Liver Fibrosis/Digest

Fibrosis Home Page

2011

2011-Dec
"Liverscore" is predictive of both liver fibrosis and activity
in chronic hepatitis C
Chronic hepatitis C (CHC)
induces injury and inflammation of the liver, which appears to be responsible for the associated fibrogenesis[1]. Morbidity and mortality in CHC is associated with  the development of cirrhosis and its complications. The rate of fibrosis
progression varies markedly from person to person and over time. The risk of  developing cirrhosis varies from 10% to 20% over a period of 20 years[2]. Treatment of CHC is complex, costly, and  associated with side effects that are difficult to accept in a population that  is predominantly asymptomatic. Furthermore, about half of the patients with
genotype 1, and slightly lesser than that in other genotypes, fail to respond to  anti-viral therapy[3,4].

Treatment decisions are recommended to be
individualized on the basis of severity of the liver disease, treatment response  rates, co-morbid conditions and the readiness of the patient for treatment[5]. Therefore, assessment of the fibrosis stage and rapidity of progression of fibrosis (necro-inflammation) may help in determining
the prognosis and the need of therapy in an individual patient. A prevalence peak of advanced fibrosis and cirrhosis in CHC patients is expected during this decade. Thus, increasing numbers of patients will require assessment.
Furthermore, with the development of anti-fibrotic therapies, there will be a need for regular and more frequent monitoring[6].

In underdeveloped countries like Pakistan,  with a high prevalence of disease and resource constrains[7,8], it seems unrealistic to offer treatment to all  patients. There is a need to identify patient categories to rationalize the need
for therapy. For patients showing minimal disease, treatment may be deferred  with follow up for disease progression. Treatment may be offered to patients  with progressive disease or else, safer, better tolerated, and more cost
effective therapy will become available.

Liver biopsy is the current tool  for the assessment of liver disease; nonetheless it is an invasive procedure and
may be associated with complications. Moreover, the biopsy facility is not  available in remote areas and is not always possible[9]. Alternative strategies are being actively
evaluated, such as imaging and non-invasive biochemical monitoring of liver  disease. Some of the biochemical markers, especially panels of multiple markers  in the form of indices are promising, and may reduce the number of liver
biopsies for assessment of liver disease[10]. The purpose of this study was to evaluate the predictive value of noninvasive biomarkers for the diagnosis of overall liver  disease categories in CHC.
Read more here.........

The phenotypic fate and functional role for bone marrow-derived stem cells in liver fibrosis

 Liver-induced inflammation hurts the brain

Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients

2011-Nov
Galectin Therapeutics Announces Formation of Liver Fibrosis
Clinical Trials Advisory Board

AASLD-Pentraxin-2 Suppresses Liver Fibrosis and Has a Clear
Hepatoprotective Effect

Predicting clinical outcomes in patients with advanced chronic Hep C 

Galectin Therapeutics to Announce New Data on the Treatment of  Fatty Liver Disease and Fibrosis--
Abstract
Accepted for Presentation at the European Association for Study of the Liver  Special Conference on Liver Transplantation -- 
NEWTON, Mass., Oct 13, 2011 (BUSINESS WIRE) --
Galectin Therapeutics Inc. the leader in developing carbohydrate-based therapeutic compounds to inhibit galectin proteins today announced that its  abstract was accepted by the European Association for the Study of the Liver  (EASL) for presentation at its Special Conference on Liver Transplantation to be held in Lisbon, Portugal, December 15-17, 2011. The abstract, "Improvement of  Steatosis, Inflammation, and Fibrosis in a Mouse Model of Steatohepatitis  Following Treatment with Galectin Inhibitor," will highlight pre-clinical data  on Galectin Therapeutics' drug candidates for the treatment of non-alcoholic  steatohepatitis (NASH).

"Galectin Therapeutics  is developing carbohydrate-based galectin inhibitors for fibrotic liver disease  and cancer based on our unique understanding of galectin proteins, which are key mediators of biologic function," said Dr. Peter G. Traber, President, Chief  Executive Officer and Chief Medical Officer, Galectin Therapeutics. "Currently,  there are no therapeutic treatments available of liver fibrosis, with liver transplantation as the only option. Galectin Therapeutics has previously  demonstrated the ability to arrest and reverse liver fibrosis in pre-clinical  studies with our GM and GR series of galectin-inhibitor compounds and we are now  expanding their therapeutic potential to pre-clinical models of NASH. The data  to be presented at EASL demonstrate promising initial pre-clinical effect in  this indication."

NASH is a common disease of  the liver, affecting 9 to 15 million people in the United States. NASH is characterized by the presence of fat in the liver along with inflammation and  damage in people who drink little or no alcohol. Over time, patients with NASH can develop fibrosis, or scarring of the liver, that can lead to cirrhosis, a  severe liver disease where transplantation is the only current treatment  available. Galectin Therapeutics is developing drug candidates as an alternative to transplantation, and lead candidates have shown in pre-clinical models to reverse fibrosis of the liver.

About Galectin  Therapeutics
Galectin Therapeutics /quotes/zigman/5431495 GALT 0.00% is developing  promising carbohydrate-based therapies for fibrotic liver disease and cancer based on the Company's unique understanding of galectin proteins, key mediators  of biologic function. We are leveraging extensive scientific and development  expertise as well as established relationships with external sources to achieve  cost effective and efficient development. We are pursuing a clear development  pathway to clinical enhancement and commercialization for our lead compounds in  liver fibrosis and cancer. Additional information is available at
www.galectintherapeutics.com  .

Forward Looking  Statements
This press release contains, in addition to historical information, forward-looking statements within the  meaning of the Private Securities Litigation Reform Act of 1995. These  statements relate to future events or future financial performance, and use  words such as "may," "estimate," "could," "expect" and others. They are based on
our current expectations and are subject to factors and uncertainties which could cause actual results to differ materially from those described in the statements.
Factors that could cause our actual performance
to differ materially from those discussed in the forward-looking statements  include, among others: incurrence of operating losses since our inception, uncertainty as to adequate financing of our operations, extensive and costly  regulatory oversight that could restrict or prevent product commercialization,  inability to achieve commercial product acceptance, inability to protect our  intellectual property, dependence on strategic partnerships, product  competition, and others stated in risk factors contained in our SEC filings. We  cannot assure that we have identified all risks or that others may emerge which  we do not anticipate. You should not place undue reliance on forward-looking  statements. Although subsequent events may cause our views to change, we  disclaim any obligation to update forward-looking statements. 
SOURCE: Galectin Therapeutics Inc.

2011-Oct
Galectin-inhibiting therapeutics to treat fibrotic liver disease
and cancer Hepatitis; Staging Liver Fibrosis: Liver Biopsy, Imaging and Biomarkers

Liver Health and Wellness
The  outstanding performance of the new drugs to treat hepatitis c can overshadow the  importance of liver health; also an important weapon in your arsenal to fight liver disease. While on HCV therapy a healthy diet, staying hydrated and getting
the proper rest are all of great importance. Liver health should remain a priority, even if you are not on treatment, or have just finished. Hopefully the topics on the blog today will inspire the reader to consider healthy lifestyle  changes.

Oct-2011
Galectin-inhibiting therapeutics to treat fibrotic liver disease and cancer

Hepatitis; Staging Liver Fibrosis: Liver Biopsy, Imaging and Biomarkers

Liver Health and Wellness
The outstanding performance of the new drugs to treat hepatitis c can overshadow the importance of liver health; also an important weapon in your arsenal to fight liver disease. While on HCV therapy a healthy diet, staying hydrated and getting the proper rest are all of great importance. Liver health should remain a priority, even if you are not on treatment, or have just finished. Hopefully the topics on the blog today will inspire the reader to consider healthy lifestyle changes.

2011-Aug

Hepatitis News Digest;Caffeine and alcohol consumption influences liver fibrosis

Non-Invasive Markers for Hepatic Fibrosis
Ancha Baranova, Priyanka Lal, Aybike Birerdinc, Zobair M Younossi
BMC Gastroenterology 2011, 11:91 (17 August 2011)
[Abstract] [Provisional PDF] [PubMed] [Related articles]

Can Caffeine and Cannabis Be Helpful for HCV and HIV?
by Larry Buhl
Doctors agree that lifestyle choices, such as food and substance intake, play a part in the progression (or improvement) of chronic diseases such as hepatitis and HIV.
Caffeine, present in coffee, tea, chocolate, cola, and some over-the-counter medications, is metabolized through the liver, but despite the fears of some, is not directly harmful to the liver, according to doctors. In fact, a growing number of recent studies suggest that the consumption of caffeine may reduce the risk of liver cancer, and lower the risk of death from cirrhosis complications.

Hepatitis; Staging Liver Fibrosis: Liver Biopsy, Imaging and Biomarkers
The extensive interest in developing noninvasive tests has resulted in alternatives to biopsy that can be used in clinical practice

2011-July

Any correlation to HCV genotype/viral load,-ALT, AST, ALP, bilirubin, gender,age-to disease progression?
Disease progression seems independent of the genotypes. Relationship between ALP and bilirubin with viral load may be an attractive marker to guess disease progression in patients with hepatitis C.

Lifestyle Changes Pay Off in Non-Alcoholic Fatty Liver Disease
7/15/2011 Medscape Gastroenterology Headlines
In a systematic review, weight loss or increased physical activity reduced liver fat and improved glucose control and insulin sensitivity in patients with nonalcoholic fatty liver disease. Reuters Health Information

Liver stiffness diminishes with antiviral response in chronic hepatitis C

Liver Fibrosis Tied to Hep C-Related Vasculitis Prognosis

The hepato-protective effect(s) of three cups of a coffee a day: Relevance for patients with chronic hepatitis C

Noninvasive liver tests may predict hepatitis C patient survival

Hepatitis/Fatty Liver Disease ; Biomarkers of Liver Fibrosis


2011-May

Genes and Hepatitis C; Susceptibility, Fibrosis Progression and Response to Treatment

Stages in Chronic Hepatitis C: Blood Test and Fibroscan for Accurate Non-Invasive Diagnosis of Liver Fibrosis

Hepatitis C; Do I still need a liver biopsy? What Is A Noninvasive Test For Fibrosis ?

2011-Apr

HCV-related liver fibrosis progresses with antiretroviral therapy interruption Hepatitis C "HALT-C" Increased mortality rates seen with pre-cirrhotic advanced fibrosis

Bristol-Myers Interferon-Free Mixture Cures Hepatitis-C Patients in Study
 Full story: Bloomberg

Bristol-Myers Squibb Co. 's cocktail of two experimental drugs cured four hepatitis C patients in the first success for a therapy that excludes often-toxic existing drugs

Fibroscan for assessing liver fibrosis: An acceptable alternative for liver biopsy

2011-Mar

HCV-related liver fibrosis progresses with antiretroviral therapy interruption

Early menopause is associated with lack of response to Hepatitis C therapy

Assessment of Liver Fibrosis before and after Hepatitis C Antiviral Therapy Using Noninvasive Tests

Hepatitis C; FibroTest is a validated non-invasive marker of fibrosis in treatment-naive patients.

2011-Feb
Hepatitis C and B;Fibrosis severity in Hepatic steatosis/insulin resistance

Natural supplements to improve liver fibrosis; Curcumin/Turmeric/Curry, Blueberries, Milk Thistle, and Coffee.

