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Drug-Induced Steatohepatitis Leading to Cirrhosis: Long-Term Toxicity of Amiodarone UseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 423-428DOI: 10.1055/s-0029-1240011ABSTRACTNonalcoholic steatosis/steatohepatitis is the most common cause for abnormal liver chemistries. Apart from metabolic syndrome, drugs may also lead to development of steatohepatitis that may, rarely, progress to cirrhosis and portal hypertension. We discuss a case of amiodarone-induced steatohepatitis with advanced fibrosis, presenting with hepatic decompensation and portal hypertension manifesting as ascites and recurrent esophageal variceal hemorrhage. Amiodarone is a lipophilic drug that concentrates in the liver and usually, over a period of time, leads...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Tags: DIAGNOSTIC PROBLEMS IN HEPATOLOGY Source Type: journals

Drug-Induced Liver Injury Associated with StatinsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 412-422DOI: 10.1055/s-0029-1240010ABSTRACTThe “statins,” or hydroxymethylglutaryl coenzyme A (HMG-CoA)-reductase inhibitors, are a generally safe class of drugs that are widely used throughout the world and are rarely associated with severe hepatotoxicity. In this article, two cases of severe hepatotoxicity attributed to statin use are presented. In addition, a detailed summary of previously published cases of statin hepatotoxicity and the risks and benefits of statins in patients with chronic liver disease are presented. Drug-induced liver injury (DILI) from statins typically presents...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

Genetic Association Studies in Drug-Induced Liver InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 400-411DOI: 10.1055/s-0029-1240009ABSTRACTGenetic studies on drug-induced liver injury (DILI) have proved challenging, both because of their rarity and their difficulty in replicating observed effects. However, significant progress has now been achieved by both candidate-gene and genome-wide association studies. These two approaches are considered in detail, together with examples of DILI due to specific drugs where consistent associations have been reported. Particular consideration is given to associations between antituberculosis drug-related liver injury and the “slow acetylator” g...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

Biomarkers for the Diagnosis and Management of Drug-Induced Liver InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 393-399DOI: 10.1055/s-0029-1240008ABSTRACTThere is a pressing need for new clinical tests that will help physicians distinguish drug-induced liver injury (DILI) from other, more common causes of liver injury, and that can identify which specific drug is the culprit when DILI occurs in the setting of polypharmacy. In situations where there are few alternative treatments, new tests are needed that can differentiate patients with DILI who would develop progressive liver injury if treatment is not stopped from patients who can safely continue drug therapy via “adaptation.” Although there h...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

Immunoallergic Drug-Induced Liver Injury in HumansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 383-392DOI: 10.1055/s-0029-1240007ABSTRACTNo conclusive data exist that define the mechanisms of idiosyncratic drug-induced liver injury (DILI) in humans; therefore, we are forced to speculate based on their clinical characteristics. The major characteristics are most easily explained by an immune mechanism. Many cases of idiosyncratic DILI tend to have a longer delay in onset and sometimes do not occur rapidly on rechallenge. These instances of DILI have been attributed to metabolic idiosyncrasy. However, these characteristics may also reflect an autoimmune mechanism, and most drugs that cause id...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

Herbal and Dietary Supplement HepatotoxicityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 373-382DOI: 10.1055/s-0029-1240006ABSTRACTHerbal and dietary supplements (HDS) are commonly used in the United States and throughout the world. The Dietary Supplement Health and Education Act and public standards set through the U.S. Pharmacopeia provide regulatory framework for these products. These regulations help to ensure the safety of grandfathered and new HDS coming onto the market, and the opportunity to identify and take action against unsafe products that have been distributed. The clinical patterns of presentation and severity of HDS-associated hepatotoxicity can be highly variable, eve...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

The Pathology of Drug-Induced Liver InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article outlines a practical approach to the diagnosis of DILI on liver biopsy, including the common patterns of injury observed in drug- and toxin-induced liver pathology and prognostic pathological features that may be associated with the outcome of patients with DILI.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Seminars in Liver Disease)
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

The Natural History of Drug-Induced Liver InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 357-363DOI: 10.1055/s-0029-1240004ABSTRACTThe development of acute hepatocellular injury with jaundice in patients with drug-induced liver injury (DILI) has been associated with a case-fatality rate of 10 to 50%, depending on the drug involved. This observation, called “Hy's rule,” is frequently used by regulatory agencies in assessing the hepatotoxic potential of drugs being tested in clinical trials. Registry studies from Sweden, Spain, and the United States have confirmed the validity of Hy's rule by demonstrating a 9 to 12% mortality rate in consecutive DILI patients. In patients w...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

