Background and aims Patients with cirrhotic refractory ascites ineligible for transjugular intrahepatic shunt (TIPSS) have limited treatment options apart from repeated large volume paracentesis. The alfapump® is an implantable device mobilizing ascites from the peritoneal cavity to the bladder, from where it can be excreted. The aim of this observational cohort study was to prospectively investigate safety and efficacy of the device in a real‐world cohort with cirrhotic refractory ascites and contraindications for TIPSS. Methods A total of 106 patients received an implant at 12 European centres and were followed up for up to 24 months. Complications, device deficiencies, frequency of paracentesis, clinical status and survival were recorded prospectively. Results Approximately half of the patients died on‐study, about a quarter was withdrawn because of serious adverse events leading to explant, a sixth were withdrawn because of liver transplant or recovery, and nine completed follow‐up. The most frequent causes of on‐study death and complication‐related explant were progression of liver disease and infection. The device reduced the requirement for large‐volume paracentesis significantly, with more than half of patients not having required any post‐implant. Survival benefits were not observed. Device‐related reinterventions were predominantly caused by device deficiencies. A post‐hoc comparison of the first 50 versus the last 50 patients enrolled revealed a decreased reintervention rate in the latter, mainly related to peritoneal catheter modifications. Conclusions The device reduced paracentesis frequency in a real‐world setting. Technical complications were successfully decreased by optimization of management and device modification (NCT01532427).
LINKED CONTENTThis article is linked to Vaz et al papers. To view these articles, visit https://doi.org/10.1111/apt.16539
Background and Aim Drug‐induced liver injury (DILI) may present with autoimmune features and require immunosuppressive therapy (IST) to reach biochemical response. Discontinuation of IST without hepatitis relapse may be more frequent in these patients as compared to patients with classical autoimmune hepatitis (AIH). We aimed to determine baseline characteristics and outcome of patients with immune‐mediated drug induced liver injury (IMDILI) with particular emphasis on IST during follow‐up. Methods We performed a single‐center retrospective study of consecutive patients presenting at a tertiary care center between January 2005 and December 2019 either with IMDILI or with classical AIH, for whom full baseline characteristics and a close follow‐up were available over a 12‐month period. Results Overall, 31 patients (IMDILI n = 16, mean age 59 [34–74] years; AIH n = 15, mean age 47 [15–61] years) were included, showing similar biochemical, serological, and histological characteristics. Incriminating drugs in IMDILI patients were mostly represented by nonsteroidal antiinflammatory drugs and sartans. Initial corticosteroids combined with IST led to biochemical response in all patients. Compared to idiopathic AIH, more patients with IMDILI were weaned off corticosteroids at the end of follow‐up (11/16 [68.7%] vs 4/15 [26.6%], P < 0.02). At 1 year of follow‐up, more patients in the IMDILI group compared to the classical AIH group were off any type of IST (13/16 [81%] vs 15/15 [100%], P = 0.08). Conclusions Although presenting with similar baseline biochemical and histological characteristics as idiopathic AIH, patients with IMDILI may not require long‐term IST.
Acute Q fever is a worldwide zoonotic infection due to C. burnetii that may be associated with hepatitis. Nonspecific clinical and biological manifestations may accompany liver involvement, including hepatomegaly and elevated liver biological tests. However, the presence of jaundice is rare. Therefore, making a diagnosis of Q fever hepatitis may be difficult in an afebrile patient with jaundice of recent onset, altered liver function tests, excessive alcohol intake and no reported contact with animals. We report here the diagnostic work-up and complex clinical management of a patient presenting with acute hepatitis resulting from both C. burnetii infection and severe alcoholic steatohepatitis. Positive serology together with a detailed examination of the liver biopsy was able to reveal the coexistence of both Q fever hepatitis with typical fibrin-ring granulomas as well as florid lesions of alcoholic steatohepatitis. A combination of antibiotics, hydroxychloroquine and steroids, guided by the helpful description of changes in histological alterations on repeated liver biopsies during the course of the disease contributed to the slow but favorable outcome.
The cover image is based on the Original Article Final safety and efficacy results from a 106 real‐world patients registry with an ascites‐mobilizing pump by Guido Stirnimann et al., https://doi.org/10.1111/liv.15337. Image Credit: Sequana Medical NV
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