AbstractAlcohol-related liver disease (ALD) is a major cause of advanced chronic liver disease in Latin-America, although data on prevalence is limited. Public health policies aimed at reducing the ...alarming prevalence of alcohol use disorder in Latin-America should be implemented. ALD comprises a clinical-pathological spectrum that ranges from steatosis, steatohepatitis to advanced forms such as alcoholic hepatitis (AH), cirrhosis and hepatocellular carcinoma. Besides genetic factors, the amount of alcohol consumption is the most important risk factor for the development of ALD. Continuous consumption of more than 3 standard drinks per day in men and more than 2 drinks per day in women increases the risk of developing liver disease. The pathogenesis of ALD is only partially understood and recent translational studies have identified novel therapeutic targets. Early forms of ALD are often missed and most clinical attention is focused on AH, which is defined as an abrupt onset of jaundice and liver-related complications. In patients with potential confounding factors, a transjugular biopsy is recommended. The standard therapy for AH (i.e. prednisolone) has not evolved in the last decades yet promising new therapies (i.e. G-CSF, N-acetylcysteine) have been recently proposed. In both patients with early and severe ALD, prolonged abstinence is the most efficient therapeutic measure to decrease long-term morbidity and mortality. A multidisciplinary team including alcohol addiction specialists is recommended to manage patients with ALD. Liver transplantation should be considered in the management of patients with end-stage ALD that do not recover despite abstinence. In selected cases, increasing number of centers are proposing early transplantation for patients with severe AH not responding to medical therapy.
Infections are an important cause of morbidity and mortality in the first month after liver transplantation (LT). It is important to know the local microbiology involved and the resistance patterns, ...to guide treatment appropriately.
To characterize infections in the first month after LT in patients from the Hospital Clínico de la Universidad de Chile.
Retrospective study of clinical records of 70 consecutive LT between February 2016 and October 2018.
20 infectious events in 16 patients (23%). In 75% it was possible to isolate agent. Eight (40%) were bacteria, 5 were fungi and 2 were viruses; 25% were bacteremia, 20% urinary tract, 20% pulmonary, 10% intra-abdominal, and 5% skin. The agents were: K. pneumoniae (2), S. epidermidis (2), E. faecium (1), C. freundii (1), E. coli (1), S. malthophilia (1). Candidas (4), Aspergillus (1), varicella zoster virus (1), respiratory syncytial virus (1). It was not possible to identify a focus in 4 patients. There was antimicrobial resistance in 7 (35%) of the cases, 3 being multi-resistant (2 due to K. pneumoniae and 1 due to S. epidermidis). 4 microorganisms showed antimicrobial resistance (E. coli, C. freundii, E. faecium, and C. glabatra). The infection was the cause of in-hospital mortality in 2 patients.
Infections in the first month after LT are frequent in our center, the majority of bacterial origin, as reported by international series. More than 1/3 of the patients present an agent with antimicrobial resistance, which should be considered in the choice of empirical therapy.
It has been observed people with low-income-level (<IL) have greater liver injury due to alcohol consumption (AC), even when their consumption levels are lower or equal to those with ...high-income-level (>IL). The aim of this study was to evaluate alcohol-associated liver disease (ALD) paradox in Chile.
With data from the ENS 2016-17 (N=2,190; age 25-64) we constructed a logit regression model that estimated the effect hazardous AC (AUDIT≥8) on the probability of presenting ALD (GPT≥40 U/L). We focus on the interaction between hazardous AC and IL, controlling for the presence of metabolic syndrome (MS), diabetes mellitus (T2DM), obesity and tobacco.
The average AC was 39g of alcohol per week (13g women <IL; 23g women >IL; 64g men, without differences by IL). In women, hazardous AC only increased ALD among those >IL who presented with obesity or MS in combination with T2DM (+36% obesity+MS+T2DM; p<0.01). In men, hazardous AC only increased ALD among those with <IL (16% without comorbidities, 17% with tobacco, 22% with MS, 26% with obesity, and 28% with all; p<0.05).
ALD paradox can be observed in Chile among men, but not among women. The evaluated associated comorbidities increased the effect of hazardous AC on ALD. It is necessary to investigate how the IL determines the patterns of AC and comorbidities. Among men, <IL is likely to be associated with more harmful drinking patterns and a greater presence of comorbidities. Among women, >IL is likely associated with higher AC and more harmful consumption patterns.
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Still, there are epidemiological and clinical data in Latin America. In Chile, this is the first study ...regarding HCC with a significant number of patients. This study aimed to obtain and analyze clinical and epidemiological data of Chilean patients with HCC.
Multicenter study from 12 Chilean hospitals that have members of the Chilean Association of Hepatology as members of their staff. Clinical records from 2015-2021 were included. Kaplan-Meier survival curves and Cox regression analysis were obtained.
We obtained data from 856 patients with HCC from 12 different centers. Median age 67 years old; 58.7% male. Cirrhosis is present in 91.2% (779) of cases. Main risk factors reported: fatty liver 47.9%(410), alcohol 19.6% (68), viral 12.2%(104) and autoimmune 3.5% (30). The median MELD score was 11.7 (CI95% 11,4-12). 38% (322) were diagnosed during surveillance; this was associated with earlier BCLC stage (OR 2,6; CI95%1,9-3,4). BCLC stages at diagnosis were 0; 8,2%(69), A: 38,5%(326), B:29,9%(253), C: 15,4%(130) and D: 8,2%(69). The main initial treatments were TACE, ablation, resection, liver transplant and sorafenib in 27,4%(226), 19,3%(159), 11,4%(94), 8%(66) and 5,5%(45), respectively. 53,4%(452) pts were in Milan Criteria at diagnosis. 9,1%(78) patients got a liver transplant. Five-year survival was 24% (CI95%20-28). The main factors associated with survival are depicted in Figure 1.
