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1. T cell immuno-phenotyping : a source of predictive biomarkers for autoimmune hepatitis relapse

Author

Astrid Imbert, Pierre-Jean Gavlovsky, Jean-Paul Judor, Edouard Bardou-Jacquet, Laure Elkrief, Adrien Lannes, Christine Silvain, Mathieu Schnee, Florence Tanne, Caroline Chevalier, Fabienne Vavasseur, Marion Khaldi, Sophie Brouard, Jean-François Mosnier, Jérôme Gournay, Sophie Conchon, and Amédée Renand

Subjects
Peripheral helper T cells, CD38, BAFF, Biomarkers, Personalized medicine, Medicine, Science
Abstract

Abstract Relapse after immunosuppression (IS) treatment withdrawal is frequent in patients with Autoimmune Hepatitis (AIH), and non-invasive biomarkers predictive of this risk are lacking. We assessed the frequency of circulating T cell subsets as potential biomarkers of disease activity and predictor of the risk of relapse after IS withdrawal. Serum levels of the cytokine B-cell Activating Factor (BAFF) were also investigated. Blood samples from 58 patients with active AIH, 56 AIH patients in remission, and 31 patients with NASH were analyzed. The frequency of activated CD4+ T peripheral helper (TPH) cells (CD4+CD45RA-CXCR5-PD1+CD38+) and of activated CD8+ T cells (CD8+CD45RA-PD1+CD38+) were assessed by flow cytometry. BAFF levels were determined by ELISA. Activated TPH and CD8+ T cell frequencies were significantly increased in patients with active AIH compared to remission AIH or NASH (TPH: 0.88% of total CD3+ vs. 0.42% and 0.39% respectively, p 0.5% of total CD3+) and/or activated CD8+ T cells (> 0.18% total CD3+) had a higher risk of relapse (80% vs. 15% after 2 years, p = 0.0071). High BAFF serum concentration (> 213pg/ml) was also associated to a higher risk of relapse (57% vs. 11%, p = 0.0452). In conclusion, high frequency of activated TPH and of activated CD8+, as well as high levels of BAFF, before IS discontinuation, were significantly associated to a greater risk of relapse during the first two years. Thus, they represent promising biomarkers to provide personalized clinical follow-up for patients with AIH.

Published
2024
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2. Ascites in cirrhotic patients: a comprehensive review

Author

Paul Carrier, Véronique Loustaud-Ratti, Marilyne Debette-Gratien, and Laure Elkrief

Subjects
paracentesis, tips, beta-blockers, low-flow ascites pump, ascites, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Ascites is a frequent complication in patients with cirrhosis, associated with a bad prognosis. Ascites is associated with severe complications, such as spontaneous bacterial peritonitis and kidney dysfunction, which must be diagnosed and managed rapidly. First-line management is based on diuretics use. Beta-blockers role remains debated but an early administration could probably decrease complications associated with portal hypertension. Albumin infusion is validated in large volume paracenteses, spontaneous bacterial peritonitis, or kidney dysfunction, but is debated in other situations. Technical progresses allow the worldwide use of TIPS (transjugular intrahepatic portosystemic shunt), but patient selection must be rigorous because of potential severe complications. An alternative treatment, automated low-flow ascites pump, can be offered in patients without TIPS possibility: It is a recent technique, whose patients’ selection and installation conditions were improved, with interesting results. Liver transplantation remains the gold standard, but the lack of grafts, and specific side effects, lead to prefer other methods. In case of acute kidney injury due to hepatorenal syndrome, terlipressin remains the standard of care; continuous infusion is associated with fewer side effects.

Published
2024
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3. International survey among hepatologists and pulmonologists on the hepatic hydrothorax: plea for recommendations

Author

Jean-François David Cadranel, Isabelle Ollivier-Hourmand, Jacques Cadranel, Thierry Thevenot, Honoré Zougmore, Eric Nguyen-Khac, Christophe Bureau, Manon Allaire, Jean-Baptiste Nousbaum, Véronique Loustaud-Ratti, Xavier Causse, Philippe Sogni, Bertrand Hanslik, Marc Bourliere, Jean-Marie Peron, Nathalie Ganne-Carrie, Thong Dao, Dominique Thabut, Bernard. Maitre, Nabil Debzi, Ryad Smadhi, Roger Sombie, Raimi Kpossou, Olivier Nouel, Julien Bissonnette, Isaac Ruiz, Mourad Medmoun, Sergio Negrin Dastis, Pierre Deltenre, Florent Artru, Chantal Raherison, Laure Elkrief, and Tristan Lemagoarou