Causality Assessment in Drug-Induced Liver InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 348-356DOI: 10.1055/s-0029-1240003ABSTRACTAssigning causality in drug-induced liver injury (DILI) due to a particular medication or herbal and dietary supplement relies on clinical history, exclusion of competing causes, prior reports of DILI, and judgment—no objective laboratory or histological tests exist to confirm a diagnosis of suspected DILI. Current causality assessment instruments are based on algorithmic scoring systems but are not widely used. Expert opinion remains the gold standard, but is cumbersome and has limited reproducibility. The lack of a valid and widely available causal...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

Epidemiology of Idiosyncratic Drug-Induced Liver InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 337-347DOI: 10.1055/s-0029-1240002ABSTRACTIdiosyncratic drug-induced liver injury (DILI) is a significant health problem because of its unpredictable nature, poorly understood pathogenesis, and potential to cause fatal outcomes. It is also a significant hurdle for drug development and marketing of safe prescription medications. Idiosyncratic DILI is generally rare, but its occurrence is likely underappreciated due to the lack of active reporting or surveillance systems and substantial challenges involved in its recognition and diagnosis. Nonetheless, DILI is a common cause of potentially serious a...
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Source Type: journals

Making the World a Safer PlaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 335-336DOI: 10.1055/s-0029-1240001© Thieme Medical PublishersGet connected:Table of contents | Full text (Source: Seminars in Liver Disease)
Source: Seminars in Liver Disease - October 14, 2009 Category: Gastroenterology Tags: FOREWORD Source Type: journals

Vaccination as a Triggering Event for Autoimmune HepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 331-334DOI: 10.1055/s-0029-1233537ABSTRACTThe pathogenesis of autoimmune hepatitis entails complex interactions between triggering factors, autoantigens, genetic predisposition, and immunoregulatory networks. Implicated triggering factors are numerous and include toxins, medications, and infectious agents. In this article, we present a unique case of a 31-year-old woman with severe autoimmune hepatitis apparently abruptly triggered by vaccination. All evidence suggests this was an idiosyncratic response to either hepatitis A or yellow fever vaccination.[...]© Thieme Medical PublishersGet connecte...
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Tags: DIAGNOSTIC PROBLEMS IN HEPATOLOGY Source Type: journals

Special Clinical Challenges in Autoimmune Hepatitis: The Elderly, Males, Pregnancy, Mild Disease, Fulminant Onset, and Nonwhite PatientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The objectives of this report are to characterize the populations that are underdiagnosed or difficult to manage and to provide guidelines for meeting their challenges. The elderly have an aggressive, indolent liver disease that responds well to conventional corticosteroid treatment, but the diagnosis of this disease can be hampered by concurrent illnesses and medication. Genetic factors affect the expression and outcome of autoimmune hepatitis in different genders, and they may influence the nature and reactivity to triggering antigens or hormonal imbalances. Pregnancy can ameliorate autoimmune hepatitis, whereas delivery...
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Source Type: journals

The Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy or Autoimmune Polyglandular Syndrome Type 1Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 307-314DOI: 10.1055/s-0029-1233535ABSTRACTAutoimmune polyglandular syndromes are rare autoimmune endocrinopathies that are associated with nonendocrine autoimmunopathies. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), also named autoimmune polyglandular syndrome type 1 (APS-1), is distinguished from autoimmune polyglandular syndrome 2 (APS-2). Major disease components of APECED are adrenal insufficiency, hypoparathyroidism, and candidiasis. The diagnosis is established by the presence of two out of the three components. Minor clinical features include autoimmune hepatitis...
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Source Type: journals

Autoimmune Hepatitis in Children: What is Different from Adult AIH?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 297-306DOI: 10.1055/s-0029-1233529ABSTRACTAutoimmune hepatitis (AIH) is characterized by inflammatory liver histology, circulating non-organ-specific autoantibodies, and increased levels of immunoglobulin (Ig) G in the absence of a known etiology. Two types of childhood AIH are recognized according to seropositivity: smooth muscle antibody (SMA) and/or antinuclear antibody (ANA), which is AIH type 1; and antibodies to liver-kidney microsome type 1 (anti-LKM1), which is AIH type 2. There is a female predominance in both. Autoimmune hepatitis type 2 presents more acutely, at a younger age, and commo...
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Source Type: journals

