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Yost CC, Jimenez DC, Weber MP, Maynes EJ, Belden KA, Tchantchaleishvili V, Massey HT, Sass DA, Rame JE, Zurlo JJ, Aburjania N. Hepatitis B in Heart Transplant Donors and Recipients: A Systematic Review and Meta-Analysis. J Surg Res 2023; 283:1078-1090. [PMID: 36914999 DOI: 10.1016/j.jss.2022.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Expanding the heart donor pool to include patients with hepatitis B virus (HBV) could help ameliorate the organ shortage in heart transplantation. We performed a systematic review and meta-analysis to evaluate the management and recipient outcomes of D+/R- and D-/R+ heart transplants. METHODS An electronic search was performed to identify all relevant studies published on heart transplants involving HBV+ donors and/or HBV+ recipients. A comparison was performed between two groups where heart transplants were performed a) D+/R- (n = 98) versus b) D-/R+ (n = 65). RESULTS Overall, 13 studies were selected, comprising 163 patients. Mean patient age was 55 y (95% CI: 39, 78) and 79% (69, 86) were male. Active post-transplant HBV infection requiring antiviral treatment occurred in 11% (1, 69) of D+/R- recipients and 33% (9, 71) of D-/R+ recipients. Post-transplant antiviral therapy was given to 80% (6, 100) of D+/R- recipients compared to 72% (42, 90) of D-/R+ recipients (P = 0.84). Hepatitis-related mortality was observed in no D+/R- recipients and 7% (2, 27) of D-/R+ recipients. Survival 1-y post-transplant was comparable between both groups at 83% (83, 92) and 81% (61, 92) for D+/R- and D-/R+ transplants, respectively. CONCLUSIONS Our review found that HBV D+/R- heart transplantation was associated with fewer active hepatitis infections and lower hepatitis-related mortality than D-/R+ transplantation, with comparable survival at 1 y. Additional studies utilizing HBV nucleic acid testing (NAT) to compare outcomes with HBsAg+ and anti-HBc+ donors are crucial to reach more definitive conclusions about the risk of donor-derived infections in this context.
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Affiliation(s)
- Colin C Yost
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Diana C Jimenez
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew P Weber
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine A Belden
- Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David A Sass
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - J Eduardo Rame
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John J Zurlo
- Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nana Aburjania
- Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Durante-Mangoni E, Vitrone M, Parrella A, Andini R, Iossa D, Ragone E, Falco E, Maiello C, Utili R, Zampino R. Efficacy and safety of tenofovir, entecavir, and telbivudine for chronic hepatitis B in heart transplant recipients. Transpl Infect Dis 2016; 18:319-25. [PMID: 26988401 DOI: 10.1111/tid.12525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/23/2015] [Accepted: 01/10/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis B (CHB) with polymerase inhibitors is key to prevent disease flares and progression toward advanced liver disease. Efficacy and tolerability of newer agents has been reported anecdotally in transplant recipients. METHODS In this prospective, observational study, we assessed outcomes of therapy with tenofovir (TDF), entecavir (ETV), and telbivudine (LdT) in 13 heart transplant recipients (HTR) with CHB. RESULTS Most patients were hepatitis B e antigen negative, had low baseline hepatitis B virus (HBV) DNA, and normal aminotransferases. Liver biopsy showed a median fibrosis score of 1.5 (range 0-4). Glomerular filtration rate (GFR) was <50 mL/min in 7 patients (54%). Two patients were started on de novo ETV before transplant. Eleven previously treated patients were switched to TDF (n = 9) or LdT (n = 2). Median treatment duration was 33 months (range 1-71). HBV DNA remained suppressed in 6 patients and became undetectable in 5. Aminotransferases went down to the normal range in all patients, with a single flare in 1 patient. One patient lost hepatitis B surface antigen. No cases occurred of hepatic decompensation, hepatocellular carcinoma, or liver-related death. The GFR remained largely stable, and no cases of TDF-related hyper-phosphaturia were observed. CONCLUSIONS This study indicates that newer antivirals are effective and safe in HTR with CHB.
