Percutaneous transvenous shunt occlusion for portosystemic encephalopathy due to lenvatinib administration to a patient with hepatocellular carcinoma and portosystemic shunt

Long-Term Efficacy and Safety of Rifaximin in Japanese Patients with Hepatic Encephalopathy: A Multicenter Retrospective Study

Background: Rifaximin is commonly used for hepatic encephalopathy (HE). However, the effects of long-term treatment for Japanese people are limited. Therefore, this study aimed to investigate the effects and safety of long-term treatment with rifaximin on HE. Methods: A total of 215 patients with cirrhosis administered with rifaximin developed overt or covert HE, which was diagnosed by an attending physician for >12 months. Laboratory data were extracted at pretreatment and 3, 6, and 12 months after rifaximin administration. The long-term effect of rifaximin was evaluated, and the incidence of overt HE during 12 months and adverse events was extracted. Results: Ammonia levels were significantly improved after 3 months of rifaximin administration and were continued until 12 months. There were no serious adverse events after rifaximin administration. The number of overt HE incidents was 9, 14, and 27 patients within 3, 6, and 12 months, respectively. Liver enzymes, renal function, and electrolytes did not change after rifaximin administration. Prothrombin activity is a significant risk factor for the occurrence of overt HE. The serum albumin, prothrombin activity, and albumin−bilirubin (ALBI) scores were statistically improved after 3 and 6 months of rifaximin administration. Moreover, the same results were obtained in patients with Child−Pugh C. Conclusions: The long-term rifaximin treatment was effective and safe for patients with HE, including Child−Pugh C.

Hepatic encephalopathy induced by Lenvatinib and anti-PD-1 mAb in a patient with advanced hepatocellular carcinoma: A case report

Previous studies have reported that the combinational therapy of Lenvatinib and anti-programmed cell death-1 (PD-1) monoclonal antibody (mAb) produced a longer overall survival in patients with hepatocellular carcinoma (HCC). The current case report presented a a patient with HCC who had hepatic encephalopathy (HE) following treatment with Lenvatinib and anti-PD-1 mAb. The 42-year-old patient was diagnosed with stage IVa HCC accompanied with cirrhosis and Child-Pugh C. Computed tomography (CT) imaging revealed collateral circulation of the portal vein, causing significant varicose veins in the gastric fundus, mesenteric varices and colon edema. The patient was administered 12 mg Lenvatinib once daily combined with 240 mg anti-PD-1 mAb. After 3 days of treatment, he presented with a disorder of psychoneurosis and blood ammonia (248 µg/dl; normal levels, 40-80 µg/dl). A cranial CT scan exhibited no significant abnormalities. The patient rapidly progressed from grade 1 to grade 3 HE. Lenvatinib treatment was discontinued. After admission to the intensive care unit, the patient's blood ammonia level dropped to 132 µg/dl, after which he was discharged. It was concluded that the portal vein collateral circulation in the patient with HCC may have caused HE development whilst receiving Lenvatinib and anti-PD-1 mAb combinational therapy.