Subjects
Hepatic hydrothorax, Therapeutic pleural puncture, Albumin infusion, Spontaneous bacterial empyema, Talcage pleurodesis, Indwelling pleural catheter, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Abstract Background The Hepatic hydrothorax is a pleural effusion related to portal hypertension; its diagnosis and therapeutic management may be difficult. The aims of this article are which follows: To gather the practices of hepatogastroenterologists or pulmonologists practitioners regarding the diagnosis and management of the hepatic hydrothorax. Methods Practitioners from 13 French- speaking countries were invited to answer an online questionnaire on the hepatic hydrothorax diagnosis and its management. Results Five hundred twenty-eight practitioners (80% from France) responded to this survey. 75% were hepatogastroenterologists, 20% pulmonologists and the remaining 5% belonged to other specialities. The Hepatic hydrothorax can be located on the left lung for 64% of the responders (66% hepatogastroenterologists vs 57% pulmonologists; p = 0.25); The Hepatic hydrothorax can exist in the absence of clinical ascites for 91% of the responders (93% hepatogastroenterologists vs 88% pulmonologists; p = 0.27). An Ultrasound pleural scanning was systematically performed before a puncture for 43% of the responders (36% hepatogastroenterologists vs 70% pulmonologists; p

Published
2023
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4. Splanchnic vein thrombosis associated with SARS-CoV-2 infection: A VALDIG case–control study

Author

Pierre Deltenre, Audrey Payancé, Laure Elkrief, Vincenzo La Mura, Florent Artru, Anna Baiges, Jean-Paul Cervoni, Louise China, Isabelle Colle, Elise Lemaitre, Bogdan Procopet, Dietmar Schiller, Christophe Bureau, Odile Goria, Isabelle Ollivier, Alexandre Nuzzo, Pierre-Emmanuel Rautou, and Aurélie Plessier

Subjects
Splanchnic vein thrombosis, Portal vein thrombosis, SARS-CoV-2 infection, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background & Aims: Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a risk factor for splanchnic vein thrombosis (SVT) is unknown. This study aims to assess the impact of SARS-CoV-2 infection on the presentation and prognosis of recent SVT and to identify specific characteristics of SARS-CoV-2-associated SVT. Methods: This is a retrospective study collecting health-related data of 27 patients presenting with recent SVT in the context of SARS-CoV-2 infection in 12 Vascular Liver Disease Group (VALDIG) centres and in comparison with 494 patients with recent SVT before the SARS-CoV-2 pandemic. Results: Twenty-one patients with SARS-CoV-2 had portal vein thrombosis with or without thrombosis of another splanchnic vein, two had superior mesenteric vein thrombosis, one had splenic vein thrombosis, and three had hepatic vein thrombosis. Diagnosis of SVT was made 10 days (95% CI 0–24 days) after the diagnosis of SARS-CoV-2 infection. Fever (52 vs. 15%; p

Published
2023
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5. Management of splanchnic vein thrombosisKey points

Author

Laure Elkrief, Audrey Payancé, Aurélie Plessier, Louis d’Alteroche, Maxime Ronot, Valérie Paradis, Dominique Valla, and Pierre-Emmanuel Rautou

Subjects
Cavernoma, Portal biliopathy, Direct oral anticoagulants, Portal vein recanalisation, Vascular liver diseases, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Summary: The expression splanchnic vein thrombosis encompasses Budd-Chiari syndrome and portal vein thrombosis. These disorders have common characteristics: they are both rare diseases which can cause portal hypertension and its complications. Budd-Chiari syndrome and portal vein thrombosis in the absence of underlying liver disease share many risk factors, among which myeloproliferative neoplasms represent the most common; a rapid comprehensive work-up for risk factors of thrombosis is needed in these patients. Long-term anticoagulation is indicated in most patients. Portal vein thrombosis can also develop in patients with cirrhosis and in those with porto-sinusoidal vascular liver disease. The presence and nature of underlying liver disease impacts the management of portal vein thrombosis. Indications for anticoagulation in patients with cirrhosis are growing, while transjugular intrahepatic portosystemic shunt is now a second-line option. Due to the rarity of these diseases, studies yielding high-grade evidence are scarce. However, collaborative studies have provided new insight into the management of these patients. This article focuses on the causes, diagnosis, and management of patients with Budd-Chiari syndrome, portal vein thrombosis without underlying liver disease, or cirrhosis with non-malignant portal vein thrombosis.

