Outcomes of Pregnancy in Recipients of Liver Transplants.

Background & Aims: Despite increasing reports of pregnancy in women who received liver transplants, it is not clear how transplantation and immunosuppression affect pregnancy. We collected data from liver transplant recipients who became pregnant on immunosuppression regimens, pregnancy management, graft morbidity, and outcomes of mothers and neonates.

Methods: We searched the liver transplant database in Birmingham, United Kingdom, for women who reported pregnancy after liver transplantation from August 1986 through May 2016.

Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management.

Objectives: To prospectively use a non-invasive algorithm to identify asymptomatic, advanced non-alcoholic fatty liver disease (NAFLD) in a secondary care diabetes clinic and to determine the short-term effect of a multi-disciplinary team (MDT) approach in a liver clinic.

Research Design And Methods: NAFLD Fibrosis Score (NFS) was calculated in 64 asymptomatic patients with type 2 diabetes. Advanced fibrosis was identified using transient elastography and confirmed with liver biopsy.

Symptomatic portal biliopathy: a single centre experience from the UK.

Background And Methods: Biliary obstruction as a consequence of portal biliopathy, because of extrahepatic portal vein occlusion is an uncommon cause of biliary disease in the western world. We reviewed all patients presenting to the Regional Liver Transplant Unit in Birmingham, UK with symptomatic portal biliopathy between 1992 and 2005 and report the presentation, investigation, management and outcome of these complex patients.

Results: Thirteen patients with symptomatic portal biliopathy were followed up for a median of 2 years (range 1-18 years).

Tacrolimus and cyclosporin doses and blood levels in hepatitis C and alcoholic liver disease patients after liver transplantation.

Hepatitis C virus (HCV)-induced cirrhosis is the most common indication for liver transplantation (LT). However, graft reinfection is nearly universal. The choice of immunosuppression, including the calcineurin inhibitor (CNI), may have some effect on severity of recurrence and graft survival.

A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation.

Background: Biliary anastomotic strictures are a common complication of liver transplantation, occurring in up to 7% of patients at our center. Endoscopic therapy has started to replace surgical biliary reconstruction as the favored means of managing these patients in some centers, although the utility of this approach has never been tested in the setting of a standardized prospective study.

Methods: This was a standardized, prospective observational study in the liver transplantation unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.

Thrombocytosis in liver transplant recipients: prevalence, natural history, and impact.

The prevalence, natural history, and implications of reactive thrombocytosis after liver transplantation (LT) are unknown. Prospectively collected data from July 2000 to February 2006 were analyzed. Post-LT thrombocytosis was defined as a platelet count of > 450 x 10(3)/microL lasting for >7 days and starting within 8 weeks of transplantation.

Liver transplantation for hepatic epithelioid hemangioendothelioma: a case series.

Epithelioid hemangioendothelioma is a rare soft-tissue tumor with unpredictable malignant potential. This type of tumor can occur in the liver but is very rare. Signs and symptoms are often nonspecific, and even if the problem is not misdiagnosed, arriving at a clear diagnosis can take some time.

Results of combination treatment with pegylated interferon and ribavirin in cirrhotic patients with hepatitis C infection.

Background: The treatment of hepatitis C patients with advanced cirrhotic liver disease remains challenging and data on the outcome of treatment for this patient group is limited.

Results: Between September 2000 and August 2004, 61 cirrhotic patients started treatment with pegylated interferon and ribavirin (42 male, age range 29-69 years, 26 Asian). Forty-three (70%) patients were serum hepatitis C virus (HCV) RNA negative at the end of treatment and 24 (39%) achieved a sustained virological response (SVR).

Self-organizing maps can determine outcome and match recipients and donors at orthotopic liver transplantation.

Background: There is a relative lack of donor organs for liver transplantation. Ideally, to maximize the utility of those livers that are offered, donor and recipient characteristics should be matched to ensure the best possible posttransplant survival of the recipient.

Methods: With prospectively collected data on 827 patients receiving a primary liver graft for chronic liver disease, we used a self-organizing map (SOM) (one form of a neural network) to predict outcome after transplantation using both donor and recipient factors.

Hepatitis B and C virus infections in the immune compromised.

Purpose Of Review: This review compares and contrasts the natural history and treatment of hepatitis B and C virus infections in three principal populations of immune compromised individuals: (1) patients co-infected with HIV; (2) patients with liver failure secondary to hepatitis B or C virus infection who undergo liver transplantation, and (3) patients with hepatitis B or C virus infection who undergo anticancer chemotherapy.

Recent Findings: Chronic liver disease resulting from hepatitis B or C virus infection progresses more rapidly in patients co-infected with HIV than in HIV negative patients. Treatment protocols for antiviral therapy are, however, similar to those used in immunocompetent individuals and although few long-term results are available, the efficacy of interferon and ribavirin therapy in hepatitis C virus/HIV infection and lamivudine in HIV/hepatitis B virus infection has been proven in the short-term.

Lymphocyte recruitment to the liver in alcoholic liver disease.

The normal liver contains a large number of lymphocytes, which include not only specialized natural killer (NK) and NKT cells but also CD4 and CD8 T cells. Whereas some of these cells are terminally differentiated effector cells that are destined to die by apoptosis, many of them are not and include immunocompetent cells that traffic through the liver to provide continuing immune surveillance as well as epithelial-associated effector T cells. In alcoholic liver disease the number of lymphocytes in the liver increases and the type and distribution of these infiltrating cells will determine the nature of the inflammation.

Genetically modified interferon: is there a consensus yet?

The treatment of patients with chronic hepatitis C virus infection has evolved during the last decade from interferon monotherapy to combination therapy with interferon and ribavirin. National and international guidelines recommend either 6 or 12 months of interferon/ribavirin combination therapy depending on the pre-treatment virological status of the patient. However, the choice for second-line treatment of patients who do not achieve sustained viral clearance with combination therapy has yet to be defined.