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Berg PV, Ulaj A, de Broqueville G, de Vos M, Delire B, Hainaut P, Thissen JP, Stärkel P, Komuta M, Henry P, Lanthier N. The beneficial impact of nutritional treatment in non-cirrhotic patients with acute liver decompensation after bariatric surgery. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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2
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Delire B, Komuta M, Michaux L, Lanthier N. A rare cause of high liver stiffness. Acta Gastroenterol Belg 2020; 83:675-676. [PMID: 33321033] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- B Delire
- Service d'Hépato-gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - M Komuta
- Service d'Anatomie Pathologique, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - L Michaux
- Service d'Hématologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - N Lanthier
- Service d'Hépato-gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
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3
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Frezin J, Komuta M, Zech F, Annet L, Horsmans Y, Gigot JF, Jouret-Mourin A, Hubert C. Mucin-producing hepatic cystic neoplasms: an uncommon but challenging disease often misdiagnosed and mismanaged. Acta Chir Belg 2020; 120:6-15. [PMID: 30388391 DOI: 10.1080/00015458.2018.1532706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Mucin-producing hepatic cystic neoplasms (MHCN) are uncommon and potentially malignant.Methods: Nine MHCN were encountered in our centre for over 32 years. Patients' clinical, biological, radiological and pathological features were reviewed. Lesions were classified into Mucinous Cystic Neoplasms (MCN) and Intraductal Papillary Neoplasms of the Bile duct (IPNB) (WHO 2010 classification).Results: Five MCN and 4 IPNB were reviewed. Serum and intracystic tumour markers were insufficient to diagnose malignancy. Complications were encountered in five out of nine patients (56%), mean symptom duration was 26 months (range: 1-132). Three patients were mismanaged pre-referral. Radiological features enabled preoperative diagnosis in eight out of nine patients (89%). Greater tumour size, unilocular lesion and mural nodularity indicated malignancy. Radical tumour excision was achieved in eight patients. One IPNB patient was misdiagnosed and underwent unroofing. For 103 months median follow-up, five out of six patients with benign tumours were alive and disease-free, whereas the misdiagnosed IPNB recurred with fatal malignant transformation seven years later. Among the three patients with malignancies (median follow-up: 77 months), two IPNB died, one from cancer recurrence and one from unrelated causes, whereas the malignant MCN was alive and disease-free.Conclusions: Appropriate MHCN diagnosis is crucial, yet it is often misdiagnosed and mismanaged. The prognosis after complete excision is favourable.
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Affiliation(s)
- J. Frezin
- Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - M. Komuta
- Pathology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - F. Zech
- Internal Medicine Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - L. Annet
- Medical Imaging Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Y. Horsmans
- Gastro-Enterology and Hepatology Department, Cliniques universitairesSaint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - J. F. Gigot
- Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - A. Jouret-Mourin
- Pathology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - C. Hubert
- Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
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Dehon R, Scagnol I, Komuta M, Gomez-Galdon M, Demetter P. Inflammatory hepatocellular adenoma, focal nodular hyperplasia and hepatic granulomas in one single patient : possible physiopathologic explanations. Acta Gastroenterol Belg 2020; 83:83-85. [PMID: 32233277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report the case of a hepatocellular adenoma associated with focal nodular hyperplasia and hepatic granulomas in a 30-yearsold woman. This association has rarely been described before but might be explained by underlying common pathophysiologic mechanisms. In this manuscript possible links between the three entities are discussed.
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Affiliation(s)
- R Dehon
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - I Scagnol
- Department of Pathology, Centre Hospitalier Universitaire de Liège, Université de Liège (ULg), Liège, Belgium
| | - M Komuta
- Department of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - M Gomez-Galdon
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P Demetter
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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5
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Clarembeau F, Komuta M, Horsmans Y, Lanthier N. Impact of liver inflammation on whole body insulin resistance : a case report on primary biliary cholangitis. Acta Gastroenterol Belg 2019; 82:536-538. [PMID: 31950811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Chronic liver diseases such as hepatitis C or non-alcoholic fatty liver disease could be associated with insulin resistance, even in the absence of cirrhosis or significant fibrosis. In this report, we present the case of a patient who was diagnosed with primary biliary cholangitis and metabolic syndrome. Initial evaluation also revealed diabetes with elevated fasting plasma glucose and glycated hemoglobin. After eight weeks of treatment with ursodeoxycholic acid, a complete normalization of the hepatic biological tests was observed. A few months later, while body weight and abdominal perimeter remained stable, fasting blood glucose and glycated hemoglobin decreased significantly, compatible with diabetes disappearance. This finding supports the concept that the inflamed liver plays a major role in the pathogenesis of insulin resistance and diabetes occurrence in chronic liver diseases, including primary biliary cholangitis.
