AIM To evaluate waiting list(WL) registration and liver transplantation(LT) rates in patients with hepatitis C virus(HCV)-related cirrhosis since the introduction of direct-acting antivirals(DAAs).METHODS All adult pa...AIM To evaluate waiting list(WL) registration and liver transplantation(LT) rates in patients with hepatitis C virus(HCV)-related cirrhosis since the introduction of direct-acting antivirals(DAAs).METHODS All adult patients with cirrhosis listed for LT at Padua University Hospital between 2006-2017 were retrospectively collected using a prospectivelyupdated database; patients with HCV-related cirrhosis were divided by indication for LT [dec-HCV vs HCV/hepatocellular carcinoma(HCC)] and into two interval times(2006-2013 and 2014-2017) according to the introduction of DAAs. For each patient, indications to LT, severity of liver dysfunction and the outcome in the WL were assessed and compared between the two different time periods. For patients receiving DAA-based regimens, the achievement of viral eradication and the outcome were also evaluated. RESULTS One thousand one hundred and ninty-four [male(M)/female(F): 925/269] patients were included. Considering the whole cohort, HCV-related cirrhosis was the main etiology at the time of WL registration(490/1194 patients, 41%). HCV-related cirrhosis significantly decreased as indication to WL registration after DAA introduction(from 43.3% in 2006-2013 to 37.2% in 2014-2017, P = 0.05), especially amongst decHCV(from 24.2% in 2006-2013 to 15.9% in 2014-2017, P = 0.007). Even HCV remained the most common indication to LT over time(289/666, 43.4%), there was a trend towards a decrease after DAAs introduction(from 46.3% in 2006-2013 to 39% in 2014-2017, P = 0.06). HCV patients(M/F: 43/11, mean age: 57.7 ± 8 years) who achieved viral eradication in the WL had better transplant-free survival(log-rank test P = 0.02) and delisting rate(P = 0.002) than untreated HCV patients. CONCLUSION Introduction of DAAs significantly reduced WL registrations for HCV related cirrhosis, especially in the setting of decompensated cirrhosis.展开更多
Bacterial infections are the most common trigger of acute decompensation of cirrhosis.The occurrence of infections in cirrhosis is associated with the development of organ dysfunctions,failures,and acute on chronic li...Bacterial infections are the most common trigger of acute decompensation of cirrhosis.The occurrence of infections in cirrhosis is associated with the development of organ dysfunctions,failures,and acute on chronic liver failure.The combination of infections and organ dysfunction/acute on chronic liver failure dramatically increases the mortality risk in these patients.Infections in cirrhosis are a big challenge for clinicians,since the mortality from sepsis is increasing in these patients worldwide.The rapid and progressive spread of multiresistant bacteria has been blamed for the increased mortality rate.Several studies have shown that early diagnosis and appropriate administration of antibiotic treatment are crucial for improving prognosis in these patients.Moreover,the prevention and treatment of acute kidney injury and organ failures are fundamental parts of management of infections in cirrhosis.Herein we provided a concise and updated review of the literature on bacterial infections in patients with cirrhosis.展开更多
基金Supported by(in Part)Grant from the Italian Ministry of Health to Sara Montagnese(Giovani Ricercatori 2009)Grants from the University of Padova to Piero AmodioPublication fees were covered by the Foundation Lionello Forin Hepatos Onlus,Padova,Italy
文摘AIM: To investigate the agreement and prognostic value of different measures of covert hepatic encephalopathy (CHE).
文摘AIM To evaluate waiting list(WL) registration and liver transplantation(LT) rates in patients with hepatitis C virus(HCV)-related cirrhosis since the introduction of direct-acting antivirals(DAAs).METHODS All adult patients with cirrhosis listed for LT at Padua University Hospital between 2006-2017 were retrospectively collected using a prospectivelyupdated database; patients with HCV-related cirrhosis were divided by indication for LT [dec-HCV vs HCV/hepatocellular carcinoma(HCC)] and into two interval times(2006-2013 and 2014-2017) according to the introduction of DAAs. For each patient, indications to LT, severity of liver dysfunction and the outcome in the WL were assessed and compared between the two different time periods. For patients receiving DAA-based regimens, the achievement of viral eradication and the outcome were also evaluated. RESULTS One thousand one hundred and ninty-four [male(M)/female(F): 925/269] patients were included. Considering the whole cohort, HCV-related cirrhosis was the main etiology at the time of WL registration(490/1194 patients, 41%). HCV-related cirrhosis significantly decreased as indication to WL registration after DAA introduction(from 43.3% in 2006-2013 to 37.2% in 2014-2017, P = 0.05), especially amongst decHCV(from 24.2% in 2006-2013 to 15.9% in 2014-2017, P = 0.007). Even HCV remained the most common indication to LT over time(289/666, 43.4%), there was a trend towards a decrease after DAAs introduction(from 46.3% in 2006-2013 to 39% in 2014-2017, P = 0.06). HCV patients(M/F: 43/11, mean age: 57.7 ± 8 years) who achieved viral eradication in the WL had better transplant-free survival(log-rank test P = 0.02) and delisting rate(P = 0.002) than untreated HCV patients. CONCLUSION Introduction of DAAs significantly reduced WL registrations for HCV related cirrhosis, especially in the setting of decompensated cirrhosis.
文摘Bacterial infections are the most common trigger of acute decompensation of cirrhosis.The occurrence of infections in cirrhosis is associated with the development of organ dysfunctions,failures,and acute on chronic liver failure.The combination of infections and organ dysfunction/acute on chronic liver failure dramatically increases the mortality risk in these patients.Infections in cirrhosis are a big challenge for clinicians,since the mortality from sepsis is increasing in these patients worldwide.The rapid and progressive spread of multiresistant bacteria has been blamed for the increased mortality rate.Several studies have shown that early diagnosis and appropriate administration of antibiotic treatment are crucial for improving prognosis in these patients.Moreover,the prevention and treatment of acute kidney injury and organ failures are fundamental parts of management of infections in cirrhosis.Herein we provided a concise and updated review of the literature on bacterial infections in patients with cirrhosis.
