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Meunier L, Malezieux E, Ursic Bedoya J, Faure S, Echenne M, Debourdeau A, Meszaros M, Pageaux GP. Mycophenolate mofetil discontinuation increases severe acute respiratory syndrome coronavirus 2 vaccine response in nonresponder liver transplantation recipients: A proof of concept. Liver Transpl 2022; 29:114-117. [PMID: 36047916 PMCID: PMC9538094 DOI: 10.1002/lt.26569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/09/2022] [Accepted: 08/15/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Lucy Meunier
- Hepatology and Liver Transplant UnitSaint Eloi University Hospital, Montpellier UniversityMontpellierFrance
| | - Emilie Malezieux
- Hepatology and Liver Transplant UnitSaint Eloi University Hospital, Montpellier UniversityMontpellierFrance
| | - José Ursic Bedoya
- Hepatology and Liver Transplant UnitSaint Eloi University Hospital, Montpellier UniversityMontpellierFrance
| | - Stéphanie Faure
- Hepatology and Liver Transplant UnitSaint Eloi University Hospital, Montpellier UniversityMontpellierFrance
| | - Maxime Echenne
- Hepatology and Liver Transplant UnitSaint Eloi University Hospital, Montpellier UniversityMontpellierFrance
| | - Antoine Debourdeau
- Hepatology and Liver Transplant UnitSaint Eloi University Hospital, Montpellier UniversityMontpellierFrance
| | - Magdalena Meszaros
- Hepatology and Liver Transplant UnitSaint Eloi University Hospital, Montpellier UniversityMontpellierFrance
| | - Georges Philippe Pageaux
- Hepatology and Liver Transplant UnitSaint Eloi University Hospital, Montpellier UniversityMontpellierFrance
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Meunier L, Sanavio M, Dumortier J, Meszaros M, Faure S, Ursic Bedoya J, Echenne M, Boillot O, Debourdeau A, Pageaux GP. Mycophenolate mofetil decreases humoral responses to three doses of SARS-CoV-2 vaccine in liver transplant recipients. Liver Int 2022; 42:1872-1878. [PMID: 35338550 PMCID: PMC9115190 DOI: 10.1111/liv.15258] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS After 2 doses, the efficacy of anti-SARS-CoV-2 vaccination seems to be lower in solid organ transplant recipients than in the immunocompetent population. The objective of this study was to determine the humoral response rate after vaccination, including with a booster dose, and to identify risk factors for non-responsiveness in liver transplant recipients. METHODS We included all patients seen in consultation in two French liver transplant centres between January 1, 2021, and March 15, 2021. RESULTS 598 liver transplant recipients were enrolled and 327 were included for analysis. Sixteen patients received one dose, 63 patients two doses and 248 patients three doses. Anti-SARS-Cov-2 antibodies were detected in 242 out of 327 (74.0%) liver transplant patients after vaccination. Considering an optimal serologic response defined as an antibody titre >260 BAU/ml, 172 patients (52.6%) were responders. Mycophenolate mofetil (MMF) treatment was an independent risk factor for a failure to develop anti-SARS-CoV-2 antibodies after vaccination (OR 0.458; 95%CI 0.258-0.813; p = .008). Conversely, male gender (OR 2.247, 95%CI 1.194-4.227; p = .012) and receiving an mRNA vaccine (vs a non-mRNA vaccine) (OR 4.107, 95%CI 1.145-14.731; p = .030) were independent predictive factors for developing an optimal humoral response after vaccination. None of the patients who received the vaccine experienced any serious adverse events. CONCLUSIONS Even after a third booster dose, response rate to vaccination is decreased in liver transplant recipients. MMF appears to be a major determinant of seroconversion and optimal response to vaccination in these patients.
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Affiliation(s)
- Lucy Meunier
- Hepatology and Liver Transplant UnitSt Eloi Hospital, UniversityMontpellierFrance
| | - Mathilde Sanavio
- Hepatology and Liver Transplant UnitSt Eloi Hospital, UniversityMontpellierFrance
| | - Jérôme Dumortier
- Hepatology and Liver Transplant UnitEdouard Herriot HospitalLyonFrance
| | - Magdalena Meszaros
- Hepatology and Liver Transplant UnitSt Eloi Hospital, UniversityMontpellierFrance
| | - Stéphanie Faure
- Hepatology and Liver Transplant UnitSt Eloi Hospital, UniversityMontpellierFrance
| | - José Ursic Bedoya
- Hepatology and Liver Transplant UnitSt Eloi Hospital, UniversityMontpellierFrance
| | - Maxime Echenne
- Hepatology and Liver Transplant UnitSt Eloi Hospital, UniversityMontpellierFrance
| | - Olivier Boillot
- Hepatology and Liver Transplant UnitEdouard Herriot HospitalLyonFrance
| | - Antoine Debourdeau
- Hepatology and Liver Transplant UnitSt Eloi Hospital, UniversityMontpellierFrance
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Roche B, Bauhofer A, Gomez Bravo MÃ, Pageaux GP, Zoulim F, Otero A, Prieto M, Baliellas C, Samuel D. Long-Term Effectiveness, Safety, and Patient-Reported Outcomes of Self-Administered Subcutaneous Hepatitis B Immunoglobulin in Liver Post-Transplant Hepatitis B Prophylaxis: A Prospective Non-Interventional Study. Ann Transplant 2022; 27:e936162. [PMID: 35534995 PMCID: PMC9107284 DOI: 10.12659/aot.936162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Bruno Roche
- Hepato-Biliary Center, AP-HP Hôpital Universitaire Paul Brousse, Paris-Saclay University, Research INSERM-Paris Saclay Unit 1193, Villejuif, France
| | - Artur Bauhofer
- Corporate Medical Affairs, Biotest AG, Dreieich, Germany
| | | | - Georges Philippe Pageaux
- Department of Hepato-GastroEnterology Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Fabien Zoulim
- Hepatology Service, North Hospital Group, Hospices Civils de Lyon; Université Lyon 1; INSERM Unit 1052, Lyon, France
| | - Alejandra Otero
- Liver Transplant Unit, University Hospital of A Coruña, Coruña, Spain
| | - Martin Prieto
- Liver Transplantation and Hepatology Unit, Hospital Universitari I Politècnic La Fe-IIS La Fe, Valencia, Spain
| | - Carmen Baliellas
- Liver Transplant Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Didier Samuel
- Hepato-Biliary Center, AP-HP Hôpital Universitaire Paul Brousse, Paris-Saclay University, Research INSERM-Paris Saclay Unit 1193, Villejuif, France
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Costentin C, Piñero F, Degroote H, Notarpaolo A, Boin IF, Boudjema K, Baccaro C, Podestá LG, Bachellier P, Ettorre GM, Poniachik J, Muscari F, Dibenedetto F, Hoyos Duque S, Salame E, Cillo U, Marciano S, Vanlemmens C, Fagiuoli S, Burra P, Van Vlierberghe H, Cherqui D, Lai Q, Silva M, Rubinstein F, Duvoux C, Boudjema K, Bachellier P, Conti F, Scatton O, Muscari F, Salame E, Bernard PH, Francoz C, Durand F, Dharancy S, Woehl ML, Vanlemmens C, Laurent A, Radenne S, Dumortier J, Abergel A, Cherqui D, Barbier L, Houssel-Debry P, Pageaux GP, Chiche L, Deledinghen V, Hardwigsen J, Gugenheim J, altieri M, Hilleret MN, Decaens T, Duvoux C, Piñero F, Chagas A, Costa P, Cristina de Ataide E, Quiñones E, Duque SH, Marciano S, Anders M, Varón A, Zerega A, Poniachik J, Soza A, Machaca MP, Arufe D, Menéndez J, Zapata R, Vilatoba M, Muñoz L, Menéndez RC, Maraschio M, Podestá LG, McCormack L, Mattera J, Gadano A, Fatima Boin ISF, Parente García JH, Carrilho F, Silva M, Notarpaolo A, Magini G, Miglioresi L, Gambato M, Benedetto FD, D’Ambrosio C, Ettorre GM, Vitale A, Burra P, Fagiuoli S, Cillo U, Colledan M, Pinelli D, Magistri P, Vennarecci G, Colasanti M, Giannelli V, Pellicelli A, Baccaro C, Lai Q, Degroote H, Vlierberghe HV, Eduard C, Samuele I, Jeroen D, Jonas S, Jacques P, Chris V, Dirk Y, Peter M, Valerio L, Christophe M, Olivier D, Jean D, Roberto T, Paul LJ. R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation. JHEP Rep 2022; 4:100445. [PMID: 35360522 PMCID: PMC8961219 DOI: 10.1016/j.jhepr.2022.100445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background & Aims Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3–6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101–1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber’s c-index was 0.76 (95% CI 0.72–0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72–0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1–2 points; 15.1%), high (3–6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber’s c-index of 0.78; 95% CI 0.73–0.83). Conclusions The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria. Clinical Trials Registration NCT03775863. Lay summary Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables independently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT. Discrepancies between pretransplant tumour assessment and liver explant are frequent. The R3-AFP predictive model of recurrence was designed and validated in a large and international cohort of patients transplanted for HCC. The components of the final model are the following: number of nodules, size of the largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value. The R3-AFP model including the last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a standardised framework to refine post-LT management of patients, irrespective of criteria used to select patients with HCC for LT.