Autoimmune Hepatitis and Liver Transplantation: Indications, Results, and Management of Recurrent DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 286-296DOI: 10.1055/s-0029-1233531ABSTRACTFor those with autoimmune hepatitis (AIH), indications for liver transplantation include end-stage liver failure (as suggested by a MELD score >16), the onset of liver cancer, intractable symptoms that make the patient's life intolerable, and fulminant liver failure; outcomes are excellent, with 10-year survival in excess of 70%. For those with a fulminant presentation, the impact of corticosteroids is controversial and liver transplantation may be required. Autoimmune hepatitis recurs in approximately one third and may be detected up to 10 years or mor...
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Source Type: journals

Treatment of Autoimmune HepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 273-285DOI: 10.1055/s-0029-1233534ABSTRACTFirst described in 1950, autoimmune hepatitis (AIH) was the first chronic liver disease with a favorable response to drug therapy and a dismal prognosis when left untreated. In the decades since the first treatment studies, the basic strategic principle of inducing remission with steroids and azathioprine has not been modified. The main problems are a timely diagnosis before cirrhosis develops, the avoidance of immunosuppressant side effects, nonresponders to standard induction therapy, and adherence to therapy. Alternative drugs for immunosuppression have...
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Source Type: journals

New Animal Models for Autoimmune HepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 262-272DOI: 10.1055/s-0029-1233536ABSTRACTAutoimmune hepatitis (AIH) is often diagnosed late in the disease course and usually requires lifelong immunosuppressive therapy. Unfortunately, the etiology of the disease and the mechanisms leading to the autoimmune destruction of the liver parenchyma are only poorly understood. For a long time, one reason for this lack of apprehension was the absence of reliable animal models with a chronic immune response against liver tissues. Initial attempts to break tolerance against hepatocytes usually just resulted in mild, transient hepatitis flares. Recently, h...
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Source Type: journals

Scoring Systems for the Diagnosis of Autoimmune Hepatitis: Past, Present, and FutureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 254-261DOI: 10.1055/s-0029-1233532ABSTRACTThe diagnosis of autoimmune hepatitis (AIH) can be challenging due to the variable clinical and laboratory findings. The original diagnostic criteria published in 1993 by the International Autoimmune Hepatitis Group (IAIHG) were revised in 1999 in an attempt to standardize the diagnosis. However, these criteria are complex and can be cumbersome in clinical practice. In 2008, simplified diagnostic criteria were reported to facilitate the bedside diagnosis of AIH. The scoring systems have been evaluated in several retrospective case series and tested for the...
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Source Type: journals

Autoantibodies and their Antigens in Autoimmune HepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article critically discusses the current knowledge of the diagnostic and clinical significance of AIH-related autoantibody reactivities, focusing on key issues that the physician needs to be aware of to be able to request the appropriate testing and to interpret correctly the laboratory results within the clinical context of the patient.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Seminars in Liver Disease)
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Source Type: journals

Autoimmune HepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 239-240DOI: 10.1055/s-0029-1233528© Thieme Medical PublishersGet connected:Table of contents | Full text (Source: Seminars in Liver Disease)
Source: Seminars in Liver Disease - August 13, 2009 Category: Gastroenterology Tags: FOREWORD Source Type: journals

Patient with Hepatitis B and Alcoholic Liver Disease Before and After Liver TransplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present the case of a patient with hepatitis B virus infection and alcohol use (30 g/day by self-report) who developed cirrhosis and proceeded to liver transplantation at age 49. The explanted liver showed cirrhosis with evidence of burnt-out steatohepatitis and hepatitis B virus and a 0.7-cm focus of well-differentiated hepatocellular carcinoma. He was managed following transplant with tacrolimus, prednisone, lamivudine, adefovir, and hepatitis B immune globulin infusions. His post-transplant course was complicated by several episodes of elevated liver enzymes. Liver biopsy 3 months after liver transplantation showed a...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Tags: DIAGNOSTIC PROBLEMS IN HEPATOLOGY Source Type: journals

