1
|
Park MJ, Na HS, Joo YS, Cho KH, Kim SY, Choi JW, Baek JA, Choi JY, You YK, Cho ML. Induction of liver transplant immune tolerance in an outbred rat strain model using tacrolimus. Lab Anim Res 2023; 39:5. [PMID: 36890604 PMCID: PMC9993642 DOI: 10.1186/s42826-023-00156-5] [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: 10/27/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Orthotopic liver transplantation is the only option for patients with end-stage liver disease and hepatocellular carcinoma. Post-transplant immunosuppressive therapy is important to prevent graft failure. We investigated the effectiveness of tacrolimus (FK506) and their mechanisms for liver transplant immune tolerance in an outbred rat LT model. RESULTS To investigate the therapeutic effect of the FK506 on outbred rat LT model, FK506 and postoperative therapy were administered subcutaneously once or twice daily to transplanted rats. Histopathological and immunohistochemical analyses were conducted for all groups. The regulation of inflammatory cytokine signaling in the spleen was analyzed by flow cytometry. FK506 attenuated allograft rejection and increased survival in rat orthotopic liver transplantation models. The FK506-treated group had reduced serum levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase. Furthermore, FK506 decreased the expression of inflammatory cytokines and the activation of pathogenic Th1 and Th17 cells in the liver. CONCLUSIONS Taken together, we revealed that FK506 ameliorated strong allograft rejection in outbred liver transplantation model by anti-inflammatory effect and inhibitory peroperty of pathogenic T cells.
Collapse
Affiliation(s)
- Min-Jung Park
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.,Lab of Translational ImmunoMedicine, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Sik Na
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.,Lab of Translational ImmunoMedicine, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Young-Shin Joo
- Department of Laboratory Animal Research Center, Catholic Medical Center, Institute of Biomedical Industry, The Catholic University of Korea, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Keun-Hyung Cho
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.,Lab of Translational ImmunoMedicine, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Se-Young Kim
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.,Lab of Translational ImmunoMedicine, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Won Choi
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.,Lab of Translational ImmunoMedicine, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Ah Baek
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.,Lab of Translational ImmunoMedicine, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Young Choi
- Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Young Kyoung You
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Mi-La Cho
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea. .,Lab of Translational ImmunoMedicine, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. .,Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. .,Impact Biotech, Seoul, 137-040, Republic of Korea.
| |
Collapse
|
2
|
Duseja A, Singh S, De A, Madan K, Rao PN, Shukla A, Choudhuri G, Saigal S, Shalimar, Arora A, Anand AC, Das A, Kumar A, Eapen CE, Devadas K, Shenoy KT, Panigrahi M, Wadhawan M, Rathi M, Kumar M, Choudhary NS, Saraf N, Nath P, Kar S, Alam S, Shah S, Nijhawan S, Acharya SK, Aggarwal V, Saraswat VA, Chawla YK. Indian National Association for Study of the Liver (INASL) Guidance Paper on Nomenclature, Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease (NAFLD). J Clin Exp Hepatol 2023; 13:273-302. [PMID: 36950481 PMCID: PMC10025685 DOI: 10.1016/j.jceh.2022.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 03/24/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease globally and in India. The already high burden of NAFLD in India is expected to further increase in the future in parallel with the ongoing epidemics of obesity and type 2 diabetes mellitus. Given the high prevalence of NAFLD in the community, it is crucial to identify those at risk of progressive liver disease to streamline referral and guide proper management. Existing guidelines on NAFLD by various international societies fail to capture the entire landscape of NAFLD in India and are often difficult to incorporate in clinical practice due to fundamental differences in sociocultural aspects and health infrastructure available in India. A lot of progress has been made in the field of NAFLD in the 7 years since the initial position paper by the Indian National Association for the Study of Liver on NAFLD in 2015. Further, the ongoing debate on the nomenclature of NAFLD is creating undue confusion among clinical practitioners. The ensuing comprehensive review provides consensus-based, guidance statements on the nomenclature, diagnosis, and treatment of NAFLD that are practically implementable in the Indian setting.