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Aghemo A, Horsmans Y, Bourgeois S, Bondin M, Gschwantler M, Hofer H, Semmo N, Negro F, Zhang Z, Marcinak J, Veitsman E, Hazzan R, Mimidis K, Goulis I, Marques N, Flisiak R, Mazur W, Roncero C, Marra F, Pageaux GP, Asselah T, Lampertico P. Correction to: Real-World Outcomes in Historically Underserved Patients with Chronic Hepatitis C Infection Treated with Glecaprevir/Pibrentasvir. Infect Dis Ther 2021; 10:2223-2225. [PMID: 34529256 PMCID: PMC8572889 DOI: 10.1007/s40121-021-00529-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy. .,Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Yves Horsmans
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | | | | | - Michael Gschwantler
- Department of Internal Medicine IV, Wilhelminenspital, and Sigmund Freud University, Vienna, Austria
| | - Harald Hofer
- Department of Internal Medicine, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Nasser Semmo
- Department of BioMedical Research, Hepatology, Inselspital, University of Bern, 3010, Bern, Switzerland
| | - Francesco Negro
- Division of Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland.,Division of Clinical Pathology, University Hospital, Geneva, Switzerland
| | | | | | - Ella Veitsman
- Liver Unit, Rambam Health Care Campus, Haifa, Israel
| | | | - Konstantinos Mimidis
- First Department of Internal Medicine, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Ioannis Goulis
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nuno Marques
- Infectious Diseases Service, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
| | - Wlodzimierz Mazur
- Clinical Department of Infectious Diseases, Medical University of Silesia, Katowice, Poland
| | - Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine and School of Medicine, University of Salamanca, Salamanca, Spain
| | - Fiona Marra
- Hepatology Drug Interactions Group, University of Liverpool, Liverpool, UK
| | - Georges Philippe Pageaux
- Département Hépato-Gastro-Entérologie, Centre Hospitalier Universitaire (CHU) de Montpellier, Montpellier Cedex 5, France
| | - Tarik Asselah
- Department of Hepatology, Hopital Beaujon, AP-HP, Paris University and INSERM UMR 1149, Clichy, France
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico-Division of Gastroenterology and Hepatology-CRC 'AM and A Migliavacca' Centre for Liver Disease, Milan, Italy.,University of Milan, Milan, Italy
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6
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Saliba F, Dharancy S, Salamé E, Conti F, Eyraud D, Radenne S, Antonini T, Guillaud O, Guguenheim J, Neau-Cransac M, Demartin E, Lasailly G, Duvoux C, Sobesky R, Coilly A, Tresson S, Cailliez V, Boillot O, Pageaux GP, Samuel D, Calmus Y, Dumortier J. Time to Conversion to an Everolimus-Based Regimen: Renal Outcomes in Liver Transplant Recipients From the EVEROLIVER Registry. Liver Transpl 2020; 26:1465-1476. [PMID: 32869469 DOI: 10.1002/lt.25879] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022]
Abstract
Longterm use of a calcineurin inhibitor (CNI)-based regimen is one of the major reasons for chronic renal failure in liver transplantation recipients (LTRs). The Everolimus Liver registry (EVEROLIVER) evaluated renal function in LTRs who were converted to everolimus (EVR). This observational registry included all LTRs receiving EVR across 9 centers from France. Data are being collected in an electronic database over 10 years (12 visits/patient) to evaluate efficacy, renal function (estimated glomerular filtration rate [eGFR]), and safety of EVR use in clinical practice, and the current analysis is reporting up to 60 months of findings. Until September 2017, 1045 patients received EVR after a mean time of 3.6 ± 5.1 years. CNI withdrawal was feasible in 57.7% of patients as of month 60. Mean eGFR improved in patients with baseline eGFR <60 mL/minute/1.73 m2 and was maintained in those with baseline eGFR ≥60 mL/minute/1.73 m2 . Among patients with chronic kidney disease (CKD; baseline eGFR <60 mL/minute/1.73 m2 ), 55% converted to EVR within 3 months (early conversion) and 39.4% converted between 4 and 12 months after transplantation (mid-conversion) experienced improvement in eGFR (≥60 mL/minute/1.73 m2 ) at month 36. Only 20.9% and 17.4% among those converted beyond 12 months (late conversion) experienced improvement respectively at month 36 and 60. A logistic regression analysis in patients with CKD stage ≥3 demonstrated that late conversion, age, and female sex were associated with nonimprovement of eGFR (≥60 mL/minute/1.73 m2 ). Data from this real-life use of EVR indicate that renal function was maintained from the preconversion period until month 36 even in patients with advanced CKD. However, early rather than late conversion appears to be a safe approach to preserve longterm renal function in LTRs.
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Affiliation(s)
- Faouzi Saliba
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Université Paris Saclay, Villejuif, France
| | - Sébastien Dharancy
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Ephrem Salamé
- Service de Chirurgie Hépato-Biliaire et Digestive, Hôpital Trousseau, Centre Hospitalier Universitaire Tours, Tours, France
| | - Filoména Conti
- Service de Chirurgie Digestive et Hépato-Biliaire, AP-HP Hôpital Pitié Salpêtrière, Transplantation Hépatique, Paris, France
| | - Daniel Eyraud
- Département d'Anesthésie-Réanimation, Service de Chirurgie Digestive et Hépato-Biliaire et de Transplantation Hépatique, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Sylvie Radenne
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital la Croix Rousse, Lyon, France
| | - Térésa Antonini
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Université Paris Saclay, Villejuif, France
| | - Olivier Guillaud
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Lyon, France
| | - Jean Guguenheim
- Département de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet, University of Nice Sophia Antipolis, Nice, France
| | - Martine Neau-Cransac
- Unité de Chirurgie Hépato-Biliaire et de Transplantation Hépatique, Hôpital Magellan, Centre Hospitalier Universitaire Bordeaux, Pessac, France
| | - Eléonora Demartin
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Université Paris Saclay, Villejuif, France
| | - Guillaume Lasailly
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christophe Duvoux
- Service d'Hépato-Gastro-Entérologie, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Rodolphe Sobesky
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Université Paris Saclay, Villejuif, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Université Paris Saclay, Villejuif, France
| | - Sylvie Tresson
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Université Paris Saclay, Villejuif, France
| | - Valérie Cailliez
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Université Paris Saclay, Villejuif, France
| | - Olivier Boillot
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Lyon, France
| | - Georges Philippe Pageaux
- Service d'Hépato-Gastro-Entérologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Didier Samuel
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, INSERM, Unité 1193, Université Paris Saclay, Villejuif, France
| | - Yvon Calmus
- Service de Chirurgie Digestive et Hépato-Biliaire, AP-HP Hôpital Pitié Salpêtrière, Transplantation Hépatique, Paris, France
| | - Jérôme Dumortier
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Lyon, France
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Calderaro J, Meunier L, Nguyen CT, Boubaya M, Caruso S, Luciani A, Amaddeo G, Regnault H, Nault JC, Cohen J, Oberti F, Michalak S, Bouattour M, Vilgrain V, Pageaux GP, Ramos J, Barget N, Guiu B, Paradis V, Aubé C, Laurent A, Pawlotsky JM, Ganne-Carrié N, Zucman-Rossi J, Seror O, Ziol M. ESM1 as a Marker of Macrotrabecular-Massive Hepatocellular Carcinoma. Clin Cancer Res 2019; 25:5859-5865. [PMID: 31358545 DOI: 10.1158/1078-0432.ccr-19-0859] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/04/2019] [Accepted: 07/11/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is a novel morphological subtype of HCC associated with early relapse after resection or percutaneous ablation, independently of classical clinical and radiological prognostic factors. The aim of the present study was to identify immunohistochemical markers of MTM-HCC, to ease its diagnosis and implementation into clinical practice. EXPERIMENTAL DESIGN To identify potential biomarkers of MTM-HCC, we first analyzed gene expression profiling data from The Cancer Genome Atlas study and further selected two candidate biomarkers. Performance of both biomarkers for diagnosis of MTM-HCC was further tested by immunohistochemistry in two independent series of 67 and 132 HCC biopsy samples. RESULTS Analysis of RNA sequencing data showed that MTM-HCC was characterized by a high expression of neoangiogenesis-related genes. Two candidate biomarkers, Endothelial-Specific Molecule 1 (ESM1) and Carbonic Anhydrase IX (CAIX), were selected. In the discovery series, sensitivity and specificity of ESM1 expression by stromal endothelial cells for the detection of MTM-HCC were 97% (28/29), and 92% (35/38), respectively. Sensitivity and specificity of CAIX were 48% (14/29) and 89% (34/38). In the validation set, sensitivity and specificity of ESM1 for the identification of MTM-HCC were 93% (14/15) and 91% (107/117), respectively. Interobserver agreement for ESM1 assessment was good in both series (Cohen Kappa 0.77 and 0.76). CONCLUSIONS Using a molecular-driven selection of biomarkers, we identified ESM1 as a reliable microenvironment immunohistochemical marker of MTM-HCC. The results represent a step toward the implementation of HCC morpho-molecular subtyping into clinical practice.
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Affiliation(s)
- Julien Calderaro
- Assistance Publique-Hôpitaux de Paris, Département Pathologie, CHU Henri Mondor, F-94000 Créteil, France. .,Université Paris-Est Créteil, Faculté de Médecine, Créteil, France.,Inserm, U955, Team 18, Créteil, France
| | - Léa Meunier
- INSERM UMR-1162, génomique fonctionnelle des tumeurs solides, Paris, France
| | - Cong Trung Nguyen
- Université Paris-Est Créteil, Faculté de Médecine, Créteil, France.,Inserm, U955, Team 18, Créteil, France
| | - Marouane Boubaya
- Unité de Recherche Clinique, AP-HP, Hôpital Universitaire Avicenne, Bobigny, France
| | - Stefano Caruso
- INSERM UMR-1162, génomique fonctionnelle des tumeurs solides, Paris, France
| | - Alain Luciani
- Université Paris-Est Créteil, Faculté de Médecine, Créteil, France.,Inserm, U955, Team 18, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Service de Radiologie, CHU Henri Mondor, F-94000 Créteil, France
| | - Giuliana Amaddeo
- Université Paris-Est Créteil, Faculté de Médecine, Créteil, France.,Inserm, U955, Team 18, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Service d'Hépatologie, CHU Henri Mondor, F-94000 Créteil, France
| | - Hélène Regnault
- Assistance Publique-Hôpitaux de Paris, Service d'Hépatologie, CHU Henri Mondor, F-94000 Créteil, France
| | - Jean-Charles Nault
- INSERM UMR-1162, génomique fonctionnelle des tumeurs solides, Paris, France.,Service d'Hépatologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, AP-HP, Bondy, France.,Université Paris 13, Sorbonne Paris-Cité, Bobigny, France
| | - Justine Cohen
- Assistance Publique-Hôpitaux de Paris, Département Pathologie, CHU Henri Mondor, F-94000 Créteil, France.,Université Paris-Est Créteil, Faculté de Médecine, Créteil, France
| | - Frédéric Oberti
- Hépato-gastroentérologie et oncologie digestive, Centre Hospitalier Universitaire d'Angers, France
| | - Sophie Michalak
- Service d'Anatomie et de Cytologie Pathologiques, Centre Hospitalier Universitaire d'Angers, France
| | - Mohamed Bouattour
- Assistance Publique-Hôpitaux de Paris, Service d'Oncologie Digestive, Hôpital Universitaire Beaujon, France
| | - Valérie Vilgrain
- Assistance Publique-Hôpitaux de Paris, Service d'Anatomie et de Cytologie Pathologiques, Hôpital Universitaire Beaujon, France
| | - Georges Philippe Pageaux
- Hépato-gastroentérologie et oncologie digestive, Centre Hospitalier Universitaire de Montpellier, France
| | - Jeanne Ramos
- Service d'Anatomie et de Cytologie Pathologiques, Centre Hospitalier Universitaire de Montpellier, France
| | - Nathalie Barget
- Assistance Publique-Hôpitaux de Paris, Centre de ressources biologiques BB-0033-00027 du Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, Bondy, France
| | - Boris Guiu
- Service de Radiologie, Centre Hospitalier Universitaire de Montpellier, France
| | - Valérie Paradis
- Assistance Publique-Hôpitaux de Paris, Service de Radiologie, Hôpital Universitaire Beaujon, France
| | - Christophe Aubé
- Service de Radiologie, Centre Hospitalier Universitaire d'Angers, France
| | - Alexis Laurent
- Assistance Publique-Hôpitaux de Paris, Département de Chirurgie Digestive et Hépato-Biliaire, CHU Henri Mondor, F-94000 Créteil, France
| | - Jean-Michel Pawlotsky
- Université Paris-Est Créteil, Faculté de Médecine, Créteil, France.,Inserm, U955, Team 18, Créteil, France.,Service de Virologie, Bactériologie-Hygiène, Mycologie-Parasitologie et Unité Transversale de Traitement des Infections, Assistance-Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France.,Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France
| | - Nathalie Ganne-Carrié
- INSERM UMR-1162, génomique fonctionnelle des tumeurs solides, Paris, France.,Service d'Hépatologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, AP-HP, Bondy, France.,Université Paris 13, Sorbonne Paris-Cité, Bobigny, France
| | - Jessica Zucman-Rossi
- INSERM UMR-1162, génomique fonctionnelle des tumeurs solides, Paris, France.,Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France.,Assistance Publique-Hôpitaux de Paris, Service d'Oncologie Médicale, Hôpital Européen Georges Pompidou, Paris, France
| | - Olivier Seror
- Service de Radiologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Marianne Ziol
- INSERM UMR-1162, génomique fonctionnelle des tumeurs solides, Paris, France.,Université Paris 13, Sorbonne Paris-Cité, Bobigny, France.,Assistance Publique-Hôpitaux de Paris, Service d'Anatomie et de Cytologie Pathologiques, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, Bondy, France
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8
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Ziol M, Poté N, Amaddeo G, Laurent A, Nault JC, Oberti F, Costentin C, Michalak S, Bouattour M, Francoz C, Pageaux GP, Ramos J, Decaens T, Luciani A, Guiu B, Vilgrain V, Aubé C, Derman J, Charpy C, Zucman-Rossi J, Barget N, Seror O, Ganne-Carrié N, Paradis V, Calderaro J. Macrotrabecular-massive hepatocellular carcinoma: A distinctive histological subtype with clinical relevance. Hepatology 2018; 68:103-112. [PMID: 29281854 DOI: 10.1002/hep.29762] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/21/2017] [Indexed: 12/19/2022]
Abstract
UNLABELLED We recently identified a histological subtype of hepatocellular carcinoma (HCC), designated as "macrotrabecular-massive" (MTM-HCC) and associated with specific molecular features. In order to assess the clinical relevance of this variant, we investigated its prognostic value in two large series of patients with HCC treated by either surgical resection or radiofrequency ablation (RFA). We retrospectively included 237 HCC surgical samples and 284 HCC liver biopsies from patients treated by surgical resection and RFA, respectively. Histological slides were reviewed by pathologists specialized in liver disease, and the MTM-HCC subtype was defined by the presence of a predominant (>50%) macrotrabecular architecture (more than six cells thick). The main clinical and biological features were recorded at baseline. Clinical endpoints were early and overall recurrence. The MTM-HCC subtype was identified in 12% of the whole cohort (16% of surgically resected samples, 8.5% of liver biopsy samples). It was associated at baseline with known poor prognostic factors (tumor size, alpha-fetoprotein level, satellite nodules, and vascular invasion). Multivariate analysis showed that MTM-HCC subtype was an independent predictor of early and overall recurrence (surgical series: hazard ratio, 3.03; 95% confidence interval, 1.38-6.65; P = 0.006; and 2.76; 1.63-4.67; P < 0.001; RFA series: 2.37; 1.36-4.13; P = 0.002; and 2.19; 1.35-3.54; P = 0.001, respectively). Its prognostic value was retained even after patient stratification according to common clinical, biological, and pathological features of aggressiveness. No other baseline parameter was independently associated with recurrence in the RFA series. CONCLUSION The MTM-HCC subtype, reliably observed in 12% of patients eligible for curative treatment, represents an aggressive form of HCC that may require more specific therapeutic strategies. (Hepatology 2018;68:103-112).