Fatty liver was remarkably the main risk factor reported for HCC in our Chilean cohort. This is a worrisome number since NAFLD is on the rise worldwide, and especially in Latin America. Surveillance is key for early detection. The liver function defined by Child-Pugh and HCC stage using BCLC staging is strongly associated with survival. Liver transplant is still a scarce treatment resource.
A new definition for non-alcoholic fatty liver disease Poniachik, Jaime; Roblero, Juan Pablo; Urzúa, Alvaro ...
Journal of hepatology,
April 2021, 2021-Apr, 2021-04-00, 20210401, Letnik:
74, Številka:
4
Journal Article
Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus ...(HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported.
A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function.
ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood.
Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated.
After 6 cycles of plasmapheresis and supportive care, the patient's condition improved without undergoing liver transplantation.
ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a complex disorder whose prevalence is rapidly growing in South America. The disturbances in the microbiota-gut-liver axis impact ...the liver damaging processes toward fibrosis. Gut microbiota status is shaped by dietary and lifestyle factors, depending on geographic location. We aimed to identify microbial signatures in a group of Chilean MASLD patients. Forty subjects were recruited, including healthy controls (HCs), overweight/obese subjects (Ow/Ob), patients with MASLD without fibrosis (MASLD/F-), and MASLD with fibrosis (MASLD/F+). Both MASLD and fibrosis were detected through elastography and/or biopsy, and fecal microbiota were analyzed through deep sequencing. Despite no differences in α- and β-diversity among all groups, a higher abundance of
and a lower presence of Defluviitaleaceae, Lachnospiraceae ND3007, and
was found in MASLD/F- and MASLD/F+, compared to HC. Ruminococcaceae UCG-013 and
were more abundant in MASLD/F+ than in Ow/Ob; both significantly differed between MASLD/F- and MASLD/F+, compared to HC. Significant positive correlations were observed between liver stiffness and
,
,
, and
abundance. Our results show that MASLD is associated with changes in bacterial taxa that are known to be involved in bile acid metabolism and SCFA production, with some of them being more specifically linked to fibrosis.
The hepatic hemodynamic study (HH) and the transjugular liver biopsy (TJLB) are complementary tests used in hepatology that provide valuable information, allowing to obtain diagnoses that change ...behavior. In our environment there is little experience regarding the performance and results obtained, particularly when it is performed by a hepatologist.
To describe the experience and results of the HH and TJLB study in our center.
All HH and TJLB studies conducted by one of the authors (AU) from January 2018 to July 2019 were included. Clinical records, HH and TJLB outcome, and behavior change were reviewed.
25 patients and 27 procedures were included; age 55 (20-72) years, 60% women. Procedures: 21 TJLB + HH and 6 HH. Reason for request: etiological study cirrhosis 29.6%, etiology acute hepatitis 18.5%, diagnostic doubt in alcohol hepatitis 11.1%, suspected idiopathic portal hypertension 11.1%, rejection 7.4%, hepatocelullar carcinoma 3,7% and another 18.5%. In 92.6% of the cases, the HH and / or TJLB result made it possible to confirm / rule out diagnosis and change therapeutic behavior. 90.5% of the TJLB results were satisfactory for diagnosis. Only one patient presented a complication: hemobilia that did not require invasive management, and one patient had an incomplete procedure.
Our experience shows that the HH study and the TJLB are important complementary tests to change behavior. For this reason, they should be considered, when indicated, in the study of the hepatological patient.
Acute-on-chronic liver failure (ACLF) is associated with reduced short-term survival, and liver transplantation is frequently the only therapeutic option. Nonetheless, the post-transplantation ...prognosis seems to be worse in ACLF patients.
The databases of two university centers were retrospectively evaluated, and adult patients with cirrhosis who underwent transplantation between 2013 and 2020 were included. One-year survival of patients with ACLF was compared to that of patients without ACLF. Variables associated with mortality were identified.
A total of 428 patients were evaluated, and 303 met the inclusion criteria; 57.1% were male, the mean age was 57.1 ± 10.2 years, 75 patients had ACLF, and 228 did not. The main etiologies of ACLF were NASH (36.6%), alcoholic liver disease (13.9%), primary biliary cholangitis (8.6%) and autoimmune hepatitis (7.9%). Mechanical ventilation, renal replacement therapy, the use of vasopressors and the requirement of blood product transfusion during liver transplantation were significantly more frequent in ACLF patients. Among those recipients without and with ACLF, survival at 1, 3 and 5 years was 91.2% vs. 74.7%, 89.1% vs. 72.6% and 88.3% vs. 72.6%, respectively (p=0.001). Among pre-transplantation variables, only the presence of ACLF was independently associated with survival (HR 3.2, 95% CI: 1.46-7.11). Post-transplantation variables independently associated with survival were renal replacement therapy (HR 2.8, 95% CI: 1.1-6.8) and fungal infections (HR 3.26, 95% CI: 1.07-9.9).
ACLF is an independent predictor of one-year post-transplantation survival. Importantly, transplant recipients with ACLF require the use of more resources than patients without ACLF.
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