Role of Alcohol in Liver CarcinogenesisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 222-232DOI: 10.1055/s-0029-1214377ABSTRACTHepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world and contributes significantly to cancer-related morbidity and mortality. Chronic alcohol consumption has long been associated with progressive liver disease toward the development of hepatic cirrhosis and the subsequent increased risk for developing HCC. In assessing the role of alcohol during hepatic disease, and as a carcinogen, many of the deleterious effects of alcohol can be attributed to alcohol metabolism in hepatocytes. In addition to the direct effects of alcoho...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Source Type: journals

Alcohol and Liver FibrosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 211-221DOI: 10.1055/s-0029-1214376ABSTRACTAlcoholic liver disease involves significant crosstalk among intracellular signaling events in the liver. Overall, inflammatory and innate immune responses in Kupffer cells due to elevated gut-derived plasma endotoxin levels, increased reactive oxygen species-induced damage, and profibrogenic factors such as acetaldehyde or lipid peroxidation products contribute to activation of hepatic stellate cells, the key cell type involved in liver fibrosis. Using in vitro and in vivo approaches, there has been great progress in our understanding of the mechanisms le...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Source Type: journals

Similarities and Differences in the Pathogenesis of Alcoholic and Nonalcoholic SteatohepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 200-210DOI: 10.1055/s-0029-1214375ABSTRACTSubpopulations of individuals with alcohol-induced fatty livers and nonalcoholic steatosis develop steatohepatitis. Steatohepatitis is defined histologically: increased numbers of injured and dying hepatocytes distinguish this condition from simple steatosis. The increased hepatocyte death is generally accompanied by hepatic accumulation of inflammatory cells and sometimes increases in myofibroblastic cells, leading to hepatic fibrosis and eventually, cirrhosis. The purpose of this review is to summarize similarities and differences in the pathogenesis of ...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Source Type: journals

Hepatitis C Virus and AlcoholEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 188-199DOI: 10.1055/s-0029-1214374ABSTRACTThis review will focus on the prevalence of hepatitis c virus (HCV) infection in alcoholics with and without liver disease. Evidence will be presented to demonstrate that ethanol and chronic HCV infection synergistically accelerate liver injury. Some of the major postulated mechanisms responsible for disease progression include high rates of apoptosis, lipid peroxidation, and generation of free radicals and reactive oxygen species with reduced antioxidant capacity of the liver. Acquisition and persistence of HCV infection may be due to the adverse effects ...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Source Type: journals

“Second Hit” Models of Alcoholic Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 178-187DOI: 10.1055/s-0029-1214373ABSTRACTAlcoholic liver disease (ALD) is a lifestyle disease with its pathogenesis and individual predisposition governed by gene–environment interactions. Based on the “second hit” or “multiple hits” hypothesis, patients are predisposed to progressive ALD when a magic combination of gene and environmental interactions exists. Reproduction of second or multiple hits in animal models serves to test a combination and to gain mechanistic insights into synergism achieved by such combination. Numerous environmental factors have been incorp...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Source Type: journals

Alcohol-induced Modulation of Signaling Pathways in Liver Parenchymal and Nonparenchymal Cells: Implications for ImmunityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 166-177DOI: 10.1055/s-0029-1214372ABSTRACTAlcoholic liver injury involves a complex array of derangements in cellular signaling of hepatic parenchymal and nonparenchymal cells as well as cells of the immune system. In the hepatocyte, chronic ethanol abuse leads to lipid accumulation and liver steatosis. Multiple pathways are affected to promote lipid accumulation in the ethanol-exposed hepatocyte. Chronic ethanol renders Kupffer cells hyperresponsive to endotoxin, which results in production of inflammatory cytokines and the tumor necrosis factor-α via a toll-like receptor 4 dependent pathway...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Source Type: journals

Alcoholic Liver Disease and Methionine MetabolismEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 155-165DOI: 10.1055/s-0029-1214371ABSTRACTAlcoholic liver disease is a major health care problem worldwide. Findings have demonstrated that ethanol feeding impairs several of the multiple steps in methionine metabolism that leads to progressive liver injury. Ethanol consumption has been reported to predominantly inhibit the activity of a vital cellular enzyme, methionine synthase, involved in remethylating homocysteine. By way of compensation in some species, ethanol can also increase the activity of the enzyme, betaine homocysteine methyltransferase. This enzyme catalyzes an alternate pathway in ...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Source Type: journals

