Hepatic Decompensation in Patients With Cirrhosis During Infection With Influenza A

Duchini, Andrea; Viernes, M. E.; Nyberg, Lisa M.; Hendry, R. Michael; Pockros, Paul J.

doi:10.1001/archinte.160.1.113

Cited by 82 publications

(57 citation statements)

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“…3 The susceptibility of patients with cirrhosis to influenza may be explained by a direct hepatotoxic effect of the influenza virus, which might occur in a similar way to that described in animal models or in Reye's syndrome. The decreased immunity of patients with cirrhosis favors this explanation.…”

Section: Influenza In Patients With Liver Disease Before Liver Transpmentioning

confidence: 91%

“…In addition, we have recently shown that influenza virus may cause significant hepatic decompensation in patients with cirrhosis awaiting transplantation. 3 We report a case of influenza A viral pneumonia in a liver transplant recipient and discuss several basic and clinical aspects of this infection in patients with endstage liver disease, both before and after liver transplantation. Also, the current guidelines regarding the prevention and treatment of influenza are discussed.…”

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confidence: 99%

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Influenza Infection in Patients Before and After Liver Transplantation

Duchini¹

2000

Liver Transplantation

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Infection with influenza virus poses specific problems in pediatric and adult liver transplant recipients, both before and after liver transplantation. These include a higher rate of pulmonary and extrapulmonary complications, development of rejection with graft dysfunction, prolonged shedding of influenza virus, and increased drug-resistance. Hepatic decompensation may occur during influenza infection in patients with cirrhosis. Current prophylaxis includes yearly vaccination with trivalent inactivated vaccine. Appropriate diagnosis and prompt treatment of any upper respiratory infections are indicated in these patients. In this review, we describe a case of influenza viral pneumonia in an adult liver transplant recipient, review basic and clinical aspects of influenza infection in this patient population, and discuss current modes of prevention and treatment in detail. (Liver Transpl 2000;6: 531-542.)

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Section: Influenza In Patients With Liver Disease Before Liver Transpmentioning

confidence: 91%

mentioning

confidence: 99%

Influenza Infection in Patients Before and After Liver Transplantation

Duchini¹

2000

Liver Transplantation

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“…1 Patients with cirrhosis awaiting transplantation may develop hepatic decompensation after infection with influenza. 2 Whether influenza vaccine should be routinely administered before and after liver transplantation remains controversial because a suboptimal immune response to several vaccines has been reported in these patients. 3 …”

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confidence: 99%

Immune response to influenza vaccine in adult liver transplant recipients

et al. 2001

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“…First, alcoholism and ALD should not be clubbed together since significant liver disease develops in only 15% of all people who drink alcohol excessively [6] . So, clearly other etiologies such as genetic predisposition, hepatitis C and other viral infections, such as influenza [7][8][9] , may contribute to the development of the disease. Further, there are other liver diseases such as hepatitis B, hepatitis C, non-alcoholic fatty liver disease and acetaminophen overdose where patient behavior is an important component either in the acquisition of these diseases or in their adequate management.…”

Section: Ethical Concerns and Issuesmentioning

confidence: 99%

Liver transplantation in acute alcoholic hepatitis: Current status and future development

Singal

Duchini

2011

WJH

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Acute alcoholic hepatitis (AH) is a distinct clinical entity amongst patients with chronic alcohol abuse. Patients with severe AH are at risk of dying in about 20%-25% cases despite specific treatment with corticosteroids and/or pentoxifylline. Clearly, a need for an additional more effective treatment option is unmet currently. Liver transplantation (LT), a definitive treatment option for alcoholic cirrhosis requires 6 mo abstinence. However, this rule cannot be applied to patients with AH as these patients are actively drinking prior to their presentation. Shortage of donors, ethical issues, and fear of recidivism after transplantation with less than 6 mo pretransplant abstinence are some of the reasons behind this rule of 6 mo of abstinence and hesitancy of transplanting patients with AH. These issues are debated at length in this manuscript. Further, retrospective studies have shown that patients undergoing transplantation for alcoholic cirrhosis and having histological changes of AH have been shown to fare as well when compared to patients without these histological changes. Recently, French workers have reported a case matched prospective study showing encouraging data on the usefulness of LT for patients who are non-responders to corticosteroid and/or pentoxifylline therapy. Future studies are needed to identify patients with severe AH who are going to benefit most with LT. In the light of emerging data on the efficacy of LT in improving survival of patients with severe acute AH who do not respond to corticosteroids, the time is ripe to re-evaluate our policy of LT in patients with AH.

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Hepatic Decompensation in Patients With Cirrhosis During Infection With Influenza A

Abstract: Influenza A infection can cause hepatic decompensation and hospitalization in patients having cirrhosis or who are awaiting liver transplantation. Effective prevention with vaccination and early recognition and treatment of influenza are strongly recommended in these individuals.

Cited by 82 publications

References 10 publications

Influenza Infection in Patients Before and After Liver Transplantation

Influenza Infection in Patients Before and After Liver Transplantation

Immune response to influenza vaccine in adult liver transplant recipients

Liver transplantation in acute alcoholic hepatitis: Current status and future development

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