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Background/aims Virological factors associated with hepatitis B virus reactivation (HBV-R), following chemotherapy for cancer in hepatitis B surface antigen (HBsAg)-negative patients, are not well known. Materials and methods HBV strains from 16 patients presenting HBV-R following chemotherapy were studied and compared to those obtained from 51 HBV chronically-infected patients. Results HBsAg variability was significantly increased within the major hydrophilic region, the a determinant and the C-terminal region. Amino acid substitutions were more frequently found in HBV-R patients as compared to controls at 17 and 11 positions within HBsAg and HBV-RT, respectively. This resulted in atypical serological testing in 56% of patients and detection of resistance mutation to nucleoside analogs in 12.5%. Conclusion HBsAg and HBV-RT mutations are frequently encountered in patients with HBV-R, resulting in atypical serological testing and emergence of HBV strains resistant to nucleos(t)ides analogs.

International audience; Purpose: The goal of this study was to identify clinical and imaging ă variables that are associated with an unfavorable outcome during the 30 ă days following transjugular intrahepatic portosystemic shunt (TIPS) ă placement. ă Material and methods: Fifty-four consecutive patients with liver ă cirrhosis (Child-Pugh 6-13, Model for End-stage Liver Disease 7-26) ă underwent TIPS placement for refractory ascites (n = 25), recurrent or ă uncontrolled variceal bleeding (n = 23) or both (n = 6). Clinical, ă biological and imaging variables including type of stent (covered n = ă 40; bare-stent n = 14), presence of spontaneous portosystemic shunt (n = ă 31), and variations in portosystemic pressure gradient were recorded. ă Early severe complication was defined as the occurrence of overt hepatic ă encephalopathy or death within the 30 days following TIPS placement. ă Results: Sixteen patients (30%) presented with early severe ă complication after TIPS placement. Child-Pugh score was independently ă associated with complication (HR = 1.52, P < 0.001). Among the imaging ă variables, opacification of spontaneous portosystemic shunt during TIPS ă placement but before its creation was associated with an increased risk ă of early complication (P = 0.04). The other imaging variables were not ă associated with occurrence of complication. ă Conclusion: Identification of spontaneous portosystemic shunt during ă TIPS placement reflects the presence of varices and is associated with ă an increased risk of early severe complication.

Resume Nous rapportons un cas de stenose de la veine porte survenant six mois apres une transplantation hepatique. Dans cette observation, c’est l’apparition d’une symptomatologie d’ischemie mesenterique veineuse qui a conduit au diagnostic. La realisation d’une angioplastie avec mise en place d’une prothese porte a permis une resolution rapide des symptomes.

We studied polymorphisms of three genes, UDP-glucuronosyltransferase1A7 ( UGT1A7 ), Glutathione-S-transferaseM1 ( GSTM1 ) and X-Ray Cross Complementing group 1 ( XRCC1 ), involved in detoxification of xenobiotics or DNA-repair in a population of 133 liver-transplanted patients, including 56 patients with hepatocellular carcinoma (HCC) and 77 without HCC, and in 89 healthy controls originating from the south of France. Multiple logistic regression analysis showed that, among liver-transplanted patients, interactions between XRCC1-G/G or -G/A and GSTM1-nul polymorphisms were independently associated with hepatocellular carcinoma ( p interaction = 0.027) concurrently with increasing age ( p p = 0.037) and chronic hepatitis B or C virus infection ( p = 0.018 and p = 0.001 respectively). On the contrary, no relationship was observed between UGT1A7 polymorphisms considered alone or in interaction with GSTM1 or XRCC1 polymorphisms and HCC. This suggests that concomitant impaired metabolism of carcinogenic compounds and impaired DNA-repair function play an important role in liver carcinogenesis in high-risk cirrhotic patients originating from the south of France.

The rate of eradication of chronic hepatitis C considerably increases with direct-acting antiviral agents, particularly hepatitis C virus (HCV) polymerase inhibitors. While implementing full-length HCV NS5B polymerase sequencing in our clinical microbiology laboratory, we identified atypical HCV sequences, classified as subtype 2l, from 2 patients. HCV-2l NS5B polymerase sequences were detected from 5 and 14 additional patients by screening our laboratory hepatitis virus sequence database and the NCBI GenBank sequence database. Phylogenetic analyses show unambiguously that all HCV-2l sequences are clustered apart from HCV 2 non-l sequences, which compose a second cluster. Mean (±SD) nucleotide identity between near full-length NS5B fragments of subtype 2l was 93.4 ± 0.8% (range: 92.4-95.1). Of note, all HCV-2l sequences obtained in our laboratory and in other centers were from serum samples collected in France. Analysis of the HCV-2l NS5B polymerase amino acid sequences at 30 positions critical for interaction with or resistance to HCV polymerase inhibitors showed specific patterns.