Collapse
Key Words
- AASLD, American Association for the Study of Liver Diseases
- ALD, alcohol-associated liver disease
- ALT, alanine aminotransferase
- APRI, AST-platelet ratio index
- AST, aspartate aminotransferase
- BMI, body mass index
- CAP, controlled attenuation parameter
- CHB, chronic Hepatitis B
- CHC, chronic Hepatitis C
- CK-18, Cytokeratin-18
- CKD, chronic kidney disease
- CRN, Clinical Research Network
- CVD, cardiovascular disease
- DAFLD/DASH, dual etiology fatty liver disease or steatohepatitis
- EBMT, endoscopic bariatric metabolic therapy
- ELF, enhanced liver fibrosis
- FAST, FibroScan-AST
- FIB-4, fibrosis-4
- FLIP, fatty liver inhibition of progression
- FXR, farnesoid X receptor
- GLP-1, glucagon-like peptide-1
- HCC, hepatocellular carcinoma
- INASL, Indian National Association for Study of the Liver
- LAI, liver attenuation index
- LSM, liver stiffness measurement
- MAFLD
- MAFLD, metabolic dysfunction-associated fatty liver disease
- MR-PDFF, magnetic resonance – proton density fat fraction
- MRE, magnetic resonance elastography
- MetS, metabolic syndrome
- NAFL:, nonalcoholic fatty liver
- NAFLD, nonalcoholic fatty liver disease
- NAS, NAFLD activity score
- NASH
- NASH, nonalcoholic steatohepatitis
- NCD, noncommunicable diseases
- NCPF, noncirrhotic portal fibrosis
- NFS, NAFLD fibrosis score
- NHL, non-Hodgkin's lymphoma
- NPCDCS, National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke
- OCA, obeticholic acid
- PPAR, peroxisome proliferator activated receptor
- PTMS, post-transplant metabolic syndrome
- SAF, steatosis, activity, and fibrosis
- SGLT-2, sodium-glucose cotransporter-2
- SWE, shear wave elastography
- T2DM, DM: type 2 diabetes mellitus
- USG, ultrasound
- VAT, visceral adipose tissue
- VCTE, vibration controlled transient elastography
- fatty liver
- hepatic steatosis
- nonalcoholic steatohepatitis
Collapse
Affiliation(s)
- Ajay Duseja
- Departmentof Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S.P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, India
| | - Arka De
- Departmentof Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kaushal Madan
- Max Centre for Gastroenterology, Hepatology and Endoscopy, Max Hospitals, Saket, New Delhi, India
| | - Padaki Nagaraja Rao
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC & KEM Hospital, Mumbai, India
| | - Gourdas Choudhuri
- Department of Gastroenterology and Hepato-Biliary Sciences, Fortis Memorial Research Institute, Gurugram, India
| | - Sanjiv Saigal
- Max Centre for Gastroenterology, Hepatology and Endoscopy, Max Hospitals, Saket, New Delhi, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil C. Anand
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Krishnadas Devadas
- Department of Gastroenterology, Government Medical College, Trivandrum, India
| | | | - Manas Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manav Wadhawan
- Institute of Liver & Digestive Diseases, BLK Super Speciality Hospital, Delhi, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Neeraj Saraf
- Department of Hepatology, Medanta, The Medicity, Gurugram, India
| | - Preetam Nath
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Sanjib Kar
- Department of Gastroenterology and Hepatology, Gastro Liver Care, Cuttack, India
| | - Seema Alam
- Department of PediatricHepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Samir Shah
- Department of Hepatology, Institute of Liver Disease, HPB Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, Sawai Man Singh Medical College, Jaipur, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Vinayak Aggarwal
- Department of Cardiology, Fortis Memorial Research Institute, Gurugram, India
| | - Vivek A. Saraswat
- Department of Hepatology, Pancreatobiliary Sciences and Liver Transplantation, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - Yogesh K. Chawla
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| |
Collapse
|
3
|