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Affiliation(s)
- F Clarembeau
- Service d'hépato-gastroentérologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Laboratory of Hepatogastroenterology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - M Komuta
- Service d'Anatomie Pathologique, Cliniques universitaires SaintLuc, Université catholique de Louvain, Brussels, Belgium
| | - Y Horsmans
- Service d'hépato-gastroentérologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Laboratory of Hepatogastroenterology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - N Lanthier
- Service d'hépato-gastroentérologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Laboratory of Hepatogastroenterology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
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Ulpiano Trillig A, Ramoisiaux L, Komuta M, Lanthier N. Autoimmune hepatitis in a patient with thymectomy: the benefit of histology and MUM-1 immunostaining. Acta Gastroenterol Belg 2019; 82:550-551. [PMID: 31950817] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- A Ulpiano Trillig
- Service de Gastroentérologie, Cliniques de l'Europe, Hôpital Saint-Michel, Brussels, Belgium
| | - L Ramoisiaux
- Service de Gastroentérologie, Cliniques de l'Europe, Hôpital Saint-Michel, Brussels, Belgium
| | - M Komuta
- Service de Pathologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - N Lanthier
- Service d'Hépato-gastroentérologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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7
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Werion A, Komuta M, Descamps OS, Henrion J. Statins and Clarithromycin : a dangerous combination. Case report and review of the literature. Acta Gastroenterol Belg 2019; 82:87-92. [PMID: 30888760] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- A Werion
- Hepato-gastroenterology unit, Centres Hospitaliers de Jolimont, Haine-Saint-Paul, Belgium
| | - M Komuta
- Anatomo-pathology unit, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - O S Descamps
- Internal medicine department, Centres Hospitaliers de Jolimont, Haine-Saint-Paul, Belgium
| | - J Henrion
- Hepato-gastroenterology unit, Centres Hospitaliers de Jolimont, Haine-Saint-Paul, Belgium
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8
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Dahlqvist G, Horsmans Y, Komuta M, Coubeau L. Acute liver graft cellular rejection after interferon-free antiviral treatment for HCV infection. Is there a risk? A warning about three cases. Acta Gastroenterol Belg 2019; 82:53-56. [PMID: 30888754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
All patients transplanted for hepatitis C (HCV)- related cirrhosis will experience a recurrence of the viral disease on the liver graft with an accelerated course of the disease and a progression to advanced liver fibrosis in up to 50% of the patients at 5 years post-liver transplantation. HCV infection is a high risk for graft lost. We report here three cases of patients transplanted for hepatocellular carcinoma on HCV-related cirrhosis. All cases experienced an acute cellular rejection after the end of HCV therapy with direct acting antivirals (DAAs). We thus advocate for a close monitoring of tacrolimus and liver tests even a few months after the end of the treatment. Clinicians using DAAs after liver transplantation should be aware of the dynamics of tacrolimus levels during therapy and immunological changes that can occur even several weeks (or months) after the end of DAA treatment.
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Affiliation(s)
- G Dahlqvist
- Hepatogastroenterology Department Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Y Horsmans
- Hepatogastroenterology Department Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - M Komuta
- Anatomopathology Department Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - L Coubeau
- Abdominal Surgery Department Cliniques Universitaires Saint-Luc, Brussels, Belgium
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9
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Affiliation(s)
- C Hamoir
- Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - M de Vos
- Department of Hepatogastroenterology, Jolimont Hospital, La Louvière, Belgium
| | - F Clinckart
- Department of Pneumology, Jolimont Hospital, La Louvière, Belgium
| | - G Nicaise
- Department of Radiology, Jolimont Hospital, La Louvière, Belgium
| | - M Komuta
- Department of Pathology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - N Lanthier
- Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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10
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Baldin P, Van den Eynde M, Hubert C, Jouret-Mourin A, Komuta M. The role of the pathologist and clinical implications in colorectal liver metastasis. Acta Gastroenterol Belg 2018; 81:419-426. [PMID: 30350532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Colorectal liver metastases (CRLM) affect about 50% of colorectal cancer patients. With the improvement of neoadjuvant chemotherapy and the introduction of targeted therapy, resectability of CRLM and survival rates have improved over time. However, 60-70% of patients still recur. Several pathological and molecular parameters have been described as prognostic factors after CRLM resection. These parameters encompass not only tumoral features, but also non-tumoral ones, such as chemotherapy related liver injury, or factors related to tumour environment, namely Immunoscore. This review summarizes these prognostic indicators to clarify which patho-molecular parameters should be addressed in the pathological report.
