Abstract:Patients with hepatitis C virus-related decompensated cirrhosis can benefit from interferon-based antiviral therapy, but the common complication of cytopenia is a contraindication for this treatment. Splenectomy prior to interferon therapy may alleviate this problem. To investigate whether splenectomy improves the efficacy of antiviral therapy, 13 interferon-naïve hepatitis C virus decompensated cirrhotic patients underwent splenectomy between January 2008 and January 2011, followed 1-3 months later by an inte… Show more
“…Previous studies have also reported splenectomy to increase the efficacy of liver transplantation and improve the prognosis of hepatocellular carcinoma [77–79]. A study by Ogawa et al has also suggested splenectomy as a supplemental treatment for anti-HCV therapy in combination with interferons and other pharmaceuticals, which is consistent with our own finding [80, 81]. Although animal studies suggest that splenectomy can ameliorate collagen deposition, improve liver function and regeneration capacity and enhance the therapeutic efficacy of stem cell transplantations [6, 59, 75], many cirrhosis patients present with contraindications which preclude splenectomy.…”
Section: Targeting Spleen For the Treatment Of Liver Cirrhosissupporting
The spleen is a secondary lymphoid organ which can influence the progression of multiple diseases, notably liver cirrhosis. In chronic liver diseases, splenomegaly and hypersplenism can manifest following the development of portal hypertension. These splenic abnormalities correlate with and have been postulated to facilitate the progression of liver fibrosis to cirrhosis, although precise mechanisms remain poorly understood. In this review, we summarize the literature to highlight the mechanistic contributions of splenomegaly and hypersplenism to the development of liver cirrhosis, focusing on three key aspects: hepatic fibrogenesis, hepatic immune microenvironment dysregulation and liver regeneration. We conclude with a discussion of the possible therapeutic strategies for modulating splenic abnormalities, including the novel potential usage of nanomedicine in non-surgically targetting splenic disorders for the treatment of liver cirrhosis.
“…Previous studies have also reported splenectomy to increase the efficacy of liver transplantation and improve the prognosis of hepatocellular carcinoma [77–79]. A study by Ogawa et al has also suggested splenectomy as a supplemental treatment for anti-HCV therapy in combination with interferons and other pharmaceuticals, which is consistent with our own finding [80, 81]. Although animal studies suggest that splenectomy can ameliorate collagen deposition, improve liver function and regeneration capacity and enhance the therapeutic efficacy of stem cell transplantations [6, 59, 75], many cirrhosis patients present with contraindications which preclude splenectomy.…”
Section: Targeting Spleen For the Treatment Of Liver Cirrhosissupporting
The spleen is a secondary lymphoid organ which can influence the progression of multiple diseases, notably liver cirrhosis. In chronic liver diseases, splenomegaly and hypersplenism can manifest following the development of portal hypertension. These splenic abnormalities correlate with and have been postulated to facilitate the progression of liver fibrosis to cirrhosis, although precise mechanisms remain poorly understood. In this review, we summarize the literature to highlight the mechanistic contributions of splenomegaly and hypersplenism to the development of liver cirrhosis, focusing on three key aspects: hepatic fibrogenesis, hepatic immune microenvironment dysregulation and liver regeneration. We conclude with a discussion of the possible therapeutic strategies for modulating splenic abnormalities, including the novel potential usage of nanomedicine in non-surgically targetting splenic disorders for the treatment of liver cirrhosis.
“…The remaining 30 patients were enrolled into the study (Fig. 1 ) included 13 treatment-experienced patients [ 8 , 11 , 32 , 33 ] and 17 treatment-naïve patients. Fig.…”
BackgroundDirect-acting antivirals have been used for decompensated cirrhotic patients with hepatitis C virus (HCV) infection. However, the benefits in Chinese patients with decompensated cirrhosis are unclear.MethodsThirty patients with HCV infection and decompensated cirrhosis were administered sofosbuvir-containing regimens at our hospital between April and December 2015. The efficacy and safety of the treatments was determined by sustained virological response at week 12 (SVR 12), change of liver function and adverse events.ResultsThe cohort included 13 treatment-experienced and 17 treatment-naïve patients. A total of 27 patients (90%) achieved SVR 12. No baseline characteristics (sex, age, treatment-experience, genotype, viral load, liver function or splenectomy) was association with achievement of SVR 12. Patients achieved SVR 12 had significantly improved liver function by post-treatment week 12 (P < 0.05). Of the 30 patients, six developed anemia, one developed hepatic decompensation, two developed impaired renal function and one developed a severe upper respiratory tract infection during the treatment. There was no death or HCC development during 12 months of follow-up off-therapy. Two patients (7.4%) with SVR 12 experienced new decompensated episodes during the follow-up.ConclusionSofosbuvir-containing regimens are effective in Chinese HCV patients with decompensated cirrhosis, regardless of baseline characteristics, as demonstrated by a high rate of SVR 12, as well as improvement in liver function. Although antiviral therapy is generally well tolerated, a vigilant monitoring of anemia and renal function should be mandatory.
“…Although the guidelines indicated splenectomy can be a useful way to increase platelet count for these patients, these studies were small; only a few successful cases reported specifically on these patients whose platelet count was more than 50×10 9 /l, guaranteeing the success of operation [9][10][11][12]. We seldom found case reports in which platelets were as low as below 10×10 9 /l with splenectomy.…”
This case report describes a 44-year-old female with hepatitis C virus-related thrombocytopenia. The laboratory tests showed a platelet count of 3×10 9 /l, positive HCV serology and high serum concentration of HCV-RNA of 6.74×10 6 copy/ml. She was refractory to standard therapies including corticosteroids, intravenous immunoglobulin (IVIG), thrombopoietin (TPO) and even interferon (IFN) regimens, due to the persistence of a low platelet count. At first, splenectomy was thought to be impossible, but then splenectomy was successfully performed and patient showed good tolerance and a constant normal platelet count after surgery. In conclusion, splenectomy is feasible in selected patients and may allow us to acquire a reasonable platelet count and completion of an anti-HCV protocol. Low platelet count itself should not be the contraindication of operation specifically for these patients. Further studies in larger numbers of patients and over a longer period of time are warranted.
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