarello CA, Zoller H, Tilg H. Alpha-1 antitrypsin governs alcohol-related liver disease in mice and humans. Gut 2021; 70:585-594. [PMID: 32699098 DOI: 10.1136/gutjnl-2020-321375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Alcohol-related liver disease (ALD) is a global healthcare problem with limited treatment options. Alpha-1 antitrypsin (AAT, encoded by SERPINA1) shows potent anti-inflammatory activities in many preclinical and clinical trials. In our study, we aimed to explore the role of AAT in ALD. DESIGN An unselected cohort of 512 patients with cirrhosis was clinically characterised. Survival, clinical and biochemical parameters including AAT serum concentration were compared between patients with ALD and other aetiologies of liver disease. The role of AAT was evaluated in experimental ALD models. RESULTS Cirrhotic ALD patients with AAT serum concentrations less than 120 mg/dL had a significantly higher risk for death/liver transplantation as compared with patients with AAT serum concentrations higher than 120 mg/dL. Multivariate Cox regression analysis showed that low AAT serum concentration was a NaMELD-independent predictor of survival/transplantation. Ethanol-fed wild-type (wt) mice displayed a significant decline in hepatic AAT compared with pair-fed mice. Therefore, hAAT-Tg mice were ethanol-fed, and these mice displayed protection from liver injury associated with decreased steatosis, hepatic neutrophil infiltration and abated expression of proinflammatory cytokines. To test the therapeutic capability of AAT, ethanol-fed wt mice were treated with human AAT. Administration of AAT ameliorated hepatic injury, neutrophil infiltration and steatosis. CONCLUSION Cirrhotic ALD patients with AAT concentrations less than 120 mg/dL displayed an increased risk for death/liver transplantation. Both hAAT-Tg mice and AAT-treated wt animals showed protection from ethanol-induced liver injury. AAT could reflect a treatment option for human ALD, especially for alcoholic hepatitis.
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Affiliation(s)
- Christoph Grander
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Benedikt Schaefer
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Julian Schwärzler
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Grabherr
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Dennis M de Graaf
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Barbara Enrich
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Oberhuber
- INNPATH, Institute of Pathology, University Hospital of Innsbruck, Innsbruck, Austria
| | - Lisa Mayr
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Moris Sangineto
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolai Jaschke
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Timon E Adolph
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander R Moschen
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Charles A Dinarello
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Heinz Zoller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
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McCabe P, Galoosian A, Wong RJ. Patients with Alcoholic Liver Disease Have Worse Functional Status at Time of Liver Transplant Registration and Greater Waitlist and Post-transplant Mortality Which Is Compounded by Older Age. Dig Dis Sci 2020; 65:1501-1511. [PMID: 31642005 DOI: 10.1007/s10620-019-05891-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 04/16/2019] [Accepted: 10/03/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Worse functional status correlates with increased mortality on the liver transplant (LT) waitlist. Whether functional status affects LT outcomes equally across cirrhosis etiologies is unclear. AIMS We evaluate the impact of functional status on waitlist and post-LT mortality stratified by etiology and age. METHODS Functional status among US adults from 2005 to 2017 United Network for Organ Sharing LT registry data was retrospectively evaluated using Karnofsky Performance Status Score (KPS-1 = functional status 80-100%, KPS-2 = 60-70%, KPS-3 = 40-50%, KPS-4 = 10-30%). Waitlist and post-LT survival were stratified by KPS and cirrhosis etiology, including alcoholic liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis C (HCV), and HCV/ALD, and evaluated using Kaplan-Meier and multivariate Cox proportional hazard models. RESULTS Among 94,201 waitlist registrants (69.4% men, 39.5% HCV, 26.7% ALD, 23.2% NASH), ALD patients had worse functional status compared to HCV (KPS-4: 17.2% vs. 8.3%, p < 0.001). Worse functional status at time of waitlist registration was associated with higher 90-day waitlist mortality with the greatest effect in ALD (KPS-4 vs. KPS-1: ALD HR 2.16, 95% CI 1.83-2.55; HCV HR 2.17, 95% CI 1.87-2.51). Similar trends occurred in 5-year post-LT survival with ALD patients the most harmed. Compared to patients < 50 years, patients ≥ 65 years had increased waitlist mortality at 90-days if they had HCV or HCV/ALD, and 5-year post-LT mortality regardless of cirrhosis etiology with ALD patients most severely affected. CONCLUSIONS In a retrospective cohort study of patients, US ALD patients had disparately worse functional status at time of LT waitlist registration. Worse functional status correlated with higher risk of waitlist and post-LT mortality, affecting ALD and HCV patients the most.
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Affiliation(s)
- Patrick McCabe
- Division of Gastroenterology and Hepatology, Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Artin Galoosian
- Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland, Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA.
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Gold MS. The Role of Alcohol, Drugs, and Deaths of Despair in the U.S.'s Falling Life Expectancy. Mo Med 2020; 117:99-101. [PMID: 32308224 PMCID: PMC7144704] [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: 06/11/2023]
Affiliation(s)
- Mark S Gold
- Mark S. Gold, MD, is Adjunct Professor in the Department of Psychiatry at Washington University and an internationally recognized and expert in addiction medicine
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Caroli D, Rosa-Rizzotto E, Pilerci C, Lobello S, De Lazzari F, Saia M. Falling Rates of Hospital Admissions for Alcoholic Liver Disease in Northeast Italy: A Retrospective Study on a Large Database. Alcohol Alcohol 2019; 54:662-666. [PMID: 31566688 DOI: 10.1093/alcalc/agz070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/07/2019] [Revised: 07/07/2019] [Accepted: 07/21/2019] [Indexed: 12/19/2022] Open
Abstract
AIM To describe recent trends in hospital admission rates for alcoholic liver disease (ALD) in the Veneto region of Italy. METHODS This retrospective cohort study is based on anonymous hospital discharge records (HDRs) for 2000-2017 from all public and accredited private hospitals operating within the context of the Regional (Veneto) Health Services that are conserved in National/Regional database. It examined the HDR's of all the hospitalizations of the residents of the Veneto region that were registered under an ALD diagnosis. These were classified under three subheadings: acute alcoholic hepatitis Alcoholic liver cirrhosis and 'other ALD'. RESULTS During 2000-2017, 30,089 hospital admissions (out of a total regional population of 4,900,000) were registered for ALD. Hospitalization stratified by age showed that the percentage attributable to acute alcoholic hepatitis is higher in younger age groups: 42% in 15-24-year-old (odds ratios (ORs): 14.74; CI95%: 7-30.86; P < 0.000) and 15% in the 25-44-year-old (OR: 3.51; CI95%: 3.12-3.94; P < 0.000). A longitudinal analysis of hospitalization patterns showed a 7% increase in average age in both sexes (from 58.8 ± 9.2 to 62.4 ± 9.7) and a substantial decrease (63.5%) in standardized hospitalization rates (HRs, χ2 trend: 4099.827; P < 0.000) and a smaller decrease (47%) in standardized mortality rates (χ2 trend: 89.563; P < 0.000). CONCLUSIONS The fall in the overall ALD-related HR in the Veneto region can be explained by a decrease in population alcohol consumption. Increase in the HRs for acute alcoholic hepatitis in the age group 15-44 suggests an ongoing need for strategies to prevent alcohol abuse by young people.
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Affiliation(s)
- Diego Caroli
- Gastroenterology Unit, St. Anthony Hospital, Local Health Unit 6, Padova, Italy
| | - Erik Rosa-Rizzotto
- Gastroenterology Unit, St. Anthony Hospital, Local Health Unit 6, Padova, Italy
| | | | | | - Franca De Lazzari
- Gastroenterology Unit, St. Anthony Hospital, Local Health Unit 6, Padova, Italy
| | - Mario Saia
- Medical Directorate, Local Health Unit 6, Padova, Italy
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Shanahan L, Hill SN, Gaydosh LM, Steinhoff A, Costello EJ, Dodge KA, Harris KM, Copeland WE. Does Despair Really Kill? A Roadmap for an Evidence-Based Answer. Am J Public Health 2019; 109:854-858. [PMID: 30998413 PMCID: PMC6506367 DOI: 10.2105/ajph.2019.305016] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2019] [Indexed: 11/04/2022]
Abstract
Two seemingly associated demographic trends have generated considerable interest: income stagnation and rising premature mortality from suicides, drug poisoning, and alcoholic liver disease among US non-Hispanic Whites with low education. Economists interpret these population-level trends to indicate that despair induced by financial stressors is a shared pathway to these causes of death. Although we now have the catchy term "deaths of despair," we have yet to study its central empirical claim: that conceptually defined and empirically assessed "despair" is indeed a common pathway to several causes of death. At the level of the person, despair consists of cognitive, emotional, behavioral, and biological domains. Despair can also permeate social relationships, networks, institutions, and communities. Extant longitudinal data sets feature repeated measures of despair-before, during, and after the Great Recession-offering resources to test the role that despair induced by economic decline plays in premature morbidity and mortality. Such tests must also focus on protective factors that could shield individuals. Deaths of despair is more than a phrase; it constitutes a hypothesis that deserves conceptual mapping and empirical study with longitudinal, multilevel data.