Published
2023
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6. Systemic treatments with tyrosine kinase inhibitor and platinum-based chemotherapy in patients with unresectable or metastatic hepatocholangiocarcinoma

Author

Elia Gigante, Christian Hobeika, Brigitte Le Bail, Valérie Paradis, David Tougeron, Marie Lequoy, Mohamed Bouattour, Jean-Frederic Blanc, Nathalie Ganne-Carrié, Henri Tran, Clémence Hollande, Manon Allaire, Giuliana Amaddeo, Hélène Regnault, Paul Vigneron, Maxime Ronot, Laure Elkrief, Gontran Verset, Eric Trepo, Aziz Zaanan, Marianne Ziol, Massih Ningarhari, Julien Calderaro, Julien Edeline, and Jean-Charles Nault

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Backgrounds and aims: Even if no systemic treatment is currently validated for unresectable hepato-cholangiocarcinoma (cHCC-CCA), tyrosine kinase inhibitors (TKI), and platinum-based chemotherapy are frequently used in clinical practice. Our study aims to describe the effectiveness of first-line systemic treatments in patients with cHCC-CCA. Patients and Methods: Patients with histological diagnosis of unresectable or metastatic cHCC-CCA confirmed by a centralized review (WHO classification 2019) and who received systemic treatment from 2009 to 2020 were included retrospectively in 11 centers. The outcomes of patients with cHCC-CCA were compared with patients with hepatocellular carcinoma (HCC) treated by sorafenib (n=117) and with intrahepatic cholangiocarcinoma (iCCA, n=94) treated mainly by platinum-based chemotherapy using a frailty Cox model. The efficacy of tyrosine kinase inhibitors and platinum-based chemotherapies in patients with cHCC-CCA was assessed using a doubly robust estimator. Results: A total of 83 patients with cHCC-CCA were included and were predominantly male (72%) with underlying cirrhosis (55%). 67% of patients had extrahepatic metastases and 31% macrovascular tumor invasion. cHCC-CCAs were more often developed on cirrhosis (55.4%) than iCCA (26.6%) but less frequently than HCC (80.2%)(p

Published
2022
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7. Pre-therapy liver transcriptome landscape in Indian and French patients with severe alcoholic hepatitis and steroid responsiveness

Author

Shvetank Sharma, Jaswinder S. Maras, Sukanta Das, Shabir Hussain, Ashwani K. Mishra, Saggere M. Shasthry, Chhagan B. Sharma, Emmanuel Weiss, Laure Elkrief, Pierre-Emmanuel Rautou, Hélène Gilgenkrantz, Sophie Lotersztajn, Valérie Paradis, Pierre de la Grange, Christophe Junot, Richard Moreau, and Shiv K. Sarin

Subjects
Medicine, Science
Abstract

Abstract Patients with severe alcoholic hepatitis (SAH) not responding to glucocorticoid therapy have higher mortality, though they do not differ in their baseline clinical characteristics and prognostic scores from those who respond to therapy. We hypothesized that the baseline hepatic gene expression differs between responders (R) and non-responders (NR). Baseline liver transcriptome was compared between R and NR in Indian (16 each) and French (5 NR, 3 R) patients with SAH. There were differentially expressed genes (DEGs) between NR and R, in Indian (1106 over-expressed, 96 under-expressed genes) and French patients (65 over-expressed, 142 under-expressed genes). Indian NR had features of hepatocyte senescence and French NR exhibited under-expression of genes involved in cell division, indicating a central defect in the capacity of hepatocytes for self-renewal in both populations. Markers of hepatic progenitor cell proliferation were either very few (Indian patients) or absent (French patients). No DEGs were enriched in inflammatory pathways and there were no differences in nuclear receptor subfamily 3 group C member 1 (NR3C1) transcript expression and splicing between NR and R. Our results reveal that baseline hepatic transcriptome is reflective of subsequent glucocorticoid non-response and indicate impaired regenerative potential of the liver as an underlying phenomenon in NR.

Published
2017
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8. Concordance in a world without a gold standard: a new non-invasive methodology for improving accuracy of fibrosis markers.