Hepatitis C: Coffee and More Coffee 

'Serum cytokine levels as putative prognostic markers in the progression of chronic HCV hepatitis to cirrhosis

Hepatitis C: Evolution of Interferon-Based Therapy

December 2010

Similar progression of fibrosis between HIV/HCV co–infected and HCV–infected patients

Hepatitis B: Nucleoside analogues slow liver fibrosis progression 

Hepatitis C genotypes in severity of liver disease

Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: A multicenter prospective study

Non-invasive tool for assessing liver fibrosis in HIV/HCV patients  (the FIBROSTIC study) - published pdf attached 

November
Liver Hormone Is A Cause Of Insulin Resistance

2010 Hepatitis C:After 30yrs 15%–35% will develop cirrhosis

HBV/Reversing Liver Fibrosis/ FibroGen starts liver fibrosis study

Varices progression/In HCV and advanced fibrosis

Magnetic Resonance Elastography Holds Promise for Detecting, Staging Liver Fibrosis: Presented at AASLD

October
HEPATOLOGY: Ameliorating scarring of the liver
HBV/Reversing Liver Fibrosis/ FibroGen starts liver fibrosis study

BARACLUDE sNDA receives FDA approval for treatment of chronic HBV patients with decompensated liver disease

Low Vitamin D Not Linked to Bone Density or Liver

Fibrosis in HIV/HCV Group

Noninvasive tests for liver disease, fibrosis, and cirrhosis: Is liver biopsy obsolete?

Aug-Sept

Does "Viusid" has any effect on fibrosis in chronic Hepatitis C.

Cyclophilin Inhibitor SYC-635 May Reduce Fibrosis in Addition to Inhibiting Hepatitis C Virus Replication

Outcome of sustained virological responders with histologically advanced chronic hepatitis C (Early HCV Therapy?)

Fibrosis Stage Predicts SVR Rate: cirrhotics have 10% SVR rate in CHARIOT Study

Vitamin D Increases Sustained Response to Interferon-based Therapy for Hepatitis C, May Improve Liver Fibrosis

Advanced Fibrosis Predicts SVR: Low virological response and high relapse rates in hepatitis C genotype 1 patients with advanced fibrosis despite adequate therapeutic dosing - Earlier HCV Peg/Rbv Therapy

Transplant/Digest

Transplant Home Page

Jan-2011
Predictors Identified for Posttransplant Recurrence of Hepatitis C

Dec-2011
Liver Transplant Recipient Reaches 3-Year Milestone 

Video-
What Organ Shortage? Just Make Your Own! Stem Cells and Organ Engineering

Morbidity and Mortality Weekly Report (MMWR)

CDC: New Report of Hepatitis C From Donor Organ

Child Infected With Hepatitis C After Boston Hospital Transplant

Presumed Consent Wouldn't Boost U.S. Organ Donation:
Study

Rapamycin toxicity
Posted on December 9, 2011 by thebileflow 

Question: A 60 year old male is seven months status post liver transplant for hepatitis C (HCV) and  hepatocellular carcinoma (HCC).  He is taking tacrolimus and ycophenolate
mofetil as immunosuppression.  In your office he asks about switching to sirolimus for its purported benefit in HCV fibrosis and HCC angiogenesis, but is  very worried about the side effect profile.  Which of the following is  not part of this feared profile?
A.  oral ulcers
B.  hypertriglyceridemia
C. hepatic artery  thrombosis
D.  agranulocytosis

Answer:  Sirolimus is an immunosuppressive agent that many patients convert to,  several months or years after transplant.  Because it is not part of the  calcineurin-inhibitor family (like tacrolimus and cyclosporin) it is less nephrotoxic.  Furthermore, it may have some anti-fibrotic and anti-angiogenic  properties that make it valuable for HCV and HCC,  respectively.

Of the above side effects, only  agranulocytosis is not seen with sirolimus.  Keep in mind that this drug can cause leukopenia (or even leukocytosis) as part of its general
marrow suppressive effect; anemia and thrombocytopenia are also possible. 

Agranulocytosis is seen 70% of the time with  medications and is due to 1) immune-mediated destruction of circulating
neutrophils by drug-induced antibodies, or 2) a direct toxic effect upon marrow  granulocytic precursors.  

The other choices  are possible.  Oral ulcers can be treated with lycine.  Hypertriglyceridemia  means you should get a baseline level and check at 6 month intervals.  Hepatic
artery thrombosis means you should get a baseline ultrasound with doppler, and  check surveillance dopplers if LFT become abnormal.

Poor Liver Transplant Outcomes for HIV/HCV Coinfected
Patients

Manipulating serotonin can promote healthy repair in chronic
liver disease
Publishing in the leading medical journal Nature
Medicine, a team led by Newcastle University academics have identified serotonin  receptors which can be targeted with drugs to enhance the natural healing  properties of the liver.....

Green tea flavonoid may prevent reinfection with hepatitis C virus following liver transplantation 

Transplant candidates seek best quality livers, even if it means waiting longer

AASLD -Livers from Older Donors Okay for Transplant 

MT MRI Contrast No Help in Cirrhosis Diagnosis
By  Diagnostic Imaging Staff | November 27, 2011 Magnetization transfer (MT)  contrast-prepared magnetic resonance maging is “unlikely to be of clinical  utility” in diagnosing cirrhosis, according to a study published online Nov. 23 in the journal
Radiology.....

AASLD-Experimental drug suppresses rebound of hepatitis C virus in liver transplant patientsOrgan transplant recipients face higher cancer risk
San Francisco — A human monoclonal antibody developed by  MassBiologics of the University of Massachusetts Medical School (UMMS) given to patients with chronic hepatitis C virus (HCV) infection undergoing liver
transplantation significantly suppressed the virus for at least a week after  transplant and delayed the time to viral rebound. Results from a randomized, double-blind, placebo-controlled, phase 2 study were presented this week at The
Liver Meeting®, the annual meeting of the American Association for the Study of  Liver Diseases, in San Francisco.

"The challenge for patients with end-stage liver disease from HCV is that a transplant is not a cure. Because the
virus remains in the blood stream, the new liver eventually becomes infected with the hepatitis C virus," said Deborah C. Molrine, MD, deputy director of clinical and regulatory affairs at MassBiologics. "These results show that a
human monoclonal antibody targeting the hepatitis C virus can significantly  reduce viral loads in infected patients who receive donor livers and moves us one step closer to clearing the virus so the new liver doesn't become
chronically infected." Five hospitals enrolled patients in the trial  —Massachusetts General Hospital, Beth Israel Deaconess Medical Center, both in Boston, Lahey Clinic in Burlington, Massachusetts, Yale-New Haven Hospital in
Connecticut and Mount Sinai Hospital in New York City. Patients enrolled in the study were treated with a total of 11 intravenous infusions of either the human monoclonal antibody, designated MBL-HCV1, prior to, during, and after surgery or  a placebo (salt solution). The first three infusions were administered on the day of transplantation followed by a daily infusion in the first week following  surgery and a final infusion 14 days after transplant. Of the 11 patients
enrolled in the first part of the trial, six received the MBL-HCV1 antibody.
"The commitment of the transplant team at each site working with study  investigators ensured the delivery of the multiple infusions according to  schedule and all infusions were well tolerated by the patients. The infusions  did not add to any patient's length of stay in the hospital." said Fredric  Gordon, MD, medical director of liver transplantation at Lahey Clinic Medical  Center.

The group of patients who received the monoclonal antibody had a significantly greater reduction in viral load from
pre-transplant levels at days three through six post-transplant compared to patients who received the placebo. One patient's viral load dropped below the detection limit starting at day two after transplant and didn't have a viral
rebound until day 35.

"Because the HCV virus  is prone to mutations, patients develop variants of the virus that can escape  from the effect of a single type of treatment," said Molrine. "In the next phase of the study, we plan to combine the monoclonal antibody with another HCV antiviral agent to see if the activity of two drugs against the virus results in  further suppression, if not clearance, of the virus."

HCV damages the liver and is the leading indication for liver transplantation, diagnosed in about half of the 6,000 patients who receive liver transplants each year in the United States.
According to the US Centers for Disease Control and Prevention, 3.2 million Americans are chronically infected with HCV and approximately 10,000 die annually of the disease. Globally, as many as 170 million people are estimated to suffer from HCV infection.

For patients  with end-stage liver disease from HCV infection, liver transplantation is the  only option. While it can be a life-saving treatment, transplantation does not  cure the disease. In nearly all cases, the patient's new liver is eventually  infected by HCV because the virus remains in the patient's bloodstream during  surgery. The course of recurrent HCV disease is accelerated after  transplantation and up to 20 percent of transplant patients develop cirrhosis  within five years. Unfortunately, the standard antiviral drugs currently used to  treat HCV prior to the onset of end-stage liver disease are poorly tolerated  after liver transplantation, leaving these patients with few options. 

"The ability to prevent allograft infection
using strategies such as immunoprophylaxis would have an enormous impact on outcomes of liver transplantation for HCV," said Raymond T. Chung, MD, director  of hepatology at Massachusetts General  Hospital.

About the University of  Massachusetts Medical School

The University of Massachusetts Medical School has built a reputation as a world-class research institution, consistently producing noteworthy advances in clinical and basic research. The Medical School attracts more than $307 million  in research funding annually, 80 percent of which comes from federal funding sources. The work of UMMS researcher Craig Mello, PhD, an investigator of the
prestigious Howard Hughes Medical Institute (HHMI), and his colleague Andrew  Fire, PhD, then of the Carnegie Institution of Washington, toward the discovery  of RNA interference was awarded the 2006 Nobel Prize in Physiology or Medicine  and has spawned a new and promising field of research, the global impact of  which may prove astounding. UMMS is the academic partner of UMass Memorial
Health Care, the largest health care provider in Central Massachusetts.
For more  information, visit www.umassmed.edu.

Drug Thwarts Hep C Return in Transplanted Livers
In a phase 2 study, infusions of MassBiologic's human monoclonal antibody suppressed Hepatitis C  resurgence in liver transplant recipients.Public release date:
7-Nov-2011
Experimental drug suppresses rebound of hepatitis C virus in liver transplant patientsNext step will combine monoclonal antibody with antiviral  drugs
San Francisco -- A human monoclonal antibody developed by MassBiologics  of the University of Massachusetts Medical School (UMMS) given to patients with
chronic hepatitis C virus (HCV) infection undergoing liver transplantation  significantly suppressed the virus for at least a week after transplant and  delayed the time to viral rebound. Results from a randomized, double-blind,
placebo-controlled, phase 2 study were presented this week at The Liver  Meeting®, the annual meeting of the American Association for the Study of Liver Diseases, in San Francisco.

"The challenge for patients with end-stage liver disease from HCV is that a transplant is not a cure. Because the virus
remains in the blood stream, the new liver eventually becomes infected with the hepatitis C virus," said Deborah C. Molrine, MD, deputy director of clinical and regulatory affairs at MassBiologics. "These results show that a human monoclonal antibody targeting the hepatitis C virus can significantly reduce viral loads in  infected patients who receive donor livers and moves us one step closer to
clearing the virus so the new liver doesn't become chronically
infected."
Continue reading this entire article:
http://www.eurekalert.org/pub_releases/2011-11/uomm-eds110711.php?trkv=481538&trks=1298469

Antiviral Treatment for HCV Recurrence After Liver
Transplantation

AASLD-Modification of CMS Conditions of Participation to
Preserve Access to Liver Life-Saving Liver Transplantations under Less than Optimal Condition

AASLD-Health of Recipients and Quality of Donor are Greater
Factors in Survival than Metabolic Factors

Organ transplant recipients face higher cancer risk

Will the increased prevalence of nonalcoholic steatohepatitis
(NASH) in the age of better hepatitis C virus therapy make NASH the deadlier disease?
Approximately one-third of the US population is presumed
to have nonalcoholic fatty liver disease (NAFLD), with a similar prevalence reported in other parts of the world. Liver-related morbidity stems almost  entirely from those individuals with nonalcoholic steatohepatitis  (NASH).