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Affiliation(s)
- Marianne Ziol
- Service d'anatomie pathologique, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France.,Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France
| | - Nicolas Poté
- Assistance Publique-Hôpitaux de Paris, Service d'Anatomie et de Cytologie Pathologiques, Hôpital Universitaire Beaujon; INSERM, Université Paris Diderot, CNRS, Centre de Recherche sur l'Inflammation (CRI), Paris, Département Hospitalo-Universitaire (DHU) UNITY, Clichy, France
| | - Giuliana Amaddeo
- Inserm, U955, Team 18, Université Paris-Est Créteil, Faculté de Médecine.,Assistance Publique-Hôpitaux de Paris, Service d'Hépatologie, CHU Henri Mondor
| | - Alexis Laurent
- Inserm, U955, Team 18, Université Paris-Est Créteil, Faculté de Médecine.,Assistance Publique-Hôpitaux de Paris, Département de Chirurgie Digestive et Hépato-Biliaire, CHU Henri Mondor, Créteil, France
| | - Jean-Charles Nault
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Service d'Hépatologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Frédéric Oberti
- Hépato-gastroentérologie et oncologie digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Charlotte Costentin
- Assistance Publique-Hôpitaux de Paris, Service d'Hépatologie, CHU Henri Mondor
| | - Sophie Michalak
- Service d'Anatomie et de Cytologie Pathologiques, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Mohamed Bouattour
- Assistance Publique-Hôpitaux de Paris, Service d'Hépatologie, Hôpital Universitaire Beaujon, France
| | - Claire Francoz
- Assistance Publique-Hôpitaux de Paris, Service d'Hépatologie, Hôpital Universitaire Beaujon, France
| | - Georges Philippe Pageaux
- Hépato-gastroentérologie et oncologie digestive, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Jeanne Ramos
- Service d'Anatomie et de Cytologie Pathologiques, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Thomas Decaens
- Clinique Universitaire d'Hépato-gastroentérologie, Pôle Digidune, CHU Grenoble Alpes; Université Grenoble Alpes; Institute for Advanced Biosciences-Inserm U1209/CNRS UMR 5309/Université de Grenoble-Alpes, Grenoble, France
| | - Alain Luciani
- Inserm, U955, Team 18, Université Paris-Est Créteil, Faculté de Médecine.,Assistance Publique-Hôpitaux de Paris, Service de Radiologie, CHU Henri Mondor, Créteil, France
| | - Boris Guiu
- Service de Radiologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Christophe Aubé
- Service de Radiologie, Centre Hospitalier-Universitaire d'Angers, Angers, France
| | - Jonathan Derman
- Assistance Publique-Hôpitaux de Paris, Département de Pathologie, Hôpital Henri Mondor, Créteil, France
| | - Cécile Charpy
- Assistance Publique-Hôpitaux de Paris, Département de Pathologie, Hôpital Henri Mondor, Créteil, France
| | - Jessica Zucman-Rossi
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Nathalie Barget
- Centre de ressources biologiques BB-0033-00027, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris
| | - Olivier Seror
- Assistance Publique-Hôpitaux de Paris, Service de Radiologie, Hôpital Jean Verdier, Bondy, France
| | - Nathalie Ganne-Carrié
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Service d'Hépatologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Valérie Paradis
- Assistance Publique-Hôpitaux de Paris, Service d'Anatomie et de Cytologie Pathologiques, Hôpital Universitaire Beaujon; INSERM, Université Paris Diderot, CNRS, Centre de Recherche sur l'Inflammation (CRI), Paris, Département Hospitalo-Universitaire (DHU) UNITY, Clichy, France
| | - Julien Calderaro
- Inserm, U955, Team 18, Université Paris-Est Créteil, Faculté de Médecine.,Assistance Publique-Hôpitaux de Paris, Département de Pathologie, Hôpital Henri Mondor, Créteil, France
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9
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Rosenthal E, Fougerou-Leurent C, Renault A, Carrieri MP, Marcellin F, Garraffo R, Teicher E, Aumaitre H, Lacombe K, Bailly F, Billaud E, Chevaliez S, Dominguez S, Valantin MA, Reynes J, Naqvi A, Cotte L, Metivier S, Leroy V, Dupon M, Allegre T, De Truchis P, Jeantils V, Chas J, Salmon-Ceron D, Morlat P, Neau D, Perré P, Piroth L, Pol S, Bourlière M, Pageaux GP, Alric L, Zucman D, Girard PM, Poizot-Martin I, Yazdanpanah Y, Raffi F, Pabic EL, Tual C, Pailhé A, Amri I, Bellissant E, Molina JM. Efficacy, safety and patient-reported outcomes of ledipasvir/sofosbuvir in NS3/4A protease inhibitor-experienced individuals with hepatitis C virus genotype 1 and HIV coinfection with and without cirrhosis (ANRS HC31 SOFTRIH study). HIV Med 2017; 19:227-237. [PMID: 29214737 DOI: 10.1111/hiv.12571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Studies evaluating the efficacy and safety of the fixed-dose combination ledipasvir (LDV)/sofosbuvir (SOF) in patients coinfected with HIV-1 and hepatitis C virus (HCV) have mainly included treatment-naïve patients without cirrhosis. We aimed to evaluate the efficacy and safety of this combination in treatment-experienced patients with and without cirrhosis. METHODS We conducted a multicentre, open-label, double-arm, nonrandomized study in patients coinfected with HIV-1 and HCV genotype 1 with and without cirrhosis, who had good viral suppression on their antiretroviral regimens. All patients were pretreated with a first-generation NS3/4A protease inhibitor (PI) plus pegylated interferon/ribavirin. Patients received a fixed-dose combination of LDV/SOF for 12 weeks, or for 24 weeks if cirrhosis was present. The primary endpoint was a sustained virological response (SVR) 12 weeks after the end of therapy. Secondary endpoints included safety, pharmacokinetics and patient-reported outcomes. RESULTS Of the 68 patients enrolled, 39.7% had cirrhosis. Sixty-five patients [95.6%; 95% confidence interval (CI): 87.6-99.1%; P < 0.0001] achieved an SVR, with similar rates of SVR in those with and without cirrhosis. Tolerance was satisfactory, with mainly grade 1 or 2 adverse events. Among patient-reported outcomes, only fatigue significantly decreased at the end of treatment compared with baseline [odds ratio (OR): 0.36; 95% CI: 0.14-0.96; P = 0.04]. Mean tenofovir area under the plasma concentration-time curve (AUC) at week 4 was high, with mean ± SD AUC variation between baseline and week 4 higher in cirrhotic than in noncirrhotic patients (3261.57 ± 1920.47 ng/mL vs. 1576.15 ± 911.97 ng/mL, respectively; P = 0.03). Mild proteinuria (54.4%), hypophosphataemia (50.0%), blood bicarbonate decrease (29.4%) and hypokalaemia (13.2%) were reported. The serum creatinine level was not modified. CONCLUSIONS LDV/SOF provided a high SVR rate in PI-experienced subjects coinfected with HCV genotype 1 and HIV-1, including patients with cirrhosis.
