Raúl Adrover

Ombitasvir/paritaprevir/ritonavir/dasabuvir ± ribavirin is safe and effective in HCV-infected patients in a real-life cohort from Latin America

Information about the use of ombitasvir/paritaprevir/ritonavir/dasabuvir ± ribavirin (OBV/PTV/r/DSV ± RBV) in real‐clinical practice in Latin America is scarce. We aimed to confirm safety and effectiveness of OBV/PTV/r/DSV ± RBV therapy in real‐world setting. We analyzed a cohort of patients with genotype 1 infection treated with OBV/PTV/r/DSV ± RBV. Data on demographics, clinical features, safety, and virological response were retrospectively collected from 21 centers in Latin America. A total of 96 patients received OBV/PTV/r/DSV, associated with RBV in 68% of the cases. Most were genotype 1b (80%), 56 (58%) had cirrhosis, and 45 (47%) failed prior HCV treatment. Adverse events occurred in 62% of patients. The most common adverse events were pruritus (21%), hyperbilirubinemia (17%), and asthenia (17%). Five patients discontinued therapy prematurely due to hepatic decompensation, three of them were Child‐Pugh B at baseline and one patient died due to multi‐organ failure. Follow up HCV‐RNA 12 weeks after completion of therapy was evaluated in all the patients and sustained virologic response rate was 97%. No virologic breakthrough was detected. Our study confirms that OBV/PTV/r/DSV treatment is highly effective in patients with chronic HCV without cirrhosis or with Child‐Pugh A cirrhosis in non‐European populations. Adverse events were often mild and rarely led to treatment discontinuation except for patients with Child‐Pugh B cirrhosis or with previous history of hepatic decompensation. These results can support the development of public strategies to expand the access of OBV/PTV/r + DSV and other DAAs combinations in order to reduce the burden of HCV infection in our region.

Entecavir in the treatment of chronic hepatitis B in kidney transplantation

have been characterized in great detail in terms of the likes of morphology, ploidy, proliferation, biochemistry and gene expression [8]. Moreover, our own recent studies in the human liver, demonstrating a portal tract to hepatic vein orientation of groups of clonally-derived hepatocytes, are in line with the concept of a dynamic lineage system [9]. On the other hand, not all studies have concurred with this concept, for example Bralet and colleagues [10] genetically labeled rat hepatocytes in vivo at 24 h after partial hepatectomy, but failed to observe any change in their location (periportal and mid-zonal) over the proceeding 15 months – observations not consistent with a ‘streaming’ liver. There are recent examples of the fairly long-term beneficial effects of HTx and survival of engrafted cells, for example, a Crigler-Najjar patient survived well for 4 years after HTx before an OLT and he still had conjugated bilirubin in his blood at 3.5 years [11]. In 2006, Sokal’s group performed a HTx for the correction of argininosuccinate lyase deficiency, and cell tracking confirmed their durable presence (12.5%) in the liver at 7 months after the last infusion [12]. More recent information on that same case confirmed that the patient was still doing well at up to 18 months when she received an OLT [13]. On the other hand, the majority of children undergoing HTx for urea cycle disorders have only been monitored for a relatively short time before OLT, though one 3-year-old patient with citrullinemia was still doing well 30 months after HTx [14]. Many other cases of HTx have also only provided short-term benefit including glycogen storage disease type I [15], and factor VII deficiency [16]. In most studies, the absence of a sustained benefit of HTx in the medium to long-term has been ascribed to rejection (‘wipe-out’) or other causes not directly related to HTx itself (e.g. infections), but we would like to suggest that hepatocyte egress (‘wash-out’) could be an alternative, but non-exclusive explanation. We believe it is beholden upon hepatologists to once and for all establish the cell replacement dynamics of the liver, preferably in a large animal model. If the ‘streaming liver’ hypothesis wins the day then attempts at the correction of metabolic liver disease should be directed towards targeting cholangiocytes and/or other hepatocyte progenitors or only transplanting hepatocytes into extrahepatic sites.

Cuándo sería más rentable realizar una endoscopia digestiva alta para establecer la presencia de varices esofágicas en pacientes con cirrosis

Introduccion La hemorragia varicosa ocurre en el 25 al 35% de los pacientes cirroticos y esta asociada con una morbimortalidad significativa y mayores costes hospitalarios. El estudio endoscopico de varices esofagogastricas (VEG) en los pacientes cirroticos incrementa los costes, tiene cierto grado de invasividad y provoca malestar en los pacientes. La asociacion de la presencia de VEG con el tamano esplenico, la funcion hepatica y el recuento de plaquetas es controvertida. Realizamos este estudio para conocer la correlacion entre la funcionalidad hepatica, evaluada mediante la clasificacion de Child-Pugh, el recuento de plaquetas y el indice volumetrico esplenico con la presencia de VEG, en pacientes con cirrosis asistidos de forma ambulatoria. Pacientes Y Metodo A los 68 enfermos incluidos se les realizaron: historia clinica, pruebas bioquimicas, ecografia abdominal en modo B y Doppler, ademas de una videoendoscopia digestiva alta. Resultados El 76,47% de los pacientes eran varones y el 23,53%, mujeres. La mediana de edad (± desviacion estandar) fue de 52,8 ± 12,4 anos. Segun la clasificacion de Child-Pugh, el 54,41% pertenecia al grupo a A, el 41,18% al B y el 4,41% al C. Las causas mas frecuentes de cirrosis fueron el consumo de alcohol (52,95%) y el virus de la hepatitis C (17,65%). Se encontraron varices esofagicas en el 85,29% de los pacientes. La mediana del indice volumetrico esplenico fue de 50,5 ± 9,2 y la mediana del recuento de plaquetas, de 150 ± 26 × 109/l. Se hallo correlacion entre la presencia de varices esofagicas, indice volumetrico esplenico ≥ 45 y recuento de plaquetas ≤ 100 × 109/l (r = 0,327; p = 0,006), pero no entre la presencia de varices esofagicas y el grado de Child-Pug A. En el analisis multivariado, solo la presencia de varices esofagicas se asocio a un indice de volumen esplenico ≥ 45 (odds ratio de 7,4; intervalo de confianza del 95%, 1,30-77,7; p = 0,02). Conclusion La presencia de varices esofagicas en pacientes cirroticos asistidos de forma ambulatoria se correlaciono con un indice volumetrico esplenico ≥ 45 y un recuento de plaquetas ≤ 100 × 109/l.