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Affiliation(s)
- Lilly Shanahan
- Lilly Shanahan and Annekatrin Steinhoff are with the Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland. Sherika N. Hill and E. Jane Costello are with the Department of Psychiatry, Duke University Medical Center, Durham, NC. Lauren M. Gaydosh is with the Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN. Kenneth A. Dodge is with the Center for Child and Family Policy, Duke University, Durham. Kathleen Mullan Harris is with the Carolina Population Center, University of North Carolina at Chapel Hill. William E. Copeland is with the Vermont Center for Children, Youth and Families, University of Vermont Medical Center, Burlington
| | - Sherika N Hill
- Lilly Shanahan and Annekatrin Steinhoff are with the Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland. Sherika N. Hill and E. Jane Costello are with the Department of Psychiatry, Duke University Medical Center, Durham, NC. Lauren M. Gaydosh is with the Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN. Kenneth A. Dodge is with the Center for Child and Family Policy, Duke University, Durham. Kathleen Mullan Harris is with the Carolina Population Center, University of North Carolina at Chapel Hill. William E. Copeland is with the Vermont Center for Children, Youth and Families, University of Vermont Medical Center, Burlington
| | - Lauren M Gaydosh
- Lilly Shanahan and Annekatrin Steinhoff are with the Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland. Sherika N. Hill and E. Jane Costello are with the Department of Psychiatry, Duke University Medical Center, Durham, NC. Lauren M. Gaydosh is with the Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN. Kenneth A. Dodge is with the Center for Child and Family Policy, Duke University, Durham. Kathleen Mullan Harris is with the Carolina Population Center, University of North Carolina at Chapel Hill. William E. Copeland is with the Vermont Center for Children, Youth and Families, University of Vermont Medical Center, Burlington
| | - Annekatrin Steinhoff
- Lilly Shanahan and Annekatrin Steinhoff are with the Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland. Sherika N. Hill and E. Jane Costello are with the Department of Psychiatry, Duke University Medical Center, Durham, NC. Lauren M. Gaydosh is with the Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN. Kenneth A. Dodge is with the Center for Child and Family Policy, Duke University, Durham. Kathleen Mullan Harris is with the Carolina Population Center, University of North Carolina at Chapel Hill. William E. Copeland is with the Vermont Center for Children, Youth and Families, University of Vermont Medical Center, Burlington
| | - E Jane Costello
- Lilly Shanahan and Annekatrin Steinhoff are with the Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland. Sherika N. Hill and E. Jane Costello are with the Department of Psychiatry, Duke University Medical Center, Durham, NC. Lauren M. Gaydosh is with the Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN. Kenneth A. Dodge is with the Center for Child and Family Policy, Duke University, Durham. Kathleen Mullan Harris is with the Carolina Population Center, University of North Carolina at Chapel Hill. William E. Copeland is with the Vermont Center for Children, Youth and Families, University of Vermont Medical Center, Burlington
| | - Kenneth A Dodge
- Lilly Shanahan and Annekatrin Steinhoff are with the Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland. Sherika N. Hill and E. Jane Costello are with the Department of Psychiatry, Duke University Medical Center, Durham, NC. Lauren M. Gaydosh is with the Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN. Kenneth A. Dodge is with the Center for Child and Family Policy, Duke University, Durham. Kathleen Mullan Harris is with the Carolina Population Center, University of North Carolina at Chapel Hill. William E. Copeland is with the Vermont Center for Children, Youth and Families, University of Vermont Medical Center, Burlington
| | - Kathleen Mullan Harris
- Lilly Shanahan and Annekatrin Steinhoff are with the Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland. Sherika N. Hill and E. Jane Costello are with the Department of Psychiatry, Duke University Medical Center, Durham, NC. Lauren M. Gaydosh is with the Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN. Kenneth A. Dodge is with the Center for Child and Family Policy, Duke University, Durham. Kathleen Mullan Harris is with the Carolina Population Center, University of North Carolina at Chapel Hill. William E. Copeland is with the Vermont Center for Children, Youth and Families, University of Vermont Medical Center, Burlington
| | - William E Copeland
- Lilly Shanahan and Annekatrin Steinhoff are with the Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland. Sherika N. Hill and E. Jane Costello are with the Department of Psychiatry, Duke University Medical Center, Durham, NC. Lauren M. Gaydosh is with the Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN. Kenneth A. Dodge is with the Center for Child and Family Policy, Duke University, Durham. Kathleen Mullan Harris is with the Carolina Population Center, University of North Carolina at Chapel Hill. William E. Copeland is with the Vermont Center for Children, Youth and Families, University of Vermont Medical Center, Burlington
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Shen NT, Londono C, Gold S, Wu A, Mages KC, Brown RSJ. Systematic review with meta-analysis on transplantation for alcohol-related liver disease: Very low evidence of improved outcomes. World J Gastroenterol 2019; 25:1628-1639. [PMID: 30983822 PMCID: PMC6452234 DOI: 10.3748/wjg.v25.i13.1628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alcohol-related liver disease (ALD) is a leading cause of liver failure and indication for liver transplantation that arises in the setting of alcohol use disorder (AUD). Previous reviews of transplantation for ALD are limited in scope of outcomes and type of ALD studied. A comprehensive systematic review could improve use of transplantation in ALD and improve future research. We hypothesize that while transplanting ALD may improve mortality and relapse, findings will be limited by pre-specified causes of heterogeneity - assessment and treatment of AUD, definition of ALD, spectrum of ALD studied, assessment and rates of relapse, and study quality and bias.
AIM To optimize liver transplantation for ALD, understanding existing research to guide future research, we conducted a systematic review with meta-analysis.
METHODS We conducted a systematic review, comparing liver transplant to no-transplant in patients with ALD, with a primary outcome of both short- and long-term mortality and relapse. We performed a comprehensive search of MEDLINE, EMBASE, Web of Science, and The Cochrane Library databases for peer-reviewed journal articles comparing use of liver transplant in ALD to no-transplant. Two reviewers independently conducted screening, full text review, and data extraction according to the PRISMA guidelines. We report the quality of the evidence according to the GRADE criteria.
RESULTS We analyzed data from 10 studies. Of 1332 participants, 34.2% (456/1332) had undergone liver transplantation, while 65.8% (876/1332) had not. While random effects meta-analysis suggested transplant in comparison to no-transplant had an association of reduced mortality that did not reach statistical significance, relative risk (RR) = 0.51 (0.25-1.05), but not relapse risk, RR = 0.52 (0.18-1.53), significant heterogeneity limited these findings. When restricted to prospective data, transplant compared to no-transplant significantly reduced mortality, RR = 0.25 (0.13-0.46, P < 0.01), and relapse, RR = 0.25 (0.14-0.45, P < 0.01), with insignificant heterogeneity but persistent small-study effects. The overall quality of the evidence was Very Low. Heterogeneity analysis suggested that AUD assessment and treatment was often not reported while ALD, relapse assessment and rate, and data collection were institutionally rather than standardly defined.
CONCLUSION Systematic review of liver transplantation for ALD suggests reduced mortality and relapse in heterogeneous, institution-specific populations with inherent bias. To understand efficacy of transplanting ALD, our research approach must change.
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Affiliation(s)
- Nicole T Shen
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY 10021, United States
| | - Cristina Londono
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, United States
| | - Stephanie Gold
- Department of Medicine, Division of Internal Medicine, Weill Cornell Medicine, New York, NY 10021, United States
| | - Ashley Wu
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, United States
| | - Keith C Mages
- Department of Medicine, Weill Cornell Medical College, Samuel J. Wood Library and C.V. Starr Biomedical Information Center, New York, NY 10021, United States
| | - Robert S Jr Brown
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY 10021, United States
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Marroni CA, Fleck Jr ADM, Fernandes SA, Galant LH, Mucenic M, de Mattos Meine MH, Mariante-Neto G, Brandão ABDM. Liver transplantation and alcoholic liver disease: History, controversies, and considerations. World J Gastroenterol 2018; 24:2785-2805. [PMID: 30018475 PMCID: PMC6048431 DOI: 10.3748/wjg.v24.i26.2785] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/23/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023] Open
Abstract
Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease (ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation (LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a “self-inflicted disease”. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this “6-mo rule” is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy.