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Affiliation(s)
- E Rosenthal
- Internal Medicine Department, CHU de Nice, Hôpital Archet 1, Nice, France
| | - C Fougerou-Leurent
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - A Renault
- Inserm, CIC1414, Rennes, France.,Pharmacology Laboratory, Faculté de Médecine, Univ Rennes 1, Rennes, France
| | - M P Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Inserm, IRD, Aix Marseille Univ, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - F Marcellin
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Inserm, IRD, Aix Marseille Univ, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - R Garraffo
- Clinical Pharmacology and Toxicology Department, CHU de Nice, Nice, France
| | - E Teicher
- Infectious Diseases Department, APHP, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - H Aumaitre
- Infectious and Tropical Diseases Department, Hôpital de Perpignan, Perpignan, France
| | - K Lacombe
- Infectious Diseases Department, APHP, Hôpital Saint Antoine, Paris, France
| | - F Bailly
- Hepatology Department, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - E Billaud
- Infectious Diseases Department, CHU Nantes, Nantes, France
| | - S Chevaliez
- Virology Department, APHP, Hôpital Henri Mondor, Créteil, France
| | - S Dominguez
- Clinical Immunology Department, APHP, Hôpital Henri Mondor, Créteil, France
| | - M A Valantin
- Infectious Diseases Department, APHP, Hôpital La Pitié Salpêtrière, Paris, France
| | - J Reynes
- Infectious Diseases Department, CHU Montpellier, Montpellier, France
| | - A Naqvi
- Infectious Diseases Department, CHU de Nice, Hôpital Archet 1, Nice, France
| | - L Cotte
- Infectious Diseases Department, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - S Metivier
- Hepatogastroenterology Department, CHU Toulouse, Toulouse, France
| | - V Leroy
- Hepatogastroenterology Department, CHU Grenoble, Grenoble, France
| | - M Dupon
- Infectious Diseases Department, CHU Bordeaux, Bordeaux, France
| | - T Allegre
- Hemato Oncology Department, CH du Pays d'Aix, Aix-en-Provence, France
| | - P De Truchis
- Infectious Diseases Department, APHP, Hôpital R Poincaré, Garches, France
| | - V Jeantils
- Infectious Diseases Department, APHP, Hôpital J Verdier, Bondy, France
| | - J Chas
- Infectious and Tropical Diseases Department, APHP, Hôpital Tenon, Paris, France
| | - D Salmon-Ceron
- Infectious Diseases Department, APHP, Hôpital Cochin, Paris, France
| | - P Morlat
- Internal Medicine and Infectious Diseases Department, CHU Bordeaux, Bordeaux, France
| | - D Neau
- Infectious and Tropical Diseases Department, CHU Bordeaux, Bordeaux, France
| | - P Perré
- Internal Medicine Department, CHD Vendée, La Roche sur Yon, France
| | - L Piroth
- Infectious Diseases Department, CHU Dijon, Dijon, France
| | - S Pol
- Hepato-Gastroenterology Department, APHP, Hôpital Cochin, Paris, France
| | - M Bourlière
- Hepatogastroenterology Department, Hôpital Saint Joseph, Marseille, France
| | - G P Pageaux
- Hepatogastroenterology Department, CHU Montpellier, Montpellier, France
| | - L Alric
- Internal Medicine Department, CHU Toulouse, Toulouse, France
| | - D Zucman
- Internal Medicine Department, Hôpital Foch, Suresne, France
| | - P M Girard
- Infectious Diseases Department, APHP, Hôpital Saint Antoine, Paris, France
| | - I Poizot-Martin
- Immuno and Clinical Hematology department, APHM Sainte-Marguerite, Aix Marseille Univ, Marseille, France.,Inserm U912 (SESSTIM), Marseille, France
| | - Y Yazdanpanah
- Infectious and Tropical Diseases Department, APHP, Hôpital Bichat, Paris, France
| | - F Raffi
- Infectious Diseases Department, CHU Nantes, Nantes, France
| | - E Le Pabic
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - C Tual
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - A Pailhé
- Unité de Recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France Recherche Nord & Sud Sida-hiv Hépatites), Paris, France
| | - I Amri
- Unité de Recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France Recherche Nord & Sud Sida-hiv Hépatites), Paris, France
| | - E Bellissant
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France.,Pharmacology Laboratory, Faculté de Médecine, Univ Rennes 1, Rennes, France
| | - J M Molina
- Hepatogastroenterology Department, APHP, Hôpital Saint Louis, Paris, France
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10
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Merle P, Camus P, Abergel A, Pageaux GP, Masliah C, Bronowicki JP, Zarski JP, Pelletier G, Bouattour M, Farloux L, Dorval E, Verset G, Si-Ahmed SN, Doffoel M, Couzigou P, Taieb J, Vasseur B, Attali P. Safety and efficacy of intra-arterial hepatic chemotherapy with doxorubicin-loaded nanoparticles in hepatocellular carcinoma. ESMO Open 2017; 2:e000238. [PMID: 29104762 PMCID: PMC5663255 DOI: 10.1136/esmoopen-2017-000238] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 01/03/2023] Open
Abstract
Background Doxorubicin Transdrug (DT), a nanoformulation of doxorubicin, was demonstrated to overcome the chemoresistance of hepatocellular carcinoma (HCC) in preclinical models. Its efficacy and safety were thus investigated in phase I and randomised phase II trials in unresectable HCC. Patients and methods Phase I was a single dose of DT through the hepatic intra-arterial (HIA) route, dose-escalating 3+3 trial, evaluating five-dose levels from 10 to 40 mg/m2 with maximal tolerated dose (MTD) as primary endpoint. The multicentre phase II trial randomly assigned (2:1 ratio) patients to receive either 30 mg/m2 of DT through HIA route every 4 weeks for up to three courses or best standard of care (BSC). Progression-free survival (PFS) rate at 3 months was the primary endpoint. Overall survival (OS) and disease control rate (DCR) were secondary endpoints. Results In phase I, haematological and respiratory limited toxicities were reported at 35 and 40 mg/m2, giving MTD at 30 mg/m2. Partial response rate was 10%, and stable disease 70%. Phase II was discontinued due to three severe acute respiratory distress events in the DT group while 17 patients had received 30 mg/m2 DT and 11 BSC. At 3 months, PFS was 64% (95% CI 31 to 89) vs 75% (95% CI 35 to 97), and DCR 35% vs 27% in DT and BSC, respectively (p=NS). Median OS was 32.6 months (95% CI 8.2 to 34.1) in DT group and 15 months (95% CI 8.0 to 18.8) in BSC group (p<0.05). Conclusion DT increased OS in unresectable HCC but induced severe respiratory distress. Efficacy data deserve further investigation using a safer dosing and schedule regimen. Trial registration number EUDRACT 2006-004088-77; Results.
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Affiliation(s)
- Philippe Merle
- Hepatology Unit, Groupement Hospitalier Lyon Nord, Lyon, France
| | - Philippe Camus
- Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Armand Abergel
- Hepato-Gastroenterology Unit, Hôtel Dieu, Clermont-Ferrand, France
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11
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Westerouen van Meeteren MJ, Hayee B, Inderson A, van der Meulen AE, Altwegg R, van Hoek B, Pageaux GP, Stijnen T, Stein D, Maljaars PWJ. Safety of Anti-TNF Treatment in Liver Transplant Recipients: A Systematic Review and Meta-analysis. J Crohns Colitis 2017; 11:1146-1151. [PMID: 28482085 DOI: 10.1093/ecco-jcc/jjx057] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/21/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Little is known about the risk of serious infection when combining anti-tumour necrosis factor [TNF] therapy for refractory inflammatory bowel disease [IBD] with immunosuppression after liver transplantation [LT]. Our aim was to investigate the infection risk in this patient group by systematic review and meta-analysis of the available data. METHODS A search was conducted for full papers and conference proceedings through September 2015, regarding liver transplant recipients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale [NOS]. Two reviewers independently extracted patient data [age, duration of follow-up, number of all infections, number of serious infections, time since transplant]. As an additional control population, primary sclerosing cholangitis [PSC]-IBD patients from the Leiden University Medical Center [LUMC] LT cohort were used. Poisson regression was used to compare serious infections (according to International Conference on Harmonisation [ICH] definition) per patien-year follow-up between the anti-TNF and control groups. RESULTS In all 465 articles and abstracts were identified, of which eight were included. These contained 53 post-LT patients on anti-TNF therapy and 23 post-LT patients not exposed to anti-TNF therapy. From the LUMC LT-cohort, 41 PSC patients with PSC-IBD not exposed to anti-TNF therapy were included as control population. The infection rate for TNF-exposed patients was 0.168 serious infections per patient year, compared with 0.149 in the control patients (rate ratio 1.12 [95% confidence interval: 0.233-5.404, P = 0.886]. When correcting for time since transplant, the infection rate was 0.194 in the TNF-exposed vs 0.115 in the non-exposed [p = 0.219]. CONCLUSIONS No significant increase in the rate of serious infection was observed in LT recipients with PSC-IBD during exposure to anti-TNF therapy.
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Affiliation(s)
| | - B Hayee
- King's College Hospital, Department of Gastroenterology, London, UK
| | - A Inderson
- Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
| | - A E van der Meulen
- Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
| | - R Altwegg
- University Hospital of St Eloi, Department of Hepatology and Gastroenterology, Montpellier, France
| | - B van Hoek
- Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
| | - G P Pageaux
- University Hospital of St Eloi, Department of Hepatology and Gastroenterology, Montpellier, France
| | - T Stijnen
- Leiden University Medical Centre, Department of Medical Statistics, Leiden, The Netherlands
| | - D Stein
- Medical College of Wisconsin, Department of Gastroenterology and Hepatology, Milwaukee, WI, USA
| | - P W J Maljaars
- Leiden University Medical Centre, Department of Gastroenterology-Hepatology, Leiden, The Netherlands
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12
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Herrero A, Souche R, Joly E, Boisset G, Habibeh H, Bouyabrine H, Panaro F, Ursic-Bedoya J, Jaber S, Guiu B, Pageaux GP, Navarro F. Early Hepatic Artery Thrombosis After Liver Transplantation: What is the Impact of the Arterial Reconstruction Type? World J Surg 2017; 41:2101-2110. [DOI: 10.1007/s00268-017-3989-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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13
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Carrat F, Nahon P, Duclos-Vallée JC, Pageaux GP, Fontaine H, Pol S. Reply to "A strong message is needed to address the issue of HCC recurrence after DAA therapy". J Hepatol 2016; 65:1269-1270. [PMID: 27480588 DOI: 10.1016/j.jhep.2016.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 12/04/2022]
Affiliation(s)
- F Carrat
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS 1136, F75012 Paris, France; AP-HP, Hôpital Saint Antoine, Unité de Santé Publique, France
| | - P Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy;Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206 Saint-Denis, France Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", F-75000 Paris, France
| | - J C Duclos-Vallée
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, and Université Paris-Sud, and Université Paris-Saclay, UMR-S 1193, and INSERM Unité 1193, and DHU Hepatinov, Villejuif, France
| | - G P Pageaux
- CHU Saint-Eloi, Département d'hépato-gastroentérologie et de transplantation hépatique, and Université de Montpellier, Montpellier, France
| | - H Fontaine
- Université Paris Descartes; APHP, Unité d'Hépatologie, Hôpital Cochin; INSERM U-1016, Institut Cochin, Paris, France
| | - S Pol
- Université Paris Descartes; APHP, Unité d'Hépatologie, Hôpital Cochin; INSERM U-1016, Institut Cochin, Paris, France
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Panaro F, Boisset G, Chanques G, Guiu B, Herrero A, Bouyabrine H, Pageaux GP, Boudjema K, Navarro F. Vena cava encirclement predicts difficult native hepatectomy. Liver Transpl 2016; 22:906-13. [PMID: 27149437 DOI: 10.1002/lt.24478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/06/2016] [Indexed: 12/14/2022]
Abstract
Recipient hepatectomy is a challenging liver transplantation (LT) procedure that has life-threatening complications. The current predictive mortality clinic-biological scores (Child/Model for End-Stage Liver Disease [MELD]) do not take into consideration the recipient's liver anatomy. The aim of this study was to evaluate the impact of the dorsal sector anatomy of a cirrhotic liver on the morbidity/mortality rates of hepatectomy. A multicenter retrospective study (clinic-biological and morphologic) was performed from 2013 to 2014. The degree of encirclement of the inferior vena cava (IVC) by the dorsal sector of the liver was measured. The study population included 320 patients. Seventy-four (23%) patients had complete IVC encirclement. A correlation (P = 0.01) has been reported between the existence of a circular dorsal sector and the number of transfusions during LT (4 packed red blood cell [PRBC] transfusions in the group without IVC versus 7 PRBC transfusions in the other group). The existence of such anatomy increases the relative risk of early reoperation for IVC bleeding by 31% (P = 0.05). There is a correlation between alcoholic cirrhosis and dorsal-sector hypertrophy (126 cc versus 147.5 cc; P = 0.05). Concerning surgical time, we found no significant between-group differences. Compared to the severity of cirrhosis, an inverse correlation was observed between the MELD and Child scores and the dorsal sector hypertrophy (P < 0.001). No significant difference in terms of transfusion was found between the temporary portocaval shunt group (n = 168) and the other group (n = 152). The presence of a circular sector is associated with an increased risk of hemorrhage during hepatectomy, as well as an immediate postoperative risk of reoperation. Liver Transplantation 22 906-913 2016 AASLD.