Influenza vaccination in the organ transplant
recipient
This month's American Journal of Transplantation
provides summary recommendations on influenza vaccination in the organ transplant recipient.

Influenza virus causes a spectrum of illness in
transplant recipients with a high rate of lower respiratory disease.

Dr Deepali Kumar and colleagues Canada investigated seasonal influenza vaccination  as an important public health measure recommended for transplant recipients and  their close contacts.
Vaccine has been shown to be safe and generally
well tolerated in both adult and pediatric transplant
recipients.Seasonal influenza vaccine has demonstrated
safetyAmerican Journal of Transplantation

However, responses to vaccine are variable and are dependent on various factors including time from
transplantation and specific immunosuppressive medication.

The research team reported that seasonal influenza vaccine has demonstrated safety and no  conclusive evidence exists for a link between vaccination and allograft dysfunction.
Annually updated trivalent inactivated influenza vaccines have been available and routinely used for several decades, although newer influenza vaccination formulations including high-dose vaccine, adjuvanted vaccine, quadrivalent inactivated vaccine and vaccine by intradermal delivery system are  now available or will be available in the near future.
Safety and immunogenicity data of these new formulations in transplant recipients requires investigation.
Dr Kumar's team commented, "In this document, we review
the current state of knowledge on influenza vaccines in transplant recipients  and make recommendations on the use of vaccine in both adult and pediatric organ  transplant recipients."
Am J Transplant 2011: 11(10):
2020–2030

Major Challenges Limiting Liver Transplantation in the United
States
Liver transplantation is the gold standard of care in
patients with end-stage liver disease and those with tumors of hepatic origin in the setting of liver dysfunction. From 1988 to 2009, liver transplantation in  the United States grew 3.7-fold from 1713 to 6320 transplants annually. The expansion of liver transplantation is chiefly driven by scientific breakthroughs that have extended patient and graft survival well beyond those expected 50  years ago. The success of liver transplantation is now its primary obstacle, as  the pool of donor livers fails to keep pace with the growing number of patients added to the national liver transplant waiting list. This review focuses on three major challenges facing liver transplantation in the United States and discusses new areas of investigation that address each issue: (1) the need for an expanded number of useable donor organs, (2) the need for improved therapies  to treat recurrent hepatitis C after transplantation and (3) the need for  improved detection, risk stratification based upon tumor biology and molecular  inhibitors to combat hepatocellular carcinoma.

New Transplant Method May Eliminate Need
for Lifelong Medication
A new technique for organ transplants may eliminate the need for lifelong anti-rejection drugs after  surgery, according to a recent study.

Oct 2011
Hepatitis C-Major Challenges Limiting Liver Transplantation in the United States

Living Donor Liver Transplantation From a Donor Previously Treated With Interferon for Hepatitis C Virus

Lifetime probabilities of needing an organ transplant vs donating an organ
A study in the most recent issue of the American Journal of Transplantation investigates lifetime probabilities of needing an organ transplant vs donating an organ after death.
The lifetime probabilities of becoming a deceased organ donor and requiring or receiving an organ transplant are unknown.

Study uncovers why anti-rejection drugs for transplant patients cause hypertension
A group of researchers led by scientists at Oregon Health & Science University has discovered the process that may be causing side effects caused by the anti-rejection drugs given to organ transplant patients. The discovery means those side effects likely can be dealt with much more cheaply and easily....
National Institutes of Health, US Department of Veterans Affairs, Dutch Kidney Foundation, Erasmus University

Pregnancy Raises Risk of Liver Graft Loss
BY MITCHEL L. ZOLER
Elsevier Global Medical News
PHILADELPHIA –
Women who become pregnant after receiving a liver transplant face an elevated risk of graft rejection,especially during or immediately after the pregnancy,based on a review of 161 cases.“The data suggest poorer outcomes for both mothers and their newborns in female liver recipients with risk factors for graft loss within 5 years post pregnancy,” Dr. Carlo B.Ramirez said at the American Transplant Congress.“The findings highlight the high-risk nature of this group,warranting closer follow-up of both mother and child,”said Dr. Ramirez, a transplant surgeon at Thomas Jefferson University, Philadelphia.

Influenza vaccination in the organ transplant recipient
This month's American Journal of Transplantation provides summary recommendations on influenza vaccination in the organ transplant recipient.

Influenza virus causes a spectrum of illness in transplant recipients with a high rate of lower respiratory disease.

How our Liver kills "killer cells"

Sept 2011

Pre-Liver Transplant Serum Ferritin Level Predicts Mortality

Liver transplantation for NASH on the rise in the USA

Aug 2011

Cyclosporine A or Tacrolimus for Hepatitis C Recurrence? An Old Debate

July 2011

Pre-Operative Risk Factors Predict Post-Operative Respiratory Failure after Liver Transplantation

"Patients With NASH and Cryptogenic Cirrhosis Are Less Likely Than Those With Hepatitis C to Receive Liver Transplants

Liver Transplant Video: An Inside Look

Organ Transplant Waiting Lists Can Be Artificially Inflated, Comment Organ Transplant Experts

Genomic medicine reaches HCV-related liver transplantation: Hopes and clinical and public health implications

What’s Up with the MELD Score? Its Future, Exceptions and Additions

HCV-associated liver disease after liver transplantation

Educational Webcast and Video Podcast of a selection of presentations of the AASLD/CDC SINGLE TOPIC CONFERENCE - Chronic Viral Hepatitis - Strategies to Improve Effectiveness of Screening and Treatment

To view these presentations you must register, the process is quick. During the registration when in doubt type in "none" to proceed. Once you begin to view/hear the webcast click on "Presentation on the sidebar to view slides and data". This is worth the effort folks.

Register Now.
Few Examples Of Data;
Burden of HBV and HCV Disease
Impact of Therapy on Disease Outcomes
Preventing and Monitoring Viral Hepatitis Infections
Introduction and Opportunities for Viral Hepatitis Prevention

Transplant;Hepatitis B and C in liver transplantation
MELD/PELDLong Term Complications/Post Transplant MalignancyInfectionsImmunosuppression/Transplant ImmunologySurgical Complications/Live Donors

AASLD is delighted to announce the Educational Webcast and Video Podcast of a selection of presentations of the AASLD/CDC SINGLE TOPIC CONFERENCE - Chronic Viral Hepatitis - Strategies to Improve Effectiveness of Screening and Treatment that was held in Atlanta in June 2011. These expert talks can be accessed from home/office computers and even on iPod Video, iPhone or iPad.

Click here to read more

In order to access webcasted presentations and video podcasts you either need to use the username and password you have received by email or upon registration by clicking on Register Now.

June 2011

Role of living donor liver transplantation in the treatment of hepatitis C virus infection

Video Hepatitis-C and its Effects on Liver Transplantation

Obesity Cuts Long-Term Survival in Liver Transplant Patients

May 2011

Organ Quality Varies According to Transplant Center

AFP Predicts Outcome If Liver Cancer Recurs Posttransplant

IL28B CC or CT genotype have better liver graft survival in Hepatitis C

Update Telaprevir;Vertex Plans US Phase 2 Post-Transplant Study

April 2011

A randomized controlled trial of peginterferon alfa-2a plus ribavirin as a prophylactic treatment after liver transplantation for hepatitis C virus

Treatment For Liver Cancer – Study On The Outcome And Survival From Liver Transplant Released

Clinical Trial MBL-HCV1: New treatment for the prevention of re-infection of the hepatitis c virus in liver transplant patients

March 2011

NY Health Dept. Revises Screening Recommendations After Transplant Recipient Gets HIV 

March 16, 2011

The New York State Department of Health has revised HIV testing recommendations for hospitals after a kidney transplant recipient contracted the virus from a donor liver after the transplant operation at one of the state’s hospitals, reports The Wall Street Journal.
The Human Immunodeficiency Virus (HIV) causes a viral infection resulting in Acquired Immune Deficiency Syndrome (AIDS).

Hepatitis C Drug ITX-5061 Phase 1b clinical trial will assess the safety and tolerability in liver transplant patients

March 15 2011
iTherX Initiates Phase 1b Study of First-in-Class Hepatitis C Virus Entry Inhibitor ITX-5061

Preclinical Studies Show that ITX-5061 Prevents Hepatitis C from Invading Liver Cells --

SAN DIEGO, March 15, 2011 /PRNewswire/ -- iTherX, a pharmaceutical company dedicated to discovering and developing a new class of therapies for hepatitis C, today announced that it has commenced patient recruitment in an open-label, proof-of-concept Phase 1b study of its lead compound ITX-5061 in liver transplant patients with hepatitis C virus infection (HCV). ITX-5061 represents a first-in-class compound that inhibits entry of the hepatitis C virus into liver cells.
"ITX-5061 possesses a unique mechanism of action that prevents the hepatitis C virus from entering liver cells and has demonstrated potent preclinical antiviral activity against all HCV genotypes.
In addition, it has already demonstrated safety in more than 280 subjects," said Jeffrey McKelvy, PhD, MD, President and Chief Executive Officer of iTherX. "We hope ITX-5061 will significantly improve long-term transplant outcomes."
The primary objective of the Phase 1b clinical trial will be to assess the safety and tolerability of ITX-5061 in liver transplant patients. The study will also assess HCV viral load for three months after liver transplantation to determine if ITX-5061 has any immediate and/or sustained impact on viral kinetics in treated patients. Approximately 20 patients will be enrolled into one of two cohorts: one group will receive supportive care only, while the second cohort will also receive ITX-5061 at a150 mg daily dose for seven days. The trial is being conducted at the University of Birmingham, UK under the direction of David Mutimer, MBBS, MD, FRACP, FRCP, Reader in Hepatology at Birmingham University and Consultant Hepatologist to the Birmingham QE Hospital Liver and Hepatobiliary Unit.
Preclinical studies have shown ITX-5061 to be a potent and selective inhibitor of HCV entry into hepatocytes, capable of preventing virus binding/fusion and cell to cell spread, suggesting ITX-5061 may reduce re-infection rates following liver transplant.
"Recurrence of HCV infection among liver transplant patients is universal and immediate. Clinicians have long sought ways to prevent re-infection by HCV, improve transplant patient outcomes and extend survival," said Dr. Mutimer. "The potential of ITX-5061 to prevent or reduce viral infection of the new liver by halting viral-entry into healthy cells represents an extraordinarily novel approach, and we are excited to advance the clinical development of this promising antiviral compound."
The Phase 1b trial of ITX-5061 in liver transplant recipients is funded through an educational grant from iTherX with the National Institute of Health Research Biomedical Research Unit (NIH-BRU Birmingham).
This is a second clinical study for ITX-5061 in hepatitis C. The first study, a single agent placebo-controlled dose response study commenced in August 2010, is being conducted in treatment naïve chronic HCV patients by the AIDS Clinical Trial Group of the National Institute of Allergy and Infectious Diseases.

IL28B gene predicts treatment outcome for liver transplantation patients
March 1 2011
Genetic variants determine severity of HCV-related graft disease and antiviral treatment response German researchers have found a significant association of IL28B genotypes to interferon-based antiviral treatment outcome, and to graft inflammation caused by hepatitis C virus (HCV). The study determined that the presence of G-allele serves as a marker for severe HCV-induced graft inflammation, as well as a predictor for unsuccessful treatment. Study findings—the largest to report on the role IL28B variants in a transplant cohort with recurrent HCV—are published in the March issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases.

The IL28B gene encodes interferons (IFNs), which are proteins made by lymphocytes to motivate the immune system in the presence of pathogens. IFN-α proteins are produced by leukocytes and are prevalent in the presence of a viral infection such as HCV. Researchers determined the prevalence of IL28B genotypes (GG, GT, TT) in 183 liver transplant patients, analyzing 605 protocol liver biopsies performed six months to ten or more years after transplantation.