Strategies to Improve Immune Suppression Post-Liver Transplantation: A Review. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2040042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Since the first liver transplantation operation (LT) in 1967 by Thomas Starzl, efforts to increase survival and prevent rejection have taken place. The development of calcineurin inhibitors (CNIs) in the 1980s led to a surge in survival post-transplantation, and since then, strategies to prevent graft loss and preserve long-term graft function have been prioritized. Allograft rejection is mediated by the host immune response to donor antigens. Prevention of rejection can be achieved through either immunosuppression or induction of tolerance. This leads to a clinical dilemma, as the choice of an immunosuppressive agent is not an easy task, with considerable patient and graft-related morbidities. On the other hand, the induction of graft tolerance remains a challenge. Despite the fact that the liver exhibits less rejection than any other transplanted organs, spontaneous graft tolerance is rare. Most immunosuppressive medications have been incriminated in renal, cardiovascular, and neurological complications, relapse of viral hepatitis, and recurrence of HCC and other cancers. Efforts to minimize immunosuppression are directed toward decreasing medication side effects, increasing cost effectiveness, and decreasing economic burden without increasing the risk of rejection. In this article, we will discuss recent advances in strategies for improving immunosuppression following liver transplantation.
Collapse
|
4
|
Pasanta D, Htun KT, Pan J, Tungjai M, Kaewjaeng S, Kim H, Kaewkhao J, Kothan S. Magnetic Resonance Spectroscopy of Hepatic Fat from Fundamental to Clinical Applications. Diagnostics (Basel) 2021; 11:842. [PMID: 34067193 PMCID: PMC8151733 DOI: 10.3390/diagnostics11050842] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
The number of individuals suffering from fatty liver is increasing worldwide, leading to interest in the noninvasive study of liver fat. Magnetic resonance spectroscopy (MRS) is a powerful tool that allows direct quantification of metabolites in tissue or areas of interest. MRS has been applied in both research and clinical studies to assess liver fat noninvasively in vivo. MRS has also demonstrated excellent performance in liver fat assessment with high sensitivity and specificity compared to biopsy and other imaging modalities. Because of these qualities, MRS has been generally accepted as the reference standard for the noninvasive measurement of liver steatosis. MRS is an evolving technique with high potential as a diagnostic tool in the clinical setting. This review aims to provide a brief overview of the MRS principle for liver fat assessment and its application, and to summarize the current state of MRS study in comparison to other techniques.
Collapse
Affiliation(s)
- Duanghathai Pasanta
- Center of Radiation Research and Medical Imaging, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (D.P.); (K.T.H.); (J.P.); (M.T.); (S.K.)
| | - Khin Thandar Htun
- Center of Radiation Research and Medical Imaging, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (D.P.); (K.T.H.); (J.P.); (M.T.); (S.K.)
| | - Jie Pan
- Center of Radiation Research and Medical Imaging, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (D.P.); (K.T.H.); (J.P.); (M.T.); (S.K.)
- Shandong Provincial Key Laboratory of Animal Resistant Biology, College of Life Sciences, Shandong Normal University, Jinan 250014, China
| | - Montree Tungjai
- Center of Radiation Research and Medical Imaging, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (D.P.); (K.T.H.); (J.P.); (M.T.); (S.K.)
| | - Siriprapa Kaewjaeng
- Center of Radiation Research and Medical Imaging, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (D.P.); (K.T.H.); (J.P.); (M.T.); (S.K.)
| | - Hongjoo Kim
- Department of Physics, Kyungpook National University, Daegu 41566, Korea;
| | - Jakrapong Kaewkhao
- Center of Excellence in Glass Technology and Materials Science (CEGM), Nakhon Pathom Rajabhat University, Nakhon Pathom 73000, Thailand;
| | - Suchart Kothan
- Center of Radiation Research and Medical Imaging, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (D.P.); (K.T.H.); (J.P.); (M.T.); (S.K.)