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Affiliation(s)
- Fabrizio Panaro
- Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France
| | - Gildas Boisset
- Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France
| | - Gérald Chanques
- Departments of Anesthesiology and Critical Care Medicine, University of Montpellier, Montpellier, France
| | - Boris Guiu
- Departments of Radiology, Faculty of Medicine, Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Astrid Herrero
- Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France
| | - Hassan Bouyabrine
- Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France
| | - Georges Philippe Pageaux
- Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier, Rennes, France.,INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France
| | - Francis Navarro
- Departments of General Surgery, Division of Transplantation, College of Medicine, University of Montpellier, Montpellier, France
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Carenco C, Faure S, Ursic-Bedoya J, Herrero A, Pageaux GP. Solid, non-skin, post-liver transplant tumors: Key role of lifestyle and immunosuppression management. World J Gastroenterol 2016; 22:427-434. [PMID: 26755888 PMCID: PMC4698505 DOI: 10.3748/wjg.v22.i1.427] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation has been the treatment of choice for end-stage liver disease since 1983. Cancer has emerged as a major long-term cause of death for liver transplant recipients. Many retrospective studies that have explored standardized incidence ratio have reported increased rates of solid organ cancers post-liver transplantation; some have also studied risk factors. Liver transplantation results in a two to five-fold mean increase in the rate of solid organ cancers. Risk of head and neck, lung, esophageal, cervical cancers and Kaposi’s sarcoma is high, but risk of colorectal cancer is not clearly demonstrated. There appears to be no excess risk of developing breast or prostate cancer. Environmental risk factors such as viral infection and tobacco consumption, and personal risk factors such as obesity play a key role, but recent data also implicate the role of calcineurin inhibitors, whose cumulative and dose-dependent effects on cell metabolism might play a direct role in oncogenesis. In this paper, we review the results of studies assessing the incidence of non-skin solid tumors in order to understand the mechanisms underlying solid cancers in post-liver transplant patients and, ultimately, discuss how to prevent these cancers. Immunosuppressive protocol changes, including a calcineurin inhibitor-free regimen, combined with dietary guidelines and smoking cessation, are theoretically the best preventive measures.
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Gondeau C, Pageaux GP, Larrey D. Hepatitis C virus infection: Are there still specific problems with genotype 3? World J Gastroenterol 2015; 21:12101-13. [PMID: 26576095 PMCID: PMC4641128 DOI: 10.3748/wjg.v21.i42.12101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/07/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is one of the most common causes of chronic liver disease and the main indication for liver transplantation worldwide. As promising specific treatments have been introduced for genotype 1, clinicians and researchers are now focusing on patients infected by non-genotype 1 HCV, particularly genotype 3. Indeed, in the golden era of direct-acting antiviral drugs, genotype 3 infections are no longer considered as easy to treat and are associated with higher risk of developing severe liver injuries, such as cirrhosis and hepatocellular carcinoma. Moreover, HCV genotype 3 accounts for 40% of all HCV infections in Asia and is the most frequent genotype among HCV-positive injecting drug users in several countries. Here, we review recent data on HCV genotype 3 infection/treatment, including clinical aspects and the underlying genotype-specific molecular mechanisms.
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Mezidi M, Belafia F, Nougaret S, Pageaux GP, Conseil M, Panaro F, Boniface G, Morquin D, Jaber S, Jung B. Interferon gamma in association with immunosuppressive drugs withdrawal and antifungal combination as a rescue therapy for cerebral invasive Aspergillosis in a liver transplant recipient. Minerva Anestesiol 2014; 80:1359-1360. [PMID: 25057936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- M Mezidi
- Department of Critical Care Medicine and Anesthesiology, Saint Eloi Teaching Hospital, Montpellier, France -
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Panaro F, Bouyabrine H, Carabalona JP, Nougaret S, Jung B, Pageaux GP, Navarro F. Omental flap for hepatic artery coverage during liver transplantation. J Gastrointest Surg 2014; 18:1518-22. [PMID: 24567171 DOI: 10.1007/s11605-014-2484-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/10/2014] [Indexed: 01/31/2023]
Abstract
In 1994, a technique of omental flap interposition to cover the celiac and mesenteric vessels after pancreaticoduodenectomy was described. It aimed to isolate the pancreatic anastomosis from the vessels dissected during pancreaticoduodenectomy. In liver transplantation (LT), the omental flap was initially used to reduce the risk of hepatic artery (HA) kinking. Currently, we use this technique to cover the dissected HA, reducing the consequences of postoperative biliary fistula (BF), particularly the risk of postoperative complications (thrombosis/bleeding). We describe this technique adding a simple modification consisting of covering the HA with an omental flap after completion of the biliary anastomosis. We performed LT with an omental flap to cover the HA vessels in 62 (55 %) of the 112 consecutive patients who underwent LT between January 2012 and July 2013. No postoperative deaths occurred. The rate of BF was 9.7 % (six cases). In the omental flap series, no postoperative thrombosis, HA pseudoaneurysm, or complications occurred. In the six cases of BF, the dissected HAs were completely isolated from the biloma. This simple technique has no specific morbidity; it isolates the HA from the biliary anastomosis and therefore may reduce the risk of severe postoperative HA complications after LT.
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Affiliation(s)
- Fabrizio Panaro
- Department of General and Liver/Pancreas Transplant Surgery, School of Medicine, Hôpital Saint Eloi, University of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France,
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Larrey D, Salse A, Ribard D, Boutet O, Hyrailles-Blanc V, Niang B, Pageaux GP, Vaucher E, Arpurt JP, Boulay G, Karlova N, Daures JP. Education by a nurse increases response of patients with chronic hepatitis C to therapy with peginterferon-α2a and ribavirin. Clin Gastroenterol Hepatol 2011; 9:781-5. [PMID: 21683161 DOI: 10.1016/j.cgh.2011.05.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 05/06/2011] [Accepted: 05/18/2011] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Education of patients with chronic hepatitis C has been proposed to increase response to therapy with peginterferon and ribavirin. We performed a prospective study to determine the effects of systematic consultation by a nurse on patient adherence and the efficacy of therapy. METHODS We analyzed data from 244 patients who received either systematic consultation after each medical visit from a nurse who used a standard evaluation grid and provided information about the disease and treatment (group A [GrA], n = 123) or the conventional clinical follow-up procedure (group B [GrB], n = 121). Treatment lasted 24 to 48 weeks. RESULTS Characteristics of each group were similar at baseline, including prior treatment (42.6% in GrA and 36.0% in GrB). Overall, GrA had significantly better adherence to treatment than GrB (74.0% vs 62.8%), especially among patients who received 48 weeks of treatment (69.7% vs 53.2%; P < .03). Significantly more patients in GrA had a sustained virologic response, compared with GrB overall (38.2% vs 24.8%; P < .02), as well as treatment-naive patients (47.1% vs 30.3%; P < .05), and those with genotypes 1, 4, or 5 infections (31.6% vs 13.3%; P < .007). There were no differences between GrA and GrB in response of patients with genotypes 2 or 3 infections or advanced fibrosis. Prognostic factors for a sustained virologic response (based on bivariate and multivariate analyses) were virologic response at week 12 (odds ratio [OR], 1.9; P < .0001), genotypes 2 or 3 (OR, 2.9; P < .0001), therapeutic education (OR, 2.5; P < .02), and lack of previous treatment (OR, 2.3; P < .005). CONCLUSIONS Therapeutic education by a specialized nurse increases the response of patients with hepatitis C to therapy, particularly in difficult-to-treat patients.
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Affiliation(s)
- Dominique Larrey
- Hepato-Gastroenterology, Saint Eloi Hospital, Montpellier, France.
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20
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Decaens T, Roudot-Thoraval F, Badran H, Wolf P, Durand F, Adam R, Boillot O, Vanlemmens C, Gugenheim J, Dharancy S, Bernard PH, Boudjema K, Calmus Y, Hardwigsen J, Ducerf C, Pageaux GP, Hilleret MN, Chazouillères O, Cherqui D, Mallat A, Duvoux C. Impact of tumour differentiation to select patients before liver transplantation for hepatocellular carcinoma. Liver Int 2011; 31:792-801. [PMID: 21645209 DOI: 10.1111/j.1478-3231.2010.02425.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To generate a new score with improved accuracy compared with Milan criteria to select patients. PATIENTS The training cohort comprised 373 patients transplanted for hepatocellular carcinoma (HCC) between 1988 and 1998 (cohort 1). An algorithm was derived from the analysis of patient data by the proportional hazard Cox regression model. The area under the receiver operating characteristic (AUROC) was used to determine a cut-off value. The validation cohort comprised 140 patients transplanted between 1999 and 2001 (cohort 2). RESULTS Multivariate analysis identified three predictors of 5-year tumour-free survival: tumour differentiation (P=0.02), diameter (P<0.0001) and number of nodules (P=0.04). A cut-off value of 4 was derived from the AUROC of the final score. Five-year tumour-free survival was 60.2 ± 3.1% in patients with as score <4 and 36.4 ± 4.7% in individuals with a score ≥4, P<0.0001. In the validation cohort, 5-year tumour-free survival was 82.8 ± 3.6% (score <4) and 50.0 ± 10.7% (score ≥4), P=0.0003. In patients with a score <4, there was no significant difference in 5-year tumour-free survival between Milan+ and Milan- patients, either in cohort 1 or 2. Five-year tumour-free survival of Milan- patients was significantly better in individuals with a score <4 compared with those with a score ≥4, both in cohort 1 (61.5 ± 9.1 vs 31.4 ± 4.6%, P=0.009) and in cohort 2 (P=0.02). CONCLUSION A novel score taking into account tumour differentiation shows higher accuracy than Milan criteria in predicting 5-year tumour-free survival following liver transplantation for HCC. Prospective studies should validate these findings.
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Affiliation(s)
- Thomas Decaens
- AP-HP, Department of Hepatology, Groupe Henri-Mondor Albert-Chenevier, Creteil, France.
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Duvoux C, Pageaux GP. Immunosuppression in liver transplant recipients with renal impairment. J Hepatol 2011; 54:1041-54. [PMID: 21145927 DOI: 10.1016/j.jhep.2010.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 11/27/2010] [Accepted: 12/01/2010] [Indexed: 02/06/2023]
Affiliation(s)
- C Duvoux
- Department of Hepatology and Gastroenterology, Liver Transplant Unit, Hospital Henri Mondor AP-HP, University Paris Est, Créteil, France.
