K Rajender Reddy

..However, the safety and efficacy of silymarin have not been studied systematically in chronic hepatitis C...

..The proper identification of those who might benefit from extended duration HCV therapy will undoubtedly lead to optimal care and outcomes...

..Despite these recent advances in our knowledge, many questions remain, such as whether the role of ribavirin will change or even be eliminated as new therapies are developed...

..Steatosis is significantly more common in genotype 3 compared with other genotypes, and in these patients, an SVR is associated with steatosis clearance...

..Peginterferon alfa-2a (40 KD) has comparable safety to interferon alfa-2a. The addition of ribavirin to peginterferon alfa-2a (40 KD) further enhances the therapeutic benefit for patients with hepatitis C...

..Liver transplantation completely restores impaired coagulation abnormalities and is the ultimate intervention that corrects coagulopathy of advanced liver disease and liver failure...

..The much-increased sustained virological response rates observed with pegylated IFN alfa-2a (40 kD) and pegylated IFN alfa-2b (12 kD) support the rationale for pegylation of IFN...

..We evaluated the effects of ribavirin and peginterferon alfa-2a dose reductions on SVR in patients infected with HCV genotype 1...

..More frequent dose modifications of ribavirin in those >50 years likely contributed to the observed higher relapse rates...

..We evaluated intensified therapy with peginterferon alfa-2a plus ribavirin...

..In conclusion, few patients with preexisting renal dysfunction, especially if <12 weeks duration, experience a significant drop in eGFR post-OLTa...

..The botanical product silymarin, an extract of milk thistle, is commonly used by patients to treat chronic liver disease, despite scant and conflicting evidence of its efficacy...

..In conclusion, this study provides a rationale for the use of lower HBIg doses in HBV patients with suppressed replication undergoing LT...

..Kidney transplantation alone may be considered in patients with hepatitis C with compensated cirrhosis or bridging fibrosis...

..Important predictors of graft loss in HCV-infected patients were limited LDLT experience, pretransplant HCC, and higher MELD at transplantation...

..The association between treatment outcome and phytohemagglutinin response suggests more global and antigen-nonspecific mechanisms for therapeutic HCV clearance...

..Furthermore, we demonstrated a racial disparity in survival of HCV/HIV-coinfected patients that needs further investigation...

..01) after transplantation. In conclusion, duration, but not cause, of renal dysfunction predicts renal outcome in OLTa recipients. Prospective studies may use duration of renal dysfunction to help identify CKLT candidates...

..Expert clinical management may help prevent and treat complications associated with disease recurrence...

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..Although HCV-specific CD4 T-cell response is associated with HCV clearance, less is known about virus-specific CD8 T-cell or neutralizing antibody (nAb) responses and the role of CD4 help in their induction during acute infection...

..25%) (P > 0.1). In conclusion, viable tumor frequently persists after pre-transplant locoregional therapy, and neoadjuvant treatment does not appear to improve post-transplant outcomes in the current MELD era...

..Clinical observations suggest that patients with HIV/hepatitis C virus (HCV) may lose body weight during dual therapy, but this has not been confirmed analytically...

..To determine whether a greater Model for End-Stage Liver Disease (MELD) score is associated with a greater risk of spontaneous bacterial peritonitis (SBP)...

..Recurrent hepatitis C with ensuing fibrosis is the leading cause of liver allograft loss. We investigated whether histologic features in early posttransplant liver biopsies could predict the rate of fibrosis progression in this population...

..Hepatitis C virus (HCV) infection has been shown to be a potential risk factor for the development of chronic kidney disease in liver transplant recipients...

..e., vascular invasion and multifocality. Present UNOS selection criteria for HCC based on tumor burden appear to provide adequate discriminatory power in predicting outcome of OLT...

..We examined the cost and cost effectiveness of distal splenorenal shunt (DSRS) and transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of variceal rebleeding...

..It is important to identify pre-liver transplant patients at high risk for early evolution of chronic kidney disease post-transplant in order to appropriately select patients for combined liver/kidney transplantation...

