FOR THE METAVIR COOPERATIVE STUDY GROUP histological classification of chronic hepatitis, and several Histological activity reflects the global assessment of propositions have recently been made by different groups of basic necroinflammatory lesions and is a criterion of mapathologists. [4][5][6][7] A consensual proposition was to separately jor importance in chronic hepatitis C. The aim of this assess, using scoring systems, the degree of liver fibrosis and study was to propose and test the accuracy of a simple that of activity. 4,6 Liver fibrosis is simple to precisely define algorithm that generates a single activity score based and thus to reproducibly score. 8 In contrast, the grading of on basic pathological features. A panel of 10 pathologists activity, which integrates the different basic necroinflammareviewed 363 chronic hepatitis C liver biopsies and tory lesions, is more difficult to assess; morever, it is of imporgraded the activity of hepatitis according to their own tance in the decision of whether or not to treat patients in experience (reference activity). Then, a consensual algomany therapeutic trials. Although not proven, inflammation rithm on the grading of activity was established by the and liver cell necrosis are the hallmarks of active disease 10 experts in a panel discussion. Finally, stepwise disthat may predict evolution toward fibrosis and cirrhosis. criminant analysis was performed to define which basic Several approaches have been proposed to assess histologifeatures had been intuitively used in the reference activcal activity. One of them is the semiquantitative scoring sysity (statistical activity). To test the accuracy of the algotem of Knodell et al., in which fibrosis and portal, periportal, rithm, concordance between the activity defined by the and lobular necrotic and inflammatory components are asalgorithm and the reference activity was assessed. It was sessed separately and their coding values added. 10 The global compared with concordance between the activity descore appears accurate because it varies over large ranges, fined by the statistical model and the reference activity.but its value may be limited by poor reproducibility, because The algorithm proposed by the panel for the grading of each feature has its own observer variation. 8 Another possible activity included piecemeal necrosis and lobular necroapproach is to consider that periportal and intralobular nesis. Concordance between reference activity and activity croinflammatory lesions are related to the same pathogenic defined by the algorithm was substantial (305 cases, 84%, mechanism and that they must be globally assessed. As prek Å .75). Discriminant analysis showed that piecemeal viously reported, assessment of activity must be separated necrosis, lobular necrosis, and portal inflammation were from staging of fibrosis.4 independently used to grade the activity. Concordance The aim of this study was to propose a simple algorithm between reference activity and activity defined by the that generates a single sco...

No abstract

No abstract

No abstract

No abstract

Summary Because of global epidemics of obesity and type 2 diabetes, the prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing both in Europe and the United States, becoming one of the most frequent causes of chronic liver disease and predictably, one of the leading causes of liver transplantation both for end-stage liver disease and hepatocellular carcinoma. For most transplant teams around the world this will raise many challenges in terms of preand post-transplant management. Here we review the multifaceted impact of NAFLD on liver transplantation and will discuss: (1) NAFLD as a frequent cause of cryptogenic cirrhosis, end-stage chronic liver disease, and hepatocellular carcinoma; (2) prevalence of NAFLD as an indication for liver transplantation both in Europe and the United States; (3) the impact of NAFLD on the donor pool; (4) the access of NAFLD patients to liver transplantation and their management on the waiting list in regard to metabolic, renal and vascular comorbidities; (5) the prevalence and consequences of post-transplant metabolic syndrome, recurrent and de novo NAFLD; (6) the alternative management and therapeutic options to improve the long-term outcomes with particular emphasis on the correction and control of metabolic comorbidities.

Two recent multicenter randomized trials 1,2 have shown that the combination of interferon alfa-2b plus ribavirin (IFN-R) is effective in the treatment of previously untreated (naive) patients with chronic hepatitis C. In both studies, IFN-R was more effective than interferon alfa-2b (IFN) alone. Efficacy in decreasing order was: IFN-R for 48 weeks (IFN 3 millions unit [MU] 3 times a week and R 1,000-1,200 mg/d), IFN-R for 24 weeks, IFN (3 MU 3 times a week) for 48 weeks, and IFN for 24 weeks. The initial conclusions from these studies were that the majority of patients will benefit from combination therapy and that patients with unfavorable risk factors benefit the most from 48 weeks of treatment.However, several pragmatic questions could not be resolved by looking at these studies individually; some were addressed in a recent international consensus conference. 3

Relatively high percentages of real-life, treatment-experienced patients with HCV genotype 1 infection and cirrhosis respond to the combination of peginterferon and ribavirin with telaprevir or boceprevir. However, side effects are frequent and often severe. Baseline levels of albumin and platelet counts can be used to guide treatment decisions. ClinicalTrials.gov number: NCT01514890.