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Affiliation(s)
- E Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.,Units of Infectious & Transplant Medicine, Ospedale Monaldi, Napoli, Italy
| | - M Vitrone
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy
| | - A Parrella
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy
| | - R Andini
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy
| | - D Iossa
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy
| | - E Ragone
- Units of Infectious & Transplant Medicine, Ospedale Monaldi, Napoli, Italy
| | - E Falco
- Microbiology and Virology, Ospedale Monaldi, Napoli, Italy
| | - C Maiello
- Cardiac Surgery A.O.R.N. dei Colli, Ospedale Monaldi, Napoli, Italy
| | - R Utili
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy.,Units of Infectious & Transplant Medicine, Ospedale Monaldi, Napoli, Italy
| | - R Zampino
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Napoli, Italy
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Xu B, Lin L, Xu G, Zhuang Y, Guo Q, Liu Y, Wang H, Zhou X, Wu S, Bao S, Cai W, Xie Q. Long-term lamivudine treatment achieves regression of advanced liver fibrosis/cirrhosis in patients with chronic hepatitis B. J Gastroenterol Hepatol 2015; 30:372-8. [PMID: 25167956 DOI: 10.1111/jgh.12718] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Antiviral therapy is important in advanced liver fibrosis/cirrhosis with chronic hepatitis B (AdLF-CHB) patients, but complete regression of cirrhosis remains to be the challenge. We aimed to investigate whether up to 10 years lamivudine treatment achieves liver fibrosis/cirrhosis regression in AdLF-CHB patients. METHODS Improvement of hepatic fibrosis/cirrhosis, virological response and disease progression were evaluated in 28 AdLF-CHB patients with up to 10 years lamivudine treatment. Liver biopsy was performed in all of the 28 patients at baseline, but only 19 patients had second biopsy at year 10. RESULTS There were 24 hepatitis B e antigen (HBeAg)-positive and 4 HBeAg-negative patients within the original 28 AdLF-CHB patients. At the end of 10 years lamivudine treatment, 20 of the 24 HBeAg-positive patients had HBeAg loss. HBeAg seroconversion was detected in 10 of these 20 HBeAg loss patients. HBsAg loss was observed in 4 of the original 28 patients. Among these four HBsAg loss patients, three had HBsAg seroconversion. All patients achieved hepatitis B virus DNA (HBV DNA) undetectable. Histopathology was evaluated between paired original and final liver biopsies among 19 patients as follows: 4/19 achieved complete liver fibrosis/cirrhosis regression; 9/19 improved in Ishak fibrosis score; whereas 6/19 showed no fibrosis improvement. About 75% patients achieved inflammatory/fibrotic improvement. No significant disease progression was observed in 24/28 patients. Furthermore, no significant difference in histopathology improvement, cirrhosis regression, disease progression between non-resistance and rescue for resistance was observed. CONCLUSION Long-term lamivudine therapy achieves regression of fibrosis/cirrhosis and improvement of histological and disease progression in AdLF-CHB patients.
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Affiliation(s)
- Bei Xu
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Should we consider patients with coexistent hepatitis B or C infection for orthotopic heart transplantation? J Transplant 2013; 2013:748578. [PMID: 24307939 PMCID: PMC3838814 DOI: 10.1155/2013/748578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/12/2013] [Accepted: 09/19/2013] [Indexed: 12/21/2022] Open
Abstract
Heart transplantation (HTX) is the gold standard surgical treatment for patients with advanced heart failure. The prevalence of hepatitis B and hepatitis C infection in HTX recipients is over 10%. Despite its increased prevalence, the long-term outcome in this cohort is still not clear. There is a reluctance to place these patients on transplant waiting list given the increased incidence of viral reactivation and chronic liver disease after transplant. The emergence of new antiviral therapies to treat this cohort seems promising but their long-term outcome is yet to be established. The aim of this paper is to review the literature and explore whether it is justifiable to list advanced heart failure patients with coexistent hepatitis B/C infection for HTX.
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Abstract
There is a mutual interaction between the function of the heart and the liver and a broad spectrum of acute and chronic entities that affect both the heart and the liver. These can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. In chronic and acute cardiac hepatopathy, owing to cardiac failure, a combination of reduced arterial perfusion and passive congestion leads to cardiac cirrhosis and cardiogenic hypoxic hepatitis. These conditions may impair the liver function and treatment should be directed towards the primary heart disease and seek to secure perfusion of vital organs. In patients with advanced cirrhosis, physical and/or pharmacological stress may reveal a reduced cardiac performance with systolic and diastolic dysfunction and electrophysical abnormalities termed cirrhotic cardiomyopathy. Electrophysiological abnormalities include prolonged QT interval, chronotropic incompetance, and electromechanical uncoupling. No specific therapy can be recommended, but it should be supportive and directed against the heart failure. Numerous conditions affect both the heart and the liver such as infections, inflammatory and systemic diseases, and chronic alcoholism. The risk and prevalence of coronary artery disease are increasing in cirrhotic patients and since the perioperative mortality is high, a careful cardiac evaluation of such patients is required prior to orthotopic liver transplantation.