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Affiliation(s)
- Claudio Augusto Marroni
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Alfeu de Medeiros Fleck Jr
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Sabrina Alves Fernandes
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
- Nutrition at the Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil
| | - Lucas Homercher Galant
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Marcos Mucenic
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Mario Henrique de Mattos Meine
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Guilherme Mariante-Neto
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Ajacio Bandeira de Mello Brandão
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
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9
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Singh S, Osna NA, Kharbanda KK. Treatment options for alcoholic and non-alcoholic fatty liver disease: A review. World J Gastroenterol 2017; 23:6549-6570. [PMID: 29085205 PMCID: PMC5643281 DOI: 10.3748/wjg.v23.i36.6549] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 07/25/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are serious health problems worldwide. These two diseases have similar pathological spectra, ranging from simple steatosis to hepatitis to cirrhosis and hepatocellular carcinoma. Although most people with excessive alcohol or calorie intake display abnormal fat accumulation in the liver (simple steatosis), a small percentage develops progressive liver disease. Despite extensive research on understanding the pathophysiology of both these diseases there are still no targeted therapies available. The treatment for ALD remains as it was 50 years ago: abstinence, nutritional support and corticosteroids (or pentoxifylline as an alternative if steroids are contraindicated). As for NAFLD, the treatment modality is mainly directed toward weight loss and co-morbidity management. Therefore, new pathophysiology directed therapies are urgently needed. However, the involvement of several inter-related pathways in the pathogenesis of these diseases suggests that a single therapeutic agent is unlikely to be an effective treatment strategy. Hence, a combination therapy towards multiple targets would eventually be required. In this review, we delineate the treatment options in ALD and NAFLD, including various new targeted therapies that are currently under investigation. We hope that soon we will be having an effective multi-therapeutic regimen for each disease.
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Affiliation(s)
- Sukhpreet Singh
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
| | - Natalia A Osna
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, Nebraska Medical Center, Omaha, NE 68198, United States
| | - Kusum K Kharbanda
- Research Service, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE 68105, United States
- Department of Internal Medicine, Nebraska Medical Center, Omaha, NE 68198, United States
- Department of Biochemistry and Molecular Biology, Nebraska Medical Center, Omaha, NE 68198, United States
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10
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Hong SK, Yi NJ, Kim HS, Ahn SW, Yoon KC, Kim H, Lee KW, Suh KS. Korean Patients Undergoing Deceased Donor Liver Transplantation for Alcoholic Liver Disease Have Non-Inferior Survival Outcomes than for Hepatitis B Virus: a Real-World Experience without Minimum Abstinence before Transplantation. J Korean Med Sci 2017; 32:919-925. [PMID: 28480648 PMCID: PMC5426245 DOI: 10.3346/jkms.2017.32.6.919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/28/2017] [Indexed: 12/14/2022] Open
Abstract
Few studies have compared outcomes in patients undergoing liver transplantation (LT) for hepatitis B virus (HBV) and alcoholic liver disease (ALD) in Asian countries in which living donor LT (LDLT) is dominant, where HBV is endemic and where there are no strict regulations on pre-transplant abstinence for ALD. This study compared post-LT outcomes of deceased donor LT (DDLT) in patients with ALD and HBV. Data from 220 patients who underwent primary DDLT at Seoul National University Hospital from January 2010 to December 2014, including 107 with HBV and 38 with ALD, were retrospectively analyzed. Seventy-four patients (69.2%) in the HBV group and 30 (78.9%) in the ALD group had United Network for Organ Sharing (UNOS) status 2A (P = 0.250). There were no significant differences in their 1-year (90.7% vs. 92.1%) and 3-year (82.1% vs. 82.3%) overall survival rates (P = 1.000). Multivariate analysis showed that high serum gamma glutamyltransferase concentration (≥ 70 IU/L) was independently prognostic of 1-year post-LT overall survival. Survival outcomes following DDLT were similar in Korean patients with ALD and HBV, even in the absence of strict pre-transplant abstinence from alcohol as a selection criterion.
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Affiliation(s)
- Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Hyo Sin Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Woo Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Chul Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeyoung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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11
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Li M, McDermott R. Elevated fasting glucose and albuminuria may be a marker for all-cause mortality in Indigenous adults in North Queensland - a follow up study, 1998-2006. J Diabetes Complications 2017; 31:708-714. [PMID: 28087205 DOI: 10.1016/j.jdiacomp.2016.12.008] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/19/2016] [Accepted: 12/28/2016] [Indexed: 02/04/2023]
Abstract
AIMS To document risk factors of all-cause mortality in a cohort of indigenous Australians from 23 communities of North Queensland during 1998-2006. METHODS Among 2787 indigenous adults, baseline weight, waist circumference, blood pressure, fasting glucose, lipids, gamma-glutamyl transferase, urine albumin creatinine ratio, smoking, alcohol intake and physical activity were measured in 1998-2000. Deaths were ascertained from State Registry of Deaths, hospitalization and clinical records till 2006. Mortality risk factors were assessed using a Cox proportional-hazards model. RESULTS The standardized all-cause mortality rate was 23.2/1000 person-years (95% CI 20.3-26.3/1000 pys). After adjusting for age, sex, and ethnicity, baseline plasm fasting glucose >=5.5mmol/L was associated with a 50% increased risk of death (HR 1.5, 95% CI 1.2-2.0). Albuminuria was associated with all-cause mortality with a hazards ratio of 1.4 for microalbuminuria (95% CI 1.0-1.9) and 2.6 (95% CI 1.8-3.7) for macroalbuminuria. Gamma-glutamyl transferase >=50IU was associated with an increased risk of all-cause mortality by 40% (95% CI 1.04-1.8). CONCLUSIONS Fasting glycaemia, albuminuria, and gamma-glutamyl transferase, may be a marker for all-cause mortality within this cohort.
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Affiliation(s)
- Ming Li
- Centre of Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide, SA, Australia 5001.
| | - Robyn McDermott
- Centre of Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide, SA, Australia 5001; Faculty of Medicine, Health & Molecular Sciences, James Cook University, Cairns, Australia 4870;.
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12
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Bouttell J, Lewsey J, Geue C, Antony G, Briggs A, McCartney G, Hutchinson S, Graham L, Heydtmann M. The SCottish Alcoholic Liver disease Evaluation: A Population-Level Matched Cohort Study of Hospital-Based Costs, 1991-2011. PLoS One 2016; 11:e0162980. [PMID: 27783619 PMCID: PMC5082635 DOI: 10.1371/journal.pone.0162980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/31/2016] [Indexed: 12/14/2022] Open
Abstract
Studies assessing the costs of alcoholic liver disease are lacking. We aimed to calculate the costs of hospitalisations before and after diagnosis compared to population controls matched by age, sex and socio-economic deprivation. We aimed to use population level data to identify a cohort of individuals hospitalised for the first time with alcoholic liver disease in Scotland between 1991 and 2011.Incident cases were classified by disease severity, sex, age group, socio-economic deprivation and year of index admission. 5 matched controls for every incident case were identified from the Scottish population level primary care database. Hospital costs were calculated for both cases and controls using length of stay from morbidity records and hospital-specific daily rates by specialty. Remaining lifetime costs were estimated using parametric survival models and predicted annual costs. 35,208 incident alcoholic liver disease hospitalisations were identified. Mean annual hospital costs for cases were 2.3 times that of controls pre diagnosis (£804 higher) and 10.2 times (£12,774 higher) post diagnosis. Mean incident admission cost was £6,663. Remaining lifetime cost for a male, 50–59 years old, living in the most deprived area diagnosed with acoholic liver disease was estimated to be £65,999 higher than the matched controls (£12,474 for 7.43 years remaining life compared to £1,224 for 21.8 years). In Scotland, alcoholic liver disease diagnosis is associated with significant increases in admissions to hospital both before and after diagnosis. Our results provide robust population level estimates of costs of alcoholic liver disease for the purposes of health-care delivery, planning and future cost-effectiveness analyses.
