Hepatopulmonary Syndrome and Portopulmonary Hypertension: Current Status and Implications for Liver Transplantation
AbstractPurpose of ReviewHepatopulmonary syndrome (HPS) and portopulmonary hypertension (PoPH) are both pulmonary vascular complications of advanced liver disease; however, these syndromes have distinct pathophysiology, clinical implications, and management.Recent FindingsWhile both conditions are associated with portal hypertension, HPS results from diffuse pulmonary capillary vasodilation and PoPH results from vasoconstriction and vascular remodeling of pulmonary arteries. In HPS, no medical therapies clearly improve outcomes; however, patients have excellent post-LT outcomes with near uniform reversal of hypoxemia. In P...
Source: Current Hepatitis Reports - July 10, 2020 Category: Infectious Diseases Source Type: research
Targeting Viral cccDNA for Cure of Chronic Hepatitis B
AbstractPurpose of ReviewChronic hepatitis B (CHB), caused by hepatitis B virus (HBV), is a major cause of advanced liver disease and hepatocellular carcinoma (HCC) worldwide. HBV replication is characterized by the synthesis of covalently closed circular (ccc) DNA which is not targeted by antiviral nucleos(t)ide analogues (NUCs) the key modality of standard of care. While HBV replication is successfully suppressed in treated patients, they remain at risk for developing HCC. While functional cure, characterized by loss of HBsAg, is the first goal of novel antiviral therapies, curative treatments eliminating cccDNA remain t...
Source: Current Hepatitis Reports - July 9, 2020 Category: Infectious Diseases Source Type: research
Non-selective Beta-Blockers in Decompensated Cirrhosis
AbstractPurpose of ReviewThe safety of non-selective beta-blockers (NSBB) in decompensated cirrhosis, particularly in patients with refractory ascites, has recently been called int question. This review summarizes recent evidence on the role of NSBBs in decompensated cirrhosis and provides recommendations for their appropriate use.Recent FindingsCurrent evidence on the use of NSBBs in decompensated cirrhosis is mixed and is based on observational data. An initial study in 2010 demonstrated decreased survival in patients with refractory ascites who received propranolol compared to those who did not. Since then, multiple sub...
Source: Current Hepatitis Reports - June 30, 2020 Category: Infectious Diseases Source Type: research
Hemodynamic and Systemic Effects of Albumin in Patients with Advanced Liver Disease
AbstractPurpose of ReviewAlbumin administration is recommended to prevent or treat specific complications of decompensated cirrhosis based on its capacity to expand plasma volume. However, the molecule also has many other biological properties that are unrelated to the oncotic activity. The purpose of this review is to examine the hemodynamic and systemic effects of albumin administration in patients with decompensated cirrhosis.Recent FindingsBesides plasma expansion, albumin appears to act against inflammation, facilitate immunocompetence, and improve cardiac and endothelial function, thus antagonizing critical steps in ...
Source: Current Hepatitis Reports - June 30, 2020 Category: Infectious Diseases Source Type: research
Esophageal Varices: Primary Prophylaxis and Prevention and Management of Rebleeding
AbstractPurpose of ReviewPortal hypertension is an important manifestation of chronic liver diseases, and the complications of portal hypertension, especially gastroesophageal variceal hemorrhage, are associated with high morbidity and mortality.Recent FindingsImportant advances made in the past several decades in risk stratification and management of patients with portal hypertension and varices have significantly improved patient outcomes.SummaryThis review addresses the pathophysiology, natural history, differential diagnoses, and diagnostic criteria of portal hypertension. We will also discuss the primary prevention, a...
Source: Current Hepatitis Reports - June 29, 2020 Category: Infectious Diseases Source Type: research
Cardiovascular Disease in Nonalcoholic Steatohepatitis: Screening and Management
AbstractPurpose of ReviewThe global burden of nonalcoholic steatohepatitis (NASH) as a major cause of chronic liver disease continues to rise. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in this patient population. The current review summarizes recent advances in the understanding of CVD in NASH and strategies for screening and management.Recent FindingsLarge genetic epidemiological studies support the intricate role of the metabolic syndrome in the pathophysiology of CVD risk in patients with NASH. Atherosclerotic CVD risk scores can predict elevated CV risk in NASH, but additional work is n...
Source: Current Hepatitis Reports - June 28, 2020 Category: Infectious Diseases Source Type: research
Budd-Chiari Syndrome: Anticoagulation, TIPS, or Transplant
ConclusionsEarly diagnosis and treatment have improved the outcome of patients with BCS. However, BCS management remains a challenge, requiring multidisciplinary teams in referral centers with BCS expertise. (Source: Current Hepatitis Reports)
Source: Current Hepatitis Reports - June 26, 2020 Category: Infectious Diseases Source Type: research
Portal Hypertensive Ascites: Current Status
AbstractPurpose of ReviewAscites is defined as the pathological accumulation of excess free fluid within the peritoneal cavity. This review article summarizes the pathogenesis and management of ascites due to cirrhosis and portal hypertension.Recent FindingsThe development of ascites signifies the transition from a compensated to a decompensated phase of cirrhosis. Management of ascites in patients who fail conventional therapy is a topic of ongoing research, as the only definitive treatment in such cases is liver transplantation.SummaryThe latest recommendations on sodium restriction, the use and discontinuation of diuret...