Resume Introduction. — L’augmentation du nombre de transplantations hepatiques est limitee par l’insuffisance des ressources en donneurs. La necessite impose donc un choix parmi les patients susceptibles de beneficier de ce traitement — les cas plus graves? ou ceux qui ont les meilleures chances de guerir? — et une evaluation optimale du moment de la transplantation dans l’histoire de la maladie: ni trop tot, ni trop tard. Actualites et points forts. — La transplantation doit etre reservee aux patients souffrant d’une affection hepatique irreversible et symptomatique. Elle doit, en regle generale et par ordre d’importance, d’une part modifier l’histoire naturelle de la maladie et, d’autre part, pour un risque minimal. Les criteres majeurs d’indication peuvent etre ainsi schematises pour les hepatopathies les plus frequentes: 1) pour les cirrhoses non cholestatiques, un score de Pugh-Child de 9–10, ou un score inferieur si des accidents evolutifs se sont deja produits, est un critere necessaire et souvent suffisant; 2) pour les cirrhoses cholestatiques, un taux de bilirubine serique superieur a 100–150 μmol/L est un critere admis; 3) si l’on excepte les «petits» carcinomes hepatocellulaires sur cirrhose (moins de trois nodules de moins de 5 cm), presque tous les cancers sont une contre-indication a la transplantation; 4) l’insuffisance hepatique aigue necessite un transfert precoce en milieu specialise pour une eventuelle indication de transplantation en urgence. Perspectives et projets. — Dans un contexte de penurie qui risque de perdurer, l’amelioration des conditions d’acces a la transplantation necessite qu’un avis consultatif puisse etre pris precocement dans l’histoire naturelle de la maladie aupres des equipes en charge de la transplantation.

Progressive multifocal leucoencephalopathy due to JC virus is a rare complication of liver transplantation. Only four cases have already been described in the literature. This disease is difficult to differentiate from leucoencephalopathy associated with immunosuppressive drugs such as cyclosporin or tacrolimus. Positive diagnosis of progressive multifocal leucoencephalopathy no longer requires cerebral biopsy. It must be confirmed by positive JC virus RNA amplification in the cerebrospinal fluid. We report a case of progressive multifocal leucoencephalopathy occurring 18 months after liver transplantation for hepatitis C-related cirrhosis.

Hepatocytes and keratinocytes are among the most widely used cells in pharmaco-toxicology, but a limitation of these models is the provision of human tissues on a regular basis. The suitability of HepG2, HaCaT and HESV cell lines as an acceptable substitute for primary cultures was examined. In these cell types, the effects of 3-methylcholanthrene (3-MC) were analysed on CYP1A1 gene expression, a crucial CYP subfamily in the activation of chemical carcinogens. Ethoxyresorufin O -deethylase (EROD) activity was never detected in HESV cells, but in other cell types it was stimulated in a concentration-dependent manner (maximal induction, 1–2.5 μ m ). Above this peak induction the effect fell rapidly. Northern blot analysis of CYP1A1 mRNA agreed with the trends obtained for EROD values. However, the decrease of the EROD activity observed at the highest 3-MC concentrations was not correlated with CYP1A1 mRNA reduction. This study also demonstrated that 3-MC is capable of significantly inducing CYP1A1 in HaCaT cells (17-fold over control), as in human hepatocytes (six- to 18-fold) and HepG2 (fourfold). Therefore, in contrast to SV40-immortalized keratinocytes (HESV), spontaneously immortalized keratinocytes (HaCaT) may constitute a valuable tool for studying epidermal CYP1A1 gene regulation by xenobiotics.

We report a case of portal vein stenosis six months after previous orthotopic liver transplantation. The patient presented with mesenteric venous ischemia. He underwent successful percutaneous transhepatic portal vein angioplasty and stent placement.

We studied and quantified the effect of ischemia-reperfusion on hepatic F-actin on bile canalicular and basolateral membranes in human liver allografts by means of confocal laser scanning microscopy imaging. The phalloidin-FITC staining of F-actin was normal in liver hepatocytes before reperfusion but decreased significantly after reperfusion (by 25% of controls). These results indicate that hepatic F-actin alteration is produced during the reperfusion phase. This modification, probably induced by reactive oxygen species, could impair bile canalicular contraction and tight junction permeability and consequently bile secretion in the postoperative period.

