Efficacy and superiority between ERCP and PTBD as first line intervention of biliary complication after liver transplantation

ObjectiveEntecavir (ETV) and tenofovir disoproxil fumarate (TDF) are first-line agents for the treatment of chronic hepatitis B (CHB). Recent studies have challenged the assumption that these agents are equally effective at preventing hepatocellular carcinoma (HCC). We aimed to determine whether the risk of HCC and mortality differ in patients with CHB treated with ETV and TDF.DesignWe performed a retrospective cohort study of Veterans Affairs patients with CHB in the USA who initiated treatment with ETV or TDF between the dates of Food and Drug Administration approval of these medications and 1 January 2017. Multivariable Cox proportional hazards regression was used to determine the association between antiviral therapy and HCC risk as well as the risk of death or liver transplantation. Propensity score adjustment and competing risks analysis were performed.ResultsWe identified 2193 ETV-treated and 1094 TDF-treated patients who were followed for a mean of 5.4 years. We found no difference in the risk of HCC in ETV-treated versus TDF-treated patients (adjusted HR (aHR) 1.00, 95% CI 0.76 to 1.32). Results were similar in propensity score adjusted and competing risks analysis, and in multiple sensitivity analyses. We also found no difference in the risk of death or liver transplantation (aHR 1.16, 95% CI 0.98 to 1.39).ConclusionsWe found no difference in the risk of HCC between patients with CHB treated with ETV versus TDF. Our results support current guideline recommendations that both agents are appropriate first-line options for the treatment of CHB.

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1170Tafamidis versus liver transplantation as first-line therapy for hereditary transthyretin amyloidosis

European Heart Journal ◽

10.1093/eurheartj/ehz748.0012 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Socie ◽

A B Benmalek ◽

A L Lallemand ◽

C C Cauquil ◽

F R Rouzet ◽

...

Keyword(s):

Liver Transplantation ◽

Final Analysis ◽

Neurological Status ◽

Cardiovascular Death ◽

Stage I ◽

First Line ◽

Transthyretin Amyloidosis ◽

First Line Therapy ◽

Line Therapy ◽

Neurological Progression

Abstract Introduction By stabilizing transthyretin tetramer, tafamidis delays neurological progression in mutated Transthyretin amyloidosis (mATTR) and has replaced liver transplantation (LT) as the first-line therapy in European patients with stage I mATTR. To date, no study compared these two therapeutic strategies. Material and methods Stage I mATTR patients treated either with tafamidis or with LT were compared using a propensity score. The primary endpoint was the all-cause mortality. Secondary endpoints were the neurological progression (assessed by a worsening in the PND score) and the cardiac progression of mATTR (defined by a cardiovascular death or the onset or the worsening of symptomatic heart failure). Results The files of 345 patients with proven mATTR were analyzed and 144 patients entered the final analysis (72 patients in each group, median age 54 years, 60% carrying the V30M mutation). Patients treated by tafamidis had a better survival than patients with LT (HR: 0.93; 95% CI: 0.17–0.91; P=0.029). Conversely, the worsening-free survival of the neurological status was significantly shorter for patients that received tafamidis than for LT patients (HR: 6.08; 95% CI: 2.97–12.45; P<0.0001). A similar non-significant trend was documented regarding the progression of the cardiac status (HR: 1.99; 95CI: 0.91–4.34; P=0.084). Conclusions In mATTR, first-line therapy with tafamidis was associated with a better survival than LT. Conversely, LT provided better neurological stabilization than tafamidis. These results confirm that LT remains a major treatment in mATTR. In patients treated with tafamidis, close follow up of the treatment efficacy is mandatory.

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Outcome after liver transplantation compared with chemotherapy in colorectal cancer patients with nonresectable liver-only disease.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.531 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 531-531

Author(s):

Svein Dueland ◽

Tormod Kyrre Guren ◽

Morten Hagness ◽

Bengt Glimelius ◽

Pål-Dag Line ◽

...

Keyword(s):