The authors determined that the presence of G-allele was a marker for more severe graft inflammation and was observed to have a strong association to antiviral treatment failure in 103 of 159 patients. T-allele was more frequent among patients with lower inflammation grades, concluding a definite association between IL28B G-allele and HCV-induced graft inflammation, and the G-allele as a predictor of unsuccessful antiviral treatment. The team also found that IL28B genotypes did not seem to affect median fibrosis.

"Successful liver transplantation creates a unique population of quasi-normal individuals relying on a harmonic interaction of two different genetic backgrounds," said Dennis Eurich, MD, from the Department of General, Visceral and Transplant Surgery at Charité, Campus Virchow in Berlin and lead author of the current study. "IL28B polymorphisms may help to identify patients at risk for developing more severe graft hepatitis. These genetic variants might help to individually predict potential response to antiviral therapy, enabling medical professionals to appropriately adapt treatment."

A related editorial also published in Liver Transplantation this month acknowledges the association between IL28B polymorphisms and HCV-induced graft inflammation, and the prediction of treatment outcomes. Geoffrey McCaughan from the Centenary Institute in Australia said, "The exact mechanisms of how this association results in higher sustained virologic response rates remain unclear, however the data has invigorated research into both prediction of treatment outcomes and the mechanisms of control of HCV replication and clearance."Infection with HCV is the primary cause of cirrhosis of the liver and liver cancer worldwide. Up to 30% of liver transplants will develop graft cirrhosis within five years after liver transplantation due to recurrent HCV-infection. HCV-induced graft fibrosis is the main determinant of morbidity and mortality of liver transplant patients. 
http://onlinelibrary.wiley.com/doi/10.1002/lt.22235/abstract.

Liver Transplantation: An Overview
—Liz Highleyman
Mar 2 2011
Over years or decades, chronic hepatitis C virus (HCV) infection can progress to severe liver problems including cirrhosis and hepatocellular carcinoma (HCC). When the liver is no longer able to perform its vital functions, whether due to acute liver failure or advanced end-stage liver disease, a transplant may be the only option.

Liver damage due to hepatitis C is the most common reason for liver transplants in the U.S., accounting for about 30% of cases. In comparison, hepatitis B is responsible for less than 10% of transplants, largely thanks to an effective vaccine. Other reasons include alcoholic liver disease and acute liver toxicity (for example due to acetaminophen overdose or poisonous mushrooms).

Advances in surgical techniques and medical management have led to improvements in liver transplant outcomes in recent decades. Today the overall one-year survival rate is approximately 90%—up from about 30% in the 1970s—and the five-year survival rate is in the range of 70% to 80%. But patients with hepatitis C, on average, do not fare as well as people receiving transplants for other causes.

Liver Transplant Procedures
The most common transplant procedure is orthotopic liver transplantation (OLT), in which the damaged liver is removed and replaced with a new one (known as an allograft), usually from a recently deceased donor, and the major blood vessels and bile ducts are connected to the new organ.

Unfortunately, the supply of donor livers does not come close to meeting the demand, meaning most people who require a transplant are put on a waiting list. In the U.S., livers are allocated on a regional basis by the United Network for Organ Sharing (UNOS).

In 2002 UNOS adopted a system called MELD (Model for End-Stage Liver Disease) that uses three lab tests–bilirubin, creatinine, and prothrombin time (a measuring of blood clotting)–to predict how likely patients are to die. The system is intended to give priority to people who need new livers most urgently, but are still well enough to benefit, rather than those who have been waiting longest.

According to a study published in 2004, the number of liver transplants increased by 10% and deaths on the waiting list fell by nearly 4% after MELD was adopted. But the system has required some adjustment so it does not favor certain groups, such as people with liver cancer. While the current method has reduced the disparity between white and black patients, a study presented at the 2010 meeting of the European Association for the Study of the Liver (EASL) found that women are more likely than men to die while awaiting a new liver.

However they are allocated, there are not enough good quality deceased donor livers to meet the existing need. In 2008, according to the U.S. Organ Procurement and Transplantation Network (OPTN), approximately 6,000 liver transplants were performed, nearly 1,800 patients died while awaiting a donor liver, and there were about 16,000 people on the liver waiting list at the end of the year.

To address the shortage of deceased donor livers, alternative methods have been developed to increase the liver supply:

• Split Liver Transplant: Thanks to the liver’s ability to regenerate itself, a deceased donor liver can be split into two pieces and transplanted into two recipients, with each piece growing into a fully functioning organ. Split liver transplants produce the best results when the larger right lobe is given to an adult and the smaller left lobe to a child. An Italian study presented at the 2008 EASL meeting found that over a ten-year period split-liver transplant outcomes were comparable to those of whole-liver procedures, leading the researchers to concluded that, “all livers meeting suitability criteria should be used as split-liver transplants to increase the availability of grafts for transplantation.”

• Living Donor Transplant: A living donor transplant uses a liver segment from a live person, usually a relative (although livers do not require close genetic matching like some other organs). The procedure, which was developed in the late 1980s, accounted for nearly 10% of transplants in 2001, but the proportion decreased to about 4% by 2010. Once hailed as a way to dramatically increase the supply of livers, the procedure has somewhat fallen out of favor due to the risk of complications, including death, for the donor.

• Lower Quality Livers: Transplants produce the best outcomes when using infection-free livers from young donors, with a short cold ischemic time (amount of time kept on ice, without a supply of oxygen, after removal from the donor). A study published in 2005, for example, found that the five-year graft survival rate was 72% when the liver came from a donor younger than 60 years, compared with 35% when the donor was age 60 or older. Under some circumstances, however, a poorer quality allograft is preferable to no new liver at all. In particular, a liver from a donor with hepatitis B or C may be given to a recipient who already has the same infection(s). Researchers reported at the 2009 American Association for the Study of Liver Diseases (AASLD) Liver Meeting that hepatitis C patients who received liver grafts infected with HCV or both HBV and HCV had survival rates similar to those of people who received uninfected livers.

Although the number of liver transplants has decreased slightly from its peak in 2006, it is expected to remain high as people infected with HCV decades ago reach the stage of advanced liver disease. Some advocates have called for implementation of a “presumed consent” system, like those in some European countries, that considers everyone a potential organ donor unless they explicitly opt out. Researchers are also studying transplants using animal livers and human liver cells grown in a laboratory, as well as various artificial liver dialysis methods.

Post-Transplant Complications
Liver transplant recipients may experience a number of complications following surgery, including graft rejection, increased risk for infection, and blood vessel or bile duct leakage. Rejection, infection, and recurrence of the original disease—for example hepatitis C or liver cancer—are the leading causes of post-transplant mortality.

Liver graft rejection may occur either as an acute episode soon after transplantation (usually within the first two weeks) or gradual worsening over a longer period. Signs and symptoms of graft rejection may resemble those of viral hepatitis, including fever, fatigue, weakness, abdominal pain, jaundice, and elevated liver enzymes. Sometimes chronic rejection does not cause symptoms initially but can damage the new liver over time.

Transplant recipients must take immunosuppressive drugs to prevent the immune system from attacking the foreign organ. These agents generally work by altering T-cell activity and cytokine production.

The most commonly used medications include corticosteroids, azathioprine, cyclosporine, mycophenolate, sirolimus (also known as rapamycin), and tacrolimus. These and other drugs are typically used in combination regimens, and the mix may change over time. Acute rejection is usually managed with a high dose of steroids. Studies have shown that many patients can safely reduce and eventually stop steroids after the first few months without significantly increasing their risk of organ rejection.

Because their immune function is suppressed, transplant recipients are at increased risk for infection. During the first weeks or months after surgery, when the strongest immunosuppressive regimens are used, patients are prone to develop bacterial infections, viral, and fungal infections.

Transplant patients are susceptible to some of the same opportunistic illnesses affecting people with AIDS, including cytomegalovirus (a virus in the herpes family), pneumocystis pneumonia, toxoplasmosis, and persistent yeast infections. Immune suppression also increases the risk of developing certain cancers. Some of these infections can be prevented by using prophylactic drugs, and most can be successfully treated. In addition to using antibiotics and other specific medications, doses of immunosuppressive drugs may need to be reduced.

Transplant recipients who do not experience overt organ rejection or develop opportunistic infections may still experience detrimental effects over the long term.

As described in the December 2009 issue of Liver Transplantation, for example, transplant patients are more likely to develop metabolic syndrome—characterized by excess abdominal fat, abnormal blood cholesterol and glucose levels, and high blood pressure—which increases the risk of cardiovascular disease, heart attacks, and stroke. And in the May 2010 issue of Liver Transplantation, British researchers reported that transplant recipients showed signs of premature T-cell aging or senescence, losing the ability to proliferate in response to invaders.

Liver transplant patients with hepatitis C face additional challenges. HCV almost always recurs and can cause fibrosis, cirrhosis, and ultimately failure of the liver graft. Post-transplant HCV recurrence will be discussed in the next issue of the HCV Advocate.

Fortunately, successful hepatitis C treatment with sustained virological response can control the virus and halt liver disease progression. Novel direct-acting anti-HCV drugs,—the first of which are expected to be approved this year,—will improve the likelihood of curing hepatitis C and preventing damage to the new liver after transplantation.

Selected Sources

De Feo, T. et al. Results of a 10-year multicenter experience in split-liver transplantation in an Italian transplant program. 43rd Annual Meeting of the European Association for the Study of the Liver. Milan, Italy. April 23-27, 2008.

Gelson, W. et al. Features of immune senescence in liver transplant recipients with established grafts. Liver Transplantation 16(5): 577-587. May 2010.

Moylan, A. et al. Disparities in liver transplantation before and after introduction of the MELD score. Journal of the American Medical Association 300(20): 2371-2318. November 26, 2008.

Myers, R. et al. Increased mortality on the liver transplant waiting list in females under the MELD allocation system: utility of revised meld incorporating estimated glomerular filtration rate. 45th Annual Meeting of the European Association for the Study of the Liver. Vienna, Austria. April 14-18, 2010. Abstract 52.

Pagadala, M et al. Posttransplant metabolic syndrome: an epidemic waiting to happen. Liver Transplantation 15(12): 1662-1670. December 2009.

Sreenivasan, P et al. Use of combined HCV and Hepatitis B core antibody positive liver grafts in HCV recipients. Impact on graft and patient survival. 60th Annual Meeting of the American Association for the Study of Liver Diseases. Boston. October 30-November 1, 2009. Abstract 615.

Revised MELD and outcomes on the liver transplant waiting list

Milk thistle- Silibinin in hepatitis C related liver transplantation
Silibinin monotherapy prevents graft infection after orthotopic liver transplantation in a patient with chronic hepatitis C

Treatment of Recurrent Hepatitis C after Liver Transplantation
SUMMARY: Hepatitis C patients with advanced liver disease may benefit from interferon-based therapy before receiving a liver transplant, but side effects are common and response rates are low, according to a systematic research review described in the January 2011 issue of Alimentary Pharmacology and Therapeutics. Injected antibodies do not prevent the new liver from becoming infected, but pegyalted interferon plus ribavirin can cures recurring HCV about 30% of the time.

