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The postoperative nervous system and neurocognition-related complications have become an important issue of research focus with the gradual increase of the survival rate after liver transplantation. Compared to other solid organ transplantation, the incidence of nervous system complications after liver transplantation is higher and closely related to death. This paper mainly overviewed the nervous system complications, neurocognition-related complications after liver transplantation and the risk factors inducing these complications. It also discussed how to evaluate, monitor, and prevent these complications in order to provide reference for future studies.

Infection is a frequent complication of cirrhosis, which often occurs in the lungs, chest, abdomen, biliary tract, urinary tract, soft tissue, and skin, and occasionally causes spontaneous bacteremia in patients. This paper reviews the risk factors and common types of infection in cirrhosis associated with infection, and the early diagnosis and symptomatic treatment of different types of infection. Moreover, this paper points out that cirrhosis associated with infection is a key factor for disease progression and the early diagnosis and treatment are essential for successful treatment. The third-generation cephalosporins are the first-line antibiotic agents. Drug-resistant bacteria should be treated with antibiotic compound containing β-lactamase inhibitors or carbapenems. Methicillin-resistant Staphylococcus aureus should be treated with glycopeptide antibiotics or combination therapies. Pulmonary mycoses are mainly treated with caspofungin or voriconazole. Antibiotics combined with supportive therapies including the administration of albumin can improve the treatment outcome and prognosis.

Hepatic encephalopathy is one of the most common complications of liver failure and has a high incidence in hospitalized patients. Most patients with hepatic encephalopathy have varying degrees of malnutrition. In recent years, more and more clinical trials have confirmed that the nutritional support therapy is beneficial to patients with hepatic encephalopathy, and more attention has been paid to nutritional therapy. This paper introduces the pathogenesis of malnutrition in hepatic encephalopathy, and reviews the methods for nutrition evaluation and nutritional therapy in patients with hepatic encephalopathy.

Precise and quantitative assessment of the severity of liver fibrosis is of great value for confirming diagnosis, making treatment decision, monitoring treatment outcome, and determining prognosis. This paper analyzes the development and application of invasive and non-invasive quantitative assessment of histological liver fibrosis. From the first descriptive histological evaluation, the assessment of liver fibrosis based on invasive liver biopsy has been developed into semi-quantitative approaches. The fully-quantitative and objective assessment of histological liver fibrosis can overcome drawbacks of traditional semi-quantitative approaches including observer bias and sampling error. The non-invasive assessment of liver fibrosis not only overcomes drawbacks of liver biopsy including invasion and sampling error, but also holds promise for predicting the long-term outcome of disease, though its application in monitoring dynamic changes in liver fibrosis still needs to be confirmed by liver histological evaluation. Therefore, the non-invasive assessment of liver fibrosis cannot yet completely replace liver histological evaluation, but it can reduce the number of liver biopsies in patients with definitive diagnosis. The application of the non-invasive diagnostic method in monitoring dynamic changes in liver fibrosis needs to be validated at more clinical settings, and for the quantitative assessment of histological liver fibrosis, the correlation of clinical relevance between the results and the long-term outcomes needs to be systematically identified.

Liver cirrhosis is a late-stage hepatic fibrosis, which results from various risk factors such as viruses, alcohol, fat, drugs and immunity, and genetic metabolism, leading to chronic liver damage. This paper reviews the etiological treatment and therapy for complications. It is pointed out that liver transplantation, which is currently the only effective approach to the treatment of liver cirrhosis, is limited by liver donor shortage and high cost. Stem cell therapy becomes a hot spot of research due to its huge potential for the treatment of liver cirrhosis. However, its mechanism remains unclear with many pending problems.

Any pathological state that causes disturbance in bile flow is called cholestasis. Liver fibrosis is a repair response to liver injury. Both cholestasis and liver fibrosis are pathological states in liver diseases. This paper briefly introduces cholestasis and liver fibrosis, and illustrates the mechanisms and therapeutic drugs for cholestasis-induced liver fibrosis. Further study is needed to prevent and treat cholestasis-induced liver fibrosis.

Decompensated hepatitis B cirrhosis is one of the final outcomes of chronic hepatitis B and liver fibrosis. Extensive studies have demonstrated that antiviral therapy can slow disease progression, improve clinical outcomes, reduce complications, slow decompensated cirrhosis progression, and improve survival. At present, nucleoside and nucleotide analogues are the most common antiviral agents in the treatment of decompensated hepatitis B cirrhosis. This paper introduces effective antiviral agents against decompensated hepatitis B cirrhosis and discusses potential problems in antiviral treatment, suggesting that personalized medication should be achieved on the basis of standardized antiviral treatment in clinical practice.

Hepatic stellate cells (HSCs) are the source of fibre in the liver which can produce a large number of extracellular matrix via proliferation and activation, and this is the central link of hepatic fibrosis. Following further research on hepatic fibrosis, signal transduction involved in the activation of HSCs have been researched as a popular topic. This paper generalizes the main signaling transduction pathways involved in activation of HSCs and Hedgehog/Gli pathway, and introduces recent advances in related research. It is promising to make new breakthroughs in the prevention and treatment of hepatic fibrosis through in-depth study of these signaling pathways.