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Stoebner PE, Fabre C, El Kabbaj N, Bismuth M, Pageaux GP, Meunier L. Koebnerizing Kaposi's sarcoma mimics a laparotomic hypertrophic scar in a liver transplant recipient. Liver Transpl 2009; 15:994-6. [PMID: 19642134 DOI: 10.1002/lt.21739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Aufort S, Molina E, Assenat E, Rigole H, Bauret P, Calvet C, Navarro F, Fabre JM, Blanc P, Taourel P, Larrey D, Bruel JM, Pageaux GP, Gallix BP. [Value of MRCP for diagnosis of biliary complications after liver transplantation]. ACTA ACUST UNITED AC 2008; 89:221-7. [PMID: 18354352 DOI: 10.1016/s0221-0363(08)70397-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the value of MRCP in the detection of biliary complications after orthotopic liver transplantation. MATERIALS AND METHODS 27 transplanted patients with suspected biliary complication underwent a total of 34 MR and direct cholangiography procedures. MRCP were reviewed by 2 independent reviewers blinded to clinical and laboratory findings. The biliary tract was divided into 7 segments, and all lesions were evaluated using this segmental anatomy. Each segment was evaluated for the presence of dilatation, stenosis and intra-ductal debris. MRCP results were compared to results frpm direct cholangiography. RESULTS 216 (98%) of 221 biliary segments could be evaluated on MRCP, with good to excellent visualization in 179 (80%) cases. Segmental analysis showed sensitivity, specificity and accuracy values of 85%, 81% and 83% for the detection of biliary stenosis, 82%, 81% and 81% for the detection of biliary dilatation, and 60%, 88% and 80% for the detection of inyraductal debris. CONCLUSION MRCP is accurate for the detection of biliary stenosis and dilatation in patients after liver transplantation and provides an alternative to direct cholangiography.
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Affiliation(s)
- S Aufort
- Service d'Imagerie Médicale, CHU Montpellier, Hôpital Saint-Eloi, 80, rue Augustin Fliche, 34295 Montpellier Cedex 5
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Decaens T, Roudot-Thoraval F, Bresson-Hadni S, Meyer C, Gugenheim J, Durand F, Bernard PH, Boillot O, Boudjema K, Calmus Y, Hardwigsen J, Ducerf C, Pageaux GP, Dharancy S, Chazouilleres O, Dhumeaux D, Cherqui D, Duvoux C. Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma. Liver Transpl 2005; 11:767-775. [PMID: 15973710 DOI: 10.1002/lt.20418] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The actual impact of transarterial chemoembolization before liver transplantation (LT) for hepatocellular carcinoma (HCC) on patient survival and HCC recurrence is not known. Between 1985 and 1998, 479 patients with HCC in 14 French centers were evaluated for LT. Among these 479 patients, this case-control study included 100 patients who received transarterial chemoembolization before LT (TACE group) and 100 control patients who did not receive chemoembolization (no-TACE group). Patients and controls were matched for the pre-LT tumor characteristics, the period of transplantation, the time spent on the waiting list, and pre- and posttransplantation treatments. Kaplan-Meier estimates were calculated 5 years after LT and were compared with the log-rank test. The mean waiting time before LT was 4.2 +/- 3.2 months in the TACE group and 4.3 +/- 4.4 months in the no-TACE group. The median number of TACE procedures was 1 (range: 1-12). Demographic data, median alpha-fetoprotein level (21.6 ng/mL and 22.0 ng/mL, respectively), and pre- and post-LT morphologic characteristics of the tumors did not differ in the TACE and no-TACE groups. Overall 5-year survival was 59.4% with TACE and 59.3% without TACE (ns). Survival rates did not differ significantly between the two groups with respect to the time on the waiting list, the tumor diameter, or the type of TACE (selective or nonselective). In the TACE group, 30 patients had tumor necrosis > or =80% on the liver explant with a 5-year survival rate of 63.2%, compared with 54.2% among their matched controls (P = 0.9). In conclusion, with a mean waiting period of 4.2 months and 1 TACE procedure, pre-LT TACE does not influence post-LT overall survival and disease-free survival.
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Affiliation(s)
- Thomas Decaens
- Service d'Hépatologie et de Gastroentérologie, AP-HP, Hôpital Henri Mondor, Créteil, France
- Institut Cochin, Inserm U567, Paris, France
| | | | | | - Carole Meyer
- Service de Transplantation, Hôpital Hautefeuille, Strasbourg, France
| | - Jean Gugenheim
- Service de Chirurgie Digestive, Hôpital L'Archet 2, Nice, France
| | - Francois Durand
- Service d'Hépatologie, AP-HP, Hôpital Beaujon, Clichy, France
| | - Pierre-Henri Bernard
- Service d'Hépatologie et de Gastroentérologie, Hôpital Pellegrin, Bordeaux, France
| | - Olivier Boillot
- Service de Chirurgie Digestive, Hôpital Edouard Herriot, Lyon, France
| | - Karim Boudjema
- Département de Chirurgie Viscérale, Hôpital Ponchaillou, Rennes, France
| | - Yvon Calmus
- Service de Chirurgie Digestive, AP-HP, Hôpital Cochin, Paris, France
| | - Jean Hardwigsen
- Service de Chirurgie Digestive, Hôpital la Conception, Marseille, France
| | - Christian Ducerf
- Service de Chirurgie Digestive, Hôpital de la Croix Rousse, Lyon, France
| | - Georges Philippe Pageaux
- Fédération Médico-Chirurgicale des Maladies de l'Appareil Digestif, Hôpital Saint-Eloi, Montpellier, France
| | - Sebastien Dharancy
- Service d'Hépatologie et de Gastroentérologie, Hôpital Claude Huriez, Lille, France
| | | | - Daniel Dhumeaux
- Service d'Hépatologie et de Gastroentérologie, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Daniel Cherqui
- Service de Chirurgie Générale et Digestive, AP-HP, Hopital Henri Mondor, Créteil, France
| | - Christophe Duvoux
- Service d'Hépatologie et de Gastroentérologie, AP-HP, Hôpital Henri Mondor, Créteil, France
- Inserm U581, Créteil, France
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Affiliation(s)
- G P Pageaux
- Department of Hepato-Gastro-Enterology, Hôpital Saint Eloi, 2 Avenue Emile Bertin Sans, 34-295 Montpellier Cedex 5, France
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Joomaye Z, Perney P, Pageaux GP, Perrigault PF, Souche B, Fabre JM, Domergue J, Le Quellec A, Blanc F. [Liver transplantation in a patient with cirrhosis and an uncontrolled extra-hepatic infectious focus]. Gastroenterol Clin Biol 2001; 25:1112-3. [PMID: 11910995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Aguilar-Martinez P, Bismuth M, Picot MC, Thelcide C, Pageaux GP, Blanc F, Blanc P, Schved JF, Larrey D. Variable phenotypic presentation of iron overload in H63D homozygotes: are genetic modifiers the cause? Gut 2001; 48:836-42. [PMID: 11358905 PMCID: PMC1728323 DOI: 10.1136/gut.48.6.836] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND First considered as a polymorphism of the HFE gene, the H63D mutation is now widely recognised as a haemochromatosis associated allele. But few H63D homozygotes with clinical manifestations of hereditary haemochromatosis (HH) have been reported. Concurrently, an increasing number of genes have been shown to interact with HFE in iron metabolism. AIMS To describe the clinical expression of iron overload (IO) associated with H63D homozygosity, and search for potential genetic modifiers (within the HFE or other genes) that could explain the variability of the phenotypes. PATIENTS AND METHODS We retrospectively analysed the clinical phenotype of 56 H63D homozygotes referred for a personal or family history of IO. For each subject we examined intragenic HFE haplotypes and transferrin receptor (TfR) gene polymorphisms and searched for the Y250X mutation on the TFR2 gene. Additionally, we sequenced the HFE gene of H63D homozygotes with HH. RESULTS Fifty of 56 subjects had biological and/or clinical abnormalities of iron metabolism. Up to two thirds of patients (n=34) had no acquired cause of IO. Among these, 12 had a phenotypic diagnosis of HH. In the iron loaded group there was a strong prevalence of male patients. No correlation was found between the potential genetic modifiers and phenotypes. No additional mutation of HFE was identified. CONCLUSION The variable phenotypes associated with H63D homozygosity do not appear to be linked to other HFE mutations, to the TFR2 Y250X mutation, or to HFE or TfR gene intragenic polymorphisms. The exact role of H63D homozygosity in IO and HH needs to be further investigated in unselected populations.
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Affiliation(s)
- P Aguilar-Martinez
- Laboratory of Haematology, CHU of Montpellier, 34295 Montpellier, France.
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Vandĵme A, Pageaux GP, Bismuth M, Fabre JM, Domergue J, Perez C, Makeieff M, Mourad G, Larrey D. Nocardiosis revealed by thyroid abscess in a liver--kidney transplant recipient. Transpl Int 2001; 14:202-4. [PMID: 11499912 DOI: 10.1007/s001470100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nocardiosis is a life-threatening infection, particularly among immunocompromised patients, which usually affects lungs, skin and central nervous system. We report a case of disseminated nocardiosis revealed by suppurative thyroiditis in a liver-kidney transplant recipient with poor nutritional status at the time of infection. Nocardia Asteroides was isolated from fine-needle aspiration material of the thyroid abscess. Clinical manifestations resolved after surgical drainage of the thyroid abscess, prolonged antibiotherapy and diminution of immunosuppressive regimen. Clinicians should be aware of this entity, as Nocardia Asteroides may need more than 5 days of culture to be isolated.
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Affiliation(s)
- A Vandĵme
- Fédération Médicochirurgicale, Hôpital Saint Eloi, Montpellier, France
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29
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Pageaux GP. [Lymphoproliferative disorders after liver transplantation]. Gastroenterol Clin Biol 2001; 25:357-66. [PMID: 11449124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- G P Pageaux
- Service d'Hépato-Gastroentérologie, Hôpital Saint-Eloi, CHU, Montpelllier, France.
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Pageaux GP, Micallef J, Nataf MB, Levron JC, Lacarelle B, Le Moing JP, Bouhours P, Blin O. Pharmacokinetics of sabeluzole and dextromethorphan oxidation capacity in patients with severe hepatic dysfunction and healthy volunteers. Br J Clin Pharmacol 2001; 51:164-8. [PMID: 11259989 PMCID: PMC2014438 DOI: 10.1111/j.1365-2125.2001.01337.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS The primary objective of this study was to determine how the pharmacokinetics of sabeluzole, an investigational drug with specific effects on memory and learning abilities, are affected by chronic liver disease. Since sabeluzole is metabolised by CYP2D6, a secondary objective was to study the correlation between CYP2D6 activity (as assessed by the dextromethorphan dextrorphan metabolic ratio) and hepatic dysfunction. METHODS The single-dose pharmacokinetics of sabeluzole (10 mg) was compared in 10 healthy Caucasian subjects and 10 patients with severe hepatic dysfunction. The urinary dextromethorphan/dextrorphan (DMP/DRP) metabolic ratio was determined after intake of 20 mg dextromethorphan (NODEX capsules). RESULTS The terminal half-life of sabeluzole was significantly prolonged in subjects with severe hepatic dysfunction vs healthy subjects (respectively 39.3 +/- 11.5 h; 17.5 +/- 10.2 h (mean +/- s.d.)). The areas under the curve (AUC) were significantly higher in subjects with severe hepatic dysfunction than in healthy volunteers (681 +/- 200 ng ml(-1) h vs 331 +/- 282 ng ml(-1) h). There was a significant correlation between the AUC(0,infinity) and the DMP/DRP metabolic ratio in healthy volunteers and subjects with severe hepatic dysfunction. AUC was greater and elimination of sabeluzole slower in poor metabolizers compared with extensive metabolizers. CONCLUSIONS These results suggest that a) sabeluzole dose should be reduced in patients with severe hepatic dysfunction and b) the AUC of sabeluzole is linked to individual CYP2D6 activity.
