Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cirrhosis due to hepatitis C virus (HCV) infection is now the most frequent indication for orthotopic liver transplantation (OLT). Recurrence of hepatitis C infection is the major cause of late mortality in patients undergoing OLT for hepatitis C cirrhosis. Recurrent HCV infection develops in 100% of patients HCV + in pre-transplantation time. Histological recurrence occurs in 75-80% of patients after OLT:1/3 of them progress to allograft cirrhosis within 5-7 years. Cholestatic hepatitis C develops in a sub-group of patients who progresses rapidly to graft failure. As a result of this accelerated course of HCV infection, long-term graft and patient survival are significantly reduced in patients undergoing OLT for HCV-related cirrhosis compared with other groups. Moreover, several recurrence's risk factors have been described as predictors of disease severity including those related to the virus, the host, the donor. There are numerous therapeutic strategies to prevent and to treat HCV disease recurrence after OLT. The most common strategy to treat HCV infection post-OLT is based on interferons and ribavirin. Even if clinical trials have shown that the combination of ribavirin with Peg-interferons is more effective than its association with standard interferons, the use of Peg-interferons in transplanted patients is limited by the side-effects of the drug. About treatment of hepatitis C virus infection in the allograft dark and not still cleared points are a lot: the timing and the target of therapy, the dose and duration of pharmacological treatment.
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PMID:[HCV reinfection after liver transplantation for HCV cirrhosis]. 1638 77

The severity of recurrent hepatitis C virus (HCV) is likely related to several factors. Controversial results have been reported regarding the effect of specific calcineurin-inhibitors. The aim of this research was to determine whether there are differences on posttransplantation outcome in HCV-infected patients based on initial immunosuppression. Prospective randomized trial comparing tacrolimus vs. cyclosporine-based immunosuppression in a cohort of patients undergoing primary orthotopic liver transplantation between 2001 and 2003 was used. Yearly biopsies were performed. Patients with at least 1 protocol biopsy and those with very severe recurrence despite a follow-up of less than 1 yr (cholestatic hepatitis, progression to bridging fibrosis/cirrhosis) were included. Baseline characteristics (demographics, liver function at transplantation, genotype distribution, donor, surgery, immunosuppression except for the type of calcineurin inhibitor) did not differ between the 2 groups. Severe disease (defined as bridging fibrosis, cirrhosis, cholestatic hepatitis, and/or death due to recurrent disease in the first year) was present in 27 in 90 (30%), and was equally distributed in the cyclosporine and tacrolimus groups (15/46 vs. 12/44, respectively). A total of 33 in 90 (37%) patients had no fibrosis in the first year biopsy with no difference between the cyclosporine and tacrolimus groups (36.5 vs. 37%). The percentage of patients developing recurrent acute hepatitis was also similar (32% vs 35%); time to acute hepatitis though was shorter in the tacrolimus group (59 days [35-185] vs. 92 days [39-343] in the cyclosporin group; P = 0.02). Cholestatic hepatitis was observed in 4 of 44 and 5 of 46 patients under cyclosporine and tacrolimus, respectively (P = not significant). In conclusions, the short-term posttransplantation course of hepatitis C is not related to the calcineurin inhibitor used.
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PMID:Effect of calcineurin inhibitors on survival and histologic disease severity in HCV-infected liver transplant recipients. 1662 96

Cholestatic hepatitis is a life-threatening recurrent pattern of hepatitis C virus (HCV) in immunosuppressed patients, for which curative treatment has not yet been established. We report the successful treatment of cholestatic hepatitis in a 59-year-old man who had undergone right lobe living donor liver transplantation (LDLT) for liver cirrhosis (LC) caused by HCV. Following uneventful surgery and an uncomplicated posttransplant clinical course, there was an abrupt increase in total bilirubin in comparison to aminotransferase on postoperative day (POD) 60 (total bilirubin 16.2 mg/dl, alanine aminotransferase 100 U/l, HCV-RNA 390 kIU/ml). The histological findings of the liver tissue showed lymphocyte infiltration in the periportal zone and severe cholestasis. Considering the clinical course, cholestatic hepatitis was strongly suspected and pegylated interferon and ribavirin therapy was started immediately, resulting in not only a viral response, but minimal progression of fibrosis. This case serves to demonstrate that early diagnosis and timely initiation of optimal antiviral therapy is essential for the resolution of cholestatic hepatitis C.
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PMID:Early diagnosis and treatment resolved cholestatic hepatitis C without fibrosis after living donor liver transplantation: report of a case. 2087 5