In order to examine glucose metabolism in liver grafts after cold ischemia and reperfusion, the heterogeneous lobular distribution pattern of glycogen content was studied using histochemical quantitative analysis. In most of the cases, this heterogeneous pattern of glycogen was observed after preservation and reperfusion. However, a 42% reduction of glycogen content, expressed as the ratio between stained surface and total surface of liver biopsies, was observed in biopsies after reperfusion. Moreover, both periportal and centrilobular hepatocytes showed a significant decrease in mean optical density after reperfusion (18% and 25%, respectively). The comparison of our results to early postoperative liver function tests and cold ischemia times showed no significant correlation (p0.05).

The presence or absence of hepatitis C virus (HCV) RNA in the semen of infected man remains controversial, mainly due to technical difficulties associated with nucleic acid detection. The aims of this study were to assess the presence of HCV RNA in spermatozoa and in seminal fluid using different polymerase chain reaction (PCR)- and non-PCR-dependent methods and, in the case of HCV presence, to correlate this detection with the viraemia.Serum and semen from 25 chronically infected hepatitis C patients were studied. The semen was separated into spermatozoa and seminal fluid and HCV RNA was analysed in the two fractions using RT-PCR and branched DNA. The presence of HCV RNA in pelleted cells was also assessed using in situ hybridization.All three approaches failed to demonstrate HCV RNA in semen. The presence of an inhibitor of the PCR was demonstrated in seminal fluid but not in spermatoza.Our results confirmed the lack of detection of HCV RNA in semen by PCR- and non-PCR-dependent techniques and support the view that viral contamination in semen remains, if present, at a very low level. Nevertheless, epidemiological studies are required to definitively assess the absence of sexual transmission of HCV

In order to examine glucose metabolism in liver grafts after cold ischemia and reperfusion, the heterogeneous lobular distribution pattern of glycogen content and glucose-6-phosphatase activity was studied using histochemical methods. The characteristic heterogeneous lobular distribution pattern of glycogen and glucose-6-phosphatase was maintained after preservation and reperfusion. However, it appeared that glycogen content decreased in both periportal and centrilobular hepatocytes after reperfusion. The glycogen decrease was higher in periportal hepatocytes. Glucose-6-phosphatase activity was maintained after reperfusion in most of the cases in periportal hepatocytes. In centrilobular hepatocytes, more cases showed a decrease in enzyme activity. It is suggested that ischemia-reperfusion mainly affects the glycogen content in both periportal and centrilobular hepatocytes and that centrilobular glucose-6-phosphatase activity is more sensitive to ischemia-reperfusion injury than periportal hepatocytes.

Liver transplantation for hepatitis C virus (HCV)-related liver disease is characterized by frequent graft infection by HCV. The prognosis and risk factors for morbidity and mortality in this condition were determined.A retrospective study of 652 consecutive anti-HCV-positive patients undergoing liver transplantation between 1984 and 1995 in 15 European centers was conducted; 102 patients coinfected with hepatitis B virus (HBV) received immunoglobulin prophylaxis for antibody to hepatitis B surface antigen.Overall, 5-year survival was 72%. Five-year actuarial rates of hepatitis and cirrhosis were 80% and 10%. Genotypes 1b, 1a, and 2 were detected in 214 (80%), 24 (9%), and 24 (9%) of 268 patients analyzed. The only discriminant factor for patient or graft survival was hepatocellular carcinoma as primary indication. Independent risk factors for recurrent hepatitis included the absence of HBV coinfection before transplantation (relative risk [RR], 1.7; 95% confidence interval [CI], 1.2-2.6; P = 0.005), genotype 1b (RR, 2; 95% CI, 1.3-2.9; P = 0.01), and age49 years (RR, 1.4; 95% CI, 1.1-1.8; P = 0.01).The results of transplantation for HCV-related disease are compromised by a significant risk of cirrhosis, although 5-year survival is satisfactory. Genotype 1b, age, and absence of pretransplantation coinfection by HBV are risk factors for recurrent HCV.

The shortage of cadaveric organ donors imposes a severe limit to the number of liver transplantations. A selection is thus necessary among patients: should the sickest be selected, or those who supposedly have the best chance to survive and recover? Optimizing the timing of transplantation during the course of the disease (not too early, but not too late) is another issue.Suitable candidates for transplantation are patients suffering from an irreversible, symptomatic liver disease. The goals of therapy are: firstly, to favorably modify the natural outcome of the disease; and secondly, in an acceptable risk taking manner. Major criteria for indication in the most common liver diseases can be summarized as follows: a) for chronic parenchymal liver diseases, a Child-Pugh score of 9 or 10, or less if complications have already occurred, is a mandatory and often sufficient criterion; b) for cholestatic liver diseases, a serum bilirubin level higher than 100-150 mumol/L is generally required; c) apart from "small" hepatocellular carcinomas on cirrhotic parenchyma (less than three tumors of less than 5 cm in diameter), most cancers are considered contraindications; d) acute liver failure requires early referral to a liver transplant center for potential emergency indication.In an organ shortage situation which is likely to perdure, early consultative contact between the patient and the liver transplant team will allow improvement in the access to transplantation procedure.