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Affiliation(s)
- Søren Møller
- Centre of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Durante-Mangoni E, Iossa D, Pinto D, Molaro R, Agrusta F, Amarelli C, Ragone E, Grimaldi M, Maiello C, Utili R. Adefovir treatment for chronic hepatitis B in heart transplant recipients. Clin Transplant 2013; 27:E282-8. [DOI: 10.1111/ctr.12109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Emanuele Durante-Mangoni
- Internal Medicine Section; Department of Cardiothoracic Sciences; University of Naples SUN, and Unit of Transplant Medicine; Monaldi Hospital; Naples; Italy
| | - Domenico Iossa
- Internal Medicine Section; Department of Cardiothoracic Sciences; University of Naples SUN, and Unit of Transplant Medicine; Monaldi Hospital; Naples; Italy
| | - Daniela Pinto
- Internal Medicine Section; Department of Cardiothoracic Sciences; University of Naples SUN, and Unit of Transplant Medicine; Monaldi Hospital; Naples; Italy
| | - Rosa Molaro
- Internal Medicine Section; Department of Cardiothoracic Sciences; University of Naples SUN, and Unit of Transplant Medicine; Monaldi Hospital; Naples; Italy
| | - Federica Agrusta
- Internal Medicine Section; Department of Cardiothoracic Sciences; University of Naples SUN, and Unit of Transplant Medicine; Monaldi Hospital; Naples; Italy
| | | | - Enrico Ragone
- Internal Medicine Section; Department of Cardiothoracic Sciences; University of Naples SUN, and Unit of Transplant Medicine; Monaldi Hospital; Naples; Italy
| | - Maria Grimaldi
- Internal Medicine Section; Department of Cardiothoracic Sciences; University of Naples SUN, and Unit of Transplant Medicine; Monaldi Hospital; Naples; Italy
| | - Ciro Maiello
- Unit of Heart Transplant; Monaldi Hospital; Naples; Italy
| | - Riccardo Utili
- Internal Medicine Section; Department of Cardiothoracic Sciences; University of Naples SUN, and Unit of Transplant Medicine; Monaldi Hospital; Naples; Italy
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Levitsky J, Doucette K. Viral hepatitis in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:147-68. [PMID: 23465008 DOI: 10.1111/ajt.12108] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J Levitsky
- Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Infections and organ transplantation: new challenges for prevention and treatment--a colloquium. Transplantation 2012; 93:S4-S39. [PMID: 22374265 DOI: 10.1097/tp.0b013e3182481347] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Chen Y, Chuang M, Chou N, Chi N, Wu I, Chen Y, Yu H, Huang S, Wang C, Tsao C, Ko W, Wang S. Twenty-four Year Single-Center Experience of Hepatitis B Virus Infection in Heart Transplantation. Transplant Proc 2012; 44:910-2. [DOI: 10.1016/j.transproceed.2012.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kanda T, Shinozaki M, Kamezaki H, Wu S, Nakamoto S, Arai M, Fujiwara K, Goto N, Imazeki F, Yokosuka O. Efficacy of lamivudine or entecavir on acute exacerbation of chronic hepatitis B. Int J Med Sci 2012; 9:27-32. [PMID: 22211086 PMCID: PMC3222087 DOI: 10.7150/ijms.9.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/31/2011] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS Spontaneous acute exacerbation of chronic hepatitis B virus (HBV) infection occasionally occurs in its natural history, sometimes leading rapidly to fatal hepatic failure. We compared the effects of lamivudine (LAM) with those of entecavir (ETV) treatments in acute exacerbation of chronic hepatitis B with 500 IU/L or higher alanine aminotransferase (ALT) levels. METHODS Thirty-four patients with acute exacerbation were consecutively treated with LAM /ETV. Their clinical improvements were compared. RESULTS Among LAM-treated and ETV-treated patients, none showed a reduction of <1 log IU/mL in HBV DNA after 1 or 3 months of treatment. Initial virological response, defined as a reduction of 4 log IU/mL in HBV DNA at 6 months, with LAM and ETV, respectively, was 83.3% and 100%. One LAM patient developed hepatic encephalopathy, but all patients in both groups survived. Twelve months after treatment, 41.6% of 24 LAM group patients switched to another drug or added adefovir to their treatment due to the emergence of LAM-resistant mutants. On the other hand, patients receiving ETV did not need to change drugs. CONCLUSIONS ETV appears to be as effective as LAM in the treatment of patients with acute exacerbation of chronic hepatitis B. Clinicians should carefully start to treat these patients as soon as possible.