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Affiliation(s)
- Janet Bouttell
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - James Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Claudia Geue
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - Grace Antony
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Briggs
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | | | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lesley Graham
- Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom
| | - Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital, Paisley, United Kingdom
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13
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Hong YS, Sinn DH, Gwak GY, Cho J, Kang D, Paik YH, Choi MS, Lee JH, Koh KC, Paik SW. Characteristics and outcomes of chronic liver disease patients with acute deteriorated liver function by severity of underlying liver disease. World J Gastroenterol 2016; 22:3785-3792. [PMID: 27076763 PMCID: PMC4814741 DOI: 10.3748/wjg.v22.i14.3785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/19/2016] [Accepted: 02/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze characteristics and outcome of patients with acute-on-chronic liver failure (ACLF) according to the severity of underlying liver disease.
METHODS: One hundred and sixty-seven adult patients with chronic liver disease and acute deteriorated liver function, defined by jaundice and coagulopathy, were analyzed. Predisposition, type of injury, response, organ failure, and survival were analyzed and compared between patients with non-cirrhosis (type A), cirrhosis (type B) and cirrhosis with previous decompensation (type C).
RESULTS: The predisposition was mostly hepatitis B in type A, while it was alcoholic liver disease in types B and C. Injury was mostly hepatic in type A, but was non-hepatic in type C. Liver failure, defined by CLIF-SOFA, was more frequent in types A and B, and circulatory failure was more frequent in type C. The 30-d overall survival rate (85.3%, 81.1% and 83.7% for types A, B and C, respectively, P = 0.31) and the 30-d transplant-free survival rate (55.9%, 65.5% and 62.5% for types A, B and C, respectively P = 0.33) were not different by ACLF subtype, but 1-year overall survival rate were different (85.3%, 71.7% and 58.7% for types A, B and C, respectively, P = 0.02).
CONCLUSION: There were clear differences in predisposition, type of injury, accompanying organ failure and long-term mortality according to spectrum of chronic liver disease, implying classifying subtype according to the severity of underlying liver disease is useful for defining, clarifying and comparing ACLF.
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MESH Headings
- Acute-On-Chronic Liver Failure/diagnosis
- Acute-On-Chronic Liver Failure/etiology
- Acute-On-Chronic Liver Failure/mortality
- Acute-On-Chronic Liver Failure/therapy
- Adult
- Aged
- Disease Progression
- Female
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/mortality
- Hepatitis B, Chronic/therapy
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/diagnosis
- Hepatitis C, Chronic/mortality
- Hepatitis C, Chronic/therapy
- Hepatitis, Autoimmune/complications
- Hepatitis, Autoimmune/diagnosis
- Hepatitis, Autoimmune/mortality
- Hepatitis, Autoimmune/therapy
- Humans
- Kaplan-Meier Estimate
- Liver Cirrhosis/diagnosis
- Liver Cirrhosis/etiology
- Liver Cirrhosis/mortality
- Liver Cirrhosis/therapy
- Liver Diseases, Alcoholic/complications
- Liver Diseases, Alcoholic/diagnosis
- Liver Diseases, Alcoholic/mortality
- Liver Diseases, Alcoholic/therapy
- Liver Function Tests
- Liver Transplantation
- Male
- Middle Aged
- Organ Dysfunction Scores
- Predictive Value of Tests
- Prognosis
- Retrospective Studies
- Risk Factors
- Severity of Illness Index
- Time Factors
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14
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Saigal S, Choudhary NS, Yadav SK, Saraf N, Kumar N, Rai R, Mehrotra S, Rastogi V, Rastogi A, Goja S, Bhangui P, Ramachandra SK, Raut V, Gautam D, Soin AS. Lower relapse rates with good post-transplant outcome in alcoholic liver disease: Experience from a living donor liver transplant center. Indian J Gastroenterol 2016; 35:123-8. [PMID: 27130453 DOI: 10.1007/s12664-016-0646-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Received: 12/03/2015] [Accepted: 03/15/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Post-transplant relapse is a major factor influencing the long-term outcome in alcoholic liver disease (ALD) patients. AIMS The aim of this study was to evaluate the relapse rates following living donor liver transplantation (LDLT) in patients with ALD in the Indian context with strong family support. METHODS Of 458 patients who underwent LDLT for ALD, 408 were included in the study. Post-transplant relapse was determined by information provided by the patient and/or family by means of outpatient and e-mail questionnaire, supported by clinical/biochemical parameters/liver histopathology. RESULTS All except one were males, with a mean age of 46.9 ± 8.5 years. The overall rate of relapse was 9.5 % at 34.7 months (interquartile range (IQR) 15-57.6), lower than that reported in the literature from the West. The relapse rate was higher in patients with a shorter duration of pre-transplant abstinence (17.4 % and 15.4 % for recipients with pre-transplant abstinence of <3 and <6 months, respectively, p < 0.05). The overall survival was 88.5 % at 3 years. Of 39 patients with relapse, 16 (41 %) were occasional drinkers, 14 (35.8 %) were moderate drinkers, and 9 (23 %) were heavy drinkers. All the heavy drinkers presented with features of graft dysfunction. CONCLUSIONS Good results can be obtained following LDLT for ALD, with significantly lower relapse rates in our setup as compared to the West.
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Affiliation(s)
- Sanjiv Saigal
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India.
| | - Narendra Singh Choudhary
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Sanjay Kumar Yadav
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Neeraj Saraf
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Naveen Kumar
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Rahul Rai
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Saurabh Mehrotra
- Department of Mental Health and Quality of Life, Medanta - The Medicity, Gurgaon, Delhi (NCR), 122 002, India
| | - Vipul Rastogi
- Department of Mental Health and Quality of Life, Medanta - The Medicity, Gurgaon, Delhi (NCR), 122 002, India
| | - Amit Rastogi
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Sanjay Goja
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Sumana K Ramachandra
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Vikram Raut
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
| | - Dheeraj Gautam
- Department of Histopathology, Medanta - The Medicity, Gurgaon, Delhi (NCR), 122 002, India
| | - Arvinder Singh Soin
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Delhi (NCR), 122 002, India
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15
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Affiliation(s)
- Stuart McPherson
- Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Michael R Lucey
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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16
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Lupsor-Platon M, Badea R. Noninvasive assessment of alcoholic liver disease using unidimensional transient elastography (Fibroscan ®). World J Gastroenterol 2015; 21:11914-11923. [PMID: 26576080 PMCID: PMC4641113 DOI: 10.3748/wjg.v21.i42.11914] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/27/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Unidimensional transient elastography (TE) is a noninvasive technique, which has been increasingly used in the assessment of diffuse liver diseases. This paper focuses on reviewing the existing data on the use of TE in the diagnosis of fibrosis and in monitoring disease progression in alcoholic liver disease, on the factors that may influence the result of fibrosis prediction, and last but not least, on its potential use in assessing the steatosis degree. Therefore, this field is far from being exhausted and deserves more attention. Further studies are required, on large groups of biopsied patients, in order to find answers to all the remaining questions in this field.
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Abstract
The review is withdrawn as it was abandoned and has not been updated since its last edition in 2008. A new team of authors resumed the work on the review, and so far, a major update to the protocol is published. The review is expected to be finalised towards the end of 2016. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Andrea Rambaldi
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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18
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Telles-Correia D, Mega I. Candidates for liver transplantation with alcoholic liver disease: Psychosocial aspects. World J Gastroenterol 2015; 21:11027-11033. [PMID: 26494959 PMCID: PMC4607902 DOI: 10.3748/wjg.v21.i39.11027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/23/2015] [Accepted: 08/31/2015] [Indexed: 02/07/2023] Open
Abstract
In Europe, 30% to 50% of liver transplantations are currently due to alcoholic liver disease (ALD). In the United States, this percentage is 17.2%. Post-transplant survival and other predictors of clinical course do not differ significantly from those in other types of transplanted patients, as long as there is no relapse of drinking. However, 20%-25% of these patients lapse or relapse to heavy drinking post-operatively, which has been associated with an increased risk of liver damage and mortality. It is therefore crucial to design specific selection and follow-up strategies aimed at this particular type of patient. Several good and poor prognosis factors that could help to predict a relapse have been suggested, among them the duration of abstinence, social support, a family history of alcoholism, abuse diagnosis versus alcohol dependence, non-acceptance of diagnosis related to alcohol use, presence of severe mental illness, non-adherence in a broad sense, number of years of alcoholism, and daily quantity of alcohol consumption. In this article, we discuss these and other, more controversial factors in selecting ALD patients for liver transplantation. Abstinence should be the main goal after transplantation in an ALD patient. In this article, we review the several definitions of post-transplant relapse, its monitoring and the psychopharmacological and psychotherapeutic treatment.