..In this article, the authors discuss immunomodulatory therapies and clinical trials in the treatment of HCV infection...

..In conclusion, despite more advanced liver disease and a lower rate of transplantation, ITT survival of patients listed for HBV-cirrhosis was comparable to those with HBV-HCC, possibly related to beneficial effects of antiviral therapy...

..To overcome such barriers in the post-MELD era, clinicians might refer patients with PSC, relative to patients without PSC, for living donor transplants more frequently...

..We determined the ability of diagnostic codes and liver-related laboratory abnormalities to identify hepatic decompensation events within the Veterans Aging Cohort Study (VACS)...

..03) albumin (OR: 0.5), and second infection (OR: 4.42) as significant variables. CONCLUSION: Potentially preventable second infections are predictors of mortality independent of liver disease severity in this multicenter cirrhosis cohort...

..Experimental interventions, and the management of pruritus in certain conditions such as intrahepatic cholestasis of pregnancy and benign recurrent intrahepatic cholestasis, are also briefly reviewed...

..016), while HBV coinfection was positively associated with HCV clearance (unadjusted OR 5.0; 95% CI, 1.26-28.6; P =.008). In conclusion, the likelihood of spontaneous clearance of HCV may be influenced by alcohol and viral coinfections...

..Supplementary material for this article can be found on the HEPATOLOGY website (http://interscience. wiley.com/jpages/0270-9139/suppmat/index.html)...

..Our objective was to determine the diagnostic accuracy of clinical and histological parameters in liver transplant recipients with RHCV and concurrent cholestasis...

..It is unclear whether patients who develop acute-on-chronic liver failure (ACLF) have poor outcomes after liver transplantation...

..LDLT may remain an option for high-risk patients affording tumor-free survival for some otherwise terminal patients...

..In patients with chronic liver disease, race plays a role in the rate of survival after transplantation. It is not known how race and ethnicity influence the presentation, etiology, and outcomes in patients with acute liver failure (ALF)...

..Our aim was to determine whether SVR rates in patients with low/elevated LDL can be improved by dose intensification...

..Use of TDF to prevent vertical transmission (VT) by such mothers has not been evaluated...

..Diabetic HCV+ kidney candidates are therefore a patient subgroup that requires frequent and careful reevaluation to ensure ongoing transplantability...

..These advances have led to constant adjustments in management approaches to benign hepatic lesions. We review the biologic and clinical features of some common hepatic lesions, to guide diagnosis and management strategies...

..Although several studies suggested the preventive effect of interferon from developing HCC in HCV-infected individuals, these findings need to be validated in large prospective and randomized trials...

..Finally, features that may influence outcomes over which there is no control include: recipient age, recipient gender, and donor age (in the case of cadaveric donors). Unfortunately, the best-case scenario is uncommon...

..Analysis of this early experience with AALDLT suggests that allograft failure may be higher than among recipients of a cadaveric liver...

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..22 (95% confidence interval: 0.52-2.87) and 1.05 (0.43-2.57), respectively. In conclusion, we did not find a positive association between PPI use and spontaneous bacterial peritonitis...

..Treatment includes removal of offending drugs, supportive care, broad-spectrum antibiotic agents with drainage of infected fluid collections, adjustment of TPN, and either cholecystectomy or cholecystostomy, respectively...

..In this study, we examined the role of HCV-specific T-cell IL-10 response in patients with acute and chronic HCV infection...

..An invasive approach is seldom required. This review discusses the various characteristics of the most common benign liver lesions and recommends a practical approach...

..We report a case of liver transplantation for metastatic neuroendocrine tumor of unknown primary source and provide a detailed review of the world literature on this controversial topic...

..To describe the design and rationale of a series of postmarketing studies to examine the safety of saxagliptin, an oral dipeptidyl peptidase-4 inhibitor for the treatment of type 2 diabetes mellitus, in real-world settings...

