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Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transplantation of the liver has progressed in recent years and has become universally accepted for numerous indications in end-stage liver diseases, predominantly primary biliary cirrhosis, sclerosing cholangitis, biliary atresia and liver-related metabolic disorders. In fulminant and subfulminant hepatitis, prognosis has been improved considerably by liver transplantation. The debate still persists whether liver transplantation might be indicated in diseases recurring after transplantation, such as HBV cirrhosis. Alcoholic cirrhosis as an indication for transplantation remains still controversial. The risk of tumor recurrence after transplantation for small hepatocellular carcinoma in cirrhosis can be calculated; adjuvant chemotherapy might increase prognosis. Transplantation for other malignant liver tumors seems to be obsolete.
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PMID:[Liver transplantation 1994]. 793 70

Any new therapeutic procedure raises the question of its possible interference with a possible liver transplantation. This management must therefore give a change to medical treatments of complications of liver disease without interfering with the possibility of subsequent liver transplantation. The treatment of the complications related to chronic liver disease: gastrointestinal haemorrhage, ascites, ascitic infection are examined from this point of view. The necessity of repeated investigation for hepatocellular carcinoma and the importance of maintaining a correct nutritional status are recalled. The elements of monitoring and treatment which can interfere with the planned transplantation are examined in patients with alcoholic cirrhosis, chronic active viral hepatitis B, sclerosing cholangitis, autoimmune chronic active hepatitis or hepatocellular carcinoma. In fulminant hepatitis, the administration of drugs and any form of clotting factor is prohibited due to the particular risk of altering regular reassessment of the level of consciousness and hepatocellular function. Don't transplant those who are going to recover and don't transplant too late those who are not going to recover.
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PMID:[Therapeutic attitude in adult recipients waiting for liver transplantation]. 799 16

The first liver transplant performed in Hawaii was on May 17, 1993 in a patient with end-stage liver disease caused by autoimmune hepatitis. Liver transplantation is a well-accepted treatment for end-stage liver disease with a 1-year patient survival of 80% to 85%. Early recognition of the appropriate candidate by primary care physicians and prompt referral to a liver transplant center are essential for optimal results. The indications, contraindications, organ procurement and allocation, complications, and results of liver transplantation are described. Finally, several controversial areas will be introduced, including liver transplant for alcoholic cirrhosis and hepatitis B, and use of transjugular intrahepatic portosystemic shunts (TIPS).
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PMID:Liver transplantation in Hawaii. 800 83

A prospective comparative study was carried out on thirty-seven consecutive patients presenting with bleeding oesophageal varices at University Hospital, Kuala Lumpur. All patients received injection sclerotherapy if active bleeding was seen at the time of initial endoscopy, followed by repetitive courses of sclerotherapy to obliterate the varices. Predominant aetiological factors were hepatitis-B cirrhosis (43%) and alcoholic cirrhosis (30%). Chinese ethnic group accounted for 62.5% of hepatitis-B cirrhotics and Indian 73% of alcoholic cirrhotics. After excluding patients lost to follow-up, analysis of the remaining thirty-four patients showed reduced long-term survival in patients with Child's C disease. Log-rank analysis of survival curves between hepatitis-B cirrhosis and alcoholic cirrhosis in patients with Child's C liver disease showed no significant difference in long-term survival (p = 0.07). However, six deaths were seen in hepatitis-B cirrhosis compared to one death in alcoholic cirrhosis in the first eight months of follow-up. Most patients died from progressive liver failure. Median survival for Child's C hepatitis-B cirrhosis was 7.5 months whereas this had not been reached for Child's C alcoholic cirrhosis (median follow-up 11.6 months). We conclude that variceal haemorrhage in Child's C hepatitis-B cirrhosis is a bad prognostic sign and is associated with reduced survival with a median survival of 7.5 months despite control of the variceal bleed.
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PMID:Survival in hepatitis-B cirrhosis compared to alcoholic cirrhosis in patients with Child's C liver disease: a prospective study of endoscopic sclerotherapy for bleeding oesophageal varices. 800 80

Morphological changes in liver biopsies from 40 alcoholic patients were studied, 20 of which being ordinary alcoholics (40-80g ethanol/day) and the other 20 being heavy drinkers (above 80g ethanol/day for over 20 years). All being male who have neither type B nor type C hepatitis. The basic morphological changes observed being: 1. Liver cell degeneration including fatty degeneration & focal ballooning, decrease in liver cell size, occasional giant mitochondrion and Mallory's body formation. 2. Focal necrosis with neutrophil infiltration. 3. Pericellular fibrosis of liver cells, hepatic fibrosis and early cirrhosis. Alcoholic liver disease can be divided into 5 types: I. alcoholic fatty liver (AFL), II. alcoholic hepatitis (AH), III. alcoholic hepatic fibrosis (AHF), IV. alcoholic liver cirrhosis (ALC), V. slight alcoholic liver disease (SALD). The degree of liver damage (liver cell necrosis and hepatic fibrosis) is closely related to the amount of daily ethanol intake. The progression of liver damage observed in our study is much milder than reports from Europe, the U.S. and Japan.
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PMID:[Morphological study on 40 cases of alcoholic liver disease]. 804 54

