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Williams KH, Viera de Ribeiro AJ, Prakoso E, Veillard AS, Shackel NA, Bu Y, Brooks B, Cavanagh E, Raleigh J, McLennan SV, McCaughan GW, Bachovchin WW, Keane FM, Zekry A, Twigg SM, Gorrell MD. Lower serum fibroblast activation protein shows promise in the exclusion of clinically significant liver fibrosis due to non-alcoholic fatty liver disease in diabetes and obesity. Diabetes Res Clin Pract 2015; 108:466-72. [PMID: 25836944 DOI: 10.1016/j.diabres.2015.02.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/28/2015] [Accepted: 02/20/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED Non-alcoholic fatty liver disease (NAFLD) is common in diabetes and obesity but few have clinically significant liver fibrosis. Improved risk-assessment is needed as the commonly used clinical-risk algorithm, the NAFLD fibrosis score (NFS), is often inconclusive. AIMS To determine whether circulating fibroblast activation protein (cFAP), which is elevated in cirrhosis, has value in excluding significant fibrosis, particularly combined with NFS. METHODS cFAP was measured in 106 with type 2 diabetes who had transient elastography (Cohort 1) and 146 with morbid obesity who had liver biopsy (Cohort 2). RESULTS In Cohort 1, cFAP (per SD) independently associated with median liver stiffness (LSM) ≥ 10.3 kPa with OR of 2.0 (95% CI 1.2-3.4), p=0.006. There was 0.12 OR (95% CI 0.03-0.61) of LSM ≥ 10.3 kPa for those in the lowest compared with the highest FAP tertile (p=0.010). FAP levels below 730 pmol AMC/min/mL had 95% NPV for LSM ≥ 10.3 kPa and reclassified 41% of 64 subjects from NFS 'indeterminate-risk' to 'low-risk'. In Cohort 2, cFAP (per SD), associated with 1.7 fold (95% CI 1.1-2.8) increased odds of significant fibrosis (F ≥ 2), p=0.021, and low cFAP reclassified 49% of 73 subjects from 'indeterminate-risk' to 'low-risk'. CONCLUSIONS Lower cFAP, when combined with NFS, may have clinical utility in excluding significant fibrosis in diabetes and obesity.
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Affiliation(s)
- K H Williams
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; The Charles Perkins Centre, Building D17, Johns Hopkins Drive, The University of Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
| | - A J Viera de Ribeiro
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - E Prakoso
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - A S Veillard
- NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
| | - N A Shackel
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - Y Bu
- Inflammation and Infection Research Centre, School of Medical Sciences, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia.
| | - B Brooks
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; Sydney Nursing School, Building M02, The University of Sydney, NSW 2006, Australia.
| | - E Cavanagh
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.
| | - J Raleigh
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.
| | - S V McLennan
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; The Charles Perkins Centre, Building D17, Johns Hopkins Drive, The University of Sydney, NSW, Australia.
| | - G W McCaughan
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - W W Bachovchin
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
| | - F M Keane
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
| | - A Zekry
- Inflammation and Infection Research Centre, School of Medical Sciences, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia; The St George Hospital, Gray Street, Kogarah, NSW 2217, Australia.
| | - S M Twigg
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia; The Charles Perkins Centre, Building D17, Johns Hopkins Drive, The University of Sydney, NSW, Australia.
| | - M D Gorrell
- Sydney Medical School, The Edward Ford Building (A27), The University of Sydney, NSW, Australia; Centenary Institute, Locked Bag 6, Newtown, NSW 2042, Australia.
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Prakoso E, Jones C, Koorey DJ, Strasser SI, Bowen D, McCaughan GW, Shackel NA. Terlipressin therapy for moderate-to-severe hyponatraemia in patients with liver failure. Intern Med J 2013; 43:240-6. [PMID: 23176166 DOI: 10.1111/imj.12032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/28/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hyponatraemia in liver failure is associated with increased morbidity and mortality. Improving serum sodium in liver failure has been observed in patients receiving terlipressin. METHODS We assessed the response of hyponatraemia in patients with liver failure to terlipressin using comparative retrospective analysis. RESULTS Twenty-three patients received terlipressin for hyponatraemia after failed conservative management (median age 52 years (27-67), model for end-stage liver disease score 28 (16-38)). The median therapy was 7 days (1-27), with an average total dose of 25 mg (4-90) and a mean follow up of 51 days (5-1248). These patients were compared with 11 hyponatraemic patients managed conservatively during the same period with comparable age, baseline serum sodium and follow up. After 1 week of terlipressin therapy, serum sodium increased from a median of 120 (115-128) to 129 mmol/L (121-144) (P < 0.001), and at the end of terlipressin therapy, the serum sodium had increased significantly to 131 mmol/L (120-148) (P < 0.001). In comparison, in the conservatively managed group, the serum sodium did not increase significantly from the baseline of 123 (117-127) mmol/L. Adverse events occurred in 26% of patients receiving terlipressin, which predominantly pulmonary oedema. Importantly, more hyponatraemic patients treated with terlipressin (48%) were alive compared with the conservative group (18%), despite the latter having a significantly lower baseline median MELD score of 21 (16-30) (P = 0.008). Moreover, the transplant-free survival was higher in the terlipressin (30%) compared with the conservative group (0%). CONCLUSIONS Terlipressin is effective in treating hyponatraemia in liver failure. Importantly, terlipressin use results in better transplant-free survival but also more adverse events.
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Affiliation(s)
- E Prakoso
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Australia
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Prakoso E, Verran D, Dilworth P, Kyd G, Tang P, Tse C, Koorey DJ, Strasser SI, Stormon M, Shun A, Thomas G, Joseph D, Pleass H, Gallagher J, Allen R, Crawford M, McCaughan GW, Shackel NA. Increasing liver transplantation waiting list mortality: a report from the Australian National Liver Transplantation Unit, Sydney. Intern Med J 2011; 40:619-25. [PMID: 20840212 DOI: 10.1111/j.1445-5994.2010.02277.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We aimed to describe the demand for liver transplantation (LTx) and patient outcomes on the waiting list at the Australian National Liver Transplantation Unit, Sydney over the last 20 years. METHODS We performed a retrospective analysis with the data divided into three eras: 1985-1993, 1994-2000 and 2001-2008. RESULTS The number of patients accepted for LTx increased from 320 to 372 and 548 (P < 0.001) with the number of LTx being performed increasing from 262 to 312 and 452 respectively (P < 0.001). The median adult recipient age increased from 45 to 48 and 52 years (P < 0.001) while it decreased in children from 4 to 2 and 1 years respectively (P = 0.001). In parallel, the deceased donor offers decreased from 1003 to 720 and 717 (P < 0.001). Methods to improve access to donor livers have been used with the use of split livers, extended criteria and non-heart beating donors, resulting in increased acceptance of deceased donor offers by 65% and 115% in the second and third eras when compared with the first era (P < 0.001). However, the adult median waiting time has increased from 23 to 41 and 120 days respectively (P < 0.001). This was associated with increased adult mortality on the waiting list from 23 to 40 and 122 respectively (P < 0.001). CONCLUSIONS Despite the increasing proportion of donor offers being used, the waiting list mortality is increasing. A solution to this problem is an increase in organ donation to keep pace with the escalating demand for LTx.
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Affiliation(s)
- E Prakoso
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, New South Wales, Australia
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