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Affiliation(s)
- G P Pageaux
- Service d'Hepatogastroenterologie et Transplantation, CHU Saint Eloi, 34295 Montpellier, Cedex 5, France
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Pageaux GP, Michel J, Coste V, Perney P, Possoz P, Perrigault PF, Navarro F, Fabre JM, Domergue J, Blanc P, Larrey D. Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism. Gut 1999; 45:421-6. [PMID: 10446113 PMCID: PMC1727657 DOI: 10.1136/gut.45.3.421] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND/AIMS Alcoholic cirrhosis remains a controversial indication for liver transplantation, mainly because of ethical considerations related to the shortage of donor livers. The aim of this study was to review experience to date, focusing on survival rates and complications, and the effect of alcohol relapse on outcome and alterations in marital and socioprofessional status. METHODS The results for 53 patients transplanted for alcoholic cirrhosis between 1989 and 1994 were compared with those for 48 patients transplanted for non-alcoholic liver disease. The following variables were analysed: survival, rejection, infection, cancer, retransplantation, employment and marital status, alcoholic recurrence. The same variables were compared between alcohol relapsers and non-relapsers. RESULTS Recovery of employment was the only significantly different variable between alcoholic (30%) and non-alcoholic patients (60%). Two factors influenced survival in the absence of alcohol recidivism: age and abstinence before transplantation. For all other variables, there were no differences between alcoholic and non-alcoholic patients, and, within the alcoholic group, between relapsers and non-relapsers. The recidivism rate was 32%. CONCLUSION The data indicate that liver transplantation is justified for alcoholic cirrhosis, even in cases of recidivism, which did no affect survival and compliance with the immunosuppressive regimen. These good results should help in educating the general population about alcoholic disease.
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Affiliation(s)
- G P Pageaux
- Fédération Médico-chirurgicale d'Hépatogastro-entérologie, Unité de Transplantation Hépatique, Hôpital Saint Eloi, Montpellier, France
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Chapoutot C, Pageaux GP, Perrigault PF, Joomaye Z, Perney P, Jean-Pierre H, Jonquet O, Blanc P, Larrey D. Staphylococcus aureus nasal carriage in 104 cirrhotic and control patients. A prospective study. J Hepatol 1999; 30:249-53. [PMID: 10068104 DOI: 10.1016/s0168-8278(99)80070-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Bacterial infections, specially Staphylococcus aureus (S. aureus) septicemia, remain a leading cause of death following liver transplantation. It has been demonstrated that nasal carriage of S. aureus is associated with invasive infections in patients undergoing hemodialysis and could be decreased by use of antibiotic nasal ointment. However, in cirrhotic patients, the frequency of nasal carriage is unknown. The aims of this study were to determine the prevalence of S. aureus nasal carriage in cirrhotic patients and to assess nosocomial contamination. METHODS One hundred and four patients were included in a prospective study, 52 cirrhotic and 52 control (hospitalized patients without cirrhosis or disease which might increase the rate of nasal carriage of S. aureus). On admission and after a few days of hospitalization, nasal specimens from each anterior naris were obtained for culture. S. aureus was identified by the gram strain, positive catalase and coagulase reactions; antibiotic susceptibility was determined using a disk-diffusion test. RESULTS Both groups were similar with regard to age and sex. The prevalence of nasal colonization on hospital admission was 56% in cirrhotic patients and 13% in control patients (p = 0.001). After an average of 4 days, 42% of cirrhotics and 8% of control patients were colonized (p = 0.001), without any nosocomial contamination. Three strains out of 29 were oxacillin-resistant in cirrhotic patients, and none in controls (p>0.05). There was no statistical difference in carriage rate according to sex, age, cause of cirrhosis and Child-Pugh score. Previous hospitalization (OR, 6.3; 95% CI, 2.3 to 19.9; p = 0.0006) and cirrhosis (OR, 4.4; 95% CI, 1.5 to 13.4; p = 0.0048) were independent predictors of colonization. CONCLUSION Cirrhotic patients had a higher S. aureus nasal carriage rate than control subjects. Previous hospitalization and cirrhosis diagnosis were correlated to nasal colonization. Further studies are necessary to determine if nasal decontamination could reduce S. aureus infections after liver transplantation.
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Affiliation(s)
- C Chapoutot
- Department of Hepato-Gastro-Enterology, School of Medicine of Montpellier, France
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Costes V, Durand L, Pageaux GP, Ducos J, Mondain AM, Picot MC, Domergue J, Larrey D, Baldet P. Hepatitis C virus genotypes and quantification of serum hepatitis C RNA in liver transplant recipients. Relationship with histologic outcome of recurrent hepatitis C. Am J Clin Pathol 1999; 111:252-8. [PMID: 9930149 DOI: 10.1093/ajcp/111.2.252] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The reasons for wide variations in the severity of recurrent hepatitis C after liver transplantation are unclear. We studied liver transplant recipients to assess the effect of hepatitis C virus (HCV) genotype and HCV RNA quantification on histologic progression of recurrent hepatitis C after transplantation. Twenty-five patients underwent transplantation for HCV cirrhosis and were followed up with virologic and histologic assessments for a mean of 51 months. HCV genotype was determined by line probe assay. HCV RNA was quantitated in serum samples by nested polymerase chain reaction. The HCV genotype 1 was detected in 17 patients and other genotypes in 8. Acute lobular hepatitis developed in 17 patients 162 days posttransplantation on average. Long-term biopsy specimens (mean, 51 months after the date of liver transplantation; range, 24-86 months) showed chronic hepatitis in 19 patients (mild, 5; moderate, 9; and severe, 5, 2 with extensive scarring). The serum alanine aminotransferase level was correlated with hepatocyte necrosis (piecemeal and lobular) but not with portal inflammation or fibrosis. Patients infected with genotype 1 had a higher Knodell score, and the 5 patients with severe hepatitis C all were infected with genotype 1. HCV RNA levels were significantly higher in patients with genotype 1 than in patients with other genotypes, as were the severity of histologic recurrence and levels of viral replication.
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Affiliation(s)
- V Costes
- Department of Pathology, Hopital Gui de Chauliac, Montpellier, France
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Navarro F, Pyda P, Pageaux GP, Perrigault PF, Ramos J, Taourel P, Fabre JM, Domergue J. Lymphoproliferative disease after liver transplantation: primary biliary localization. Transplant Proc 1998; 30:1486-8. [PMID: 9636604 DOI: 10.1016/s0041-1345(98)00327-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- F Navarro
- Département de Transplantation Hépatique, Hôpital St. Eloi, Montpellier, France
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Pageaux GP, le Bricquir Y, Berthou F, Bressot N, Picot MC, Blanc F, Michel H, Larrey D. Effects of interferon-alpha on cytochrome P-450 isoforms 1A2 and 3A activities in patients with chronic hepatitis C. Eur J Gastroenterol Hepatol 1998; 10:491-5. [PMID: 9855065 DOI: 10.1097/00042737-199806000-00010] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIM The risk of adverse drug interactions with interferon-alpha has been poorly assessed. The aim of our study was to establish whether administration of interferon-alpha at therapeutic doses in patients with chronic hepatitis C may have significant inhibitory effects on other drug metabolism. The study was focused on cytochromes P-450 1A2 and 3A, two major isoforms involved in the metabolism of numerous substrates. METHODS Eighteen patients with chronic active hepatitis C requiring an interferon-alpha treatment were studied. Cytochrome P-450 1A2 activity was determined on the basis of an in vivo caffeine metabolism study. Cytochrome P-450 3A activity was determined according to in vivo cortisol metabolism into 6-beta-hydroxycortisol. Both activities were determined 1 month before, at initiation and 1 month after interferon-alpha therapy (3 x 10(6) units, three times a week). RESULTS There were no significant differences in the caffeine index (CYP 1A2) and in the 6-beta-hydroxycortisol/free cortisol urinary ratio (CYP 3A) before and after alpha interferon treatment CONCLUSION Chronic administration of interferon-alpha at therapeutic doses does not change in vivo cytochrome P-450 1A2 and 3A activities. These results support the suggestion that drugs metabolized by these isoenzymes may be used together with interferon-alpha in patients with chronic hepatitis C without significant risks of drug interactions.
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Affiliation(s)
- G P Pageaux
- Service d'Hépatogastroentérologie, Hôpital Saint-Eloi, Montpellier, France
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36
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Pageaux GP, Blanc P. [Alcoholism recurrence after liver transplantation for alcoholic cirrhosis]. Gastroenterol Clin Biol 1998; 22:561-2. [PMID: 9762301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- G P Pageaux
- Service d'Hépato-Gastroentérologie et Transplantation, Hôpital Saint Eloi, Montpellier
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Pageaux GP, Bonnardet A, Picot MC, Perrigault PF, Coste V, Navarro F, Fabre JM, Domergue J, Descomps B, Blanc P, Michel H, Larrey D. Prevalence of monoclonal immunoglobulins after liver transplantation: relationship with posttransplant lymphoproliferative disorders. Transplantation 1998; 65:397-400. [PMID: 9484759 DOI: 10.1097/00007890-199802150-00018] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A high incidence of serum monoclonal immunoglobulins (mIgs) has been described after solid organ transplantation. For transplant recipients, the prevalence of posttransplant lymphoproliferative disorders (PTLDs) has been reported to be between 2% and 6%. The relationship between the finding of serum mIg in transplant recipients and the subsequent development of PTLDs is not clearly documented. METHODS We retrospectively analyzed all cases of mIg and PTLD that occurred in 86 liver transplant recipients who survived more than 3 months. Patients were characterized by protein electrophoresis, immunofixation electrophoresis, pre- and post-liver transplantation Epstein-Barr virus (EBV) serology, EBV presence in lymphoproliferative tissues by in situ hybridization, type of infection episodes, rejection episodes, and immunosuppressive treatment. RESULTS Thirty-eight patients (44%) had abnormal immunofixation electrophoresis with an electrophoretic Ig peak. Twelve patients had a polyclonal Ig peak, and 26 patients had mIgs (30%). These 26 patients were divided into two groups: 13 patients had a transient mIg peak with a mean delay for normalization of electrophoresis of 2 months, and 13 patients had a permanent mIg peak. No correlation could be demonstrated between the appearance of abnormal banding and indications for transplantation, age of patients, and acute rejection rate. There was a strong correlation between occurrence of viral infections and presence of permanent mIg. Three patients with permanent mIg (23%) developed PTLD and died. CONCLUSIONS We concluded that the prevalence of mIg after liver transplantation was 30%. Viral infections increase the risk of developing mIg. Persistence of mIg beyond 7 months may be regarded as prelymphomas necessitating a careful follow-up in these patients.
