Return to active and productive life is a key goal of modern liver transplantation(LT). Despite marked improvements in quality of life and functional status, a substantial proportion of LT recipients are unable to res...Return to active and productive life is a key goal of modern liver transplantation(LT). Despite marked improvements in quality of life and functional status, a substantial proportion of LT recipients are unable to resume gainful employment. Unemployment forms a threat to physical and psychosocial health, and impairs LT cost-utility through lost productivity. In studies published after year 2000, the average postLT employment rate is 37%, ranging from 22% to 55% by study. Significant heterogeneity exists among studies. Nonetheless, these employment rates are lower than in the general population and kidneytransplant population. Most consistent employment predictors include pre-LT employment status, male gender, functional/health status, and subjective work ability. Work ability is impaired by physical fatigue and depression, but affected also by working conditions and society. Promotion of post-LT employment is hampered by a lack of interventional studies. Prevention of pre-LT disability by effective treatment of(minimal) hepatic encephalopathy, maintaining mobility, and planning work adjustments early in the course of chronic liver disease, as well as timely post-LT physical rehabilitation, continuous encouragement, self-efficacy improvements, and depression management are key elements of successful employment-promoting strategies. Prolonging LT recipients' working life would further strengthen the success of transplantation, and this is likely best achieved through multidisciplinary efforts ideally starting even before LT candidacy.展开更多
The aim of this review is to enlighten the critical roles that the liver plays in cholesterol metabolism. Liver transplantation can serve as gene therapy or a source of gene transmission in certain conditions that aff...The aim of this review is to enlighten the critical roles that the liver plays in cholesterol metabolism. Liver transplantation can serve as gene therapy or a source of gene transmission in certain conditions that affect cholesterol metabolism, such as low-density-lipoprotein(LDL) receptor gene mutations that are associated with familial hypercholesterolemia. On the other hand, cholestatic liver disease often alters cholesterol metabolism. Cholestasis can lead to formation of lipoprotein X(Lp-X), which is frequently mistaken for LDL on routine clinical tests. In contrast to LDL, Lp-X is non-atherogenic, and failure to differentiate between the two can interfere with cardiovascular risk assessment, potentially leading to prescription of futile lipid-lowering therapy. Statins do not effectively lower Lp-X levels, and cholestasis may lead to accumulation of toxic levels of statins. Moreover, severe cholestasis results in poor micellar formation, which reduces cholesterol absorption, potentially impairing the cholesterol-lowering effect of ezetimibe. Apolipoprotein B-100 measurement can help distinguish between atherogenic and non-atherogenic hypercholesterolemia. Furthermore, routine serum cholesterol measurements alone cannot reflect cholesterol absorption and synthesis. Measurements of serum non-cholesterol sterol biomarkers- such as cholesterol precursor sterols, plant sterols, and cholestanol- may help with the comprehensive assessment of cholesterol metabolism. An adequate cholesterol supply is essential for liver-regenerative capacity. Low preoperative and perioperative serum cholesterol levels seem to predict mortality in liver cirrhosis and after liver transplantation. Thus, accurate lipid profile evaluation is highly important in liver disease and after liver transplantation.展开更多
Background and aims Steatotic liver disease(SLD)is a growing global concern.The Chronic Liver Disease(CLivD)risk score predicts liver-related outcomes in the general population using easily accessible variables with o...Background and aims Steatotic liver disease(SLD)is a growing global concern.The Chronic Liver Disease(CLivD)risk score predicts liver-related outcomes in the general population using easily accessible variables with or without laboratory tests(CLivDlab and CLivDnon-lab).We assessed CLivD’s associations with liver steatosis,fibrosis and its combined performance with fibrosis-4(FIB-4)for advanced fibrosis detection.Methods Using the National Health and Nutrition Examination Survey data(2017–2020),3603 participants aged 40–70 years with valid liver stiffness measurements(LSMs)were included.Advanced fibrosis was defined as LSM≥12 kPa,and SLD as controlled attenuation parameter≥288 dB/m.Results Significant associations were found between CLivD and SLD and advanced fibrosis.CLivDlab had an area under the curve(AUC)for advanced fibrosis of 0.72(95%CI 0.68 to 0.77),while CLivDnon-lab had an AUC of 0.68(95%CI 0.64 to 0.72),both slightly higher than FIB-4(AUC 0.66,95%CI 0.60 to 0.72).Among participants without obesity,AUC of CLivDlab was 0.82(95%CI 0.76 to 0.88)and AUC of CLivDnon-lab was 0.72(95%CI 0.65 to 0.79).The CLivD score improved FIB-4’s AUC for advanced fibrosis detection from<0.5 at minimal CLivD scores to>0.8 at high CLivD scores.A sequential CLivD→FIB-4 strategy outperformed universal FIB-4 testing,enhancing specificity from 72%to 83%,with sensitivity at 51%–53%.This strategy identified a subgroup with a 55%prevalence of advanced fibrosis,while 47%had minimal-risk CLivD scores,eliminating the need for FIB-4 testing.Conclusions The CLivD score,designed for predicting liver-related outcomes,effectively identifies liver steatosis and advanced fibrosis in the general population.Combining CLivD with FIB-4 enhances advanced fibrosis detection accuracy.The CLivD score could enhance population-based liver fibrosis screening,optimising resource allocation.展开更多
文摘Return to active and productive life is a key goal of modern liver transplantation(LT). Despite marked improvements in quality of life and functional status, a substantial proportion of LT recipients are unable to resume gainful employment. Unemployment forms a threat to physical and psychosocial health, and impairs LT cost-utility through lost productivity. In studies published after year 2000, the average postLT employment rate is 37%, ranging from 22% to 55% by study. Significant heterogeneity exists among studies. Nonetheless, these employment rates are lower than in the general population and kidneytransplant population. Most consistent employment predictors include pre-LT employment status, male gender, functional/health status, and subjective work ability. Work ability is impaired by physical fatigue and depression, but affected also by working conditions and society. Promotion of post-LT employment is hampered by a lack of interventional studies. Prevention of pre-LT disability by effective treatment of(minimal) hepatic encephalopathy, maintaining mobility, and planning work adjustments early in the course of chronic liver disease, as well as timely post-LT physical rehabilitation, continuous encouragement, self-efficacy improvements, and depression management are key elements of successful employment-promoting strategies. Prolonging LT recipients' working life would further strengthen the success of transplantation, and this is likely best achieved through multidisciplinary efforts ideally starting even before LT candidacy.