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Affiliation(s)
- P Baldin
- Department of Pathology, Cliniques universitaires Saint-Luc/Université Catholique de Louvain (UCL), Belgium
| | - M Van den Eynde
- Department of Medical Oncology, Cliniques universitaires Saint-Luc/Université Catholique de Louvain (UCL), Belgium
| | - C Hubert
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc/Université Catholique de Louvain (UCL), Belgium
| | - A Jouret-Mourin
- Department of Pathology, Cliniques universitaires Saint-Luc/Université Catholique de Louvain (UCL), Belgium
| | - M Komuta
- Department of Pathology, Cliniques universitaires Saint-Luc/Université Catholique de Louvain (UCL), Belgium
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11
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Francque S, Lanthier N, Verbeke L, Reynaert H, Van Steenkiste C, Vonghia L, Kwanten WJ, Weyler J, Trépo E, Cassiman D, Smets F, Komuta M, Driessen A, Dirinck E, Danse E, Op de Beeck B, van Craenenbroeck E, Van Nieuwenhove Y, Hubens G, Geerts A, Moreno C. The Belgian Association for Study of the Liver Guidance Document on the Management of Adult and Paediatric Non-Alcoholic Fatty Liver Disease. Acta Gastroenterol Belg 2018; 81:55-81. [PMID: 29562379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is highly prevalent and associated with considerable liver-related and non-liverrelated morbidity and mortality. There is, however, a lot of uncertainty on how to handle NAFLD in clinical practice. The current guidance document, compiled under the aegis of the Belgian Association for the Study of the Liver by a panel of experts in NAFLD, from a broad range of different specialties, covers many questions encountered in daily clinical practice regarding diagnosis, screening, therapy and follow-up in adult and paediatric patients. Guidance statements in this document are based on the available evidence whenever possible. In case of absence of evidence or inconsistency of the data, guidance statements were formulated based on consensus of the expert panel. This guidance document is intended as a help for clinicians (general practitioners and all involved specialties) to implement the most recent evidence and insights in the field of NAFLD within a Belgian perspective.
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Affiliation(s)
- S Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp
- Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Healthcare Sciences, University of Antwerp, Antwerp
| | - N Lanthier
- Department of Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels
| | - L Verbeke
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven
| | - H Reynaert
- Department of Gastroenterology and Hepatology, Brussels University Hospital, Brussels
| | - C Van Steenkiste
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent
- Department of Gastroenterology and Hepatology, Maria Middelares Ziekenhuis, Ghent
| | - L Vonghia
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp
- Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Healthcare Sciences, University of Antwerp, Antwerp
| | - W J Kwanten
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp
- Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Healthcare Sciences, University of Antwerp, Antwerp
| | - J Weyler
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp
- Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Healthcare Sciences, University of Antwerp, Antwerp
| | - E Trépo
- Department of Gastroenterology and Hepatology, ULB Erasme, Brussels
| | - D Cassiman
- Department of Gastroenterology and Hepatology, Brussels University Hospital, Brussels
| | - F Smets
- Department of Paediatrics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels
| | - M Komuta
- Laboratory of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels
| | - A Driessen
- Department of Pathology, Antwerp University Hospital, Antwerp
| | - E Dirinck
- Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Healthcare Sciences, University of Antwerp, Antwerp
- Department of Diabetes, Endocrinology and Metabolic Diseases, Antwerp University Hospital, Antwerp
| | - E Danse
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels
| | - B Op de Beeck
- Department of Radiology, Antwerp University Hospital, Antwerp
| | | | | | - G Hubens
- Department of Abdominal Surgery, Antwerp University Hospital, Antwerp
| | - A Geerts
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven
| | - C Moreno
- Department of Gastroenterology and Hepatology, ULB Erasme, Brussels
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12
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Hamoir C, Dano H, Komuta M, Druez P, Negrin Dastis S. Cholestatic hepatitis after diagnostic ajmaline challenge. Acta Gastroenterol Belg 2017; 80:425-426. [PMID: 29560676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report a cholestatic hepatitis in an elderly woman after ajmaline challenge during electrophysiological testing for Brugada syndrome. No other medication was reported in the previous 6 months of the onset of jaundice. Liver biopsy showed a cholestatic hepatitis with mild biliary damage. Liver enzymes normalized within 2 weeks as well as jaundice. To the best of our knowledge this is the second case of histologically proved cholestatic hepatitis induced by intravenous ajmaline testing.