Jan 2011
Liver Transplant Update http://www.gastroendonews.com
/download/BB113_WM.pdf

First liver transplant patients receive experimental drug to prevent hepatitis C infection

FDA: Severe Liver Injury Tied to Dronedarone (Multaq)Two cases of acute liver failure leading to liver transplant reported to the agency

Cell Transplantation Reports A Success In Treating End-Stage Liver Disease

Health Studies Cited for Transplant Cuts Put Under the Knife

Virologic Response Protects Against Death in Liver Transplant Patients With HCV

Treating Hepatitis C Virus Infection after Liver Transplantation

MELD score is fair to patients waiting for liver re-transplant:study

December 2010
MELD score is fair to patients waiting for liver re-transplant: study

Treating Hepatitis C Virus Infection after Liver
Transplantation

Health Studies Cited for Transplant Cuts Put Under the Knife

November 2010
Live-donor liver transplantation

The conversation just about over about donor gender mismatch and donor gender, at least for non-hepatitis C infected patients

The importance of organ donationAASLD/SVR with recurrent HCV After Liver Transplant Key for Long-Term Outcomes

Cancer incidence and risk factors after solid organ transplantation

October 2010
Quality of life after liver tranplants/ 20 Years Post Transplant

Cancer incidence and risk factors after solid organ transplantation

A Darling Story/ 3 Time Liver Transplant Recipient

Donor race may impact recurrent hepatitis C in liver transplant patients
Oct 30 2010
Click here for more information.

DETROIT – The race of liver donors may affect recurrent hepatitis C in patients after liver transplant, according to a study by Henry Ford Hospital.

"Patients receiving white cadaveric donor grafts had significantly more aggressive recurrent hepatitis C than those receiving grafts from African-American donors regardless of recipient race," says Matthew Moeller, M.D., gastroenterology fellow at Henry Ford Hospital and lead author of the study.

"This difference was especially marked in African-American recipients and persisted on multivariate analysis."

The study will be presented Oct. 29 at the American Association for the Study of Liver Diseases annual meeting in Boston.

Of patients transplanted at Henry Ford Hospital between 2000 and 2006, 222 were infected with hepatitis C. Of these, 165 were eligible to be evaluated for recurrent hepatitis C after transplant. The study excluded those with patient and graft loss within one year not related to recurrent hepatitis C, patients with advanced fibrosis from other causes, those who did not undergo post-transplant liver biopsy and those lost to follow-up.

Patients were given a recurrent HCV score of 1, 2 or 3. A score of 1 was assigned if the patient had no more than mild portal fibrosis at year one and no bridging fibrosis at any point. A score of 2 was defined as moderate portal fibrosis or focal bridging fibrosis at one year or bridging fibrosis or cirrhosis after three years. A score of 3 was defined as bridging fibrosis, cirrhosis, or graft loss from hepatitis C within three years. Analysis was performed using ordinal multivariate logistic regression modeling.

Results showed that of the 165 patients with a recurrent hepatitis score, 105 (64%) had a score of 1, 29 patients (18%) had a score of 2 and 31 patients (19%) had a score of 3. Of the recipients, 115 (70%) were white and 40 (24%) were African-American; 132 (80%) recipients had white donors and 26 (16%) had African-American donors.

The mean recurrent hepatitis score for the patient donor/recipient race combinations were:

• white donor/white recipient was 1.54,
• white donor/African-American recipient was 1.89,
• African-American donor/white recipient was 1.18, and
• African-American donor/African-American recipient was 1.23.

The study showed that having a white donor for a liver transplant, especially in African American patients, was significantly associated with having a higher recurrent hepatitis C score.

Dr. Moeller explained that after adjusting for donor age and sex and patient age, gender, and sex, having a white donor was still associated with a higher recurrent hepatitis score on multivariable analysis. Using all 222 patients, donor race was not associated with overall patient and graft survival.

"The data suggests a graft from a white donor is potentially one more important variable in identifying patients at risk for more aggressive recurrent hepatitis after transplant and warrants further study," said Dr. Moeller.

According to the U.S. Department of Health & Human Services, more than 16,000 liver transplants were performed last year and according to the United Network for Organ Sharing (UNOS), there are currently almost 18,000 Americans on the liver transplant list.

Obesity Cuts Long-Term Survival in Liver Transplant Patients

Angioplasty May Be Feasible for Liver Transplantation Candidates With Heart Disease

(HCV)-associated liver disease after liver transplantation

Organ Quality Varies According to Transplant Center

May 2010

IL28B CC or CT genotype have better liver graft survival in Hepatitis C

Update Telaprevir;Vertex Plans US Phase 2 Post-Transplant Study

A randomized controlled trial of peginterferon alfa-2a plus ribavirin as a prophylactic treatment after liver transplantation for hepatitis C virus

Cirrhosis/Digest

Cirrhosis Home Page

2011

From Medscape
Gastroenterology > Ask the Experts
How Should I  Approach Elevated Liver Enzymes?
William F. Balistreri,  MD
Posted: 12/29/2011
Question: How should I approach elevated liver enzymes in primary care – how much investigation is  warranted?

Dec 2011
From Medscape General Surgery > Viewpoints
Umbilical Hernia Repair in Patients With Liver Cirrhosis Albert B. Lowenfels, MD
Posted: 12/20/2011
A Prospective Study on Elective Umbilical Hernia Repair in Patients With Liver Cirrhosis and Ascites Eker HH, van Ramshorst GH, de Goede B, et al.
Surgery. 2011;150:542-546

Increased Risk of Liver Cancer in Diabetes Patients with Cirrhosis
Chief researcher Dr. Shih-Wei Lai stated that, "In our study, diabetic patients comorbid with liver cirrhosis, hepatitis B, and hepatitis C were at significantly increased risk of developing hepatocellular carcinoma, and the risk associated with hepatitis C was stronger than that with hepatitis B."

Recent Trends of Japanese Hepatocellular Carcinoma due to HCV

Transesophageal Echocardiogram Appears Safe in Patients With Varices

Studies of patients with cirrhosis uncover limitations in liver cancer screening

Enoxaparin May Prevent Portal Vein Thrombosis in Advanced Cirrhosis

Nov 2011

MT MRI Contrast No Help in Cirrhosis Diagnosis
By Diagnostic Imaging Staff | November 27, 2011 Magnetization transfer (MT) contrast-prepared magnetic resonance imaging is “unlikely to be of clinical utility” in diagnosing cirrhosis, according to a study published online Nov. 23 in the journal Radiology.

Hepatic Encephalopathy: Overview for Patients
  In this article, Dr. Saira Khaderi is a guest blogger for this this important topic that our patients with chronic liver disease face.

Medscape Medical News
Enoxaparin Ups Survival in Cirrhotic Portal Vein Thrombosis

Rifaximin-Related Presentations at AASLD
Oct 2011

If you have hepatitis C, should you get a flu shot?

Response to standard of care antiviral treatment in patients with HCV liver cirrhosis - a systematic review.
Bota S, Sporea I, Popescu A, Sirli R, Neghina AM, Danila M, Strain M.
 Full Text Download Full Article (PDF file)

Study finds curcumin able to inhibit traumatic death of liver cells
2011/10/08 17:35:21Taipei, Oct. 8 (CNA)
Taiwanese researchers have discovered that curcumin, a compound that gives turmeric its yellow color, is effective in inhibiting liver cells from turning fibrous before they lead to cirrhosis and liver cancer.

Translocation of gut-derived bacterial products such as endotoxin is a major problem in liver cirrhosis.

Response to Standard of Care Antiviral Treatment in Patients with HCV Liver Cirrhosis – a Systematic Review

Cleveland Clinic study discovers new targets for treating inflammatory, autoimmune diseases

Liver and Pancreatic Diseases

Sept 2011

Boceprevir response and resistance differs according to HCV genotype 1 subtype
28 July 2011
By
Liz Highleyman
People with hepatitis C virus (HCV) genotype 1b respond better to boceprevir and are less likely to develop drug resistance than those with genotype 1a, according to study findings reported last week at the International AIDS Society Conference (IAS 2011) in Rome.
The advent of direct-acting antiviral agents has led to a paradigm shift in treatment for chronic hepatitis C. The first two drugs out of the pipeline – the HCV protease inhibitors boceprevir (Victrelis) and telaprevir (Incivek) – are used with pegylated interferon plus ribavirin standard therapy, but all-oral combinations are currently under study. As with HIV treatment, using these new agents in suboptimal regimens canlead to resistance....

Telomerase mutations are genetic risk factors for cirrhosis This month's publication of Hepatology reports that telomerase mutations are genetic risk factors for cirrhosis.

Some patients with liver disease progress to cirrhosis, but the risk factors for cirrhosis development are unknown.

Dyskeratosis congenita, an inherited bone marrow failure syndrome associated with mucocutaneous anomalies, pulmonary fibrosis, and cirrhosis, is caused by germline mutations of genes in the telomerase complex.

Dr Rodrigo Calado and colleagues examined whether telomerase mutations also occurred in sporadic cirrhosis.

In all, 134 patients with cirrhosis of common etiologies treated at the Liver Research Institute, University of Arizona, between 2008 and 2009 were screened.

In addition, the team screened 528 healthy subjects for variation in the TERT and TERC genes by direct sequencing.

The team examined 1,472 controls for the most common genetic variation observed in patients.

Telomere length of leukocytes was measured by quantitative polymerase chain reaction. 7% of patients with cirrhosis carried a missense variant in TERT Hepatology

Functional effects of genetic changes were assessed by transfection of mutation-containing vectors into telomerase-deficient cell lines, and telomerase activity was measured in cell lysates.

The research team found that 7% of patients with cirrhosis carried a missense variant in TERT, resulting in a cumulative carrier frequency significantly higher than in controls.

One patient was homozygous and eight were heterozygous.

The allele frequency for the most common missense TERT variant was 6% in patients with cirrhosis vs less than 1% in controls.

The team observed that 1 additional patient carried a TERC mutation.

The research team found that the mean telomere length of leukocytes in patients with cirrhosis, including 6 mutant cases, was shorter than in age-matched controls.

Dr Calado's team concludes, "Most TERT gene variants reduced telomerase enzymatic activity in vitro."

"Loss-of-function telomerase gene variants associated with short telomeres are risk factors for sporadic cirrhosis."

Hepatic encephalopathy: Suspect it early in patients with cirrhosis
As viral hepatitis and nonalcoholic fatty liver disease continue to increase in prevalence, we will see more cases of hepatic encephalopathy. Primary care physicians are often the first to suspect it, as they are familiar with the patient’s usual mental and physical status. This serious complication typically occurs in patients with severe comorbidities and requires multidisciplinary evaluation and care.

CGH Podcast September 2011: Immune Dysfunction and Infections in Patients With Cirrhosis

Treating cirrhosis
The first part of this article by Dr. Upali Weragama was published in last month’s MediScene The ability to recognize complications of cirrhosis has led to improved treatments aimed at preventing them. One of the biggest advances in cirrhosis treatment is liver transplantation, a procedure in which the diseased liver is replaced with a new healthy liver.

September issue of Gastroenterology

Cirrhosis patients believe in benefits of cancer screening
Most patients with cirrhosis are in favour of screening for liver cancer, experts say, after finding they could not recruit enough patients to an randomised controlled trial (RCT) of screening because few would risk being in the control group.

Using a decision aid, 205 patients with cirrhosis were asked to make an informed choice about participating in a randomised trial for liver cancer screening.

However, the majority (99.5 per cent) declined randomisation, preferring to undergo surveillance rather than accept possible allocation to non-screening, the researchers found.

The study authors said the majority of patients chose non-randomised surveillance in the belief that screening helped doctors detect cancer earlier.

“This points to a general misconception about, and unrealistic expectations of, the benefits of screening in the general population,” they wrote.When they examined doctors’ attitudes towards hepatocellular carcinoma (HCC) screening, their results suggested that although the benefits of surveillance were not clear to doctors, it was currently routine practice among the majority of gastroenterologists.

Together with a reluctance by patients to risk randomisation, this made it “impossible” to allocate a genuine control group, meaning RCTs were not “ethically feasible” in current clinical practice, the study authors said.