文摘The aim of this review is to enlighten the critical roles that the liver plays in cholesterol metabolism. Liver transplantation can serve as gene therapy or a source of gene transmission in certain conditions that affect cholesterol metabolism, such as low-density-lipoprotein(LDL) receptor gene mutations that are associated with familial hypercholesterolemia. On the other hand, cholestatic liver disease often alters cholesterol metabolism. Cholestasis can lead to formation of lipoprotein X(Lp-X), which is frequently mistaken for LDL on routine clinical tests. In contrast to LDL, Lp-X is non-atherogenic, and failure to differentiate between the two can interfere with cardiovascular risk assessment, potentially leading to prescription of futile lipid-lowering therapy. Statins do not effectively lower Lp-X levels, and cholestasis may lead to accumulation of toxic levels of statins. Moreover, severe cholestasis results in poor micellar formation, which reduces cholesterol absorption, potentially impairing the cholesterol-lowering effect of ezetimibe. Apolipoprotein B-100 measurement can help distinguish between atherogenic and non-atherogenic hypercholesterolemia. Furthermore, routine serum cholesterol measurements alone cannot reflect cholesterol absorption and synthesis. Measurements of serum non-cholesterol sterol biomarkers- such as cholesterol precursor sterols, plant sterols, and cholestanol- may help with the comprehensive assessment of cholesterol metabolism. An adequate cholesterol supply is essential for liver-regenerative capacity. Low preoperative and perioperative serum cholesterol levels seem to predict mortality in liver cirrhosis and after liver transplantation. Thus, accurate lipid profile evaluation is highly important in liver disease and after liver transplantation.
基金F.was supported by Finska L.kares.llskapet,Academy of Finland(#338544),Sigrid Jusélius Foundation,Mary and Georg Ehrnrooth Foundation,Medicinska Underst.dsf.rening Liv&H.lsaWilhelm and Else Stockmann Foundation.ML was supported by Finnish State Research Funding and Mary and Georg Ehrnrooth Foundation.The researchers are independent of the funders.
文摘Background and aims Steatotic liver disease(SLD)is a growing global concern.The Chronic Liver Disease(CLivD)risk score predicts liver-related outcomes in the general population using easily accessible variables with or without laboratory tests(CLivDlab and CLivDnon-lab).We assessed CLivD’s associations with liver steatosis,fibrosis and its combined performance with fibrosis-4(FIB-4)for advanced fibrosis detection.Methods Using the National Health and Nutrition Examination Survey data(2017–2020),3603 participants aged 40–70 years with valid liver stiffness measurements(LSMs)were included.Advanced fibrosis was defined as LSM≥12 kPa,and SLD as controlled attenuation parameter≥288 dB/m.Results Significant associations were found between CLivD and SLD and advanced fibrosis.CLivDlab had an area under the curve(AUC)for advanced fibrosis of 0.72(95%CI 0.68 to 0.77),while CLivDnon-lab had an AUC of 0.68(95%CI 0.64 to 0.72),both slightly higher than FIB-4(AUC 0.66,95%CI 0.60 to 0.72).Among participants without obesity,AUC of CLivDlab was 0.82(95%CI 0.76 to 0.88)and AUC of CLivDnon-lab was 0.72(95%CI 0.65 to 0.79).The CLivD score improved FIB-4’s AUC for advanced fibrosis detection from<0.5 at minimal CLivD scores to>0.8 at high CLivD scores.A sequential CLivD→FIB-4 strategy outperformed universal FIB-4 testing,enhancing specificity from 72%to 83%,with sensitivity at 51%–53%.This strategy identified a subgroup with a 55%prevalence of advanced fibrosis,while 47%had minimal-risk CLivD scores,eliminating the need for FIB-4 testing.Conclusions The CLivD score,designed for predicting liver-related outcomes,effectively identifies liver steatosis and advanced fibrosis in the general population.Combining CLivD with FIB-4 enhances advanced fibrosis detection accuracy.The CLivD score could enhance population-based liver fibrosis screening,optimising resource allocation.