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Affiliation(s)
- C Hamoir
- Service de Gastroentérologie, Grand Hopital de Charleroi, Charleroi, Belgium
| | - H Dano
- Service d'Anatomopathologie, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Komuta
- Service d'Anatomopathologie, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - P Druez
- Service de Gastroentérologie, Grand Hopital de Charleroi, Charleroi, Belgium
| | - S Negrin Dastis
- Service de Gastroentérologie, Grand Hopital de Charleroi, Charleroi, Belgium
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13
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Varma S, Ambroise J, Komuta M, Latinne D, Baldin P, Reding R, Smets F, Stephenne X, Sokal EM. Progressive Fibrosis Is Driven by Genetic Predisposition, Allo-immunity, and Inflammation in Pediatric Liver Transplant Recipients. EBioMedicine 2016; 9:346-355. [PMID: 27333038 PMCID: PMC4972529 DOI: 10.1016/j.ebiom.2016.05.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/22/2016] [Accepted: 05/30/2016] [Indexed: 12/17/2022] Open
Abstract
Aim To determine predisposing factors of idiopathic allograft fibrosis among pediatric liver transplant recipients. Background Protocol biopsies (PB) from stable liver transplant (LT) recipient children frequently exhibit idiopathic fibrosis. The relation between allograft inflammation, humoral immune response and fibrosis is uncertain. Also the role of HLA-DRB1 genotype has not been evaluated, though it's associated with fibrosis in autoimmune hepatitis. Patients and Methods This observational study, included 89 stable LT recipient transplanted between 2004–2012 with mean follow-up of 4.3 years, 281 serial PBs (3.1 biopsy/child) and human leukocyte antigen (HLA) antibody data. PBs were taken 1–2, 2–3, 3–5, 5–7, and 7–10 years post-LT, and evaluated for inflammation and fibrosis using liver allograft fibrosis score (LAFSc). The evolution of fibrosis, inflammation and related predisposing factors were analysed. Findings HLA-DRB1*03/04 allele and Class II DSA were significantly associated with portal fibrosis (p = 0.03; p = 0.03, respectively). Portal inflammation was predisposed by Class II DSA (p = 0.02) and non-HLA antibody presence (p = 0.01). Non-portal fibrosis wasn't predisposed by inflammation. Lobular inflammation was associated with non-HLA antibodies. Interpretation We conclusively demonstrated that allograft inflammation results in fibrosis and is associated with post-LT Class II DSA and non-HLA antibodies. The HLA-DRB1*03/04 allele caused genetic predisposition for fibrosis. Funding None. There is a link between genetic predisposition, alloimmune antibodies, allograft inflammation and fibrosis Description of allograft natural history by assessing evolution of inflammation, fibrosis in different histological zones Allograft inflammation results in allograft fibrosis and is associated with post-LT Class II DSA and non-HLA antibodies The HLA-DRB1*03/04 allele causes genetic predisposition for fibrosis
Among pediatric liver transplant recipients, the graft longevity is expected to parallel the life expectancy of the recipient. A major impediment in this is progressive allograft fibrosis, the cause of which is not well understood. If this pathogenesis could be found, then interventions to arrest the progressive fibrosis could be explored. In our 89 patients for whom we did periodic surveillance liver biopsies, inflammation was found to precede the fibrosis and associated with presence of specific antibodies. Certain genetic predisposition for higher fibrogenesis was also found, thus establishing a link between genetic predisposition, alloimmune response, inflammation, and allograft fibrosis.
