Matilla Pena A.,Institute Investigacion Sanitaria Gregorio Maranon |
Matilla Pena A.,CIBER ISCIII |
Chiva M.T.,Seccion de Hepatologia |
Chiva M.T.,Hospital General Universitario Gregorio Maranon |
And 2 more authors.
Medicine (Spain) | Year: 2012
Hepatocellular carcinoma is the most frequent malignant primary liver tumor that is generally found on the cirrhotic liver. There are different risk populations that determine the need to carry out screening strategies for early diagnosis. In cirrhotic patients, it is recommended to perform an ultrasound graph every six months. Diagnoses of the hepatocarcinoma is made using dynamic imaging tests. Detection on the four-dimension phase computed tomography or magnetic angioresonance of a hypervascular node in arterial phase and with early washout in the phase is diagnostic of hepatocarcinoma is performed. The BCLC staging system allows classification of the patients based on the tumor characteristics and those of the hepatic disease, and facilitates assigning therapeutic attitudes. Surgery, percutaneous ablation and liver transplant are alternatives with applicable curative intention in patients in early stages. Sorafenib is a multikinase inhibitor that improves survival in patients with advanced tumors.
Dirchwolf M.,Hepatopatias Infecciosas |
Podhorzer A.,University of Buenos Aires |
Marino M.,Seccion de Hepatologia |
Shulman C.,Hepatopatias Infecciosas |
And 9 more authors.
Cytokine | Year: 2016
Background/objectives: Cirrhosis associated immune dysfunction has been proposed to switch from a pro-inflammatory phenotype in stable cirrhosis to an immunodeficient one in patients with decompensated cirrhosis and acute-on-chronic liver failure. The aim of the present study was to compare serum cytokine levels between healthy patients, stable cirrhosis, and decompensated cirrhotic patients with and without development of acute-on-chronic liver failure (ACLF); and to explore whether any of the measured cytokines is associated with cirrhosis severity and prognosis in ACLF patients. Methods: Patients were enrolled from October 2013 to May 2014 in two hospitals located in Buenos Aires. Cirrhotic patients with an acute decompensating event were enrolled accordingly to the development of ACLF defined by the CANONIC study group. There were two control groups: healthy subjects (n= 14) and stable cirrhotic patients (n= 14). Demographic, clinical and biochemical data were obtained. Seventeen cytokines were measured using Bio-Plex Pro Human Cytokine 17-plex Assay. Results: Of the 49 decompensated cirrhotic patients enrolled, 18 (36.7%) developed ACLF. Leukocyte count, MELD score at admission, Clif-SOFA at admission and day 7 were significantly higher in the ACLF group (p= 0.046, p<. 0.001, p<. 0.001, p<. 0.001 respectively) as well as short-term mortality (p<. 0.001) compared to stable and decompensated cirrhotic patients. In comparison with healthy controls, stable cirrhotic and decompensated cirrhotic patients showed increased levels of pro-inflammatory and anti-inflammatory cytokines: IL-6, IL-7, IL-8, IL-10, IL 12, and TNF-α. Decompensated cirrhotic patients with the development of ACLF showed a significant decrease of IL-7, IL-10, IL-12, TNF-α, MCP-1 and IFN-γ, but a sustained response of IL-6 and IL-8. When evaluating cirrhosis severity, IL-6 and IL-8 correlated positively with MELD score, whereas only IL-6 correlated positively with Clif-SOFA score at day 7; IL-2 correlated negatively with Clif-SOFA at admission. In comparison with all scores, leukocyte count showed positive correlation and IFN-γ negative correlation with disease severity. When evaluating survival, only MELD and Clif-SOFA scores had a significant association with mortality. Conclusions: Pro-inflammatory cytokines and chemo-attractant elements are increased in cirrhosis in comparison with healthy subjects, and display higher values concomitantly with cirrhosis progression. However, in acute-on-chronic liver failure an opposite cytokine pattern that can be resumed as a combination of immune paresis and excessive inflammatory response was observed. Several pro-inflammatory cytokines (IL-2, IL-6, IL-8 and IFN-γ) showed correlation with disease severity; their utility as prognostic biomarkers needs to be further studied. © 2015 Elsevier Ltd.
Prognostic staging system "Barcelona Clinic Liver Cancer "and alpha-fetoprotein in hepatocellular carcinoma [Valor pronóstico del sistema de estadificación "Barcelona Clinic Liver Cancer" y la alfa-fetoproteína en el carcinoma hepatocelular]
Rodriguez R.G.,Seccion de Hepatologia |
Gutierrez M.R.,Seccion de Hepatologia |
Varasa T.A.,Seccion de Hepatologia |
Frutos C.G.,Seccion de Hepatologia |
And 2 more authors.