| |
Collapse
|
5
|
Verhoeff K, Dang JT, Modasi A, Switzer N, Birch DW, Karmali S. Bariatric Surgery Outcomes in Patients with Previous Organ Transplant: Scoping Review and Analysis of the MBSAQIP. Obes Surg 2020; 31:508-516. [PMID: 33057982 DOI: 10.1007/s11695-020-05042-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Obesity is a major risk factor for transplant. Laparoscopic bariatric surgery (LBS) offers transplant patient benefits including improved comorbidities, graft function, and longevity. We completed a scoping review and analyzed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to determine the risk-benefit profile of LBS after transplant. We also compared laparoscopic sleeve gastrectomy (LSG) to laparoscopic Roux-en-Y gastric bypass (LRYGB) following transplant. METHODS Univariate analysis determined between group differences with subgroup analysis comparing LSG versus LRYGB in transplant patients. Multivariable analysis assessed whether prior transplant was independently associated with major complications or mortality. RESULTS A total of 469 (0.1%) patients had previous transplant and had more comorbidities and more often underwent LSG. Operative time (93.9 min vs 83 min, p < 0.001) and length of stay were longer. Major complications were threefold higher in patients with a transplant history (9.6% vs 3.2%; p < 0.001. Previous transplant was the second greatest independent predictor for major complication (OR 2.14 [1.54-2.98], p = < 0.001) but was not predictive of death (OR 1.06 [0.14-8.13] p = 0.956). Amongst transplant patients, LRYGB demonstrated higher rates of leak (n = 1), VTE, AKI, unplanned intubation, and readmission. CONCLUSIONS The 30-day complication rate from LBS is three times higher amongst patients with a transplant. LSG is likely the best surgical approach. Despite risks, post-transplant patients incur important benefits from LBS. Surgeons must be aware of this risk-benefit profile when determining LBS candidacy.
Collapse
Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jerry T Dang
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Aryan Modasi
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Noah Switzer
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel W Birch
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
Yang F, Jia X, Lei P, He Y, Xiang Y, Jiao J, Zhou S, Qian W, Duan Q. Quantification of hepatic steatosis in histologic images by deep learning method. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:1033-1045. [PMID: 31744039 DOI: 10.3233/xst-190570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To develop and test a novel method for automatic quantification of hepatic steatosis in histologic images based on the deep learning scheme designed to predict the fat ratio directly, which aims to improve accuracy in diagnosis of non-alcoholic fatty liver disease (NAFLD) with objective assessment of the severity of hepatic steatosis instead of subjective visual estimation. MATERIALS AND METHODS Thirty-six 8-week old New Zealand white rabbits of both sexes were fed with high-cholesterol, high-fat diet and sacrificed under deep anesthesia at various time points to obtain the pathological specimen. All rabbits were performed by multislice computed tomography for surveillance to measure density changes of liver parenchyma. A deep learning scheme using a convolutional neural network was developed to directly predict the liver fat ratio based on the pathological images. The average error value, standard deviation, and accuracy (error <5%) were evaluated and compared between the deep learning scheme and manual segmentation results. The Pearson's correlation coefficient was also calculated in this study. RESULTS The deep learning scheme performs successfully on rabbit liver histologic data, showing a high degree of accuracy and stability. The average error value, standard deviation, and accuracy (error <5%) were 3.21%, 4.02%, and 79.10% for the cropped images, 2.22%, 1.92%, and 88.34% for the original images, respectively. The strong positive correlation was also observed for cropped images (R = 0.9227) and original images (R = 0.9255) in comparison to labeled fat ratio. CONCLUSIONS This new deep learning scheme may aid in the quantification of steatosis in the liver and facilitate its treatment by providing an earlier clinical diagnosis.