“However, carefully conducted prospective studies to compare individual HCC screening strategies and modalities were needed to improve early diagnosis and hopefully to improve the outcomes of liver cancer,” they concluded.
Hepatology 2011; doi: 10.1002/hep.24581.

COMMENTARY
Early TIPS for Ascites Study Seeks to Improve Survival
BY DR. THOMAS D. BOYER

The possibility that we can improvethe quality and length of life for liver disease patients, without a transplant, is one of the most exciting potentia lopportunities in our field today. Ascites,the most common complication from cirrhosis, develops in 50% of patients within10 years.1 Development of ascites reflects decompensation of the liver and is associated with an increase in morbidity and mortality.

Initially, the ascites is usually controlled easily with diuretics, but as the liver disease worsens, higher and higher doses of diuretics are required to maintain patient comfort. Eventually, diuretic treatment fails and the patient is diagnosed with refractory ascites. The current standard of care for refractory ascites consists of large volume paracentesis (LVP), coupled with an aggressive pharmacotherapy regimen.

Transjugular intrahepatic portosystemicshunt (TIPS) therapy is regarded as the last line of defense, a bridge to liver transplantation.

However, these conclusions are based on trials in which bare stents were used to create the TIPS. With covered stents that are now available, better outcomes might be possible.

Interventional radiologists and hepatologists have come together in an international trial to determine if TIPS intervention can increase transplant-free survival compared to LVP when performed earlier in the ascitic patient population.

Previous studies comparing TIPS to LVP must be revisited. Conducted in the1990s and early 2000s, these studies may have failed to consistently demonstrate increased life expectancy for three reasons.

First, mostly end-stage patients with refractory ascites were included. Second, neither therapy changes the underlying liver disease, a reason why most therapies, except transplant, have failed to show a survival benefit.

Finally, bare metal stents,which had a high failure rate, were the only option for TIPS therapy at the time.

This study is being conducted to evaluate whether newer technology like covered stents with a lower failure rate will address this last potential pitfall. The Early TIPS for Ascites Study is a randomized, multi-center study, sponsored by Gore Medical in collaboration with both hepatologists and interventional radiologists.

Given the nature of the TIPS referral pathway, the team approach will lead to better patient care, more coordinated medical management, and improved recruitment. The goal of the study is to determine whether patients with difficult-to-treat ascites benefit most from early TIPS therapy using a covered stent or from continued LVP,based on transplant-free survival.

This study has survival as its primary endpoint, in contrast to previous trials, which looked at control of ascites. There is little question that TIPS is better than LVP in controlling the ascites. But controlled trials have shown that use of TIPS is associated with more encephalopathy than alternative forms of therapy.1

What is unclear is the balance of these two factors and the over all impact on survival. This study will also differ from prior studies that focused on refractory ascites, because the Early TIPS forAscites Study protocol allows for enrollment of patients prior to reaching the refractory stage as defined by TheInternational Ascites Club. This is also the first study of its kind in which the Modelfor End-Stage Liver Disease score is used for patient selection and will also be tracked during follow-up as a study end point.

Previous studies comparing TIPS with bare metal stents to LVP in patients with refractory ascites had mixed findings.2 Yet arecent meta-analysis of these studies found that TIPS patients had significantly longer transplant-free survival than paracentesis patients.3 And a study published last year in the New England Journal of Medicine4 compared early TIPS intervention with a covered stent to pharmacotherapy/endoscopicband ligation in high-risk variceal bleeding patients, with positive results.

TIPS therapy is a minimally invasive procedure done with closed surgery, as only a small puncture is made in the jugular vein for insertion of the device. A TIPS creates a functional side-to-side portocaval shunt to route blood flow through the damaged liver and into the main blood vessels that carry blood back to the heart.

With the TIPS procedure, alternative treatments such as medications and paracentes is for ascites, and endoscopic treatment of varices, may possibly not be needed as often. Some reports have shown significant improvements in TIPS therapy when using a covered stent versus a bare metal stent.5,6

As one of the national principal investigators for the Early TIPS for Ascites Study, I believe that the possibility of prolonging patient lives is one of the most exciting new questions in TIPS therapy that we must answer. Most treatments for complications of portal hypertension improve the patient’s condition without affecting survival. We believe that if survival improves in the TIPS cohort, the paradigm for management of cirrhotic ascites might change significantly.

■THOMAS D. BOYER, M.D., is Director ofthe Arizona Liver Research Institute,Professor of Medicine, and Medical Director of the University Medical CenterLiver Transplant Program, University ofArizona College of Medicine, Tucson.References1. Hepatology 2005;41:386-400.2. Hepatology 2009;49:2087-107.3.
Gastroenterology 2007;133:825-34.4. N. Engl. J. Med. 2010;362:2370-9.5. Hepatology 2003;38:1043-50.6. Liver International 2007;27:742-7

Nutritional considerations in end-stage liver disease

Aug 2011

Midodrine Controls Ascites, Improves Survival in Cirrhotic Patients

Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy
"patients with cirrhosis present decreased brain density in many areas of the grey and white matter......showed a clear relationship between the extension and size of decreased brain density areas and the severity of cerebral dysfunction......similarities with the lesions observed in Alzheimer Disease suggest that it may represent organic lesions".........

A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C - (08/10/11)

Metformin Improves Outcomes in Diabetics With Hepatitis C Cirrhosis

Hepatic encephalopathy does not impair quality of life in cirrhosis
Minimal hepatic encephalopathy does not impair health-related quality of life in patients with cirrhosis, reports a study in this month's issue of Liver International.
Minimal hepatic encephalopathy is a serious complication of cirrhosis.
However, the impact of minimal hepatic encephalopathy on health-related quality of life remains controversial.
The Psychometric Hepatic Encephalopathy Score remains a ‘gold standard’ for the assessment of minimal hepatic encephalopathy, but its results clearly differ between studied populations.
Dr Ewa Wunsch and colleagues from Poland studied the effect of minimal hepatic encephalopathy on patient health-related quality of life.
The research team evaluated 87 consecutive cirrhotic patients.
All patients underwent clinical and psychometric evaluation at the same day.
The research team excluded 10 subjects with overt hepatic encephalopathy confirmed with West Haven criteria.

The team finally analyzed 77 patients.
Patients with minimal hepatic encephalopathy were identified on the grounds of an altered Psychometric Hepatic Encephalopathy Score.
Health related quality of life was assessed by the Medical Outcomes Study 36-Item Short Form Health Survey and the Chronic Liver Disease Questionnaire.
Normative reference data for the Psychometric Hepatic Encephalopathy Score were established from a cohort of 305 healthy Polish subjects.
The team diagnosed 38% patients with minimal hepatic encephalopathy.
When patients with and without minimal hepatic encephalopathy were compared, health related quality of life was not significantly different in none of the Short Form-36 and Chronic Liver Disease Questionnaire domains.
Dr Wunsch's team concludes, "Minimal hepatic encephalopathy does not affect health related quality of life."
Liver Int 2011: 31(7): 980–984
02 August 2011

Symptomatic gallstones quantification of the effects of obesity, alcohol and serum lipids on risk
The latest issue of the European Journal of Gastroenterology & Hepatology investigates the effects of obesity, alcohol and serum lipids on risk of gallstones.
The development of gallstones is influenced by obesity and alcohol.
Dr Paul Banim quantified these risks and investigate whether the etiological mechanism may involve serum lipids, for the first time using a European prospective cohort study.
The European Prospective Investigation into Cancer-Norfolk, recruited 25,639 men and women, aged 40 to 74 years, between 1993 and 1997.
At enrolment weight, height and alcohol intake were recorded and nonfasting blood samples taken to measure serum triglycerides, cholesterol, high-density lipoproteins and low-density lipoproteins.
The cohort was monitored for 14 years for symptomatic gallstones.
Every unit of alcohol consumed per week decreased risk in men by 3%European Journal of Gastroenterology & Hepatology
The team found that symptomatic gallstones developed in 68% women.
For each additional unit of body mass index, the hazard ratio in men was 1, in women the hazard ratio was 1.08.
Every unit of alcohol consumed per week decreased risk in men by 3% with no effect in women.
The research team found that serum triglycerides increased risk in men and women.
Increased high-density lipoprotein was associated with a decreased risk in men and women.
The team observed no effects for serum cholesterol and low-density lipoprotein.
Dr Banim's team, "Obesity and alcohol influence gallstone formation, possibly in part through their effects on serum lipids."
"Reducing obesity may prevent gallstones in the population, as 38% of incident cases of gallstones were associated with a body mass index of more than 25."
Eur J Gastroenterol Hepatol 2011: 23(8): 733–74001

August 2011

Source: J Gastroenterol Hepatol
Long-Term Cohort Study of Chronic Hepatitis C according to Interferon Efficacy
Maruoka D, Imazeki F, Arai M, Kanda T, Fujiwara K, Yokosuka O;
Journal of Gastroenterology and Hepatology (Jul 2011)
Background and Aim:
We investigated the prognosis of patients with C-viral chronic liver disease (C-CLD) according to efficacy of interferon (IFN) therapy in a long-term retrospective cohort study.
Methods:
Of 721 patients with C-CLD who underwent liver biopsy between January 1986 and December 2005, 577 were treated with IFN, and 221 of these patients achieved sustained virological response (SVR) with a follow-up period of 9.9 ± 5.3 years.
Results:
The annual rate of HCC development was 2.71%/year, 2.31%/year, and 0.24%/year in untreated, non-SVR, and SVR patients, respectively. Multivariate Cox proportional regression analysis showed that the risk of HCC development was significantly lower in SVR patients than in untreated or non-SVR patients; moreover, this risk was similar in non-SVR patients and untreated patients. The annual mortality rate in overall death was 3.19%/year, 1.98 %/year, and 0.44%/year in untreated, non-SVR, and SVR patients, respectively. Multivariate Cox proportional hazards regression analysis showed that the SVR status reduced the risk ratio for overall death to 0.173, whereas the non-SVR status did not significantly reduce the risk ratio.
Conclusions:
The risk ratio of overall death and HCC development was significantly reduced in SVR patients, whereas no significant reduction was found in non-SVR patients in a long-term cohort study.

Source: J Gastroenterol Hepatol

High-Dose Pegylated Interferon-α and Ribavirin in Nonresponder Hepatitis C Patients and Relationship With IL-28B Genotype (SYREN Trial)

CDC: 1 death, 76 illnesses linked to ground turkey
By MARY CLARE JALONICK Associated Press
WASHINGTON (AP) -- Federal officials say one person has died from salmonella poisoning that appears to be linked to eating ground turkey, but the government so far has declined to say who produced the meat or initiate a recall.
July 2011

Von Willebrand factor levels predict clinical outcome in patients with cirrhosis and portal hypertension

Hepatitis C; Patients With Clinically Significant Portal Hypertension Caused by HCV Cirrhosis Respond Poorly to Antiviral Therapy

Bleeding Varices in Cirrhosis Linked to Adrenal Insufficiency

Simplified psychometric evaluation for the diagnosis of minimal hepatic encephalopathy
7/5/2011 GastroHep.com News
A study in this month's issue of Clinical Gastroenterology Hepatology developed a simplified psychometric evaluation for the diagnosis of minimal hepatic encephalopathy.

Impact of antiviral therapy and long-term outcome of chronic hepatitis C
7/5/2011 GastroHep.com News
The most recent issue of the Journal of Viral Hepatitis investigates long-term outcome of chronic hepatitis C in a population-based cohort and impact of antiviral therapy.

VTE burden significant in patients with cirrhosis
7/4/2011 MedWire News - Gastroenterology
A substantial proportion of patients with cirrhosis are hospitalized with venous thromboembolism throughout the year, US study data show.