Oxidative Stress and Alcoholic Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 141-154DOI: 10.1055/s-0029-1214370ABSTRACTReactive oxygen species (ROS) are highly reactive molecules that are naturally generated in small amounts during the body's metabolic reactions and can react with and damage complex cellular molecules such as lipids, proteins, or DNA. This review describes pathways involved in ROS formation, why ROS are toxic to cells, and how the liver protects itself against ROS. Acute and chronic ethanol treatment increases the production of ROS, lowers cellular antioxidant levels, and enhances oxidative stress in many tissues, especially the liver. Ethanol-induced oxid...
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Source Type: journals

Alcohol and Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 139-139DOI: 10.1055/s-0029-1214369© Thieme Medical PublishersGet connected:Table of contents | Full text (Source: Seminars in Liver Disease)
Source: Seminars in Liver Disease - April 23, 2009 Category: Gastroenterology Tags: FOREWORD Source Type: journals

Chronic Rejection Preceded by Central Perivenulitis, Rapidly Ensuing After Liver Transplantation in a Pediatric PatientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 134-138DOI: 10.1055/s-0029-1202551ABSTRACTA 15-year-old boy who underwent liver transplantation for fulminant Wilson's disease, presented with elevated transaminases 2 months post-transplant. He had recently seroconverted from previous Epstein-Barr virus (EBV) naive status and by polymerase chain reaction (PCR) had increasing viral load copies of EBV in blood. A liver biopsy was obtained 6 weeks post-transplant, which showed isolated central perivenulitis (CP). His immunosuppresion was reduced and antiviral therapy was added with subsequent increase in liver transaminases. A second liver biopsy 6 ...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Tags: DIAGNOSTIC PROBLEMS IN HEPATOLOGY Source Type: journals

Evolving Surgical Approaches in Liver TransplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 121-133DOI: 10.1055/s-0029-1192060ABSTRACTThe growing discrepancy between the need and the availability of donor livers has resulted in evolving surgical approaches in liver transplantation during the last two decades to expand the donor pool. One approach is to transplant partial grafts, obtained either from a living donor or splitting a cadaveric donor liver. For both surgical methods, it is important to obtain a minimal viable graft volume to prevent small-for-size syndrome and graft failure. This minimal volume, expressed as graft-to-whole body ratio, must be between 0.8 and 1%. Living donor l...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Long-Term Care of the Liver Allograft RecipientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 102-120DOI: 10.1055/s-0029-1192059ABSTRACTAs outcomes after liver transplant surgery continue to improve, management of the long-term consequences of the procedure and the associated immunosuppression become increasingly important. Liver allograft recipients have, compared with age and sex-matched controls, increased risk for cardiovascular and cerebrovascular events and death, for bone disease, and for some cancers. Early recognition and treatment of modifiable risk factors, especially of hypertension (present in up to 77% recipients), diabetes (in up to 22%), obesity (up to 40%), renal impairmen...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Unique Aspects of Rejection and Tolerance in Liver TransplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 091-101DOI: 10.1055/s-0029-1192058ABSTRACTSpontaneous acceptance of liver allografts occurs in several species. However, tolerance is rare in human transplant patients even though rejection is relatively easily reversed. Histological features of acute rejection in liver transplantation are similar to those in other organs. Nevertheless, mechanisms of rejection of liver transplants may differ in degrees and cellular involvement. Liver-specific cell populations, such as Kupffer cells (KCs), liver sinusoidal epithelial cells (LSECs), and hepatic stellate cells (HSCs), may contribute to liver toleroge...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Transplantation PathologyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article focuses on the main patterns of damage that are seen in liver allograft biopsies. As with the interpretation of liver biopsies from the native liver, clinicopathological correlation is very important. The therapeutic implications of the biopsy report should also be considered, in particular whether changes in immunosuppression are indicated. For some conditions, such as liver allograft rejection, histology remains the gold standard for diagnosis. In other cases, a likely cause of graft dysfunction may already have been identified by other methods, but liver biopsy still provides useful additional information (...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Alcohol and Substance AbuseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 066-073DOI: 10.1055/s-0029-1192056ABSTRACTAlcoholic liver disease is an important cause of cirrhosis, liver-associated death, and need for liver transplant. Up to 50% of recipients use some alcohol, and perhaps 10% drink addictively. Careful evaluation by an addiction medicine specialist is the best predictive instrument before transplant surgery, whereas the 6-month rule lacks sensitivity and specificity. Addictive drinking, but not minor slips, is associated with increased mortality. There is no standard therapy for alcoholism in alcoholics waiting for a transplant or for those who have undergon...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Hepatitis CEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 053-065DOI: 10.1055/s-0029-1192055ABSTRACTHepatitis C virus (HCV) is a leading cause of end-stage liver disease worldwide and the most common indication for liver transplantation in the United States and Europe. HCV nearly always recurs in liver-transplanted patients, and 10 to 25% of them develop cirrhosis within 5 to 10 years. One of the strategies suggested to limit virological HCV recurrence is pretransplant antiviral treatment, but studies are warranted on the pharmacokinetics of antiviral drugs in cirrhotic patients, the benefits of fixed or escalating antiviral drug dosage schedules, the du...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Candidate Selection and Organ Allocation in Liver TransplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 040-052DOI: 10.1055/s-0029-1192054ABSTRACTOptimal candidate selection and organ allocation should offer liver transplantation to those who are sufficiently sick to justify the procedure but not too sick to benefit from it, in an order determined by patients' projected survival benefit, matching organs of sufficiently good quality to the appropriate recipients. Significant steps have been made in recent years toward devising selection and allocation criteria based on more objective and evidence-based definitions of candidate disease severity, transplant futility, organ quality, and appropriate dono...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Organ DonationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 019-039DOI: 10.1055/s-0029-1192053ABSTRACTLiver transplantation expertise has expanded throughout the world to the point where liver transplants are available in most developed countries. In many cases, however, legislation and regulations have not kept pace with the advances in healthcare technology. In a few cases, these regulatory voids have lead to exploitation and profit making around transplantation activities. The growing patient demand has motivated governments to develop numerous national efforts to improve the standards by which organ donation and transplantation are practiced and progra...
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Liver Transplantation: The Current SituationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses the utility of the mentioned techniques along with other strategies (e.g., Model for End-Sage Liver Disease [MELD] score), as well as the evolution of indications, contraindications, and postoperative care.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: Seminars in Liver Disease)
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Source Type: journals