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19
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Ursic-Bedoya J, Faure S, Donnadieu-Rigole H, Pageaux GP. Liver transplantation for alcoholic liver disease: Lessons learned and unresolved issues. World J Gastroenterol 2015; 21:10994-11002. [PMID: 26494956 PMCID: PMC4607899 DOI: 10.3748/wjg.v21.i39.10994] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/10/2015] [Accepted: 09/02/2015] [Indexed: 02/06/2023] Open
Abstract
The use of liver transplantation (LT) as a treatment for alcoholic liver disease (ALD) has been highly controversial since the beginning. The ever increasing shortage of organs has accentuated the low priority given to patients suffering from ALD, which is considered a “self-inflicted” condition. However, by improving the long-term survival rates, making them similar to those from other indications, and recognizing that alcoholism is a primary disease, ALD has become one of the most common indications for LT in Europe and North America, a situation thought unfathomable thirty years ago. Unfortunately, there are still many issues with the use of this procedure for ALD. There are significant relapse rates, and the consequences of excessive drinking after LT range from asymptomatic biochemical and histological abnormalities to graft failure and death. A minimum three-month period of sobriety is required for an improvement in liver function, thus making LT unnecessary, and to demonstrate the patient’s commitment to the project, even though a longer abstinence period does not guarantee lower relapse rates after LT. Recent data have shown that LT is also effective for severe alcoholic hepatitis when the patient is unresponsive to corticosteroids therapy, with low relapse rates in highly selected patients, although these results must be confirmed before LT becomes a standard procedure in this setting. Finally, LT for ALD is accompanied by an increased risk of de novo solid organ cancer, skin cancer, and lymphoproliferative disorders, which has a large impact on the survival rates.
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20
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Abstract
BACKGROUND The incidence of hepatocellular carcinoma (HCC) has increased over the past decades as a result of alcoholic liver disease, the metabolic syndrome and the increasing incidence of viral hepatitis B and C. OBJECTIVES An evaluation of the epidemiology of HCC, presentation and discussion of the risk factors for the development of HCC. MATERIAL AND METHODS This study was based on a literature review, analysis of the statistics of the World Health Organization (WHO), discussion of current basic research and expert recommendations. RESULTS The results show that HCC already represents the fifth most common malignancy in men and the ninth most common malignancy in women, and the incidence is still rising. The pronounced regional differences in prevalence and underlying risk factors are mainly, but not exclusively, due to the prevalence of chronic viral hepatitis B. CONCLUSION Hepatocellular carcinoma is a major medical problem. Primary prevention measures and suitable screening algorithms are gaining more and more importance.
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Affiliation(s)
- M Güthle
- Zentrum für Innere Medizin, Klinik für Innere Medizin I, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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21
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Abstract
Inflammation and intestinal permeability are believed to be paramount features in the development of alcohol-related liver damage. We aimed to assess the impact of 3 surrogate markers of inflammation (anemia, fibrinogen, and ferritin levels) on mid-term mortality of patients with alcohol dependence. This longitudinal study included patients with alcohol dependence admitted for hospital detoxification between 2000 and 2010. Mortality was ascertained from clinical charts and the mortality register. Associations between markers of inflammation and all-cause mortality were analyzed with mortality rates and Cox proportional hazards regression models. We also performed a subgroup analysis of mortality rates in patients with anemia, based on their mean corpuscular volume (MCV). We included 909 consecutive patients with alcohol dependence. Patients were mostly male (80.3%), had a median age of 44 years (interquartile range [IQR]: 38-50), and upon admission, their median alcohol consumption was 192 g/day (IQR: 120-265). At admission, 182 (20.5%) patients had anemia; 210 (25.9%) had fibrinogen levels >4.5 mg/dL; and 365 (49.5%) had ferritin levels >200 ng/mL. At the end of follow-up (median 3.8 years [IQR: 1.8-6.5], and a total of 3861.07 person-years), 118 patients had died (12.9% of the study population). Cox regression models showed that the presence of anemia at baseline was associated with mortality (hazard ratio [HR]: 1.67, 95% confidence interval [CI]: 1.11-2.52, P < 0.01); no associations were found between mortality and high fibrinogen or high ferritin levels. A subgroup of patients with anemia was analyzed and compared to a control group of patients without anemia and a normal MCV. The mortality ratios of patients with normocytic and macrocytic anemia were 3.25 (95% CI: 1.41-7.26; P < 0.01) and 3.39 (95% CI: 1.86-6.43; P < 0.01), respectively. Patients with alcohol dependence admitted for detoxification had an increased risk of death when anemia was present at admission. More accurate markers of systemic inflammation are needed to serve as prognostic factors for poor outcomes in this subset of patients.
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Affiliation(s)
- Daniel Fuster
- From the Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain (DF, AS, PZ, JT, RM); Department of Internal Medicine, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain (FB); and Municipal Centre for Substance Abuse Treatment (Centro Delta), IMSP Badalona, Badalona, Spain (IR)
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Williams R, Aspinall R, Bellis M, Camps-Walsh G, Cramp M, Dhawan A, Ferguson J, Forton D, Foster G, Gilmore I, Hickman M, Hudson M, Kelly D, Langford A, Lombard M, Longworth L, Martin N, Moriarty K, Newsome P, O'Grady J, Pryke R, Rutter H, Ryder S, Sheron N, Smith T. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet 2014; 384:1953-97. [PMID: 25433429 DOI: 10.1016/s0140-6736(14)61838-9] [Citation(s) in RCA: 409] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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González-Reimers E, Santolaria-Fernández F, Martín-González MC, Fernández-Rodríguez CM, Quintero-Platt G. Alcoholism: A systemic proinflammatory condition. World J Gastroenterol 2014; 20:14660-14671. [PMID: 25356029 PMCID: PMC4209532 DOI: 10.3748/wjg.v20.i40.14660] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Excessive ethanol consumption affects virtually any organ, both by indirect and direct mechanisms. Considerable research in the last two decades has widened the knowledge about the paramount importance of proinflammatory cytokines and oxidative damage in the pathogenesis of many of the systemic manifestations of alcoholism. These cytokines derive primarily from activated Kupffer cells exposed to Gram-negative intestinal bacteria, which reach the liver in supra-physiological amounts due to ethanol-mediated increased gut permeability. Reactive oxygen species (ROS) that enhance the inflammatory response are generated both by activation of Kupffer cells and by the direct metabolic effects of ethanol. The effects of this increased cytokine secretion and ROS generation lie far beyond liver damage. In addition to the classic consequences of endotoxemia associated with liver cirrhosis that were described several decades ago, important research in the last ten years has shown that cytokines may also induce damage in remote organs such as brain, bone, muscle, heart, lung, gonads, peripheral nerve, and pancreas. These effects are even seen in alcoholics without significant liver disease. Therefore, alcoholism can be viewed as an inflammatory condition, a concept which opens the possibility of using new therapeutic weapons to treat some of the complications of this devastating and frequent disease. In this review we examine some of the most outstanding consequences of the altered cytokine regulation that occurs in alcoholics in organs other than the liver.
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Streba LAM, Vere CC, Streba CT, Ciurea ME. Focus on alcoholic liver disease: from nosography to treatment. World J Gastroenterol 2014; 20:8040-7. [PMID: 25009375 PMCID: PMC4081674 DOI: 10.3748/wjg.v20.i25.8040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/06/2014] [Accepted: 02/16/2014] [Indexed: 02/06/2023] Open
Abstract
Abusive alcohol intake currently ranks as a major cause of liver disease, and is associated with significant mortality worldwide. Alcoholic liver disease (ALD) generically defines liver abnormalities ranging from liver steatosis to the end-stages of disease such as liver cirrhosis. Information regarding the precise incidence and prevalence of ALD is still limited by a lack of large population-based studies and by the absence of large systematic reviews of all epidemiological data available. However, existing collected data show an overall increase in the number of alcohol abusers and alcohol-related liver disease. The burden exerted on medical systems worldwide is significant, with hospitalization and management costs rising constantly over the years. A great number of all cirrhosis-related deaths in Europe and a significant percentage worldwide are associated with alcohol consumption. The main possible risk factors for ALD are the amount and duration of alcohol abuse, patterns of drinking and the type of alcoholic beverage consumed. However, ALD does not progress to cirrhosis in all patients, therefore a series of additional factors are implicated. Even though insufficiently studied, genetic factors are generally regarded as highly important, and the presence of comorbidities and dietary habits seem to play a role in disease onset and progression. This lack of clear pathophysiological data further translates in the absence of definite treatment for ALD and shall prove challenging in the coming years. In this article, we aimed to briefly review epidemiologic data on the burden of ALD, risk factors, clinical and nosographic as well as therapeutic aspects of this disease. Without attempting to be exhaustive, this short topic highlight emphasizes each point and may serve as a general guidance tool in the complicated literature related to ALD.
