Cardiovascular risk profile in patients with hepatic steatosis

Background. Fatty liver disease (FLD) is composed of a wide spectrum including metabolic associated fatty liver disease (MAFLD). Cardiovascular disease (CVD) is the leading cause of mortality in this populational group. Many risk estimation systems are in existence for improving the management of population groups, but currently, none of the available risk prediction models are authenticated in patients with hepatic steatosis. Materials and methods. Transversal, observational, prospective, case control study has been included 680 patients with MAFLD and 96 control subjects without MAFLD. Experimental group was divided in tree subgroups: A - overweight or obesity (BMI ≥ 25 kg/m2 ) N= 498; B – lean/normal weight (BMI <25kg/m2 ) N= 58 and C – Type 2 diabetes mellitus N= 156. For each patient, cardiovascular risk was estimated using the Framingham equation (risk ≥ 20% – high), SCORE risk chat (risk ≥ 10% – high) and Atherosclerotic Cardiovascular Disease Risk Algorithm from the American College of Cardiology and the American Heart Association (AHA/ACC) (risk ≥ 20% – high). Results. Model Risk SCORE and Risk ACC/AHA had identified the low proportion of patients with high risk, however, Risk FRS determined the highest proportion of the patients as being ‘at high-risk’ (Risk SCORE -7% vs Risk ACC/AHA - 15% vs Risk FRS - 38%, p <0.001). Statistically significant correlations were found between the scoring systems Risk FRS and Risk ACC/AHA (Pearson’s r = 0.939, p = 0.0001, Spearman`s rho=0.960, p <0.001). The highest proportion of the patients as being ‘at high-risk’ from group C – DMT2 was found by model RiskFRS – 82.7%, with statistically significant difference between group A and B – 28.1 % vs 6.8%, p < 0.001. The same tendency was observed for RiskSCORE and Risk ACC/AHA (RiskSCORE DMT2 – 26.3% vs Risk ACC/AHA DMT2 – 46.8%), bur these scores have identified the low proportion of patients with high risk in this populational group. Conclusions. The study shows that RiskFRS appeared to be most useful CVD risk assessment model in hepatic steatosis, RiskFRS is likely to identify a greater number of patients at ‘high-risk’ as compared to Risk SCORE and Risk ACC/AHA.

Endothelial dysfunction in nonalcoholic fatty liver disease

Introduction. The prevalence of nonalcoholic fatty liver disease (NAFLD) in western countries is increasing rapidly and is considered as component of metabolic syndrome. Endothelial dysfunction is a pathophysiological problem of cardiovascular disease. NAFLD, as a component of metabolic syndrome, is associated with endothelial dysfunction. Material and methods. PubMed database was used in order to review and select articles according to the keywords. A total of 216 articles matching search criteria were found between 2000-2021. Results. The present study has been underlined the role of pathophysiological mechanisms of endothelial dysfunction in nonalcoholic fatty liver disease, which involves oxidative stress, inflammation and insulin resistance. The main factor in the occurrence of endothelial dysfunction is related to nitric oxide (NO) biosynthesis. The markers associated with regulation of nitric oxide biosynthesis, such as asymmetric dimethylarginine, free fatty acid, lectin-like oxidized low-density lipoprotein (LDL) receptor-1 and pentraxin-3, are potential targets in the assessment of endothelial dysfunction. Conclusions. Insulin resistance, inflammation and oxidative stress have been involved in the reduction of NO biosynthesis that influences the occurrence of endothelial dysfunction. Markers, such as lectin-like oxidized LDL receptor-1 and pentraxin-3, have been considered as potential targets in the assessment of endothelial dysfunctions in NAFLD.

The impact of liver steatosis on the postoperative evolution after right lobe living-donor hepatectomy

Background

Living donor liver transplantation has become a feasible treatment modality for end-stage liver disease. The obesity epidemic worldwide has made it increasingly common to encounter liver steatosis in living donor candidates. The aim of study was to analyze the impact of moderate hepatic steatosis on the postoperative evolutions after right lobe living-donor hepatectomy.

Methods

Living donors who underwent donor hepatectomy during the period 2000 to 2020 in two medical centers were included in this study. We distinguished 3 groups based on the degree of steatosis: Group O - 0%, Group I - 1-10% and Group II >10%.

