The article Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update, written by [Shiv Sarin], was originally published electronically on the publisher’s internet portal (currently SpringerLink) on June 06, 2019 without open access.

AimLipid lowering therapy with 3-hydroxy-3-methylglutaryl-coenzyme A (H MG-CoA) reductase inhibitors is increasingly used for the prevention of cardiovascular events, but they should be used with caution in patients with impaired liver function. We therefore studied the pharmacokinetics of pitavastatin in patients with liver cirrhosis. MethodsPlasma concentrations of pitavastatin were determined after administration of 2 mg single-dose pitavastatin to 12 male patients with liver cirrhosis (six Child-Pugh grade A and six grade B). These results were compared with the single-dose pharmacokinetic results obtained from six male volunteers without liver disease. ResultsAdministration of 2 mg single-dose pitavastatin to patients with Child-Pugh grade A and grade B cirrhosis resulted in a 1.19-and 2.47-fold increase in C max and 1.27-and 3.64-fold increase in AUC t , respectively, when compared with normal subjects. The geomean C max of pitavastatin was 59.5 ng ml -1 , 70.7 ng ml -1 and 147.1 ng ml -1 in the control, Child-Pugh grade A and Child-Pugh grade B groups, respectively. The geomean AUC t of pitavastatin in the three groups was 121.2 ng h -1 ml -1 , 154.2 ng h -1 ml -1 and 441.7 ng h -1 ml -1 , respectively. The geomean C max of pitavastatin lactone was 20.3 ng ml -1 , 19.1 ng ml -1 and 9.9 ng ml -1 in the control, ChildPugh grade A and grade B groups, respectively. The AUC t of pitavastatin lactone was 120.2 h -1 ml -1 , 108.8 h -1 ml -1 and 87.5 h -1 ml -1 , respectively. ConclusionThe plasma concentration of pitavastatin is increased in patients with liver cirrhosis. In such patients, caution is required, although dose reduction may not be necessary in Child-Pugh A cirrhosis.

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Summary:In the Asia-Pacific region, autologous and allogeneic bone marrow transplantation (BMT) in patients infected with the hepatitis B virus (HBV) may be complicated by fatal hepatic failure due to viral reactivation. Survivors may suffer from accelerated hepatitis and cirrhosis. We report the first case of hepatocellular carcinoma (HCC) after autologous BMT for mediastinal B cell lymphoma. The tumor developed rampantly during a planned pregnancy 5 years after BMT. Less than 40 cases of HCC complicating pregnancy have been reported, and outcome is invariably poor. Immunosuppression and HBV reactivation after autologous BMT, as well as immune tolerance and hormonal changes associated with pregnancy may contribute to the rapid tumor growth. Biochemical and radiological surveillance for HCC should be strengthened in HBV carriers after BMT, especially in patients with the histology of chronic liver disease, or biochemical/ virological evidence of increased HBV activity. Bone Marrow Transplantation (2002) 29, 177-179. DOI: 10.1038/sj/bmt/1703339 Keywords: autologous bone marrow transplanation; hepatitis B virus; hepatocellular carcinoma; pregnancyThe incidence of secondary malignancy is increased after bone marrow transplantation (BMT). The commonest secondary malignancy after autologous BMT is therapy-related myelodysplasia (t-MDS). 1 After allogeneic BMT, the incidence of post-transplantation lymphoma (PTLD) is also increased. 2,3 The incidence of other common solid malignancies, including lung and breast carcinoma, increase with longer follow-up of survivors. 2 Hepatocellular carcinoma (HCC) is the second commonest malignancy in the Southern Chinese (10% population hepatitis B virus (HBV) carriers). We report the first case of aggressive HCC after autologous BMT. Materials and methodsBetween 1991 and 2000, 159 and 525 consecutive autologous and allogeneic BMTs were performed at the Queen Mary Hospital. Among all marrow recipients, 23 autologous and 60 allogeneic cases were HBV carriers. 4 Their median age was 35 years (range 5-56 years), and they included 56 men and 27 women. The protocol for myeloablation and HBV chemoprophylaxis were according to the study protocol during the time periods. 5 HBV carriers were monitored by serial hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) and hepatitis B e antibody (anti-HBe), liver biochemistry, half-yearly alpha-fetoprotein (AFP) and ultrasound (USG), and quantitative serum circulating HBV DNA (Digene Capture II) assays, at 1-6 monthly interval. 6 The median overall survival of 83 HBV cases was 23 months, with an actuarial median follow-up of 115 months. There were 32 deaths, 10 due to conditioning toxicity and liver failure (Ͻday 100), 13 due to relapse, and eight due to graft-versus-host disease (GVHD). One patient died of aggressive HCC, during a rare planned pregnancy after autologous BMT. Among the other 647 BMT recipients, no other cases of a solid tumor developing after BMT have been detected to date. Case history and resultsA 29-year-old w...

We report a unique case of emergency living related donor orthotopic liver transplantation (OLT) for late fulminant reactivation of hepatitis B virus (HBV) after matched unrelated bone marrow transplantation (BMT) for chronic myeloid leukemia (CML). Cessation of lamivudine after BMT for HBV positive patients may carry risks of late fatal HBV reactivation. Similar to fulminant HBV reactivation in the general population, OLT under resumption of lamivudine can be life saving. In our case, concomitantly molecular relapse of CML at the time of liver failure was also cleared by OLT, possibly via a 'liver-graft vs. leukemia' effect. Liver rejection (graft vs. graft disease) was mild due to inherent immunocompromise of the marrow graft. Hence BMT recipients in stable remission should not be denied the opportunity for life-saving solid organ transplantation. A choice of marrow and liver donors with innate HBV immunity may be needed to give the additional advantage of long-term HBV clearance.