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Affiliation(s)
- S Varma
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Department of Pediatrics, Service of pediatric gastroenterology and hepatology, Brussels, Belgium.
| | - J Ambroise
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Centre for applied molecular technologies (CTMA), Institute of experimental and clinical research (IREC), Brussels, Belgium.
| | - M Komuta
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Service of anatomical pathology, Brussels, Belgium.
| | - D Latinne
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Department of clinical biology, Brussels, Belgium.
| | - P Baldin
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Service of anatomical pathology, Brussels, Belgium.
| | - R Reding
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Service of pediatric surgery and transplantation, Brussels, Belgium.
| | - F Smets
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Department of Pediatrics, Service of pediatric gastroenterology and hepatology, Brussels, Belgium.
| | - X Stephenne
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Department of Pediatrics, Service of pediatric gastroenterology and hepatology, Brussels, Belgium.
| | - E M Sokal
- Université Catholique de Louvain, Cliniques Universitaires St Luc, Department of Pediatrics, Service of pediatric gastroenterology and hepatology, Brussels, Belgium.
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Darius T, Monbaliu D, Jochmans I, Meurisse N, Desschans B, Coosemans W, Komuta M, Roskams T, Cassiman D, van der Merwe S, Van Steenbergen W, Verslype C, Laleman W, Aerts R, Nevens F, Pirenne J. Septuagenarian and octogenarian donors provide excellent liver grafts for transplantation. Transplant Proc 2013; 44:2861-7. [PMID: 23146543 DOI: 10.1016/j.transproceed.2012.09.076] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Wider utilization of liver grafts from donors ≥ 70 years old could substantially expand the organ pool, but their use remains limited by fear of poorer outcomes. We examined the results at our center of liver transplantation (OLT) using livers from donors ≥ 70 years old. METHODS From February 2003 to August 2010, we performed 450 OLT including 58 (13%) using donors ≥ 70 whose outcomes were compared with those using donors <70 years old. RESULTS Cerebrovascular causes of death predominated among donors ≥ 70 (85% vs 47% in donors <70; P < .001). In contrast, traumatic causes of death predominated among donors <70 (36% vs 14% in donors ≥ 70; P = .002). Unlike grafts from donors <70 years old, grafts from older individuals had no additional risk factors (steatosis, high sodium, or hemodynamic instability). Both groups were comparable for cold and warm ischemia times. No difference was noted in posttransplant peak transaminases, incidence of primary nonfunction, hepatic artery thrombosis, biliary strictures, or retransplantation rates between groups. The 1- and 5-year patient survivals were 88% and 82% in recipients of livers <70 versus 90% and 84% in those from ≥ 70 years old (P = .705). Recipients of older grafts, who were 6 years older than recipients of younger grafts (P < .001), tended to have a lower laboratory Model for End-Stage Liver Disease score (P = .074). CONCLUSIONS Short and mid-term survival following OLT using donors ≥ 70 yo can be excellent provided that there is adequate donor and recipient selection. Septuagenarians and octogenarians with cerebrovascular ischemic and bleeding accidents represent a large pool of potential donors whose wider use could substantially reduce mortality on the OLT waiting list.
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Affiliation(s)
- T Darius
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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Schouten JNL, Van der Ende ME, Koëter T, Rossing HHM, Komuta M, Verheij J, van der Valk M, Hansen BE, Janssen HLA. Risk factors and outcome of HIV-associated idiopathic noncirrhotic portal hypertension. Aliment Pharmacol Ther 2012; 36:875-85. [PMID: 22971050 DOI: 10.1111/apt.12049] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 08/15/2012] [Accepted: 08/27/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Idiopathic noncirrhotic portal hypertension (INCPH) has been reported increasingly in patients with HIV infection. AIM To evaluate the number of nationwide diagnosed HIV-associated INCPH cases and to assess its clinical features, risk factors and outcome. METHODS All HIV centres in the Netherlands were contacted and requested to notify INCPH cases diagnosed in their population. A case–control study was performed to identify the risk factors of INCPH. The cases were group-matched for duration of follow-up after HIV diagnosis to controls. Controls were selected from a database of HIV patients with negative screening for signs of portal hypertension on abdominal ultrasound. Univariate and multivariate conditional logistic regression analyses were performed. RESULTS On 1st of July 2011, 18.085 individuals were infected with HIV in the Netherlands. Within this population, sixteen patients with clinically overt INCPH were identified. At the time of INCPH diagnosis, cases had a lower platelet count and a higher ALT level. In univariate and multivariate analyses, didanosine [OR: 1.9 (1.3–2.8)], concomitant didanosine and stavudine treatment [OR: 6.3 (2.1–19.1)] and concomitant didanosine and tenofovir treatment [OR: 5.1 (1.2–22.6)] were independently associated INCPH. During follow-up, 4 patients died [malignancy (n = 3), liver failure (n = 1)]. A significant decline in platelets was observed after didanosine discontinuation (P = 0.003). CONCLUSIONS HIV-associated clinically relevant idiopathic noncirrhotic portal hypertension appears to be a rarely diagnosed disease. Long-term exposure to didanosine and short-term combination of didanosine and stavudine or tenofovir exposure are associated with idiopathic noncirrhotic portal hypertension. Mortality in HIV-associated idiopathic noncirrhotic portal hypertension is mainly related to HIV-associated disorders. Portal hypertension continues despite didanosine discontinuation