Collapse
Affiliation(s)
- Fan Yang
- School of Biology & Engineering, Guizhou Medical University, Guiyang, Guizhou Province, China
- Key Laboratory of Biology and Medical Engineering, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Xianyuan Jia
- School of Biology & Engineering, Guizhou Medical University, Guiyang, Guizhou Province, China
- Key Laboratory of Biology and Medical Engineering, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Pinggui Lei
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Yan He
- School of Biology & Engineering, Guizhou Medical University, Guiyang, Guizhou Province, China
- Key Laboratory of Biology and Medical Engineering, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Yining Xiang
- Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Jun Jiao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Shi Zhou
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Wei Qian
- Department of Electrical and Computer Engineering, College of Engineering, University of Texas, El Paso, TX, USA
| | - Qinghong Duan
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| |
Collapse
|
7
|
Akki AS, Chung SM, Rudolph BJ, Ewart MR. Differential Diagnosis of a Patient with Lysosomal Acid Lipase Deficiency: A Case Report. Lab Med 2018; 49:377-384. [PMID: 29982809 DOI: 10.1093/labmed/lmy027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND We describe the differential diagnosis of an obese 12-year-old boy of Mexican origin who presented with a 6-year history of abnormal lipid profile and elevated liver transaminase levels. METHODS The patient underwent routine clinical testing, an abdominal ultrasound and, ultimately, a liver biopsy. Based on the histologic findings, a serum leukocyte lysosomal acid lipase (LAL) assay and DNA sequencing of the lipase A (LIPA) gene were performed. RESULTS Liver biopsy revealed diffuse microvesicular steatosis with clusters of foamy histiocytes in the lobules and portal areas. Our differential diagnosis included nonalcoholic fatty liver disease; medication-induced hepatotoxicity; glycogenic hepatopathy; medium-chain acyl coenzyme A dehydrogenase or long-chain acyl coenzyme A dehydrogenase deficiency; and lysosomal storage disorders, including Niemann-Pick disease and lysosomal acid lipase deficiency (LAL-D). Serum LAL activity was absent, and DNA sequencing confirmed homozygous mutation in LIPA. CONCLUSIONS Although it occurs rarely, LAL-D should be considered in the differential diagnosis of microvesicular steatosis for a timely diagnosis.
Collapse
Affiliation(s)
- Ashwin S Akki
- Department of Pathology, Montefiore Medical Center, Bronx, NY
| | - Sun M Chung
- Department of Pathology, Montefiore Medical Center, Bronx, NY
| | | | | |
Collapse
|
8
|
Bharath R, Rajalakshmi P, Mateen MA. Multi-modal framework for automatic detection of diagnostically important regions in nonalcoholic fatty liver ultrasonic images. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
9
|
Suraweera D, Saab EG, Choi G, Saab S. Bariatric Surgery and Liver Transplantation. Gastroenterol Hepatol (N Y) 2017; 13:170-175. [PMID: 28539844 PMCID: PMC5439136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Obesity is an important public health and medical concern in the United States. The rate of obesity has steadily risen for the past several decades. Obesity is associated with the development of nonalcoholic steatohepatitis, which is one of the leading indications for liver transplantation. After liver transplantation, recipients tend to gain weight and develop recurrent fatty liver. Over time, recurrent fatty liver may impact patient and graft survival. A bariatric surgical approach may be beneficial in select patients.