Liver TransplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2009; 29: 001-001DOI: 10.1055/s-0029-1192051© Thieme Medical PublishersGet connected:Table of contents | Full text (Source: Seminars in Liver Disease)
Source: Seminars in Liver Disease - February 25, 2009 Category: Gastroenterology Tags: FOREWORD Source Type: journals

Multiple Inflammatory and Serum Amyloid A Positive Telangiectatic Hepatic Adenomas with Glycogenated Nuclei Arising in a Background of Nonalcoholic SteatohepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2008; 28: 434-439DOI: 10.1055/s-0028-1091987ABSTRACTThe authors describe multiple telangiectatic or inflammatory adenomas in a 53-year-old woman with steatohepatitis who presented with acute right upper quadrant abdominal pain. Magnetic resonance imaging revealed 6 lesions consistent with multiple hepatic adenomas, 2 of which showed hemorrhage. She underwent right lobectomy and nonanatomical segment 2 liver resections and seven nodules ranging in size from 1.0 to 5.0 cm were identified. All nodules contained portal-like structures and ductular reaction, features seen in focal nodular hyperplasia, as well as...
Source: Seminars in Liver Disease - October 28, 2008 Category: Gastroenterology Tags: DIAGNOSTIC PROBLEMS IN HEPATOLOGY Source Type: journals

Effects of Weight Loss on Nonalcoholic Fatty Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2008; 28: 427-433DOI: 10.1055/s-0028-1091986ABSTRACTNonalcoholic fatty liver disease (NAFLD) is one of the most prevalent liver diseases worldwide, affecting men, women, and children. This is due, in part, to the obesity epidemic, which is associated with increased prevalence of NAFLD. The NAFLD spectrum ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), which is the potentially progressive form. NAFLD is associated with metabolic syndrome and insulin resistance. Treatment recommendations include weight reduction through both diet and physical activity, and weight-loss surgery for extreme ...
Source: Seminars in Liver Disease - October 28, 2008 Category: Gastroenterology Source Type: journals