Cirrhosis risk score predicts fibrosis progression in HCV
7/1/2011 GastroHep.com News
The latest Journal of Hepatology investigates role of a cirrhosis risk score for the early prediction of fibrosis progression in hepatitis C patients with minimal liver disease.

A Sustained Virologic Response Reduces Risk of All-Cause Mortality in Patients With Hepatitis C - pdf attached -

Study suggests obesity accelerates progression of cirrhosis

June 2011
Telomerase mutation: A genetic risk factor for cirrhosis†

General Recommendations for Patients with Advanced Cirrhosis

May
Effects of Gut Flora Modulation using Prebiotics, Probiotics and Synbiotics on Minimal Hepatic Encephalopathy

Increasing & Peaking Cirrhosis, Decompensated Cirrhosis & HCC(liver cancer) in UK Projected

First Patient Enrolled in Gore Early TIPS for Ascites Study at Indiana University Hospital

New antioxidant may prevent liver damage in chronic alcoholics

Laparoscopic Hepatic Resection Found Safe For HCC Patients With Cirrhosis

Telaprevir SVR & African-Americans, Latinos & Advanced Fibrosis

April 2011

Boceprevir Helps Hepatitis C Patients with Cirrhosis
April 1 2011
SUMMARY: Chronic hepatitis C patients with advanced liver fibrosis or cirrhosis were more likely to achieve a cure when they added boceprevir to standard therapy, according to a report this week at EASL 2011.

By Liz Highleyman
Direct-acting hepatitis C virus (HCV) drugs -- the first of which are expected to be approved in the U.S. as soon as this summer -- will offer new hope to people with chronic hepatitis C. This is especially true for "hard-to-treat" patients including those with HCV genotype 1, prior non-responders, people of African descent, and individuals with advanced liver disease.

This week at the European Association for the Study of the Liver's International Liver Congress (EASL 2011) in Berlin, researchers presented an analysis of patient subgroups with advanced fibrosis or cirrhosis in 2 Phase 3 clinical trials of Merck's experimental protease inhibitor boceprevir (now known as Victrelis).

As reported in the March 31, 2011, New England Journal of Medicine, SPRINT-2 enrolled more than 1000 treatment-naive patients and RESPOND-2 included about 400 prior non-responders and relapsers.

Participants used pegylated interferon alfa-2b (PegIntron) plus ribavirin for a 4-week lead-in period, and were randomly assigned to subsequently either stay on standard therapy alone or add boceprevir, for either a fixed duration or using response-guided therapy.

Overall, both SPRINT-2 and RESPOND-2 showed that adding boceprevir led to significantly higher sustained virological response (SVR) rates compared with standard therapy alone.

The present sub-analysis looked at 100 previously untreated SPRINT-2 participants and 78 treatment-experienced RESPOND-2 participants who had advanced liver disease graded as Metavir fibrosis stage F3-F4.

Results

Here too, sustained response occurred significantly more often in the boceprevir triple-therapy arms compared with the standard therapy control arms. In SPRINT-2, SVR rates were 52% using fixed-duration boceprevir, 41% using boceprevir response-guided therapy, and 38% using standard therapy. Among previously treated patients in RESPOND-2 the differences were greater: 68%, 44%, and 13%, respectively. Boceprevir produced better outcomes among people with either good or poor initial response at week 4, and those who had either detectable or undetectable HCV RNA at week 8. Based on these findings, the researchers concluded, "In treatment-naive or previous-treatment-failure patients with HCV [genotype] 1 infection and advanced fibrosis/cirrhosis, addition of boceprevir to [standard of care] in 48-week treatment arms was associated with enhanced SVR."

"SVR was also substantially increased in previous treatment failure patients using response-guided therapy," they continued, "and it was also achievable in patients poorly responsive to [interferon]."

Investigator affiliations: A.O. Fatebenefratelli e Oftalmico, Milan, Italy; Baylor College of Medicine, Houston, TX; Vall d'Hebron Hospital, Barcelona, Spain; Kaiser Permanente, San Diego, CA; Hospital Provincial del Centenario, Rosario, Argentina; Merck, Whitehouse Station, NJ.

4/1/11

Reference
S Bruno, JM Vierling, R Esteban, et al. Boceprevir in addition to standard of care enhanced SVR in hepatitis C virus (HCV) genotype-1 with advanced fibrosis/cirrhosis: subgroup analysis of S-2 and RESPOND-2 studies. 46th Annual Meeting of the European Association for the Study of the Liver (EASL 2011). Berlin. March 30-April 3.
Abstract 195.


Noninvasive tests may determine chronic hepatitis C survival

Hepatitis C "HALT-C" Increased mortality rates seen with pre-cirrhotic advanced fibrosis

Novel Understanding Of How HCV Persists In The Liver

The Future Looks Bright For HCV Patients Who Have Failed To Respond To Current Treatments

EASL; EARLY RESULTS SHOW BENEFITS IN USING ACUTE KIDNEY INJURY CRITERIA (AKIN) FOR THE DIAGNOSIS OF CIRRHOTIC PATIENTS

March 2011

Cholesterol regulator plays key role in development of liver scarring, cirrhosis

Cirrhosis; Vitamin K Deficiencies

Treatment and Vitamin D

The Importance Of Monitoring Vitamin D Levels In All Patients With Cirrhosis
Minimal hepatic encephalopathy is associated with falls

In liver-disease patients, cognitive impairment may not be fully reversible
.
The Rate of Decompensation In Cirrhosis;Alcoholic, Viral Hepatitis, Autoimmune liver disease

Esophageal varices' presence can be better predicted if both spleen and liver stiffness measurements are used

Cirrhosis;Definition, Epidemiology, and Etiology Mar 2011

Feb 2011

SVR Signals Good Prognosis in Decompensated Cirrhosis Due to HCV

Abstract 
Full Text (subscription or payment may be required

Liver Health: Deep vein thrombosis (DVT) In Cirrhosis

Apparent development of liver cirrhosis unfolded

Scientists develop method to regrow human liver tissue

The Health Benefits Of Coffee

Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas

Cirrhosis; Surgery In Patients With Liver
Disease

The odds of gallbladder disease in Hepatitis C Patients

Case Study;Hepatitis C-Related Cirrhosis W-HCC In An Older Patient

Rifaximin improves quality of life in minimal hepatic encephalopathy

Regenerative Medicine Provides the Gift of Life

Frequent Use of Over-the-Counter Painkillers Carries Real Risks

The Stories of Chronic Disease

Jan 2011
Liver Heath: Prebiotics, probiotics and synbiotics was associated with significant improvement in minimal hepatic encephalopathy MHE'Serum cytokine levels as putative prognostic markers in the progression of chronic HCV hepatitis to cirrhosis

Hepatocellular carcinoma surveillance among Hepatitis C virus-infected patients with cirrhosis in Veterans Affairs

A Few Facts On Chronic Liver Disease and Cirrhosis

Hepatitis C:Fibrosis Liver Biopsy vs Transient Elastography

Management of gastric varicesHepatitis C and B : Cirrhosis etiology a major factor in cancer risk
______________________________________


December 2010

Radiofrequency ablation :Hepatocellular carcinoma in patients with cirrhosis

Hepatitis C : Complete Text On Silymarin (Milk Thistle) use is associated with reduced progression to cirrhosis in Hep C

Liver Cancer in Cirrhotic Patients Effectively Treated

Hepatitis C Best Of The Liver Meeting:Infectious

Complications of Cirrhosis 

What Goes Wrong in the Liver with Cirrhosis?

Cardiac operations in patients with cirrhosis

November 2010

Decompensated cirrhosis
Growth Factor Drugs Bolster Compliance in Hepatitis C Therapy

2010 Hepatitis C:After 30yrs 15%–35% will develop cirrhosis

Pro-Pharmaceuticals to Receive $489,000 in Federal Grants for Its Galectin-Targeting Cancer and Liver Fibrosis Compounds

Cirrhosis With Large Varices Adding Probiotics to Propranolol Reduces HVPG

Researchers Call for Reassessment:Cirrhosis Classification System

Increased Risk of Hip/Wrist Fractures in Cirrhosis

Cirrhosis:Diet and cognition in chronic liver disease.

Urine color in cirrhosis or acute viral hepatitis

Chugai submits application for additional indication of Pegasys, Copegus:Compensated cirrhosis

AASLD/Abstract Preview/ LT/Cirrhosis/Halt C and More

HCV The Difficult To Treat: Re-Cap Telaprevir/Boceprevir

Infections: Exert Heavy Mortality Toll in Cirrhosis

Oct 2010

Varices progression/In HCV and advanced fibrosis

Blood test developed for non-alcoholic fatty liver disease diagnosis
19. September 2010 21:35

The E solution to liver disease
By LIM WEY WEN
starhealth@thestar.com.myWednesday September 29, 2010

Local study finds antioxidant tocotrienol a potential treatment for non-alcoholic fatty liver disease.

Sustained Response to Antiviral Therapy Prevents Esophageal Varices in Hepatitis C Patients with Cirrhosis7-05-2010

Treating Hepatitis C in People with Compensated Cirrhosis Is Most Cost-effective Approach
7-02-2010

Rifaximin Reduces Encephalopathy Recurrence, Improves Quality of Life in People with Liver Cirrhosis
5-28-2010

Liver Cancer/Hepatocellular Carcinoma/Digest

2011
Bristol-Myers: Liver cancer drug failed in study 

The Role of Pre-Existing Diabetes Mellitus on Hepatocellular
Carcinoma-Meta-analysis

Risk Factors for Hepatocellular Carcinoma in a Cohort Infected With Hepatitis B or C

Guidelines for diagnosis and treatment of hepatocellular
carcinoma

Snapshot liver transcriptome in Hepatocellular Carcinoma 

Researchers identify a novel therapeutic approach for liver
cancer

Studies of patients with cirrhosis uncover limitations in liver
cancer screening

Nov 2011
Liver Cancer Treatment Turns Up the Heat on
Chemotherapy

AASLD-Jennerex to Present Final Survival Data From Randomized Phase 2 Clinical Trial of JX-594 in Advanced Liver Cancer

Hepatitis C Genotype-4 Infection: Role of Insulin Resistance in  Hepatocellular Carcinoma

Is Radiofrequency Ablation as Good as Surgery for HCC up to 4cm? 

Two studies in top-ranking journals show new approaches to the treatment of early-stage liver cancer

Oct  2011
PEG-IFN α-2b/Ribavirin Following Treatment of Hepatitis C
Virus-Associated Hepatocellular Carcinoma

AFP Level Predicts Mortality in Hepatitis C-Related Liver
Cancer

Radiation traveling in microspheres hits liver cancer where
surgery can’t

Radiology Studies On Yttrium-90 Radioembolization Treatmentfor  Liver Cancer Illustrate Ways To Assist In Treating Even The Most Challenging Cases

Oct 2011
PEG-IFN α-2b/Ribavirin Following Treatment of Hepatitis C Virus-Associated Hepatocellular Carcinoma

AFP Level Predicts Mortality in Hepatitis C-Related Liver Cancer

Radiation traveling in microspheres hits liver cancer where surgery can’t

Radiology Studies On Yttrium-90 Radioembolization Treatmentfor Liver Cancer Illustrate Ways To Assist In Treating Even The Most Challenging Cases

Liver cancer incidence lower in patients with nonalcoholic fatty liver disease than hepatitis C

Preventing recurrence in hepatocellular carcinoma

Liver cancer incidence lower in patients with nonalcoholic fatty liver disease than hepatitis C

Liver and Pancreatic Diseases

New Liver Cancer Treatment
MORGANTOWN -- West Virginia Health Report from the WVU Health Sciences Center:
Selective Internal Radiation therapy, also known as SIRT, is a targeted treatment for inoperable liver tumors. It's much more effective because it delivers the radiation directly to the tumors, leaving healthy tissue unaffected.