Collapse
Affiliation(s)
- Duminda Suraweera
- Dr Suraweera is a chief medical resident/attending physician in the Department of Medicine at Olive-View Medical Center in Sylmar, California. Ms Saab is a research assistant in the Department of Surgery at the University of California at Los Angeles in Los Angeles, California. Dr Choi and Dr Saab are attending physicians in the Departments of Surgery and Medicine at the University of California at Los Angeles
| | - Elena G Saab
- Dr Suraweera is a chief medical resident/attending physician in the Department of Medicine at Olive-View Medical Center in Sylmar, California. Ms Saab is a research assistant in the Department of Surgery at the University of California at Los Angeles in Los Angeles, California. Dr Choi and Dr Saab are attending physicians in the Departments of Surgery and Medicine at the University of California at Los Angeles
| | - Gina Choi
- Dr Suraweera is a chief medical resident/attending physician in the Department of Medicine at Olive-View Medical Center in Sylmar, California. Ms Saab is a research assistant in the Department of Surgery at the University of California at Los Angeles in Los Angeles, California. Dr Choi and Dr Saab are attending physicians in the Departments of Surgery and Medicine at the University of California at Los Angeles
| | - Sammy Saab
- Dr Suraweera is a chief medical resident/attending physician in the Department of Medicine at Olive-View Medical Center in Sylmar, California. Ms Saab is a research assistant in the Department of Surgery at the University of California at Los Angeles in Los Angeles, California. Dr Choi and Dr Saab are attending physicians in the Departments of Surgery and Medicine at the University of California at Los Angeles
| |
Collapse
|
10
|
Impact of Recipient and Donor Obesity Match on the Outcomes of Liver Transplantation: All Matches Are Not Perfect. J Transplant 2016; 2016:9709430. [PMID: 27688905 PMCID: PMC5023820 DOI: 10.1155/2016/9709430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/29/2016] [Accepted: 07/25/2016] [Indexed: 12/19/2022] Open
Abstract
There is a paucity of literature examining recipient-donor obesity matching on liver transplantation outcomes. The United Network for Organ Sharing database was queried for first-time recipients of liver transplant whose age was ≥18 between January 2003 and September 2013. Outcomes including patient and graft survival at 30 days, 1 year, and 5 years and overall, liver retransplantation, and length of stay were compared between nonobese recipients receiving a graft from nonobese donors and obese recipient-obese donor, obese recipient-nonobese donor, and nonobese recipient-obese donor pairs. 51,556 LT recipients were identified, including 34,217 (66%) nonobese and 17,339 (34%) obese recipients. The proportions of patients receiving an allograft from an obese donor were 24% and 29%, respectively, among nonobese and obese recipients. Graft loss (HR: 1.27; 95% CI: 1.09–1.46; p = 0.002) and mortality (HR: 1.38; 95% CI: 1.16–1.65; p < 0.001) at 30 days were increased in the obese recipient-obese donor pair. However, 1-year graft (HR: 0.83; 95% CI: 0.74–0.93; p = 0.002) and patient (HR: 0.84; 95% CI: 0.74–0.95; p = 0.007) survival and overall patient (HR: 0.93; 95% CI: 0.86–1.00; p = 0.042) survival were favorable. There is evidence of recipient and donor obesity disadvantage early, but survival curves demonstrate improved long-term outcomes. It is important to consider obesity in the donor-recipient match.
Collapse
|
11
|
Erard-Poinsot D, Guillaud O, Hervieu V, Thimonier E, Vallin M, Chambon-Augoyard C, Boillot O, Scoazec JY, Dumortier J. Severe alcoholic relapse after liver transplantation: What consequences on the graft? A study based on liver biopsies analysis. Liver Transpl 2016; 22:773-84. [PMID: 26929100 DOI: 10.1002/lt.24425] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 12/13/2022]
Abstract
Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT), but up to 20% of patients experience severe alcoholic relapse. The aims of this study were to evaluate the impact of severe alcoholic relapse on the graft (based on histological examination) and to identify predictive factors associated with recurrent alcoholic cirrhosis (RAC). From 1990 to 2010, 369 patients underwent LT for ALD at Edouard Herriot Hospital (Lyon, France) and survived more than 1 year. All patients who presented severe alcoholic relapse and histological follow-up were included. Liver biopsies were performed at 1 and 5 years and at every 5 years after LT, and when clinically indicated. The median follow-up after LT was 11 years (range, 3-18 years). Severe alcoholic relapse was observed in 73 (20%) of the 369 patients, from whom 56 patients with histological evaluation were included. RAC was diagnosed in 18 (32%) of the 56 patients included, which represents 5% of the 369 patients transplanted for ALD. The median delay between LT and RAC was 6 years (range, 3-10 years) and 4.5 years (range, 2-8 years) after severe alcoholic relapse. The median cumulated years of alcohol use before RAC was 3.5 years (range, 2-7 years). The cumulative risk for F4 fibrosis was 15% at 3 years, 32% at 5 years, and 54% at 10 years after severe alcoholic relapse. A young age at LT (≤50 years old) and an early onset of heavy drinking (within the first 3 years after LT) were associated with RAC. In conclusion, severe alcoholic relapse usually occurs in the first years after LT and is responsible for accelerated severe graft injury. Liver Transplantation 22 773-784 2016 AASLD.
