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The results of our study confirm the efficacy of TIPS for refractory ascites. The use of narrow-diameter dilatation without aiming at lowering the PPG below a certain threshold might simplify the procedure and the follow-up for these patients.

Acanthamoeba-related cerebral abscess and encephalitis are rare but usually fatal, being caused by free-living amoebic infections usually occurring in immunocompromised patients. In patients receiving transplants, a literature review showed that the infection is universally fatal. The diagnosis is often missed despite appropriate investigations including lumbar puncture, computerized tomography, and brain biopsy. We present the first reported liver transplant patient with Acanthamoeba cerebral abscess. The diagnosis was made in brain tissue removed at decompressive frontal lobectomy. He was successfully treated with a 3-month course of co-trimoxazole and rifampicin. There was no recurrence of the disease after 11 years of follow-up. Liver Transpl 14:308-312, 2008 Central nervous system (CNS) infections by free-living amoebae, including Acanthamoeba species, Balamuthia mandrillaris, and Naegleria fowleri, have been recognized only in recent decades. The first two amoebae cause chronic granulomatous encephalitis, whereas the last one causes acute fulminant meningitis. Acanthamoeba-related infection is usually limited to immunocompromized patients, although infection in healthy children has been reported.1 Unfortunately, most of the infections are fatal and are diagnosed at autopsy. 2,3 We report the first case of successfully treated Acanthamoeba cerebral infection following liver transplantation. CASE REPORTA 41-year-old male had liver transplantation with a cadaveric donor graft in our hospital in September 1994 for end-stage alcoholic liver cirrhosis. He had a previous history of abdominal tuberculosis in 1986 and was an insulin-dependent diabetic. He recovered well after the operation and was given maintenance immunosuppression of cyclosporine, azathioprine, and prednisolone. He received fluconazole and acyclovir prophylaxis, which he continued for 6 weeks after discharge, which took place 3 weeks after the operation. At 3 months after transplantation, his prednisolone was tailed off completely. He developed depression and resumed drinking alcohol about 9 months after transplantation without affecting his graft function. He was followed up by a psychiatrist specializing in alcohol and substance abuse. Azathioprine was also stopped at the same time because of neutropenia, which subsequently recovered fully.At 14 months after transplantation, the patient was admitted as an emergency because of pyrexia, sore throat, and green sputum for 2 days. Physical examination was normal apart from the abdominal scar of his surgery. Chest X-ray showed elevated right hemidiaphragm but was otherwise normal. Cytomegalovirus polymerase chain reaction in blood was positive. Otherwise, no positive culture or serological positivity for bacteria or viruses was obtained. Ganciclovir was started on day 4 of admission. However, the patient continued to have a high unremitting fever. On day 6, Abbreviations: CNS, central nervous system; CT, computerized tomography.

Despite universal HBV vaccination since 1988, CHB remains the commonest cause of CLD in Hong Kong. PBC and nonalcoholic fatty liver disease were not rare in the Chinese population, being important causes of nonviral liver disease. The prevalence of chronic viral infection among patients with PBC or ALD confirmed the findings of other published literatures.

Thromboelastography evaluates the viscoelastic properties of blood coagulation. Using native blood, measurement must start soon after sampling. With normal coagulation, native and citrated blood values correlate well. No data exists from cirrhotic patients. We compared native and citrate thromboelastography parameters in 30 cirrhotic patients (20 Child-Pugh C class, two liver failure). Thromboelastography was performed within 4 min using native blood and after recalcification within 1-2 h of citrate storage. Thromboelastography variables (, alpha, ) were compared using the Mann-Whitney test, correlation investigated with the Pearson method and the degree of agreement with the Bland-Altman method. There was no significant difference between citrated and native blood for all variables. Median values for native and citrated were, respectively, 16.4 (range 2.3-22.5) and 15.1 (range 9.8-29.9); 6.3 (range 3.5-11.3) and 6.2 (range 2.8-10.9); 48.3 (range 30.7-62.9) and 46.2 (range 30.4-60.4); angle alpha 30.8 (range 18.7-46.8) and 33.2 (range 19.9-55.8). Correlation for each variable was significant ( 0.01). There was a good degree of agreement for all but two patients (both bleeding) for all variables. Citrated blood can substitute native blood using thromboelastography in cirrhotic patients, allowing more time between sampling and the thromboelastography measurement.

We systematically reviewed the evidence for determining the best radiological imaging for characterizing hepatocellular carcinoma (HCC) in cirrhotic patients in 997 articles between 1995 and 2001. We selected only prospective and retrospective cohorts of patients, excluding both case reports and studies without separate data on HCC. Only 29 studies, comprising 918 patients, fulfilled the inclusion criteria: 10 used the explanted liver as the reference standard of diagnosis. All except one, either found no statistically significant difference between imaging modalities or had no direct comparison of sensitivity between different modalities of imaging; 16 studies evaluated HCC among cirrhotic patients and had biopsy or imaging as the reference standard for diagnosis. However, no one imaging technique was shown to be superior. In two studies, data of a HCC subgroup was derived from the studies evaluating different kinds of focal hepatic lesions. No conclusion could be drawn because of the small sample size. One study addressed the issue of therapeutic impact. The evidence for choosing the best modality of imaging for characterizing HCC in cirrhotic patients is inadequate. Large multicentre studies with defined reference standards for diagnosis, and studies evaluating therapeutic impact are needed.

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