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Iruzubieta P, Crespo J, Fábrega E. Long-term survival after liver transplantation for alcoholic liver disease. World J Gastroenterol 2013; 19:9198-9208. [PMID: 24409048 PMCID: PMC3882394 DOI: 10.3748/wjg.v19.i48.9198] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/26/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
Currently, alcoholic cirrhosis is the second leading indication for liver transplantation in the United States and Europe. The quality of life and survival after a liver transplantation (LT) in patients with alcoholic liver disease (ALD) are similar to those in patients with other cirrhosis etiologies. The alcoholic relapse rate after a LT varies from 10%-50%, and these relapse patients are the ones who present a reduced long-term survival, mainly due to cardiovascular diseases and the onset of de novo neoplasms, including lung and upper aerodigestive tract. Nearly 40% of ALD recipients resume smoking and resume it early post-LT. Therefore, our pre-and post-LT follow-up efforts regarding ALD should be focused not only on alcoholic relapse but also on treating and avoiding other modifiable risk factors such as tobacco. The psychiatric and psychosocial pre-LT evaluation and the post-LT follow-up with physicians, psychiatrists and addiction specialists are important for reversing these problems because these professionals help to identify patients at risk for relapse as well as those patients who have relapsed, thus enabling responsive actions.
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Roman S, Zepeda-Carrillo EA, Moreno-Luna LE, Panduro A. Alcoholism and liver disease in Mexico: Genetic and environmental factors. World J Gastroenterol 2013; 19:7972-7982. [PMID: 24307790 PMCID: PMC3848144 DOI: 10.3748/wjg.v19.i44.7972] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/15/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
Alcoholism and cirrhosis, which are two of the most serious health problems worldwide, have a broad spectrum of clinical outcomes. Both diseases are influenced by genetic susceptibility and cultural traits that differ globally but are specific for each population. In contrast to other regions around the world, Mexicans present the highest drinking score and a high mortality rate for alcoholic liver disease with an intermediate category level of per capita alcohol consumption. Mexico has a unique history of alcohol consumption that is linked to profound anthropological and social aspects. The Mexican population has an admixture genome inherited from different races, Caucasian, Amerindian and African, with a heterogeneous distribution within the country. Thus, genes related to alcohol addiction, such as dopamine receptor D2 in the brain, or liver alcohol-metabolizing enzymes, such as alcohol dehydrogenase class I polypeptide B, cytochrome P450 2E1 and aldehyde dehydrogenase class 2, may vary from one individual to another. Furthermore, they may be inherited as risk or non-risk haplogroups that confer susceptibility or resistance either to alcohol addiction or abusive alcohol consumption and possibly liver disease. Thus, in this era of genomics, personalized medicine will benefit patients if it is directed according to individual or population-based data. Additional association studies will be required to establish novel strategies for the prevention, care and treatment of liver disease in Mexico and worldwide.
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Affiliation(s)
- Roger Williams
- Institute of Hepatology London, Foundation for Liver Research, London WC1E 6HX, UK.
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Singal AK, Chaha KS, Rasheed K, Anand BS. Liver transplantation in alcoholic liver disease current status and controversies. World J Gastroenterol 2013; 19:5953-5963. [PMID: 24106395 PMCID: PMC3785616 DOI: 10.3748/wjg.v19.i36.5953] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Alcoholic cirrhosis remains the second most common indication for liver transplantation. A comprehensive medical and psychosocial evaluation is needed when making a decision to place such patients on the transplant list. Most transplant centers worldwide need a minimum of 6 mo of alcohol abstinence for listing these patients. Patients with alcohol dependence are at high risk for relapse to alcohol use after transplantation (recidivism). These patients need to be identified and require alcohol rehabilitation treatment before transplantation. Recidivism to the level of harmful drinking is reported in about 15%-20% cases. Although, recurrent cirrhosis and graft loss from recidivism is rare, occurring in less than 5% of all alcoholic cirrhosis-related transplants, harmful drinking in the post-transplant period does impact the long-term outcome. The development of metabolic syndrome with cardiovascular events and de novo malignancy are important contributors to non liver-related mortality amongst transplants for alcoholic liver disease. Surveillance protocols for earlier detection of de novo malignancy are needed to improve the long-term outcome. The need for a minimum of 6 mo of abstinence before listing makes transplant a nonviable option for patients with severe alcoholic hepatitis who do not respond to corticosteroids. Emerging data from retrospective and prospective studies has challenged the 6 mo rule, and beneficial effects of liver transplantation have been reported in select patients with a first episode of severe alcoholic hepatitis who are unresponsive to steroids.
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Deruytter E, Van Steenkiste C, Trépo E, Geerts A, Van Vlierberghe H, Berrevoet F, de Hemptinne B, Rogiers X, Troisi R, Colle I. Liver transplantation for alcoholic liver disease: a retrospective analysis of recidivism, survival and risk factors predisposing to alcohol relapse. Acta Gastroenterol Belg 2013; 76:282-290. [PMID: 24261021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND STUDY AIMS Alcoholic liver disease (ALD) is the second most common indication for liver transplantation. The aim of this study was to evaluate the alcohol relapse rate and long-term survival after liver transplantation for ALD and to identify risk factors predisposing to alcohol relapse. PATIENTS AND METHODS Between 2000 and 2007, 108 patients transplanted for ALD in the Ghent University Hospital were included in this retrospective analysis. Relapse was defined as any drinking after transplantation, problem drinking as more than 2 units/day for women and 3 units/day for men. A wide range of variables was obtained from a questionnaire and medical records. RESULTS The mean follow-up was 55 months. Relapse was observed in 29%, 16% in problem drinking. The one- and five-year survival was 87% and 74% respectively. No significant difference in survival was found between non-relapsers, occasional drinkers and problem drinkers. The following risk factors were found to be significantly associated with relapse into problem drinking in an univariate analysis: a shorter pre-transplant abstinence period, the presence of a first degree relative with alcohol abuse and a higher number of prior attempts to quit. In multivariable analysis, the presence of a first degree relative with alcohol abuse was found associated with relapse into problem drinking. CONCLUSIONS The presence of a first degree relative with alcohol abuse is a valuable pre-transplant variable evaluating an ALD patient's eligibility for liver transplantation. Other variables are also helpful to outline the broader context of the drinking behavior of the patient.
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Affiliation(s)
- Elise Deruytter
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
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Affiliation(s)
- Nick Sheron
- NIHR Biomedical Research Unit (Nutrition, Diet and Lifestyle), University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
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Abstract
BACKGROUND Randomised clinical trials have addressed the question whether propylthiouracil has any beneficial effects in patients with alcoholic liver disease. OBJECTIVES To assess the beneficial and harmful effects of propylthiouracil for patients with alcoholic liver disease. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (April 2011), The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (April 2011), MEDLINE (1948 to April 2011), EMBASE (1980 to April 2011), and Science Citation Index Expanded (1900 to April 2011). These electronic searches were combined with full text searches. Manufacturers and researchers in the field were also contacted. SELECTION CRITERIA Randomised clinical trials studying patients with alcoholic steatosis, alcoholic fibrosis, alcoholic hepatitis, and/or alcoholic cirrhosis were included irrespective of blinding, publication status, or language. Interventions encompassed propylthiouracil at any dose versus placebo or no intervention. DATA COLLECTION AND ANALYSIS All analyses were performed according to the intention-to-treat method in RevMan Analyses. The risk of bias of the randomised clinical trials was evaluated by bias risk domains such as generation of allocation sequence, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, academic bias, and source of funding. MAIN RESULTS Combining the results of six randomised clinical trials with high risk of bias which included 710 patients demonstrated no significant effects of propylthiouracil versus placebo on all-cause mortality (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.66 to 1.30), liver-related mortality (RR 0.90, 95% CI 0.58 to 1.40), or complications of the liver disease. Although propylthiouracil was not associated with a significant increased risk of non-serious adverse events, there were occasional instances of serious adverse events such as leukopenia and generalised bullous eruption. AUTHORS' CONCLUSIONS We could not demonstrate any significant beneficial effect of propylthiouracil on all-cause mortality, liver-related mortality, liver complications, or liver histology of patients with alcoholic liver disease. Propylthiouracil was associated with adverse events. Confidence intervals were wide. Thus, the risk of random errors and systematic errors was high. Accordingly, there is no evidence for using propylthiouracil for alcoholic liver disease outside randomised clinical trials.