Source: Current Hepatitis Reports - June 23, 2020 Category: Infectious Diseases Source Type: research
Lessons Learned from Faecal Microbiota Transplantation in Cirrhosis
AbstractPurpose of ReviewWe examine recent developments in the treatment of cirrhosis by gut microbiome manipulation specifically focusing on the phase 1 safety and feasibility trials of faecal microbiota transplantation (FMT). We interrogate the published data so far on its feasibility, safety and efficacy.Recent FindingsA large number of trials have demonstrated the efficacy of FMT in treating recurrentClostridium difficile infection which is now considered standard of care. In cirrhosis, FMT is still being evaluated and there are a number of clinical trials underway. There are two phase 1 pilot safety studies that have ...
Source: Current Hepatitis Reports - June 23, 2020 Category: Infectious Diseases Source Type: research
Point of Care Diagnostic Testing for Hepatitis B Virus
AbstractPurpose of ReviewAs we strive to reach the World Health Organization (WHO) goal of eliminating viral hepatitis as a public health threat by 2030, point of care tests (POCTs) will be important in low- to middle-income and developed countries. This review aims to investigate available POCT choices for hepatitis B virus (HBV) and to provide an algorithm for screening, assessing, and monitoring chronic HBV.Recent FindingsThere are 3 WHO pre-qualified rapid diagnostic assays for hepatitis B surface antigen (HBsAg) that are sensitive, specific, and reliable in screening for HBV: SD Bioline, Determine 2, and VIKIA. POCTs ...
Source: Current Hepatitis Reports - June 21, 2020 Category: Infectious Diseases Source Type: research
Role of Core/Capsid Inhibitors in Functional Cure Strategies for Chronic Hepatitis B
This article reviews the preclinical and clinical results of CpAMs.Recent FindingsCpAMs interfere with the hepatitis B virus (HBV) nucleocapsid assembly and also exert a secondary action on covalently closed circular DNA replenishment. CpAMs are able to sustainably suppress hepatitis B viral load and viral antigens in in vivo studies. In phase I/II clinical trials, CpAMs are well tolerated and are efficacious in suppressing viral replication. CpAMs also have synergistic antiviral effects when combined with nucleoside analogues or pegylated interferon. The clinical data has yet to demonstrate the capability of CpAMs in indu...
Source: Current Hepatitis Reports - June 21, 2020 Category: Infectious Diseases Source Type: research
Assessment of HCC Risk in Patients with Chronic HBV (REACH, PAGE-B, and Beyond)
AbstractPurpose of ReviewTo provide an updated overview on the current status of risk prediction scores for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus infection.Recent FindingsMore HCC risk scores have been developed, validated, and optimized (e.g., with liver stiffness measurement) in different patient and ethnic groups. Risk scores for treated patients with high negative predictive values would be able to identify patients who may not need HCC surveillance anymore as their HCC risk has been reduced by antiviral therapy.SummaryCurrent HCC risk scores can accurately predict HCC in specific po...
Source: Current Hepatitis Reports - June 18, 2020 Category: Infectious Diseases Source Type: research
Selection for Liver Transplantation: Indications and Evaluation
AbstractPurpose of ReviewLiver transplantation is an important therapeutic option for patients with life-limiting liver disease, which may present in the form of acute liver failure, end-stage chronic liver disease, primary hepatic cancers, or inborn metabolic disorders. While significant strides have been made with respect to liver transplantation outcomes, the practice is constrained by an organ supply/demand mismatch. The purpose of this review, therefore, is to review the general indications and contraindication to liver transplantation, and to provide an overview of the transplant evaluation process. These considerati...
Source: Current Hepatitis Reports - June 18, 2020 Category: Infectious Diseases Source Type: research
Early Transplantation in Acute on Chronic Liver Failure: Who and When
AbstractPurpose of ReviewAcute on chronic liver failure (ACLF) is a unique syndrome that afflicts patients with chronic liver disease and results in high short-term mortality,> 50% at 28 days in patients with severe ACLF (grade 3, ACLF-3). Given this prognosis, there is an urgent need to understand risk factors for this condition, as well as selection criteria for patients who may benefit from liver transplantation (LT).Recent FindingsSeveral studies have identified risk factors for developing ACLF, including higher model for end-stage liver disease score, anemia, and morbid obesity, as well ACLF mortality, such as ...
Source: Current Hepatitis Reports - June 17, 2020 Category: Infectious Diseases Source Type: research
PSC and Overlap Syndromes
AbstractPurpose of ReviewOverlap syndromes show concomitant or sequential findings of two or more autoimmune liver diseases. Primary sclerosing cholangitis (PSC) is rare and PSC-overlap syndromes are much rarer. There is limited data in PSC-overlap syndromes which pose significant diagnostic and therapeutic challenges for this condition. We summarized the published data in this review to update the management strategies in PSC-overlap syndrome.Recent FindingsPSC incidence is 0.77 –1 per 100,000 person/years, of which 2–10% are reported to have PSC-autoimmune hepatitis (AIH) overlap syndrome. The incidence of PSC-primar...
Source: Current Hepatitis Reports - May 18, 2020 Category: Infectious Diseases Source Type: research