Study finds curcumin able to inhibit traumatic death of liver cells
2011/10/08 17:35:21 Taipei, Oct. 8 (CNA) Taiwanese researchers have discovered that curcumin, a compound that gives turmeric its yellow color, is effective in inhibiting liver c

‘Micro’-chemo and Cancer Pill Combo Tested in Liver Cancer Patients

Study Suggests HCC Resection Superior to Transplant
September issue of Gastroenterology

Aug 2011
The ignored virus that causes liver cancer

Saffron shows promise in preventing liver cancer 
 
Radioembolization improves chance of survival for liver cancer patients

Utilization of Surveillance for Hepatocellular Carcinoma Among Hepatitis C Virus-Infected Veterans in the United States: 'HCC surveillance low among cirrhotics despite recommendations for HCC surveillance in these high-risk patients' -
Download the PDF here or visit NATAP for full text
Current practice guidelines recommend screening for hepatocellular carcinoma (HCC) in patients with cirrhosis. The evaluation of data in a Veterans Affairs database showed that routine, annual screening for HCC with either serum α-fetoprotein measurement or abdominal ultrasonography was done in only 12% of veterans with cirrhosis. Testing was done inconsistently in 58.5% and not at all in 29.5% of patients with cirrhosis. This study could not determine whether missing screening was due to physicians' failure to recommend tests or patients' failure to adhere to testing. Efforts are needed to improve screening for HCC in at-risk patients."

Video; Dr. Riad Salem discusses his manuscript "Radiographic Response to Locoregional Therapy in Hepatocellular Carcinoma Predicts Patient Survival Time." Watch Video Here, and View Abstract Here

Hepatocellular Carcinoma After Diagnosis of Hepatitis B or C Infection

Watch; RF ablation alternative to surgery in early liver cancer

The Role of Inflammation In Causing GI Cancers
Inflammation has been linked with various diseases, including many types of malignancies. This association has become well enough known that a cover of Time magazine in recent years pronounced inflammation the “surprising killer,” noting the “surprising link” between inflammation and cancer

Peginterferon Maintenance Therapy in Patients with Advanced Hepatitis C to Prevent Hepatocellular Carcinoma: The Plot Thickens
The Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial showed that 4 years of maintenance therapy with pegylated interferon (peginterferon) does not reduce liver disease progression.
We investigated whether peginterferon decreases the incidence of HCC in the HALT-C cohort over a longer posttreatment follow-up period.

Celsion Reaches Major Milestone With Enrollment of 600th Patient in Its Pivotal Phase III HEAT Study of ThermoDox(R) in Primary Liver Cancer

July 2011

Metabolic syndrome increases risk of both major types of primary liver cancer
Incidence rates of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) have increased in the U.S. This population-based study publishing in the August issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, found that metabolic syndrome significantly increases risk of developing these primary liver cancers.

Fighting the bushfire in HCC trials
Until recently, few options for systemic therapy have been available for hepatocellular carcinoma (HCC). However, significant benefits have now been demonstrated for the kinase inhibitor sorafenib [1] that have led to its approval for HCC therapy in the palliative setting. This has dramatically increased the previously timid interest of drug companies for HCC, and indeed there are now on their way more than 50 phase I–III clinical trials employing more or less targeted substances

Interactive map of cancer mortality risk worldwide
What emerges from looking at the mortality rates of different cancers is the uneven distribution. For example, liver cancer is a blight on the people of Mongolia, a consequence of high rates of hepatitis C and B combined with alcohol, but barely registers in other countries.

June 2011 Full Text ; Chronic Hepatitis C

Peregrine Financial Results and Recent Developments: Three Phase II Programs Advancing in Liver Cancer and HCV

FDA Grants Orphan Drug Designation to 4SC's Oral Pan-HDAC Inhibitor Resminostat for the Treatment of Hepatocellular Carcinoma

Liver Transplantation for the Treatment of Hepatocellular Carcinoma

Impact of Pegylated Interferon Therapy on Outcomes of Patients with Hepatitis C Virus-Related Hepatocellular Carcinoma After Curative Hepatic Resection

Study;Safety of radioembolisation using SIR-Spheres in patients with inoperable primary liver tumours

Anti-Inflammatory Drugs Reduce the Risk of Hepatocellular Carcinoma Development

Genetic Variant Linked to Development of Liver Cancer in Hepatitis C Virus Carriers
Tokyo, July 4, 2011 - (JCN Newswire) - A genome-wide study by researchers at the RIKEN Center for Genomic Medicine, Hiroshima University Hospital and Sapporo-Kosei General Hospital has identified a genetic variant associated with the development of liver cancer in chronic hepatitis C virus carriers. The findings are based on a study of 3,312 Japanese individuals and appear in the journal Nature Genetics

Increased incidence of hepatocellular carcinoma after diagnosis of Hep B or C
7/6/2011 GastroHep.com News
This month's Journal of Viral Hepatitis examines trends in incidence of hepatocellular carcinoma after diagnosis of hepatitis B or C infection.

Hepatitis C; Effects of interferon on development/progression of hepatocellular carcinoma
Available literature on the effects of interferon (IFN) treatment on development and progression of hepatocellular carcinoma (HCC) in patients with chronic virus infection reports controversial results. The primary objective of this meta-analysis was to evaluate the effect of IFN on HCC risk in patients with chronic hepatitis C virus (HCV) or hepatitis B virus (HBV) infection; IFN's efficacy on local tumor progression and survival of advanced HCC patients was also assessed.

Growth of hepatocellular carcinoma in the regenerating liver
7/4/2011 GastroHep.com News
Liver regeneration after partial hepatectomy facilitates the growth and malignant transformation of microscopic hepatocellular carcinoma, finds the most recent issue of Liver Transplantation.

Scientists Fish For Answers About Hepatocellular Carcinoma
05 July 2011Hepatocellular carcinoma (HCC), the most common type of liver cancer, is a leading cause of cancer-related deaths worldwide. Although there are several treatment options available, they are largely unsuccessful because the...

Ultrasound Guided Liver Surgery Makes Tumour Removal Safer
05 July 2011ALOKA Holding Europe AG, the innovator in ultrasound, is working with the world renowned liver surgeon, Professor Guido Torzilli to explore the clinical benefits of intra-operative ultrasound in hepatic cancer cases...

Hepatitis C; Effects of interferon on development/progression of hepatocellular carcinoma

Earlier Diagnosis Of Liver Cancer
Hepatocellular carcinoma is the most common cancer to strike the liver. More than 500,000 people worldwide, concentrated in sub-Saharan Africa and Southeast Asia, are diagnosed with it yearly. Most of those afflicted die within six months...

BioAlliance Pharma Submits a Phase III Clinical Trial Application for Livatag® (doxorubicin Transdrug™) to the French Drug Agency (Afssaps

June 2011
Gold nanoparticles help earlier diagnosis of liver cancer

AASLD Publishes New Guideline on HCC(liver Cancer)

Hepatocellular carcinoma (HCC);A common cancer

Diabetes Doubles Liver Cancer threat For individuals With innovative Hepatitis C

 Laparoscopic Liver Surgery Safe for HCC With Cirrhosis

Sorafenib Superior to Sunitinib in Overall Survival in Advanced Hepatocellular Carcinoma

 Risk estimation for hepatocellular carcinoma in chronic hepatitis B

 AFP Predicts Outcome If Liver Cancer Recurs Posttransplant

May 2011
Having a Healthcare 'Navigator' Ups Cancer Screening

CF102 Drug; Interim Analysis Data Phase I/II Liver Cancer Study

Liver Cancer Cells Coaxed To Commit Suicide By Common Anti-InflammatoryWith boost from Southwest Florida, possible cancer treatment advances

Study shows how inflammation can lead to cancer

Histological diagnosis (markers) of early hepatocellular carcinoma - Editorial  

March 2011

Liver Cancer Home Page

Screening for hepatocellular carcinoma among cirrhotics

Predictors of Surgical Intervention for Hepatocellular Carcinoma

The Relationship Between Body Mass Index And Age At Hepatocellular Carcinoma Onset

Alarm bells: Hepatitis today, cancer tomorrow

Factors associated with hepatocellular carcinoma in Hepatitis C

Hepatitis C News; Vertex Patient Website, Liver Cancer and More..

Screening for Hepatocellular Carcinoma in Elderly Residentsin a Hepatitis B- and C-endemic Area

Interventional and combined approaches show promise in advanced liver Cancer

Announcing 510(k) Clearance of a New Microfluidic-based IVD Test System, the uTASWako® i30

Immunoanalyzer, and AFP-L3 and DCP Assays for Liver Cancer Risk Assessment.

Hepatitis B; Newly Discovered Biomarker Predicts Cancer Growth

Feb 2011
Hepatitis C and B ; European Journal of Cancer Prevention Report

Liver cancer in US-born Hispanic men in California have increased by 87%

Case Study;Hepatitis C-Related Cirrhosis W-HCC In An Older Patient

Liver Cancer Symptoms/Risk Factors

Cirrhosis Patients at Increased Risk of Extrahepatic Cancer
Abstract 
Full Text (subscription or payment may be required

A Diagnostic Marker In Hepatocellular Carcinoma
Predicting The Spread Of Cancer From The Level Of Tumor Protein

Patients And Physicians Rally On Capitol Hill To Tell Congress YES! We Can Beat Liver Tumors
The Daily Checkup: Liver cancer is on the rise but early screenings & treatment offer hope

Racial Disparities Evident In Early-Stage Liver Cancer Survival
Ablative therapies, which aim to destroy tumors in-situ, are limited by the number and size of the tumors that can be targeted, therefore eliminating them as an option in many cases due to the limited performance of existing RFA and microwave systems. However, the Acculis Accu2i pMTA system is the first high power 2.45 GHz system that enables larger and faster ablations to be performed. This means that ablative therapy will now be available as an option for many more patients.

For more information about the Acculis Accu2i pMTA system,click here

December 2010

Liver Cancer:Initiation of Phase 2 Trial to Evaluate VT-122 in Patients with Liver Cancer Receiving Nexavar

Duke University, Division of Gastroenterology reports research in hepatitis C virus

Studies from University of Texas, M. D. Anderson Cancer Center add new findings in the area of hepatocellular cancer

Compare drug-eluting microspheres to conventional chemoembolization (cTACE) in the treatment of hepatocellular carcinoma 

Radiofrequency ablation :Hepatocellular carcinoma in patients with cirrhosis

Liver Cancer in Cirrhotic Patients Effectively Treated

Liver Cancer:First U.S. Patient Treated with the Accu2i Percutaneous Microwave Tissue Ablation Device

FDA Approves Merit Medical's HiQuality Clinical Trial
 Protocol for the Treatment of Primary Liver Cancer

All About Liver Cancer

Hepatitis C & B Screening reasonable way of reducing or at least managing the incidence of liver cancer

Liver Cancer: Resection of liver and lung colorectal metastases produced superior survival

FDA Approves Merit Medical's HiQuality Clinical Trial Protocol for the Treatment of Primary Liver Cancer 

 Liver Cancer:Peregrine Initiation Of Phase I/II trial bavituximab in combination with sorafenib.

Liver Cancer: Video Understanding SIR-Spheres microspheres - Whats Being Discussed ?

November
Compare drug-eluting microspheres to conventional chemoembolization (cTACE) in the treatment of hepatocellular carcinoma

Hepatitis C : (SIRT) is a targeted treatment for liver tumors

Combination therapy improves survival time for patients with advanced liver cancer

Liver Treatments:Body Radiation Therapy (SBRT)

HCV And HCC Updates: ThermoDox® To Treat Primary Liver Cancer

Survival Improved After Colorectal Liver/Lung Mets Resection