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Affiliation(s)
- Tatsuo Kanda
- Department of Medicine and Clinical Oncology, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
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Schildgen O. Host factors may influence response to antiviral therapy in chronic hepatitis B virus infections. Med Hypotheses 2011; 76:417-20. [DOI: 10.1016/j.mehy.2010.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 11/02/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
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Abstract
Hepatitis B virus is a common cause of acute liver failure. It can be especially problematic in patients coinfected with hepatitis C, hepatitis D or human immunodeficiency virus. In addition, immunosuppression-associated hepatitis B reactivation is being increasingly recognized following chemotherapy, biologic therapy, and organ transplantation. This article highlights treatment options in these special populations.
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Affiliation(s)
- J Levitsky
- Division of Hepatology and Organ Transplantation, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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15
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Wiegand J, Wedemeyer H, Finger A, Heidrich B, Rosenau J, Michel G, Bock CT, Manns MP, Tillmann HL. A Decline in Hepatitis B virus Surface Antigen (HBsAg) Predicts Clearance, but does not Correlate with Quantitative HBeAg or HBV DNA Levels. Antivir Ther 2008. [DOI: 10.1177/135965350801300402] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The elimination of hepatitis B virus surface antigen (HBsAg) is the final goal of hepatitis B treatment, but is rarely achieved. As quantitative assays for HBsAg recently became available, we have investigated whether quantitative HBsAg measurements can substitute for hepatitis B virus (HBV) DNA quantification in treatment monitoring. Methods Within this study, 23 liver transplant patients and 18 heart transplant recipients were retrospectively analysed. Patients had been treated with famciclovir and/or lamivudine, in addition some had also received adefovir in cases of lamivudine resistance. Quantitative HBsAg and hepatitis B virus e antigen (HBeAg) levels were determined with the ArchitectTM assay. HBV DNA levels were determined with different assays available at given time points. Results We did not find a significant correlation between either HBsAg or HBeAg and HBV DNA levels – both in treated and untreated patients. More importantly, there was no significant concordance between an increase or decrease of HBsAg or HBeAg with HBV DNA. However, the curve and decline of quantitative HBsAg enabled prediction of eventual viral clearance. Eight patients showed a 2 log10 drop of HBsAg levels and eight patients demonstrated a reduction of HBsAg levels below 100 IU/ml; five patients fulfilled both criteria. Three of those five cleared HBsAg and became positive for antibodies against HBsAg. Conclusions Quantitative HBsAg and HBeAg cannot substitute for HBV DNA quantification during the assessment of antiviral therapy; however, the decline of HBsAg does predict eventual HBsAg clearance. A 2 log10 drop to below 100 IU/ml is associated with a high likelihood of HBsAg clearance.
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Affiliation(s)
- Johannes Wiegand
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
- Medizinische Klinik & Poliklinik II, Universität Leipzig, Leipzig, Germany
| | - Heiner Wedemeyer
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Andrea Finger
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Benjamin Heidrich
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jens Rosenau
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gerd Michel
- Foundation for Innovative New Diagnostics (FIND), 1216 Cointrin/Geneva, Switzerland
| | - C Thomas Bock
- Department of Molecular Pathology, Institute for Pathology, University Hospital of Tübingen, Tübingen, Germany
| | - Michael P Manns
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
- Medizinische Klinik & Poliklinik II, Universität Leipzig, Leipzig, Germany
- Duke Clinical Research Institute, Durham, NC 27705, USA
| | - Hans L Tillmann
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
- Medizinische Klinik & Poliklinik II, Universität Leipzig, Leipzig, Germany
- Duke Clinical Research Institute, Durham, NC 27705, USA
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