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Affiliation(s)
- J N L Schouten
- Department of Gastroenterology Hepatology, University Hospital Rotterdam, Rotterdam, the Netherlands
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Schouten JNL, Nevens F, Hansen B, Laleman W, van den Born M, Komuta M, Roskams T, Verheij J, Janssen HLA. Idiopathic noncirrhotic portal hypertension is associated with poor survival: results of a long-term cohort study. Aliment Pharmacol Ther 2012; 35:1424-33. [PMID: 22536808 DOI: 10.1111/j.1365-2036.2012.05112.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/02/2012] [Accepted: 04/04/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Idiopathic noncirrhotic portal hypertension (INCPH) is a rare disease in the Western world. As a result, little is known about the clinical characteristics and outcome of these patients. Survival in these patients is considered to be similar to that of the general population. AIM To investigate the clinical manifestations, pathophysiology, outcome and determinants of survival in Western INCPH patients. METHODS Multicentre cohort study of INCPH patients. RESULTS A total of 62 patients were followed for a median time of 90 months (range 24-310). Initial manifestations leading to the diagnosis of INCPH were related to portal hypertension in 82% of the patients. Histological signs of portal blood supply disturbances were present in nearly all patients. During follow-up, 12 of 62 patients developed liver decompensation, of which four were considered for liver transplantation. One patient died in the context of variceal bleeding. Hepatocellular carcinoma was not observed during follow-up. A total of 23 patients died during follow-up, only four of them due to liver related mortality. The Kaplan-Meier estimates for overall survival were 100% (95% CI 95-100%), 78% (95% CI 67-89%) and 56% (95% CI 40-72%) at 1, 5 and 10 years respectively. Survival for INCPH was significantly decreased (P < 0.001) compared to survival of the general population. Ascites was an independent predictor of poor outcome. CONCLUSIONS In comparison to the general population, survival in INCPH patients is poor. Mortality is related to associated disorders and medical conditions occurring at older age. Patients rarely die due to liver related complications. Patients with ascites have a poor prognosis.
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Affiliation(s)
- J N L Schouten
- Department of Gastroenterology Hepatology, University Hospital Rotterdam, The Netherlands
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Vekemans K, van Pelt J, Komuta M, Wylin T, Heedfeld V, Detry O, Monbaliu D, Pirenne J. Attempt to Rescue Discarded Human Liver Grafts by End Ischemic Hypothermic Oxygenated Machine Perfusion. Transplant Proc 2011; 43:3455-9. [DOI: 10.1016/j.transproceed.2011.09.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liu Q, Monbaliu D, Vekemans K, Peeters R, De Keyzer F, Dresselaers T, Ni Y, Van Hecke P, Komuta M, Brassil J, Marchal G, Pirenne J. Can apparent diffusion coefficient discriminate ischemic from nonischemic livers? A pilot experimental study. Transplant Proc 2007; 39:2643-6. [PMID: 17954198 DOI: 10.1016/j.transproceed.2007.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Using magnetic resonance imaging, the apparent diffusion coefficient (ADC) is an indicator to assess cerebral ischemia. The aim of this porcine study was to evaluate whether ADC assessed hepatic ischemia during ex vivo hypothermic machine perfusion (HMP) as well as in vivo. METHODS Ex vivo: ADC of normal versus warm ischemic (WI) livers was assessed during HMP and subsequent rewarming to mimic ischemia-reperfusion injury. As the preservation solution, we used either an acellular solution or diluted blood. WI was induced in the left lobe or in the whole liver and compared 2-hour WI and non-WI. In vivo: One liver was scanned with the left lobe vessels occluded for 2-hour WI and subsequently for 3 hour reperfusion to compare with the right lobe without WI. Aspartate aminotransferase (AST) in the perfusate and morphology were used as surrogates of WI. RESULTS In all WI livers, AST reached high levels and histology showed severe injury. Ex vivo ADC during acellular perfusion showed negligible differences between the livers with versus without WI, namely, 0.75 x 10(-3) or 0.88 x 10(-3) mm(2)/s during HMP. Ex vivo ADC using sanguineous perfusion showed 1.11 x 10(-3) or 0.83 x 10(-3) mm(2)/s during HMP in regions with versus without WI, respectively, a difference that remained stable during the whole experiment. ADC in vivo decreased from the physiological level of 1.07 x 10(-3) mm(2)/s to 0.75 x 10(-3) mm(2)/s in the first 30 minutes of WI, whereas ADC in the non-WI liver remained constant. CONCLUSION ADC in vivo decreased during hepatic ischemia, as previously seen in cerebral ischemia. However, the effect of WI on ADC was less clear during ex vivo HMP.