In order to elucidate the long-term prognosis of liver cirrhosis, we analyzed a total of 795 consecutive patients with viral or alcoholic cirrhosis prospectively. During the observation period (median, 5.8 yr), hepatocellular carcinoma (HCC) developed in 221 patients. Cumulative appearance rates of HCC were 19.4%, 44.3%, and 58.2% at the end of the 5th, 10th, and 15th year, respectively. When classified by the state of hepatitis virus infection, the appearance rates of HCC in 180 patients with only hepatitis B surface antigen and in 349 patients with only anti-hepatitis C virus (anti-HCV) were 14.2% and 21.5% at the 5th year, 27.2% and 53.2% at the 10th year, and 27.2% and 75.2% at the 15th year, respectively. Cox proportional hazard model identified that alpha-fetoprotein (p = 0.00001), age (p = 0.00067), positive anti-HCV (p = 0.00135), total alcohol intake (p = 0.00455), and indocyanine green retention rate (p = 0.04491) were independently associated with the appearance rates of HCC. The survival rates of patients with cirrhosis were 84.1%, 57.0%, and 30.9% at the end of the fifth, tenth, and fifteenth year, respectively.
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PMID:[Long-term prognosis of liver cirrhosis]. 811 13

Alcoholism alone, or in combination with other etiologic factors, is a common cause of liver failure because of hepatitis, cirrhosis, and/or hepatocellular cancer. Encountered morphologic and functional alterations are due to immunologic reactivity to cell injury evoked by acetaldehyde, other noxious factors, and nutrient deficits. Less than 20% of subjects who consume over 90 g/d of ethanol for years develop progressive liver damage and cirrhosis. Alcoholism should be interrupted in patients with subclinical hepatic abnormalities. Although early alcoholic hepatitis and cirrhosis respond to abstinence and symptomatic therapy, available measures have little influence on functional and morphologic abnormalities in end-stage alcoholic liver disease. Resection is desirable for localized hepatocellular cancer, and liver transplantation should be considered for cirrhosis. Transplantation is appropriate for patients with uncomplicated end-stage alcoholic cirrhosis in whom evidence of liver failure can be controlled during a 6-month period of rehabilitation. Continuous psychosocial support is required to prevent recividism in the posttransplant immunosuppressed alcoholic.
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PMID:Alcoholic liver disease. 813 22

Control serum levels of IL-6 measured by ELISA in 30 healthy blood donors or volunteers were 18 +/- 34 pg/ml (mean +/- SD). Pretransplant serum levels of IL-6 in 169 adult candidates for liver transplantation were significantly higher than control in those with fulminant hepatitis (203 +/- 232 pg/ml), alcoholic cirrhosis (116 +/- 257 pg/ml), and hepatocellular carcinoma (82 +/- 105 pg/ml). With these data as background, plasma or serum levels of IL-6 were monitored in 24 adult patients after first OLT and correlated with the clinical courses and the histopathological diagnosis of rejection. Serum or plasma levels of IL-6 decreased after transplantation regardless of pretransplant value. Four patients with infection subsequently developed continuously high IL-6 values. In the 20 of 24 patients who did not have infection, significantly higher levels of IL-6 were consistently found 0-4 days before histopathological diagnosis of rejection (131 +/- 78 pg/ml) compared with significantly lower values in patients without rejection episodes (40 +/- 21 pg/ml). The elevations of IL-6 were spike shaped, did not correlate well with the histopathological grades of rejection, and were highly responsive to augmented immunosuppression. These 20 cases were classified as: group 1, no spikes of IL-6 after liver transplantation; group 2, single spike of IL-6 after liver transplantation; and group 3, multiple spikes of IL-6 after liver transplantation. The combined early and late graft loss of each group was 0% (group 1), 25% (group 2), and 67% (group 3). We conclude that daily monitored serum or plasma IL-6 levels can be a good premonitor of liver allograft rejection and also a useful predictor of long-term graft outcome.
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PMID:Evaluation of sequential serum interleukin-6 levels in liver allograft recipients. 816 99

247 liver transplantations in 210 patients were done between June 1983 and April 1991 in our hospital. In this paper we have analyzed our experience with adult liver transplantation from the view point of quality of life after liver transplant. Indications for liver transplantation were the following: 46 patients with cirrhosis due to non A, non B hepatitis, 29 with alcoholic cirrhosis, 13 with hepatitis B, 34 with primary biliary cirrhosis, 26 with primary sclerosing cholangitis, 29 with acute hepatic necrosis, 10 with liver tumor, 13 with miscellaneous other diseases. Of the 210 patients, 125 are alive to date. One, three and five year survival rates (excluding perioperative death) of all patients were 80.2%, 70.6% and 65.45% respectively. The best rehabilitation is in 73 patients who are full time workers or full time students and in 16 patients who are homemakers. The degree of rehabilitation in these patients is very high: 6 patients died after achieving complete rehabilitation; 11 patients retired from employment after liver transplantation; 8 patients are chronically disabled; 79 patients died before rehabilitation could be achieved. Rehabilitation rates of one and five year survivors are 78% and 84.2% respectively. Quality of life has been satisfactory following liver transplantation.
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PMID:[Quality of life following liver transplantation]. 833 22

We analyze the current state of liver transplantation (OLTx) in Italy that in the last few years had reached approximately 150 OLTx per year for a population of 58 millions of inhabitants. The need for OLTx in Italy is high and mainly due to the incidence of post-hepatitis and post-alcoholic liver cirrhosis, which are the prevalent indication for OLTx. On the contrary the availability of donor organs in Italy is very low as compared with other European countries, and as a consequence the gap between need and performed OLTx is widening. The reasons for poor donations are multifactorial among which; lack of organization, insufficient ICU care beds, poor knowledge of health personnel. General attitudes of the society and brain death concepts are also involved as a recent survey has demonstrated. Under certain circumstances the patient who cannot be transplanted on time in Italy is allowed to seek for care abroad under the local government economical assistance. Finally some ethical considerations and the proposal for better education of both population and health care providers are advocated.
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PMID:Liver transplantation in Italy and the scarcity of donors: causative factors and ethical considerations. 835 33


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