Results

A total number of 157 living donors underwent surgery, of whom 112 (71.34%) were right lobe liver donors. There were 62 without steatosis, 31 - with steatosis 1-10% and 19 with steatosis >10%. No difference has been found in proportion of men, median of age, body mass index and left lobe/total liver volume ration in compared groups. Total liver volume was significantly higher in the Group I than in the Group O (p=0.028). The moderate hepatic steatosis (HS) group presented significant higher volume of intraoperative hemorrhage than no-HS group (p=0.041). No differences were observed in the postoperative liver function between the groups. The minimal HS group comprised a significantly higher proportion of postoperative complications than no-HS group (67.7% vs 40.3%, p=0.043). The longer postoperative length of hospital stay in ICU was observed in Group I than in Group O (p=0.024).

Conclusion

Moderate HS does not importantly impair living liver donors' safety.

Profile of hepatocellular carcinoma in the Republic of Moldova: first-hand information on the presentation, distribution and etiologies

INTRODUCTION

Moldova is the European country with the highest incidence of hepatocellular carcinoma (HCC) in both sexes. There is, however, no data comprehensively describing the presentation and the risk factors of HCC in the country. We decided to analyze cases of HCC recently received in a tertiary healthcare Institution from Chisinau, the Moldovian capital.

METHODS

A series of 148 primary liver tumors including 139 cases of HCC were retrospectively analyzed for demographic features, serological and biochemical data, and clinical presentation.

RESULTS

The mean age of patients was 59 ± 10 years (range: 19-66) with a M:F sex ratio of 1.9. Tumors appeared on full-blown liver cirrhosis in 83% of cases and were composed of multiple nodules at diagnosis in 36% of patients. Serum Alpha-fetoprotein was exceeding 10ng/mL in 76% of cases. Liver tumor and hepatitis were co-discovered in 34% of cases. More than 81% of hepatocellular carcinomas were associated with at least one hepatitis virus. Carriers of anti-hepatitis C virus were predominating (55% of cases) over patients seropositive for hepatitis B virus surface antigen (36%). Half of the latter were also infected with hepatitis Delta virus. In total, dual or triple infections were present in 24% and 7% of cases.

CONCLUSIONS

The burden of infections with hepatitis viruses is particularly important in Moldova and corresponds to a situation commonly observed in countries of the Southern hemisphere. A pro-active policy of screening for persistent liver infection targeting population at risk of HCC (> 50 years) and coupled with the distribution of antivirals in positive cases should be rapidly implemented in Moldova to reduce incidence or primary liver cancer.

Four Years of Hepatic Transplantation in the Republic of Moldova

Ever since the first liver transplant in the Republic of Moldova in 2013 we have performed 30 liver transplantations, the first having been performed in collaboration with the surgical team from Romania, led by Professor Irinel Popescu. The serious deficit of available cadaveric organs has forced us to begin with right hemi-liver transplantation from a living donor. In one third of liver transplantations we used right hemi-liver graft from a living donor, and in 2/3 of cases whole liver graft was harvested from brain-dead donors. The indication for surgical intervention in most cases was hepatic cirrhosis of viral aetiology in terminal stages, three cases of hepatocellular carcinoma, and one case for each of primary biliary cirrhosis, drug-induced toxic hepatitis, and liver retransplantation caused by hepatic arterial thrombosis. 10 cadaveric grafts were harvested from elderly donors ( 65 years). In the early postoperative period, four recipients died (2 live donor graft recipients and 2 graft recipients from donors with brain death). Causes of death were: intracerebral haemorrhage in the early postoperative period - 1, acute graft rejection - 1, hepatic artery thrombosis - 1, primary graft dysfunction - 1. There were no deaths during the late postoperative period. Of the complications that occurred during the early postoperative period we can highlight acute graft rejection -2, hepatic arterial thrombosis - 1, intraabdominal postoperative haemorrhage - 1, hepatic artery thrombosis -1, biliary peritonitis - 1, primary graft dysfunction -1, seizures -1. Complications during the postoperative period: biliary peritonitis after choledochal drainage removal - 1, "small-for-size" - 2. The accumulated experience and the use of modern technologies has allowed us to reduce the postoperative mortality rate, as well as the rate of occurring complications, in order to transfer this surgical intervention from the category of exclusivity operations to the category of daily interventions.