..Prolonged exposure to ART, specially ddl, can play a pathogenic role. Rarely, liver synthetic function is sufficiently severe to warrant liver transplantation...

..Further work is necessary to correlate Q(TIPS) with the risk of hepatic encephalopathy and liver failure...

..Competing effects of hepatic encephalopathy, requirement for repeated LVP, and need for hospitalizations explain similar changes in quality of life between the two groups...

..Various imaging modalities can be utilized to accurately diagnose such masses without resort to more invasive diagnostic measures...

..We review the pathogenesis of infections in these patients, along with diagnostic and management strategies...

..ERCP is useful for diagnosis, can successfully treat most LDLT-related biliary complications, and should be attempted prior to more invasive interventions...

..001). In conclusion, the initial AFP level may be useful along with tumor stage in defining an urgency score for liver transplant candidates with HCC...

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..CONCLUSIONS: The mechanisms of resistance to PEG-IFN combination therapy may be different in black and white HCV genotype 1 patients...

..We evaluated the prognostic value of baseline factors and early viral RNA among patients treated with peginterferon alfa-2a (40KD)...

..This might be explained by a viral dynamics model assuming a jump-start of the immune response when viral loads are reduced below a threshold, subsequently giving rise to a faster 2nd phase decline slope...

..The present study was performed to evaluate the impact of the international unit standard for measuring HCV RNA in the management of patients with chronic hepatitis C virus (HCV) infection...

..They also suggest that early viral kinetics during the first month of therapy can predict non-SVR and thus save a patient a year long treatment which is fraught with side-effects and significant cost...

..Pegylated IFNs with ribavirin are the standard of care for treating patients with chronic HCV who have not been treated previously...

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..Prediction of sustained virological response (SVR) during treatment would allow clinicians to identify patients most likely to benefit from therapy...

..Close monitoring and management of therapeutic side effects are required to assist these patients in adhering to therapy...

..Subgroups of patients with elevated ITAC levels and perhaps less advanced disease may be considered for future studies with IFN-gamma1b...

..In the meantime, physicians must make the best possible use of the available options for managing anemia, especially in select patient groups who are most at risk for anemia and its complications...

..It is possible that if consensus interferon is administered daily rather than three times weekly, eradication of HCV could be achieved in a larger proportion of patients infected with HCV genotype 1...

..The aim of this prospective study was to compare the clinical utility of AFP-L3% with that of total AFP in North American patients...

..In conclusion, patients infected with HCV genotype 1 and treated with peginterferon alpha-2a/ribavirin sustained a RVR 24% of the time. This portends an 89% probability of a SVR after 24 weeks of treatment...

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..Pooled data from five studies of peginterferon alpha-2a in patients with chronic HCV infection (CHC) were compared with two studies of the drug in patients with chronic HBV infection (CHB)...

..This assessment is being used to individualize treatment duration, which is currently recommended as 48 weeks in patients infected with HCV genotype 1 (G1) and 24 weeks in those infected with HCV G2 or G3...

..Occult HBV infection is strongly associated with the presence of anti-HBc, history of injection drug use, and explant-proven HCC...

..A significantly higher proportion of patients treated with the 180 microg dose of peginterferon alpha-2a had clinically significant histological improvement...

..Here, we discuss how optimizing the ribavirin component of combined therapy for HCV is an essential part of treatment optimization...

..In this article, we present a summary of the most recent information on screening, diagnosis, staging, and different treatment modalities of HCC, as well as our recommended management approach...

..We reviewed our experience with liver grafts from hepatitis-B surface antigen (HBsAg)(-), antibody to core antigen (anti-HBc)(+) donors...

..A sampling error may have led to underdiagnosis of cirrhosis in 14.5% of the patients. These differences could not be attributed to intraobserver variation, which appeared to be low...

..The clinical utility of transjugular intrahepatic portosystemic shunts (TIPS) vis-à-vis total paracentesis in the management of refractory ascites is unclear...

..This study will examine the safety and tolerability of various doses of milk thistle as well as start to explore its role in hepatitis C. ..