No abstract

Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

Higher than normal levels of aspartate aminotransferase (AST) in the bloodstream may be a sign of a health problem. Individuals with macro-AST have elevated blood AST levels, without ongoing disease and often undergo unnecessary medical tests before the diagnosis of macro-AST is established. We found a genetic variant in the GOT1 gene associated with macro-AST. Genetic testing for this variant may aid diagnosis of macro-AST.

From the many prognostic models for primary biliary cirrhosis (PBC) patients based on Cox's regression analysis, the Mayo model has gained the most popularity and was successfully validated in some centers. The aim of our study was to validate the Mayo survival model for Polish PBC patients and, in case of its inapplicability, to select prognostic variables and to create time-fixed and time-dependent survival models for the patients. We used database information on patients from 6 medical centers in Poland, fulfilling clinical, serological, and/or pathological criteria of PBC. The Mayo model was validated using data from 116 PBC patients. The time-fixed and time-dependent models were created using data on clinical and biochemical variables used in the Mayo model from 162 and 208 patients, respectively. The Mayo model validation was performed graphically and by one-sample log-rank tests after dividing the study sample into 3 groups of high, medium, and low risk. Primary biliary cirrhosis (PBC) is a rare, chronic disorder involving intrahepatic bile ducts. Its cause remains unknown and the only effective treatment in its advanced stage is orthotopic liver transplantation (OLT). Years of relatively symptom-free survival may be expected between the time of diagnosis and the time that occurrence of complications leading to liver transplantation supervene. Precise timing of liver transplantation is therefore crucial to fulfill the National Institutes of Health criteria of no opportunity for spontaneous stabilization and a fair chance of the procedure success. 1 Prognostic models based on Cox' s regression give an estimation of survival probability and have served in PBC to help in OLT timing. 2-5 So far, the survival model for PBC patients developed in the Mayo Clinic has gained the greatest popularity. It was developed on relatively numerous groups of PBC patients, and it comprised easily obtainable variables of age, serum bilirubin and albumin concentration, prothrombin time, and presence of edema at the moment of disease diagnosis. 6 The Mayo model was cross-validated on several independent groups of patients in different American and European centers. 7-10 The time-dependent extension of the original Mayo model can be used to predict survival at any moment of follow-up for limited time periods. 11 According to preliminary reports, the estimated prevalence of PBC in Poland is probably one of the lowest in the world. 12 However, PBC constitutes one of the major indications for OLT in the recently established national liver transplantation program. The aim of our study was to establish a tool for helping the clinician decide the moment for OLT in Polish PBC patients. Because our preliminary analysis showed that the Mayo model could inadequately estimate their survival, 13 initially we validated the Mayo model on a representative group of Polish PBC patients. Our next step was to find important prognostic variables for the patients at the time of disease diagnosis and incorporate them into our own survival model. Fina...

Our results from Poland do not confirm a high prevalence of coeliac disease in PBC patients. Guinea-pig liver transglutaminase immunolinked assay cannot be used as a screening test for coeliac disease in PBC patients. A gluten-free diet may be helpful in restoration of liver function in patients with such an association.