The development of hepatocellular carcinoma among prospectively followed children with chronic hepatitis B virus infection

Wen, Wan–Hsin; Chang, Mei–Hwei; Ni, Yen‐Hsuan; Chen, Huey‐Ling

doi:10.1016/j.jpeds.2003.11.022

Cited by 74 publications

(77 citation statements)

References 10 publications

(5 reference statements)

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“…Despite the early age of onset, prognosis after liver transplantation was excellent, and recurrence was not observed [103] . HCC has also been reported in children with BA and Alagille syndrome [104,105] and in adolescents with chronic hepatitis B [106,107] or C [108] . Children with cirrhosis of any etiology should undergo abdominal ultrasound examinations and alphafetoprotein measurements every 6 mo or at least on a yearly basis [101,109] .…”

Section: Hepatocellular Carcinomamentioning

confidence: 95%

Cirrhosis in children and adolescents: An overview

Pinto

Schneider

Silveira

2015

WJH

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Several conditions, especially chronic liver diseases, can lead to cirrhosis in children and adolescents. Most cases in clinical practice are caused by similar etiologies. In infants, cirrhosis is most often caused by biliary atresia and genetic-metabolic diseases, while in older children, it tends to result from autoimmune hepatitis, Wilson's disease, alpha-1-antitrypsin deficiency and primary sclerosing cholangitis. The symptoms of cirrhosis in children and adolescents are similar to those of adults. However, in pediatric patients, the first sign of cirrhosis is often poor weight gain. The complications of pediatric cirrhosis are similar to those observed in adult patients, and include gastrointestinal bleeding caused by gastroesophageal varices, ascites and spontaneous bacterial peritonitis. In pediatric patients, special attention should be paid to the nutritional alterations caused by cirrhosis, since children and adolescents have higher nutritional requirements for growth and development. Children and adolescents with chronic cholestasis are at risk for several nutritional deficiencies. Malnutrition can have severe consequences for both pre-and post-liver transplant patients. The treatment of cirrhosis-induced portal hypertension in children and adolescents is mostly based on methods developed for adults. The present article will review the diagnostic and differential diagnostic aspects of end-stage liver disease in children, as well as the major treatment options for this condition.

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Section: Hepatocellular Carcinomamentioning

confidence: 95%

Cirrhosis in children and adolescents: An overview

Pinto

Schneider

Silveira

2015

WJH

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“…However, it is not necessarily a case of the earlier the HBeAg seroconversion the better. If it occurs before 3 years of age and is associated with elevated ALT levels and severe liver injury, the children involved are at risk for the rapid development of HCC, which occurs at around 10 years of age [33,39]. This may be due to various oncogenetic mechanisms.…”

Section: Disease Course and Viremia Profilementioning

confidence: 99%

Natural history of hepatitis B virus infection: pediatric perspective

2010

J Gastroenterol

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Hepatitis B virus (HBV) infection is an important disease globally. Chronic HBV infection may result in serious complications. Its transmission may be either perinatal or horizontal. Perinatal transmission is particularly important after the implementation of a universal vaccination program. Through either route, chronic carrier status is usually established in early childhood. The course of the disease course is determined by the host-virus interaction. The host's immune system initially tolerates the virus, and then gradually attempts to clear it. The virus, on the other hand, tries to avoid host immune system attack by a strategy involving targeted epitope mutations. By generating mutants, the virus can survive attacks from the host's immune system, enabling the infection to persist. Different individuals have different responses to HBV infection; genetic polymorphisms in cytokines, hormones, and other immune modulators may affect the final outcome of chronic HBV infection. Due to the implementation of a universal infant HBV vaccination program, HBV infection is now under control. Unfortunately, there still are some cases of vaccination failure. Very high maternal viremia, in utero infection, or escape mutants are possible reasons for vaccination failure. Immunocompromised hosts also risk vaccination failure. Blood or organ donors with occult HBV infection are possible sources for immunocompromised hosts. These victims of vaccination failure may exhibit a different disease course due to chronic HBV infection from those who acquired the infection before the universal vaccination era. The achievement of our ultimate goal of HBV elimination depends on a globally effective universal vaccination program, as well as the application of some novel successful medications to control those who are already infected.

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“…In fact, it seems to be a bad prognosis factor, and early anti-HBe conversion in very young children has been associated with a higher risk of HCC. Another subgroup is the 10% of antiHBe-positive pediatric patients who show active replication with histologically active hepatitis (54,58,59). …”

mentioning

confidence: 99%