Liver Transplantation ◽

Second Line ◽

First Line ◽

Liver Malignancies ◽

Data Set ◽

The Difference ◽

Third Line ◽

Colorectal Cancer Patients ◽

Clinical Trial Information ◽

Line Chemotherapy

531 Background: Surgical treatment of colorectal liver metastases (CLM) is the only treatment option with curative potential; however, only about 10-20% of the patients are candidates for surgical resection. The majority of CLM patients has non-resectable disease, and receives palliative chemotherapy. These patients have poor prognosis with median OS of about 20-24 months after starting first-line chemotherapy and only about 10% survive five years. Methods: Individual data from patients with non-resectable liver only disease who had received liver transplantation (Ltx) (SECA-study, Hagness et al., Ann Surg. 2013) were compared to a similar group of patients with non-resectable liver only metastases included in the NORDIC VII study (first-line Flox chemotherapy ± Cetuximab, Tveit et al., J Clin Oncol. 2012). Twenty one patient included in the Ltx study were compared to 47 patients with liver only metastases included in the NORDIC VII study. All patients in the NORDIC VII study started first-line chemotherapy, whereas 57% of patients in the Ltx study had received second- or third-line chemotherapy at time of Ltx. Results: Median age of the Ltx group was 56 years (range 45-65 years) and 57 years (range 34-65 years) in the Nordic VII study. Median tumor size was 4.5cm (range 2.8-13.0cm) and 5.0cm (range 1.4-16.0cm) in the Ltx and Nordic VII groups, respectively. 5 year OS in the Ltx group was 60% compared to a 5 year OS of 9% in the NORDIC VII group. The 5 year OS of the 21 patients in the NORDIC VII data set with the longest OS was 19%. The patients in the Ltx study who had received only first-line chemotherapy at time of Ltx had a 5 year OS of 80%. Patients in the NORDIC VII study had an OS from end of second-line chemotherapy of 6-7 months. In comparison, patients with progressive disease on second-line/third-line chemotherapy at time of Ltx, had a median OS of 39 months and a 5 year OS of 30%. Conclusions: Patients with non-resectable CLMonly, has a dramatic improved OS after Ltx compared to chemotherapy. The difference could not be explained by patient selection. Selected patients with CRC obtain OS similar to Ltx patients transplanted for primary liver malignancies. Selected CRC patients should therefore be considered for Ltx. Clinical trial information: NCT01311453.

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Clinical usefulness of T1-weighted MR cholangiography with Gd-EOB-DTPA for the evaluation of biliary complication after liver transplantation

Annals of Hepato-Biliary-Pancreatic Surgery ◽

10.14701/ahbps.2021.25.1.39 ◽

2021 ◽

Vol 25 (1) ◽

pp. 39-45

Author(s):

Chang Jin Lim ◽

Kwangpyo Hong ◽

Jeong-Moo Lee ◽

Eui Soo Han ◽

Suk Kyun Hong ◽

...

Keyword(s):

Liver Transplantation ◽

Biliary Complication ◽

Clinical Usefulness ◽

Mr Cholangiography

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Novel Composite Endpoint for Assessing Outcome in Liver Transplantation: Arterial and Biliary Complication‐Free Survival

Liver Transplantation ◽

10.1002/lt.26269 ◽

2021 ◽

Author(s):

Eric Savier ◽

Yann de Rycke ◽

Chetana Lim ◽

Claire Goumard ◽

Geraldine Rousseau ◽

...

Keyword(s):

Liver Transplantation ◽

Composite Endpoint ◽

Biliary Complication ◽

Free Survival

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Understanding the impact of neurologic complications in patients with cirrhosis

SAGE Open Medicine ◽

10.1177/2050312119832090 ◽

2019 ◽

Vol 7 ◽

pp. 205031211983209

Author(s):

Sanath K Allampati ◽

Kevin D Mullen

Keyword(s):

Liver Transplantation ◽

Hepatic Encephalopathy ◽

Neurologic Complications ◽

Line Treatment ◽

Precipitating Factors ◽

First Line ◽

Neurologic Impairment ◽

Overt Hepatic Encephalopathy ◽

The Impact ◽

First Line Treatment

Patients with cirrhosis may experience neurologic complications, including hepatic encephalopathy. Hepatic encephalopathy may be classified as covert (mild symptoms (e.g. lack of awareness)) or overt (moderate to severe symptoms (e.g. confusion or coma)), and symptoms may overlap with other neurologic conditions (e.g. epilepsy, stroke). Managing hepatic encephalopathy includes identifying and treating precipitating factors (e.g. dehydration). First-line treatment for patients with overt hepatic encephalopathy is typically lactulose; to reduce the risk of overt hepatic encephalopathy recurrence, lactulose plus the nonsystemic antibiotic rifaximin is recommended. Rifaximin reduced the risk of breakthrough overt hepatic encephalopathy by 58% versus placebo over 6 months (p < 0.001; 91% of patients in each group were on concomitant lactulose). However, neither pharmacologic hepatic encephalopathy treatment nor liver transplantation may completely reverse neurologic impairment in patients with hepatic encephalopathy. Additional neurologic considerations for patients with cirrhosis include preventing falls, as well as managing sleep-related issues, hyponatremia, and cerebral edema. Thus, monitoring neurologic impairment is an important component in the management of patients with cirrhosis.

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