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Affiliation(s)
- Giuseppe Fede
- Royal Free Hampstead NHS Foundation TrustSheila Sherlock Liver CentrePond StreetHampsteadLondonUKNW3 2QG
| | - Giacomo Germani
- Royal Free Hampstead NHS Foundation TrustSheila Sherlock Liver CentrePond StreetHampsteadLondonUKNW3 2QG
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of Surgery8th Floor South (Hepatology office)Royal Free Hospital, Pond StreetLondonUKNW3 2QG
| | - Andrew K Burroughs
- Royal Free Hampstead NHS Foundation TrustSheila Sherlock Liver CentrePond StreetHampsteadLondonUKNW3 2QG
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Affiliation(s)
- Nick Sheron
- Clinical Hepatology, Division of Infection, Inflammation and Immunity, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
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Abstract
Since the advent of effective antiretroviral therapy (ART) for human immunodeficiency virus-1 (HIV), there has been a substantial decrease in deaths related to acquired immunodeficiency syndrome (AIDS). However, in the ART era, liver disease is now the most common non-AIDS-related cause of death among HIV-infected patients, accounting for 14%-18% of all deaths in this population and almost half of deaths among hospitalized HIV-infected patients. Just as the burden of non-AIDS morbidity and mortality has changed in the ART era, the types of liver disease the clinician is likely to encounter among these patients have changed as well. This review will discuss the causes of liver disease in the HIV-infected population in the ART era, including chronic hepatitis C virus, chronic hepatitis B virus, medication-related hepatotoxicity, alcohol abuse, nonalcoholic fatty liver disease, and AIDS-related liver diseases.
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Affiliation(s)
- Jennifer C Price
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
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Ramstedt M, Stokkeland K, Hultcrantz R. [New alcohol consumption pattern and more liver injuries following Swedish entry into the European Union. Development 1997-2007]. Lakartidningen 2010; 107:1463-1466. [PMID: 20645595] [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: 05/29/2023]
Affiliation(s)
- Mats Ramstedt
- Centrum för socialvetenskaplig alkohol- och drogforskning (So-RAD), Stockholms universitet.
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Affiliation(s)
- Vijay H Shah
- Gastrointestinal Research Unit, Mayo Clinic, Rochester, MN 55905, USA.
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Miranda-Mendez A, Lugo-Baruqui A, Armendariz-Borunda J. Molecular basis and current treatment for alcoholic liver disease. Int J Environ Res Public Health 2010; 7:1872-88. [PMID: 20622998 PMCID: PMC2898022 DOI: 10.3390/ijerph7051872] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/05/2010] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders and alcohol dependency affect millions of individuals worldwide. The impact of these facts lies in the elevated social and economic costs. Alcoholic liver disease is caused by acute and chronic exposure to ethanol which promotes oxidative stress and inflammatory response. Chronic consumption of ethanol implies liver steatosis, which is the first morphological change in the liver, followed by liver fibrosis and cirrhosis. This review comprises a broad approach of alcohol use disorders, and a more specific assessment of the pathophysiologic molecular basis, and genetics, as well as clinical presentation and current modalities of treatment for alcoholic liver disease.
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Affiliation(s)
- Alejandra Miranda-Mendez
- Institute for Molecular Biology in Medicine and Gene Therapy, University of Guadalajara, Jalisco 44281, Mexico; E-Mails:
(A.M.M.);
(A.L.B.)
| | - Alejandro Lugo-Baruqui
- Institute for Molecular Biology in Medicine and Gene Therapy, University of Guadalajara, Jalisco 44281, Mexico; E-Mails:
(A.M.M.);
(A.L.B.)
- OPD Hospital Civil de Guadalajara, Jalisco 44340, Mexico
| | - Juan Armendariz-Borunda
- Institute for Molecular Biology in Medicine and Gene Therapy, University of Guadalajara, Jalisco 44281, Mexico; E-Mails:
(A.M.M.);
(A.L.B.)
- OPD Hospital Civil de Guadalajara, Jalisco 44340, Mexico
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +52-33-1058-5317; Fax: +52-33-1058-5318
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Lin CW, Chen YS, Lai CH, Perng DS, Weng HC, Hu JT, Huang YW, Hsu MY, Yang SS. Esophagogastric varices predict mortality in hospitalized patients with alcoholic liver disease in Taiwan. Hepatogastroenterology 2010; 57:305-308. [PMID: 20583432] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND/AIMS Alcoholic liver disease (ALD) is a major cause of morbidity and mortality in Western countries. The present study investigated the status and the risk factors for predicting mortality of ALD in Taiwan. METHODOLOGY We retrospective studied 100 consecutive in patients with ALD between 1992 and 2000. All patients had a history of alcohol consumption exceeding 80 g per day for at least 5 years. RESULTS The study comprised 93 men and 7 women with a mean age of 45.4 years. The ALD included fatty liver (21%), alcoholic hepatitis (15%), alcoholic hepatitis superimposed on alcoholic cirrhosis (24%), and alcoholic cirrhosis (40%). Forty-four percent of patients had esophagogastric varices. Thirty-three percent of patients were mortality. The presence of esophagogastric varices was the only parameter identified by univariate and multivariate analyses and had a statistically significant association with increased mortality (OR: 8.603; 95% CI: 2.009-36.864; p = 0.004). The cumulative survival for ALD patients with varices was significantly lower than for patients without varices. CONCLUSIONS The presence of esophagogastric varices had a statistically significant relationship with increased mortality. This study strongly implicates esophagogastric varices were a valuable poor prognostic factor with mortality. Upper gastrointestinal endoscopy is a simple clinical available tool for the assessment of the occurrence of varices to predict the disease severity and mortality in hospitalized patients with ALD.
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Affiliation(s)
- Chih-Wen Lin
- Division of Gastroenterology, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
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Higuera-de la Tijera MF, Pérez-Hernández JL, Serralde-Zúñiga AE, Servín-Caamaño AI, Cruz-Palacios A, Bernal-Sahagún F, Salas-Gordillo F. [Three prognostic utility scales to determine early mortality in patients with alcoholic hepatitis in the General Hospital of Mexico]. Rev Gastroenterol Mex 2010; 75:281-286. [PMID: 20959177] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND There are many models to predict survival in patients with alcoholic hepatitis (AH). The most commonly used are the modified Maddrey's index, the Glasgow scale and the Model for End stage Liver Disease (MELD). OBJECTIVE To evaluate three prognostic scales ability to predict early mortality (first 30 days) in patients with AH. METHODS We retrospectively reviewed the database of hospitalized patients with AH during a 3-years period. Seventy one patients were included. We calculated the modified Maddrey's index, the Glasgow scale and the MELD scores. We evaluated if the scales predicted early (30-day) mortality. For each scale we determined sensitivity, specificity, positive and negative values (PPV and NPV) and likelihood value of each scale. RESULTS For modified Maddrey's index, the values obtained were sensitivity 98.8%, specificity 11.7%, PPV 61.6%, NPV 87.5% and likelihood ratio 1.12. For Glasgow scale corresponding values were sensitivity 98.8%, specificity 61.7%, PPV 78.7%, NPV 97.4% and likelihood ratio 2.64. For the MELD scale sensitivity 98.8%, specificity 0.1%, PPV 59%, NPV 50% and likelihood ratio 1. CONCLUSIONS The three scales were very sensitive. Glasgow's scale was the most specific and, maybe, the most exact test.
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Affiliation(s)
- M F Higuera-de la Tijera
- Servicio de Gastroenterología Unidad 107, Hospital General de México O.D., México, D. F., Mexico.
