NCT02487030.

No abstract

Background Acute-on-chronic liver failure (ACLF) is a distinct syndrome associated with high short-term mortality. Early identification of patients at high risk is essential to determine emergency for transplantation and decide and prioritize the need for intensive care unit (ICU). We aimed to evaluate the performance of the different prognostic scores in the prediction of in-hospital mortality in patients with ACLF. A total of 249 patients with ACLF were included and followed till discharge from the hospital. Univariate and Cox regression analyses were used to assess the performance of liver-specific (Child-Pugh and MELD) and ACLF prognostic scores (CLIF-C OF, CLIF-SOFA, CLIF-C AD, CLIF-C ACLF) in the prediction of in-hospital mortality. Results Patients were mostly males (71.1%) with a mean age of 53.9 ± 12.8 years. The etiology of pre-existing liver disease was HCV in 57.8%. Sepsis was the most common precipitating factor (49.8%) and the mortality rate was 74.3%. In univariate analysis, all scores were significantly higher in the deceased group (P<0.0001). AUROC were 0.897, 0.884, 0.870, 0.861, 0.861, and 0.850 for CLIF-C OF, CLIF-C AD, CLIF-C ACLF, Child-Pugh, CLIF-SOFA, and MELD scores, respectively. In multivariate analysis, 2 independent predictors of mortality were identified: CLIF-C ACLF score (OR 3.25, 95% CI 1.03–10.25, P<0.0001) and Child-Pugh class C (OR 1.04, 95% CI 1.02–1.06, P=0.044). Conclusions All the studied scores could predict in-hospital mortality of patients with ACLF. However, CLIF-C ACLF and Child-Pugh class performed better as they could significantly and independently predict mortality.

Background/Objectives. Liver fibrosis is the inevitable end result of chronic hepatitis C (HCV) infection and is responsible for almost all liver-related complications. After the big advancement in therapeutics of HCV, liver fibrosis would expectedly improve after viral clearance. Many studies showed significant improvement of liver fibrosis shortly after successful treatment with direct acting antiviral agents (DAAs); however, the long-term changes have been scarcely addressed in the literature. We aimed to trace dynamical changes in liver stiffness 1, 3, and 5 years after HCV eradication. Methods. Liver stiffness measurements (LSM) have been serially assessed 1, 3, and 5 years after HCV clearance in 655 patients who have been treated with DAAs. Results. The mean age was 51.44 ± 10 years. 73% of patients were males. 48% were cirrhotics. In noncirrhotics, the mean LSM was significantly decreased from 8.29 ± 2.3 kPa to 4.03 ± 1.0 kPa p < 0.0001 at the end of the follow-up. Likewise, LSM decreased in cirrhotics from 29.66 ± 14.25 kPa to 22.50 ± 11.16 kPa p < 0.0001 . The proportions of F1, F2, F3, and F4 patients at the baseline were 17.7%, 17.9%, 16.6%, and 47.8%, which became 56.5%, 4.1%, 4.9%, and 34.5%, respectively, with a substantial reversal of cirrhosis in 87 patients (27.7%) at the end of follow-up. Conclusions. There was an overall significant regression of liver stiffness in all patients after sustained HCV eradication. Liver stiffness reflecting mild fibrosis (F0–F2) usually improves shortly after treatment, while measurements reflecting advanced fibrosis (F3–F4) take a longer time to regress to lower fibrosis stages.

Background: Computed tomography (CT) is the current gold standard for preoperative assessment of graft volume in the context of living donor liver transplantation (LDLT) despite the commonly noted mismatch between CT estimated graft volume (CT-GV) and actual graft weight (AGW). Aim: to find a formula that correlates preoperative virtual CT graft volume with AGW measured on the back table. Methods: CT volumetric data as well as AGW of 125 consecutive living liver donors in the period between 2010 and 2016 were reviewed. Correlation between CT-GV and AGW was done. Formula for line of best fit was obtained by plotting CT-GV against AGW for right and left lobes using linear regression analysis. Results: One hundred and nineteen living donors had complete data allowing downstream analysis. Donors were mostly males (59.7%) with mean age of 28.4±6.7 years. Ninety-seven of them (81.5%) donated right lobe while 22 (18.5%) left lobe grafts. Mean CT-GV was 870.0±142.9 ml for right lobe grafts and 335.5±112.1 ml for left lobe grafts. Mean AGW was 851.7±162.9 g for right lobe grafts and 296.2±74.5 g for left lobe grafts. The following formulae were derived to calculate AGW (g): [0.92xCT-GV (ml)+51.48; R 2 =0.651, P<0.0001] and [0.53xCT-GV (ml)+120; R 2 =0.625, P<0.0001)] for the right and left lobe grafts respectively. Conclusion: We postulate reliable formulae to convert virtual CT-GV into AGW, to accurately correct the discrepancy between preoperative CT-GV and AGW in the setting of LDLT.