Wait-listed (n ϭ 226) or post-liver transplantation (n ϭ 241) chronic hepatitis B (CHB) patients with lamivudine-resistant hepatitis B virus (HBV) were treated with adefovir dipivoxil for a median of 39 and 99 weeks, respectively. Among wait-listed patients, serum HBV DNA levels became undetectable (Ͻ1,000 copies/mL) in 59% and 65% at weeks 48 and 96, respectively. After 48 weeks, alanine aminotransferase (ALT), albumin, bilirubin, and prothrombin time normalized in 77%, 76%, 60%, and 84% of wait-listed patients, respectively. Among posttransplantation patients, serum HBV DNA levels became undetectable in 40% and 65% at weeks 48 and 96, respectively. After 48 weeks, ALT, albumin, bilirubin, and prothrombin time normalized in 51%, 81%, 76%, and 56% of posttransplantation patients, respectively. Among wait-listed patients who underwent on-study liver transplantation, protection from graft reinfection over a median of 35 weeks was similar among patients who did (n ϭ 34) or did not (n ϭ 23) receive hepatitis B immunoglobulin (HBIg). Hepatitis B surface antigen was detected on the first measurement only in 6% and 9% of patients who did or did not receive HBIg, respectively. Serum HBV DNA was detected on consecutive visits in 6% and 0% of patients who did or did not receive HBIg, respectively. Treatment-related adverse events led to discontinuation of adefovir dipivoxil in 4% of patients. Cumulative probabilities of resistance were 0%, 2%, and 2% at weeks 48, 96, and 144, respectively. In conclusion, adefovir dipivoxil is effective and safe in wait-listed or posttransplantation CHB patients with lamivudine-resistant HBV and prevents graft reinfection with or without HBIg. Liver Transpl 13:349-360, 2007.

SUMMARY Background:The 13 C-methacetin breath test enables the quantitative evaluation of the cytochrome P450-dependent liver function. Aim: To find out whether this breath test is sensitive in noncirrhotic patients also with chronic hepatitis C in early stages of fibrosis. Methods: Sixty-one healthy controls and 81 patients with chronic hepatitis C underwent a 13 C-methacetin breath test. In all patients, a liver biopsy was performed. The liver histology was classified according to the histology activity index-Knodell score.Results: Delta over baseline values of the patients at 15 min significantly differed from controls (19.2 ± 9.2& vs. 24.1 ± 5.7&; P < 0.003). The cumulative recovery after 30 min in patients was 11.4 ± 4.8% and in healthy controls 13.8 ± 2.8% (P < 0.002).However, patients with early fibrosis (histology activity index IVB) did not differ in delta over baseline values of the patients at 15 min (23.2 ± 7.9& vs. 22.6 ± 7.2&; P ¼ 0.61) or cumulative recovery (13.6 ± 3.7% vs. 13.2 ± 3.8%; P ¼ 0.45) from patients with more advanced fibrosis (histology activity index IVC).Patients with clinically nonsymptomatic cirrhosis (histology activity index IVD; Child A) metabolized 13 Cmethacetin to a significantly lesser extent (delta over baseline values of the patients at 15 min: 8.3 ± 4.9&; P < 0.005 and cumulative recovery after 30 min: 5.6 ± 3.2%; P < 0.003). The 13 C-methacetin breath test identified cirrhotic patients with 95.0% sensitivity and 96.7% specificity. Conclusion:The non-invasive 13 C-methacetin breath test reliably distinguishes between early cirrhotic (Child A) and noncirrhotic patients, but fails to detect early stages of fibrosis in patients with chronic hepatitis C. can be quantified by isotope ratio mass spectrometry or nondispersive isotope-selective infrared spectroscopy. 4-6Like the 13 C-aminopyrine breath test and the monoethylglycinexylidide (MEGX) test, the 13 C-MBT is a microsomal liver function test.To determine the degree of fibrosis in patients with chronic liver disease, liver biopsy is still considered as the gold standard. Non-invasive serum tests to classify patients as having mild or advanced liver fibrosis allow correct determination in approximately 40-70% of the cases only. [7][8][9][10][11] Most liver function tests, including the 13 C breath tests, together with the clinical judge-

Low-dose deoxycholate stimulates colon cancer cell proliferation while > 100 micromol L(-1) of this secondary bile acid induces apoptosis in colon cancer cells. Deoxycholate might promote the likelihood of malignant transformation by increasing epithelial cell turnover in the colon.

Perihepatic lymphadenopathy is found in infectious and autoimmune liver diseases, but not in metabolic or toxic liver damage. The absence of perihepatic lymph nodes in acute liver failure should lead to intensive search for a toxic or metabolic cause.

Long-term administration of i.m. HBIG saves up to 60% of the usual costs for i.v. prophylaxis of HBV reinfection in patients after OLT. In combination with lamivudine, long-term i.m. HBIG therapy is as efficient as i.v. HBIG treatment, but its lower costs clearly favour its use in preventing HBV reinfection after OLT.

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Our data suggest that 5-MTHF, being the key metabolite in both the folate and homocysteine metabolic pathway, is the main modulator of growth-promoting actions of homocysteine as well as antiproliferative effects of folate in colon cancer cells.

AIM:To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy. METHODS:Patients who developed biliary complications were analysed in detail for the clinical information, laboratory tests, treatment offered, response to it, follow up and outcomes. The profile of liver enzymes was determined. The safety, efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed.RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1 ± 70.9 U/mL vs 168.5 ± 34.2 U/L, P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs 152.7 ± 21.4 U/L, P = 0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%). Sustained success was achieved in 26 (81%) patients. CONCLUSION:Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early, non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.