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Orrego H, Blake JE, Medline A, Israel Y. Interrelation of the hypermetabolic state, necrosis, anemia and cell enlargement as determinants of severity in alcoholic liver disease. Acta Med Scand Suppl 2009; 703:81-95. [PMID: 3867246 DOI: 10.1111/j.0954-6820.1985.tb08906.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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González-Reimers E, Galindo-Martín L, Santolaria-Fernández F, Sánchez-Pérez MJ, Alvisa-Negrín J, García-Valdecasas-Campelo E, González-Pérez JM, Martín-González MC. Prognostic value of serum selenium levels in alcoholics. Biol Trace Elem Res 2008; 125:22-9. [PMID: 18521549 DOI: 10.1007/s12011-008-8152-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [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] [Received: 04/09/2008] [Accepted: 04/22/2008] [Indexed: 10/22/2022]
Abstract
In alcoholics, exposure of Kupffer cells to intestinal-borne Gram-negative bacteria increases free radical release, which may, in turn, enhance cytokine secretion, creating a positive feedback loop, which contributes to liver inflammation. Impaired antioxidant mechanisms further aggravates this scenario. Some trace elements, such as selenium, are main cofactors of antioxidant enzymes. Some authors have found low Se levels in alcoholics in relation either with undernutrition, liver dysfunction, or intensity of alcoholism, but in general, Se supplementation has no effect on survival. In this study we measured serum Se in 16 controls and 76 alcoholics, 34 of them cirrhotics, 68 of whom were followed up for a median period of 38 months; 17 died during this period. Se levels were lower in patients than in controls and were related to prothrombin activity and nutritional status, more closely to this last parameter (stepwise logistic regression analysis). Patients who died showed lower Se values than those who survived. Se values over the median were associated with better survival, assessed by Kaplan-Meier curves and log-rank test. However, in multivariate analysis (Cox regression model), prothrombin activity displaced serum Se as a prognostic factor. We conclude that serum Se levels are low in alcoholics; these low values depend more heavily on impaired nutrition but also on liver dysfunction; although low Se levels were associated with a higher mortality, prothrombin activity displaced serum Se when survival was assessed using Cox's regression model.
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Affiliation(s)
- Emilio González-Reimers
- Servicio de Medicina Interna, Hospital Universitario, Ofra s/n, Tenerife, Canary Islands, Spain.
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Centers for Disease Control and Prevention (CDC). Alcohol-attributable deaths and years of potential life lost among American Indians and Alaska Natives--United States, 2001--2005. MMWR Morb Mortal Wkly Rep 2008; 57:938-41. [PMID: 18756193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Excessive alcohol consumption is a leading preventable cause of death in the United States and has substantial public health impact on American Indian and Alaska Native (AI/AN) populations. To estimate the average annual number of alcohol-attributable deaths (AADs) and years of potential life lost (YPLLs) among AI/ANs in the United States, CDC analyzed 2001-2005 data (the most recent data available), using death certificate data and CDC Alcohol-Related Disease Impact (ARDI) software. This report summarizes the results of that analysis, which indicated that AADs accounted for 11.7% of all AI/AN deaths, that the age-adjusted AAD rate for AI/ANs was approximately twice that of the U.S. general population, and that AI/ANs lose 6.4 more years of potential life per AAD compared with persons in the U.S. general population (36.3 versus 29.9 years). These findings underscore the importance of implementing effective population-based interventions to prevent excessive alcohol consumption and to reduce alcohol-attributable morbidity and mortality among AI/ANs.
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Abstract
CONTEXT Suicide is a major cause of mortality worldwide. Rates vary widely within and between countries. A suicide prevention program has never been tested in a region with a very high suicide rate in comparison with control regions without such intervention over the same period. OBJECTIVE To determine the effectiveness of a depression-management educational program for general practitioners (GPs) on the suicide rate in a region with a high suicide rate in Hungary. DESIGN Effects were compared with a control region, the larger surrounding county, and Hungary. SETTING Southwest Hungary. PARTICIPANTS Twenty-eight GPs servicing 73,000 inhabitants participated in the educational program. INTERVENTION A 5-year depression-management educational program for GPs and their nurses was implemented together with establishment of a Depression Treatment Clinic and psychiatrist telephone consultation service in the intervention region. MAIN OUTCOME MEASURES The primary study outcome measure was annual suicide rate. The secondary outcome measure was antidepressant prescription use. RESULTS The annual suicide rate in the intervention region decreased from the 5-year preintervention average of 59.7 in 100,000 to 49.9 in 100,000. The decrease was comparable with the control region but greater than both the county and Hungary (P < .001 and P < .001, respectively). In rural areas, the female suicide rate in the intervention region decreased by 34% and increased by 90% in the control region (P < .07). The increase in antidepressant treatment was greater in the intervention region compared with the control region, the county, and Hungary and in women compared with men (P < .002). CONCLUSIONS A GP-based intervention produced a greater decline in suicide rates compared with the surrounding county and national rates. Increases in patients with depression treated and of dosing were modest and may require additional measures such as depression-care managers. The importance of alcoholism in local suicides was unanticipated and not addressed. Optimal suicide prevention plans must consider major local risk factors.
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Affiliation(s)
- Katalin Szanto
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
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Abstract
Acute decompensation of chronically stable alcoholic liver disease (ALD) is the most common cause of terminal liver failure in developed countries. Molecular adsorbent recirculation system (MARS) is increasingly used as artificial liver support to facilitate spontaneous organ recovery. However, the experience to date and the evidence to justify this therapeutic strategy in acutely decompensated ALD are still insufficient. We report our clinical experience with MARS in 14 patients with acutely decompensated ALD (6 male subjects; median age [interquartile range], 51 [47-56] years; Child-Pugh score, 12 [10-13]; Acute Physiology and Chronic Health Evaluation (APACHE) II score, 20 [18-24]) and severely impaired liver function whose disease was unresponsive to conventional supportive care. At least 3 sessions were applied in any patient (48 sessions in total). Under MARS treatment, the following levels decreased: bilirubin (544 [489-604] to 242 [178-348] micromol/L; P<0.001), creatinine (212 [112-385] to 91 [66-210] micromol/L; P=0.002), cholestatic parameter gamma-glutamyl transpeptidase (5.9 [1.8-13.1] to 4.6 [1.8-8.3] micromol/L) (P<0.001), blood urea nitrogen (56 [32-91] to 34 [21-68] mmol/L; P=0.044), and platelet count (176 [85-241] to 84 [31-145] Gpt/L; P=0.004). In contrast, MARS failed to improve daily urine output (P=0.846), ammonia levels (P=0.340), or thromboplastin time (P=0.775). Only 3 patients survived the hospital stay (mortality 78.6%). Although MARS improved laboratory parameters of hepatic detoxification and renal function in patients with acutely decompensated ALD, the patients' mortality remained unsatisfactorily high. Our experience does not support the indiscriminative use of MARS in acutely decompensated ALD without further controlled studies.
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Affiliation(s)
- Birger Wolff
- Department of Internal Medicine, Intensive Care Division, HELIOS Kliniken Schwerin, Schwerin, Germany.
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Rosenthal E, Pialoux G, Bernard N, Pradier C, Rey D, Bentata M, Michelet C, Pol S, Perronne C, Cacoub P. Liver-related mortality in human-immunodeficiency-virus-infected patients between 1995 and 2003 in the French GERMIVIC Joint Study Group Network (MORTAVIC 2003 Study). J Viral Hepat 2007; 14:183-8. [PMID: 17305884 DOI: 10.1111/j.1365-2893.2006.00791.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [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: 01/05/2023]
Abstract
The objective of the present study was to determine mortality because of end-stage liver disease (ESLD) in a nationwide population of HIV-infected patients, 7 years following the introduction of highly active antiretroviral therapy (HAART). All departments of internal medicine and infectious diseases from the GERMIVIC Study Group prospectively recorded all deaths in HIV-infected patients during 2003. Fifty-nine departments, following a total of 20 940 HIV-infected patients, participated in the study. Results were compared with those of previous surveys conducted using similar methodology in 1995, 1997 and 2001. Among 215 deaths observed during 2003, 101 (46.9%) were related to AIDS, 27 (12.6%) to ESLD and 87 (40.5%) to other causes. Mortality because of ESLD represented 23.7% of non-AIDS-related deaths. Patients dying from ESLD had chronic hepatitis because of hepatitis C virus (HCV) in 92.6% of cases and moderate (30-60 g) or high (>60 g) alcohol consumption (43.5% and 26.0%, respectively). In this population, deaths because of ESLD were 1.5% in 1995, 6.6% in 1997, 14.3% in 2001 and 12.6% in 2003. The prevalence of hepatocellular carcinoma as a cause of death remained high in 2003 but stable when compared with 2001 (25%vs 14.8%). Treatment of hepatitis C in patients who died from ESLD was more frequent in 2003 (44.4%) than in 2001 (26.3%). Seven years after the introduction of HAART, ESLD associated with HCV infections is a leading cause of mortality in HIV-infected patients, which did not increase between the years 2001 and 2003.
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Affiliation(s)
- E Rosenthal
- Department of Internal Medicine, Hôpital de l'Archet 1, Nice, France
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