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Affiliation(s)
- G P Pageaux
- Service d'Hépatogastroentérologie, Hôpital Saint-Eloi, Montpellier, France
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Pageaux GP, Ducos J, Mondain AM, Costes V, Picot MC, Perrigault PF, Domergue J, Larrey D, Michel H. Hepatitis C virus genotypes and quantitation of serum hepatitis C virus RNA in liver transplant recipients: relationship with severity of histological recurrence and implications in the pathogenesis of HCV infection. Liver Transpl Surg 1997; 3:501-5. [PMID: 9346792 DOI: 10.1002/lt.500030504] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The reasons for the wide variation of incidence and severity of recurrent hepatitis C after liver transplantation are not clear. We have studied liver transplant recipients to assess the impact of hepatitis C virus (HCV) genotype and HCV RNA quantification on HCV recurrence after transplantation. Twenty-two patients received transplants for HCV cirrhosis and were followed up with virological and histological assessments. Mean follow-up was 39 months. HCV genotype was determined with line probe assay (Inno-Lipa). HCV RNA quantity was determined in serum samples by use of polymerase chain reaction nested assay. HCV genotype 1 was detected in 13 patients and other genotypes in 9. Histological recurrence rates were 69% in patients with genotype 1 and 66% in patients with other genotypes. All cases of severe histological injury (chronic active hepatitis or cirrhosis) were observed in patients with genotype 1. HCV RNA quantity was significantly higher in patients with genotype 1 (mean, 2.023 x 10(3) copies/mL) than in patients with other genotypes (mean, 27,403 copies/mL). In conclusion, the severity of histological recurrence after liver transplantation for HCV disease was higher in patients infected by HCV genotype 1 than in those infected with other genotypes. The levels of viral replication were higher in patients with HCV genotype 1 than in those with other genotypes.
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Affiliation(s)
- G P Pageaux
- Service d'Hépatogastroentérologie, Hôpital Saint-Eloi, Montpellier, France
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39
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Affiliation(s)
- C Turc Baron
- Department of Nephrology, University Hospital, Montpellier, France
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40
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García-Compeán D, Blanc P, Bories JM, Michel J, Desprez D, Pageaux GP, David XR, Larrey D, Michel H. Treatment of active gastroesophageal variceal bleeding with terlipressin or hemostatic balloon in patients with cirrhosis. A randomized controlled trial. Arch Med Res 1997; 28:241-5. [PMID: 9204616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gastroesophageal variceal bleeding due to portal hypertension should be treated by endoscopic sclerotherapy. This procedure, however, has some limitations. It has been established that vasoactive drugs are effective for controlling active variceal bleeding. We report the results of a randomized controlled trial comparing terlipressin to hemostatic tube (Linton-Michel tube) for the treatment of bleeding gastroesophageal varices in cirrhotic patients. Thirty-seven cirrhotic patients with a total of 40 episodes of gastroesophageal variceal bleeding were included in this trial. Patients were randomly assigned to intravenous terlipressin or Linton-Michel tube (LM tube), for 24 h. During this period, hemostasis was defined as obtaining of hemodynamic and hematocrit stabilization and/or absence of hematemesis or melena. Bleeding recurrence was assessed during a 1-month period after treatment. Twenty bleeding episodes were treated with terlipressin (Group I) and 20 with LM tube (Group II). Both groups of patients were similar in age, sex distribution, etiology of cirrhosis and degree of hepatic insufficiency. Bleeding was controlled in 70% of patients from Group I and in 95% from Group II (p < 0.05) during treatment. Bleeding recurred in 14% of patients in Group I vs. 36% in Group II 1 week following the treatment (p > 0.05) and in 16.6% in Group I vs. 83.3% in Group II 1 month after treatment (p < 0.05). Complications were more frequent in Group II than in Group I (65 vs. 15%, p < 0.05). Mortality rate was similar in both groups 1 month after treatment. In conclusion, hemostatic tubes were superior to terlipressin for the control of active gastroesophageal variceal bleeding within the first 24 h. Complications and bleeding recurrence were more frequent in patients treated by hemostatic tube within a period of 1 month after treatment. Mortality rate was similar in both groups of patients.
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Affiliation(s)
- D García-Compeán
- Service d'Hepato-Gastroenterologie, Hospital Saint-Eloi, Montpellier, France
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Abstract
Drug-induced hepatitis is uncommon and generally unpredictable. Hepatotoxicity may be related to the drug itself, or to chemically reactive metabolites which can bind covalently to hepatic macromolecules and may lead to either idiosyncratic, toxic hepatitis or to immunoallergic hepatitis. There is now evidence indicating that genetic variations in systems of biotransformation or detoxication may modulate either the toxic or sensitizing effects of some drugs. Thus, the genetic deficiency in a particular hepatic cytochrome P 450 isozyme (CYP 2D6) is involved in per-hexiline liver injury. The deficiency in CYP 2C19 might also contribute to Atrium hepatotoxicity. Slow acetylation related to N-acetyltransferase 2 deficiency contributes to sulfonamide hepatitis. The genetic deficiency in glutathione synthetase may increase the susceptibility to several drugs including acetaminophen. A constitutional deficiency in another cell defense mechanism, still not characterized, seems to increase significantly the risk of hepatotoxicity with halothane, phenytoin, carbamazepine, phenobarbital, sulfamides and amineptine.
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Affiliation(s)
- D Larrey
- Service d'Hépatogastroentérologie, Hôpital Saint-Eloi, Montpellier, France
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Perrigault PF, Pageaux GP, Souche B, Navarro F, Abdesalem K, Robles G, Fabre JM, Domergue J, Colson P. Intraoperative use of continuous arteriovenous hemodiafiltration in orthotopic liver transplantation. Transplant Proc 1996; 28:2841. [PMID: 8908091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P F Perrigault
- Service d'Anesthésie Réanimation, Hopital St Eloi, Montpellier, France
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Barki J, Blanc P, Michel J, Pageaux GP, Hachemane-Aourag S, Carabalona JP, Larrey D, Michel H. [Painful rib syndrome (or Cyriax syndrome). Study of 100 patients]. Presse Med 1996; 25:973-6. [PMID: 8692774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To analyse clinical expression and outcome of painful rib syndrome in a large series of 100 cases. METHODS From 1978 to 1993, 100 consecutive patients with chronic anterior chest pain or supramesocolic abdominal pain of unknown origin underwent complete physical examination, laboratory tests and complementary explorations as required. RESULTS Among the first 100 patients the sex ratio was 3.34 and mean age 50.6 years (21-80). Chronic pain had persisted for an average 41.2 months (15 days-30 years), predominantly on the right (81%) and exceptionally bilaterally (1%). No evidence of a cause could be identified from laboratory tests or complementary explorations. A past history of direct trauma was found in 71 patients and indirect trauma in 21. Seventy-three patients were given 1% lidocaine infiltrations (20 to 40 ml) including 14 who received 2 or 3 infiltrations. Six patients underwent surgical resection of a luxated cartilage with curative effect in 5. CONCLUSION The diagnosis of painful rib syndrome is based solely on the presence of pain upon applying pressure to the anteroinferior border of the rib cage and is related to often neglected or forgotten trauma.
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Affiliation(s)
- J Barki
- Service d'Hépato-Gastroentérologie, Hôpital Saint-Eloi, Montpellier
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Abstract
We report the case of a patient who developed jaundice, encephalopathy, a marked increase in serum aminotransferase activity and a decrease in prothrombin and proaccelerin levels, after 6 weeks' treatment with carbimazole and propranolol for hyperthyroidism. The patient ultimately underwent orthotopic liver transplantation. This case strongly suggests that carbimazole may occasionally induce fulminant hepatitis and that careful monitoring of liver enzymes may be useful during the treatment of hyperthyroidism with this drug.
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Affiliation(s)
- J M Epeirier
- Service d'Hépato-gastroentérologie, Hôpital Saint Eloi, Montpellier, France
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45
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Remy AJ, Diaz R, Blanc P, Pageaux GP, Larrey D, Michel H. [Extrahepatic cancer in cirrhosis patients. A retrospective clinical study of 164 diagnosed cancers in 2060 cirrhosis patients]. Ann Gastroenterol Hepatol (Paris) 1996; 32:5-9. [PMID: 8669807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A retrospective study of 2060 inpatients with cirrhosis of the liver identified 164 patients with extrahepatic cancer, a 20-fold increase over the expected number. Gastrointestinal, ENT, pulmonary, and hematologic malignancies predominated. Extrahepatic cancers occur more often and at an earlier age in patients with cirrhosis of the liver than in the population at large.
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Affiliation(s)
- A J Remy
- Service d'Hépato-gastroentérologie, Hôpital Saint-Eloi, Montpellier
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46
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Epeirier JM, Pageaux GP, Bauret P, Gineston JL, Larrey D, Michel H. [Cholangiocarcinoma: a rare cause of chylous ascites]. Gastroenterol Clin Biol 1995; 19:1062. [PMID: 8729420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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47
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Taourel PG, Pageaux GP, Coste V, Fabre JM, Pradel JA, Ramos J, Larrey D, Domergue J, Michel H, Bruel JM. Small hepatocellular carcinoma in patients undergoing liver transplantation: detection with CT after injection of iodized oil. Radiology 1995; 197:377-80. [PMID: 7480680 DOI: 10.1148/radiology.197.2.7480680] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To assess computed tomography (CT) with iodized oil for depiction of small hepatocellular carcinoma (HCC) before liver transplantation. MATERIALS AND METHODS Thirty-five consecutive cirrhotic patients underwent CT with iodized oil to determine the presence, number, size, and location of possible nodules. All patients underwent liver transplantation within 4 months after CT. Explanted livers were cut in 8-mm slices that corresponded to axial CT scan planes. Comparison between CT staging and pathologic findings was made. RESULTS Pathologic studies showed 17 HCC nodules (diameter, 0.9-4.0 cm) in nine of the 35 livers. CT depicted nine of these 17 nodules. Lesion-by-lesion analysis revealed a sensitivity of 53%; CT falsely depicted three additional nodules not confirmed with pathologic findings. Patient-by-patient analysis revealed an 89% sensitivity and an 88% specificity. CONCLUSION CT with iodized oil, when assessed lesion by lesion, has a low sensitivity. These results must be considered when liver resection is proposed for HCC.
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Affiliation(s)
- P G Taourel
- Service d'Imagerie Médicale, Hôpital Saint-Eloi, France
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48
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Perrigault PF, Pageaux GP, Grevy V, Souche B, Gouiry C, Fabre JM, Domergue J, Colson P. Hemodynamic changes after lateral inferior vena cava clamping in orthotopic liver transplantation. Transplant Proc 1995; 27:2513. [PMID: 7652909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- P F Perrigault
- Departement d'Anesthésie Réanimation, C. Hôpital St Eloi, Montpellier, France
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49
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Affiliation(s)
- D Larrey
- Service d'Hépatogastroentérologie, Hôpital Saint-Eloi, Montpellier, France
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50
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Pageaux GP, Blanc P, Perrigault PF, Navarro F, Fabre JM, Souche B, Domergue J, Larrey D, Michel H. Failure of ursodeoxycholic acid to prevent acute cellular rejection after liver transplantation. J Hepatol 1995; 23:119-22. [PMID: 7499781 DOI: 10.1016/0168-8278(95)80324-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Acute rejection is still a major problem after liver transplantation. Ursodeoxycholic acid has beneficial effects in cholestasis by reducing the expression of major histocompatibility complex antigens. METHODS We have performed a double-blind randomised study comparing ursodeoxycholic acid with placebo for the prevention of acute cellular rejection after liver transplantation. Twenty-six patients received ursodeoxycholic acid 600 mg per day and 24 patients received placebo for 2 months. RESULTS Neither rejection incidence nor rejection severity was significantly different in the two groups (p > 0.90). CONCLUSIONS We conclude that adjuvant ursodeoxycholic acid administration does not prevent rejection after liver transplantation.
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Affiliation(s)
- G P Pageaux
- Service d'Hépato-gastroentérologie, Hôpital Saint-Eloi, Montpellier, France
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