Autoimmune liver disease overlap syndrome is a special type of autoimmune disease, and consensus has not been reached regarding the etiology and diagnosis and treatment. This paper reviews many aspects of overlap syndrome, such as etiology, pathogenesis, diagnosis and treatment, and its development process. In addition, the definition of this disease and the recent development of diagnosis and treatment are analyzed. It is pointed out that the pathogenesis of this disease is still not fully elucidated, and the standards for the diagnosis and treatment of this disease still need further discussion. Finally, the analysis showed that the clinical forms of AIH-PBC overlap syndrome can be varied, and early diagnosis and differentiation and reasonable treatment are the key points of current research.

ObjectiveThe development of alcoholic liver fibrosis (ALF) is a complex process involving both parenchymal and nonparenchymal cells. The knowledge about the proteome of liver nonparenchymal cells (NPCs) in response to ethanol is limited. This paper aims to investigate the regulatory effect of alcohol on the protein expression in liver NPCs during liver fibrosis development and to provide new clues for understanding the molecular mechanism of liver fibrosis. MethodsRats were treated with ethanol by gastric administration to establish a liver fibrosis model. The pathological changes in the liver were evaluated by James staining. Liver NPCs were enriched by Percoll density gradient centrifugation, and proteins were extracted from NPCs by two-dimensional gel electrophoresis (2DE) and stained by Coomassie Brilliant Blue G-250. The differentially expressed proteins were identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Some of the differentially expressed proteins were verified by real time RT-PCR and Western blot. The protein spots on 2DE gels were analyzed by two sample t-test. The RT-PCR results were statistically analyzed by Mann-Whitney test. ResultsA rat model of ALF was established. Among the NPCs purified by Percoll density gradient centrifugation, lymphocytes, Kupffer cells, and endothelial cells were enriched for 1.5, 3.2, and 3.7 times, respectively. More than 800 protein spots were detected by 2DE, and there were 26 proteins with more than 2-fold increases or decreases in expression; 21 non-redundant proteins were identified by LC-MS/MS and real-time RT-PCR analysis of 7 of these proteins showed that the mRNA levels of ANXA3, CES3, ATPA and NDUFV2 were in accordance with the proteome analysis results. ConclusionThis study detected and identified a group of differentially expressed proteins related to ALF. Our work might offer some new clues to understand the mechanism of ALF.

The metabolism of amino acids mainly takes place in the liver, and patients with liver cirrhosis may develop metabolic disorders of proteins, carbohydrates, fats, and amino acids, which in turn causes dysfunction of multiple organs and systems, as well as complications like hepatic encephalopathy, esophageal variceal bleeding, and ascites, resulting in high mortality. This paper summarizes the metabolic characteristics of amino acids and the application of branched-chain amino acids (BCAAs) in the treatment of liver cirrhosis, and it points out the significance of BCAAs in regulating serum aminogram, increasing the ratio of BCAAs to aromatic amino acids, preventing complications of liver cirrhosis, and improving the quality of life for patients with the disease.

The primary aim of preventing variceal bleeding in liver cirrhosis is to reduce portosystemic pressure gradient. Carvedilol is a non-selective beta blocker with selective inhibition of α-1 receptor and blockage of calcium channel. This paper reviews the role of carvedilol in reducing hepatic venous pressure gradient and preventing variceal bleeding. Analysis has shown that carvedilol is superior to propranolol in reducing portosystemic pressure gradient. Carvedilol may be similar to propranolol or endoscopic ligation for the primary and secondary prevention of variceal bleeding. Further randomized controlled trials with a larger sample size are warranted to confirm these findings.

Ascites is a common complication of liver cirrhosis. Liver ascites may occur repeatedly, which increases the therapeutic difficulty. This paper reviews the definition of intractable liver ascites, general treatment measures, and current treatment of common complications such as spontaneous bacterial peritonitis and hepatorenal syndrome, as well as the advances in conventional, unconventional, and surgical treatment of intractable liver ascites. It is pointed out that abdominocentesis for excessive drainage and active preparation for liver transplantation are the preferred approach to the treatment of intractable liver ascites.

Liver cirrhosis can do great harm to human health due to irreversible function impairment of hepatocytes and severe complications caused by portal hypertension. Liver fibrosis is an inevitable stage through which chronic liver disease progresses to cirrhosis. So far, most studies have demonstrated that the liver disease in fibrosis stage can be reversed. This paper reviews recent research on liver fibrosis and cirrhosis.

Different degrees of malnutrition is common in patients with liver cirrhosis, mainly manifested by protein-energy malnutrition. The nutritional status of patients is associated with their prognosis and survival rate. However, clinicians have not paid much attention to this fact, and malnutrition is often neglected in the patients with liver cirrhosis. This paper reviews several nutritional assessment tools applied in recent years among patients with liver cirrhosis and summarizes the characteristics of each tool, so as to provide a reference for nutritional assessment by clinicians.