Revista Espanola de Enfermedades Digestivas | Year: 2012
Introduction and objectives: presently, the reference staging system to evaluate the prognosis of hepatocellular carcinoma (HCC) patients is "The Barcelona Clinic Liver Cancer" (BCLC) system. The value of alpha-fetoprotein (AFP) has not been properly defined. The aim of this study was to evaluate the BCLC classification in our clinical practice and to know what the prognostic value of AFP is. Material and methods: 136 consecutive HCC patients were prospectively included in this study. The diagnosis of HCC was based on the recommendation of international guidelines. The patients were studied and managed according to usual clinical practice. Survival curves were estimated using the Kaplan-Meier method and predictors of survival were identified using the Cox model. Results: 110 patients (80.9%) were male. The mean age of the patients was 66.62 ± 11.68 years. Liver cirrhosis was present in 91.2%. The most frequent cause of liver disease was hepatitis C infection (38.97%). Serum AFP was ≤ 20 ng/mL in the 57%, > 20- 200 ng/mL in the 20%, and > 200 ng/mL in 23%. According to the BCLC staging system, 79 patients were classified as stage A (58.09%), 29 (21.32%) stage B, 17 (12.50%) stage C and 11 patients (8.09%) as stage D. The overall median survival time was 26.52 months (95% CI 16.7-36.3). The median survival according to BCLC system was: BCLC A 62.27, BCLC B 12.72, BCLC C 4.83, and BCLC D 0.62 months (p < 0.0001); and according to serum AFP was: AFP ≤ 20: 62.27 months, > 20-200: 22.08 months, and > 200 ng/mL: 5.39 months (p < 0.0001). Multivariate analysis showed that AFP, BCLC classification and treatment were independent prognostic factors. Conclusions: our results confirm that the BCLC is a good prognostic system. The AFP has prognosis value in HCC patients. The addition of AFP could improve the BCLC system. Future studies are needed to confirm our results and also the best way to combine BCLC and AFP properly. © 2012 ARÁN EDICIONES, S. L.
Successful treatment with telaprevir of post-transplant fibrosing cholestatic hepatitis C in an HIV co-infected patient [Hepatitis C fibrosante colestásica tratada con telaprevir luego del trasplante hepático en un paciente co-infectado con HIV]
Marciano S.,Seccion de Hepatologia |
Galdame O.A.,Seccion de Hepatologia |
Barcan L.A.,Seccion de Infectologia |
Gadano A.C.,Seccion de Hepatologia
Acta Gastroenterologica Latinoamericana | Year: 2015
Hepatitis C recurrence is the main cause of graft loss in liver transplant patients co-infected with human immunodeficiency virus (HIV). These patients have higher risk of fibrosing cholestatic hepatitis, which is the most severe type of hepatitis C recurrence. Until direct antiviral agents were released, only a minority of patients could be satisfactorily treated. We describe the successful treatment with pegylatedinterferon, ribavirin and telaprevir of an hepatitis C virus (HCV)/HIV co-infected patient who developed fibrosing cholestatic hepatitis after liver transplantation. A 40-yearold male (HCV genotype 1a; IL-28 CC) underwent liver transplantation for decompensated cirrhosis. On post-transplant day 60, he rapidly developed progressive jaundice, worsening of liver function tests and ascites. A transjugular liver biopsy confirmed the diagnosis of fibrosing cholestatic hepatitis. Treatment with pegylated-interferon, ribavirin and telaprevir was indicated for 48 weeks, achieving sustained virological response at 12 weeks of follow-up. The rapid negativization of the viral load observed during the first 4 weeks of treatment was associated with regression of ascites and jaundice. Red blood cell transfusions, erythropoietin and filgrastim were required for the management of anemia and neutropenia. Triple therapy with telaprevir might be indicated for the treatment of severe HCV recurrence in selected HCV/HIV co-infected patients, especially in countries with limited access to pegylated-interferon-free regimens. © 2015 Sociedad Argentina de Gastroenterologia. All rights reserved.
Transient elastography: Noninvasive assessment of liver fibrosis. Report of 1,000 cases in Argentina [Elastometría transicional: Medición no invasiva de la fibrosis hepática. Reporte de 1.000 casos en Argentina]
Kucharczyk M.,Servicio de Diagnostico Por Imagenes |
Solari J.,Seccion de Hepatologia |
Tarzian C.,Servicio de Diagnostico Por Imagenes |
Galdame O.,Seccion de Hepatologia |
And 3 more authors.
Acta Gastroenterologica Latinoamericana | Year: 2012
Background. Transient elastography (TE) is a noninvasive method for assessment of hepatic fibrosis. Objective. To present the first case series evaluated in Latin America, in an University Hospital in Buenos Aires, during an 18-month period. Methods. Data was collected between August 2009 and January 2011. A database was built considering clinical, biochemical and histology data. The exams were performed with a medium probe. An exam was considered valid when success rate was higher than 60% and interquartile range lower than 30%. Results. 1,023 studies were performed. Patients were referred by in-hospital (53%) and out-hospital physicians (47%). Etiologies were: HCV 409 (40%), NAFLD 213 (20.8%), HBV 110 (10.7%), cholestasis 93 (9.1%), other 198 (19.4%). Significant fibrosis (F>2) was detected in 32.4% HCV, 32.1% HBV, 31.5% NASH, and 33.4% cholestasis. Exams were not technically achievable in 29 patients (2.8%), of whom 96.5% had body mass index (BMI) higher than 28 kg/m2. However 117 of 145 patients with BMI higher than 28 kg/m2 had a successful exam. In 332 patients simultaneously biopsies (less than 6 months) were obtained, with overall coincidence of 77%. In 21 HCV transplanted patients coincidence was 90.4%. Conclusion. Similar results to those in the literature were obtained, with excellent biopsy correlation in HCV transplanted patients. The increasing use of TE in the assessment and monitoring of chronic liver diseases has become evident by both increasing number of exams and decreasing number of diffuse liver biopsies.