Collapse
Affiliation(s)
- Domitille Erard-Poinsot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Service d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Guillaud
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Valérie Hervieu
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Elsa Thimonier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Mélanie Vallin
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Olivier Boillot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Jean-Yves Scoazec
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| |
Collapse
|
12
|
Goceri E, Shah ZK, Layman R, Jiang X, Gurcan MN. Quantification of liver fat: A comprehensive review. Comput Biol Med 2016; 71:174-89. [PMID: 26945465 DOI: 10.1016/j.compbiomed.2016.02.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 12/19/2022]
Abstract
Fat accumulation in the liver causes metabolic diseases such as obesity, hypertension, diabetes or dyslipidemia by affecting insulin resistance, and increasing the risk of cardiac complications and cardiovascular disease mortality. Fatty liver diseases are often reversible in their early stage; therefore, there is a recognized need to detect their presence and to assess its severity to recognize fat-related functional abnormalities in the liver. This is crucial in evaluating living liver donors prior to transplantation because fat content in the liver can change liver regeneration in the recipient and donor. There are several methods to diagnose fatty liver, measure the amount of fat, and to classify and stage liver diseases (e.g. hepatic steatosis, steatohepatitis, fibrosis and cirrhosis): biopsy (the gold-standard procedure), clinical (medical physics based) and image analysis (semi or fully automated approaches). Liver biopsy has many drawbacks: it is invasive, inappropriate for monitoring (i.e., repeated evaluation), and assessment of steatosis is somewhat subjective. Qualitative biomarkers are mostly insufficient for accurate detection since fat has to be quantified by a varying threshold to measure disease severity. Therefore, a quantitative biomarker is required for detection of steatosis, accurate measurement of severity of diseases, clinical decision-making, prognosis and longitudinal monitoring of therapy. This study presents a comprehensive review of both clinical and automated image analysis based approaches to quantify liver fat and evaluate fatty liver diseases from different medical imaging modalities.
Collapse
Affiliation(s)
- Evgin Goceri
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, USA.
| | - Zarine K Shah
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, USA
| | - Rick Layman
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, USA
| | - Xia Jiang
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, USA
| | - Metin N Gurcan
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, USA
| |
Collapse
|
13
|
Sarkar M, Watt KD, Terrault N, Berenguer M. Outcomes in liver transplantation: does sex matter? J Hepatol 2015; 62:946-55. [PMID: 25433162 PMCID: PMC5935797 DOI: 10.1016/j.jhep.2014.11.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/05/2014] [Accepted: 11/16/2014] [Indexed: 02/06/2023]
Abstract
A growing literature has highlighted important differences in transplant-related outcomes between men and women. In the United States there are fewer women than men on the liver transplant waitlist and women are two times less likely to receive a deceased or living-related liver transplant. Sex-based differences exist not only in waitlist but also in post-transplant outcomes, particularly in some specific liver diseases, such as hepatitis C. In the era of individualized medicine, recognition of these differences in the approach to pre and post-liver transplant care may impact short and long-term outcomes.
Collapse
Affiliation(s)
- Monika Sarkar
- Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, S-357, San Francisco, CA 94143, USA.
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, 200 First St, Rochester, MN 55905, USA
| | - Norah Terrault
- Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, S-357, San Francisco, CA 94143, USA
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, La Fe Hospital and Ciberehd, Universidad Valencia, C/Bulevar Sur sn (Torre F-5) 46026 Valencia, Spain
| |
Collapse
|