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Affiliation(s)
- Q Liu
- Abdominal Transplant Surgery, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Vekemans K, Liu Q, Brassil J, Komuta M, Pirenne J, Monbaliu D. Influence of flow and addition of oxygen during porcine liver hypothermic machine perfusion. Transplant Proc 2007; 39:2647-51. [PMID: 17954199 DOI: 10.1016/j.transproceed.2007.08.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In contrast with kidneys, data on hypothermic machine perfusion (HMP) of livers remain scarce. Optimal liver HMP is poorly defined. Superiority of liver HMP over simple cold storage (SCS), the current standard preservation, must be proven before HMP is applied clinically. In this study, morphology and adenosine triphosphate (ATP) contents of HMP livers at different flows and with versus without O(2) studied in a porcine ex vivo model were compared to SCS. METHODS Pig livers were procured, flushed with HTK and preserved via SCS or HMP at 3 HMP settings: high flow (HF); low flow (LF); low flow + O(2) (300 mm Hg) (LFO). HMP livers were perfused via the hepatic artery (HA) and portal vein (PV) with KPS-1 TM at 4 degrees C to 6 degrees C for 24 hours with HF: PV: 3 to 5 mm Hg, 1 mL/g liver/min for HA and 25 mm Hg; LF: PV: 3 to 5 mm Hg, 0.5 ml/g liver/min with HA: 20 mm Hg. Morphology and ATP levels were measured in preserved liver tissues. RESULTS Throughout the SCS preservation, livers remained intact. In HMP livers, vacuoles appeared after 4 hours of preservation in the HF group and after 12 hours in the LF livers. LFO livers remained intact with limited vacuoles. Compared to SCS, HMP livers showed dilated sinusoids, particularly in the HF group. ATP remained relatively constant or even increased during HMP, particularly in the LF group, whereas ATP decreased after SCS. CONCLUSION Among the various HMP settings, HMP with LFO was superior. ATP levels were the highest in LF. In contrast with all HMP groups, SCS showed the lowest ATP levels, indicating that HMP has the potential to better preserve energy stores.
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Affiliation(s)
- K Vekemans
- Abdominal Transplant Surgery, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Komuta M, Harada M, Ueno T, Uchimura Y, Inada C, Mitsuyama K, Sakisaka S, Sata M, Tanikawa K. Unusual accumulation of glycogen in liver parenchymal cells in a patient with anorexia nervosa. Intern Med 1998; 37:678-82. [PMID: 9745854 DOI: 10.2169/internalmedicine.37.678] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anorexia nervosa is an eating disorder characterized by a fear of weight gain and a preoccupation with body image. Although hepatic involvement has been reported in patients with anorexia nervosa, the mechanism is not fully understood. We describe a patient with anorexia nervosa with liver function abnormalities. Light and electron microscopic observations revealed a remarkable accumulation of glycogen in hepatocytes. These results suggest that adaptive responses to starvation may alter carbohydrate metabolism in patients with anorexia nervosa.
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Affiliation(s)
- M Komuta
- Second Department of Medicine, Kurume University School of Medicine
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