Role of Fatty Acids in the Pathogenesis of Obesity and Fatty Liver: Impact of Bariatric SurgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2008; 28: 407-426DOI: 10.1055/s-0028-1091985ABSTRACTNonalcoholic fatty liver disease (NAFLD) spans a spectrum from simple steatosis to nonalcoholic steatohepatitis (NASH) to cirrhosis. Simple steatosis is the substrate upon which the more serious entities in the spectrum develop; it is the first “hit” in the multistep pathogenesis of NASH, which is considered the hepatic manifestation of the metabolic syndrome. Demonstration of the existence of regulatable fatty acid transport mechanisms has contributed to clarifying the role of fatty acid disposition in obesity, the various components of NAFLD,...
Source: Seminars in Liver Disease - October 28, 2008 Category: Gastroenterology Source Type: journals

Current and Emerging Therapies in Nonalcoholic Fatty Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2008; 28: 396-406DOI: 10.1055/s-0028-1091984ABSTRACTThe prevalence of obesity and the metabolic syndrome (MS) is on the rise, and subsequently the hepatic manifestation of MS, nonalcoholic fatty liver disease (NAFLD), has become a common entity in clinical practice. Most patients with NAFLD face medical complications related to their underlying MS in other organ systems; however, a small but significant group of patients with the more aggressive form of fatty liver, nonalcoholic steatohepatitis (NASH), are at risk of developing cirrhosis and hepatocellular carcinoma. As patients are generally asymptomatic, ...
Source: Seminars in Liver Disease - October 28, 2008 Category: Gastroenterology Source Type: journals

Diagnosis of Nonalcoholic Fatty Liver Disease: Invasive versus NoninvasiveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2008; 28: 386-395DOI: 10.1055/s-0028-1091983ABSTRACTNonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States and many other parts of the world. Its prevalence continues to rise—currently affecting ~20 to 30% of adults and 10% of children in the United States. NAFLD represents a wide spectrum of conditions ranging from fatty liver, which in general follows a benign nonprogressive clinical course, to steatohepatitis or NASH, a more serious form of NAFLD that may progress to cirrhosis and end-stage liver disease. Although currently a combination of noninvasiv...
Source: Seminars in Liver Disease - October 28, 2008 Category: Gastroenterology Source Type: journals

Hepatic, Cardiovascular, and Endocrine Outcomes of the Histological Subphenotypes of Nonalcoholic Fatty Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2008; 28: 380-385DOI: 10.1055/s-0028-1091982ABSTRACTThis review covers the diagnosis and outcomes of histological subphenotypes of nonalcoholic fatty liver disease (NAFLD) including nonalcoholic steatohepatitis (NASH) in both children and adults. Serious outcomes of NAFLD include cirrhosis, hepatocellular carcinoma, coronary heart disease, and diabetes. The ability to determine differential outcomes by NAFLD subtypes is dependent upon both the adequate assessment of histological subtypes, as well as the appropriate measure of the outcome of interest. Steatohepatitis, which can only be diagnosed by liver bio...
Source: Seminars in Liver Disease - October 28, 2008 Category: Gastroenterology Source Type: journals

Mechanisms of Disease Progression in Nonalcoholic Fatty Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2008; 28: 370-379DOI: 10.1055/s-0028-1091981ABSTRACTNonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of hepatic pathology, ranging from simple steatosis (also called nonalcoholic fatty liver or NAFL) in its most benign form, to cirrhosis in its most advanced form. Nonalcoholic steatohepatitis (NASH) is an intermediate level of hepatic pathology. Hepatocyte accumulation of triglyceride is a hallmark of NAFL and NASH, but this sometimes subsides once cirrhosis has developed. Triglyceride storage per se is not hepatotoxic. Rather, it is a marker of increased exposure of hepatocytes to potentiall...
Source: Seminars in Liver Disease - October 28, 2008 Category: Gastroenterology Source Type: journals

Molecular Mechanisms of Lipotoxicity in Nonalcoholic Fatty Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Semin Liver Dis 2008; 28: 360-369DOI: 10.1055/s-0028-1091980ABSTRACTNonalcoholic fatty liver disease (NAFLD) is characterized by insulin resistance, which results in elevated serum concentration of free fatty acids (FFAs). Circulating FFAs provide the substrate for triacylglycerol formation in the liver, and may also be directly cytotoxic. Hepatocyte apoptosis is a key histologic feature of NAFLD, and correlates with progressive inflammation and fibrosis. The molecular pathways leading to hepatocyte apoptosis are not fully defined; however, recent studies suggest that FFA-induced apoptosis contributes to the pathogenesis o...
Source: Seminars in Liver Disease - October 28, 2008 Category: Gastroenterology Source Type: journals