We report four cases of ileo-colonic varices in one family. This congenital disease is uncommon with only 21 cases described in the literature. Recurrent digestive tract bleeding is the most common manifestation, but varices can be asymptomatic. Digestive endoscopy leads to the diagnosis. The diagnosis of familial colonic varices can be considered when colonic varices occur in several members of a family with no evident cause, particularly portal hypertension or venous thrombosis. No treatment is usually necessary except when major or recurrent bleeding indicates surgical resection. These malformations are classified as vascular ectasia in the subgroup of cavernous haemangiomas.

With the increasing demand for insecticide products, the question of their safety has become one of the serious world public health concerns. The capability of compounds belonging to the major insecticide families [such as chlorinated hydrocarbons (DDT), carbamates (carbaryl: CBR), organophosphorus compounds (malathion, tetrachlorvinfos: MAL, TCV), pyrethroids (cypermethrin: CPR) and benzoylurea (diflubenzuron: DFU)] in inducing CYP1 Al in rat and human hepatocyte cultures has been tested. Cells were treated during 3 days with six non-toxic increasing doses of insecticides and CYP1A1 expression was assessed by ethoxyresorufin O-deethylase (EROD) activity and by Northern blots. A strong and dose-dependent induction was observed with TCV and DFU, both in human (approx. five- and sevenfold over control, respectively) and in rat hepatocytes (approx. sevenfold). However, EROD induction and CYP/A1 mRNA levels were correlated for DFU but not for TCV, suggesting different regulation mechanisms for PCYP1A1 gene expression by the two compounds. CBR and CPR exerted less induction in both cell types (approx. 2.5-fold induction compared with approximately 16-fold for 3-methylcholanthrene), whereas DDT and MAL showed no action on human hepatocytes but decreased EROD activity in rat cells. Finally, cytotoxicity studies performed using the MTT and the neutral red tests demonstrated significant differences between insecticides.

Livers of Wistar rats were stored between 0 and 36 hrs. in the University of Wisconsin preservation liquid in order to determine time-related biochemical and morphological hepatic changes. Ursodeoxycholate (100 microM) was also added in the medium to test the hepatoprotective properties of the bile salt. Biochemical assays were performed on hepatic microsomes, plasma and biliary canalicular membranes. Protein and lipid composition of the microsomal and baso-lateral plasma membranes remained stable. Protein and cholesterol content of the biliary canalicular membranes decreased, phospholipid/cholesterol ratio increased between 0 and 36 hrs.; it resulted in a leak of 5'-nucleotidase and leucine amino peptidase activity of these biliary canalicular membranes, especially up to 12 hrs. Between 0 and 36 hrs., the lipid and protein content remained stable in the plasma membranes, as well as both tested enzymatic activities. Observations under electron microscopy showed alterations and underlined fragility of the bile canaliculi, particularly after 24 hrs. preservation. Ultrastructure of sinusoidal membranes showed damaged microvilli. Endoplasmic reticulum remained unchanged, in relation to the stability of the microsomal lipidic, proteic content and hydroxymethylglutaryl-coenzyme A reductase activity, except the decreased protein content after preservation for 36 hrs without ursodeoxycholate. Ursodeoxycholate by itself did not protect against the described disturbances.

The transmissibility of viral hepatitis by medical technics is a topical question in public health care. So, it becomes important to assess transmission risk in medically assisted procreation (MAP), to define the management of couples according to their viral status. Mainly, B and C virus are concerned by transmission risk, because of their epidemiology. In that work, B and C virus epidemiology and transmissibility will be rapported, with the recent notions about detection and knowledge of C virus. According to that transmission risk a logical attitude in MAP will be defined.

The case of a 29 year old woman affected by fulminant hepatitis during the third trimester of pregnancy, after a 3 week administration of chlormezanone is reported. Following induced Caesarean delivery, the patient underwent an orthotopic liver transplantation. The mother and her baby were in good condition 26 months after liver transplantation. In this case, chlormezanone was probably responsible for the fulminant hepatitis.