Author

Thierry Poynard, Patrick Ingiliz, Laure Elkrief, Mona Munteanu, Pascal Lebray, Rachel Morra, Djamila Messous, Francoise Imbert Bismut, Dominique Roulot, Yves Benhamou, Dominique Thabut, and Vlad Ratziu

Subjects
Medicine, Science
Abstract

BACKGROUND: Assessing liver fibrosis is traditionally performed by biopsy, an imperfect gold standard. Non-invasive techniques, liver stiffness measurements (LSM) and biomarkers [FibroTest(R) (FT)], are widely used in countries where they are available. The aim was to identify factors associated with LSM accuracy using FT as a non-invasive endpoint and vice versa. METHODS: The proof of concept was taken using the manufacturers recommendations for excluding patients at high risk of false negative/positive. The hypothesis was that the concordance between LSM and FT, would be improved by excluding high-risk patients. Thereafter, the impact of potential variability factors was assessed by the same methods. Liver biopsy and independent endpoints were used to validate the results. RESULTS: Applying manufacturers' recommendations in 2,004 patients increased the strength of concordance between LSM and FT (P

Published
2008
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9. Expert opinion on bleeding risk from invasive procedures in cirrhosis

Author

Nezam H, Afdhal, Walter, Ageno, Marcello, Bianchini, Annabel, Blasi, Stephen H, Caldwell, Mark, Callaway, Andres, Cardenas, Sarwa, Darwish Murad, Andrea, De Gottardi, Lesley, De Pietri, Emmanuelle, De Raucourt, Alessandra, Dell'Era, Alban, Denys, Laure, Elkrief, Juan-Carlos, Garcia-Pagan, Guadalupe, Garcia-Tsao, Alexander, Gatt, Edoardo G, Giannini, Rita, Golfieri, Charles S, Greenberg, Virginia, Hernández-Gea, Mathis, Heydtmann, Nicolas M, Intagliata, Patrick S, Kamath, Will, Lester, Maria, Magnusson, James, Neuberger, Patrick G, Northup, G, O'Leary Jacqueline, Heather, Patton, Markus, Peck-Radosavljevic, Anjana, Pillai, Aurélie, Plessier, Pierre-Emmanuel, Rautou, Cristina, Ripoll, Lara N, Roberts, Ammar, Sarwar, Marco, Senzolo, Akash, Shukla, Paolo, Simioni, Douglas A, Simonetto, Ashwani K, Singal, Robin, Soto, Jonathan G, Stine, Elliot B, Tapper, Dominique, Thabut, Jecko, Thachil, Dana, Tomescu, Dhiraj, Tripathi, Emmanuel A, Tsochatzis, Erica, Villa, Dominique, Valla, Riescher-Tuczkiewicz, Alix, Caldwell, Stephen H., Kamath, Patrick S., Villa, Erica, and Rautou, Pierre-Emmanuel

Published
2024
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10. Liver Transplantation for Porto-sinusoidal Vascular Liver Disorder: Long-term Outcome

Author

Marta Magaz, Heloïse Giudicelli-Lett, Oana Nicoară-Farcău, Neil Rajoriya, Ashish Goel, Karlien Raymenants, Sophie Hillaire, Gonzalo Crespo, Luis Téllez, Laure Elkrief, Constantino Fondevila, Lara Orts, Filipe Nery, Akash Shukla, Hélène Larrue, Yiliam Fundora, Helena Degroote, Victoria Aguilera, Elba LLop, Laura Turco, Federica Indulti, Stefania Gioia, Giulia Tosetti, Niccolò Bitto, Chiara Becchetti, Edilmar Alvarado, Cristina Roig, Raquel Diaz, Michael Praktiknjo, Anna-Lena Konicek, Guillem Soy, Pol Olivas, José Ignacio Fortea, Helena Masnou, Ángela Puente, Alba Ardèvol, Carmen Álvarez-Navascués, Marta Romero, Bernhard Scheiner, Georg Semmler, Mattias Mandorfer, Filipe Damião, Anna Baiges, Fanny Turon, Macarena Simón-Talero, Carlos González-Alayón, Alba Díaz, Ángeles García-Criado, Andrea de Gottardi, Enric Reverter, Annabel Blasi, Joan Genescà, Olivier Roux, Claire Francoz, Carlos Noronha Ferreira, Thomas Reiberger, Manuel Rodríguez, Rosa María Morillas, Javier Crespo, Jonel Trebicka, Rafael Bañares, Càndid Villanueva, Annalisa Berzigotti, Massimo Primignani, Vincenzo La Mura, Oliviero Riggio, Filippo Schepis, Bogdan Procopet, Xavier Verhelst, José Luis Calleja, Christophe Bureau, Agustín Albillos, Frederik Nevens, Virginia Hernández-Gea, Dhiraj Tripathi, Pierre-Emmanuel Rautou, François Durand, and Juan Carlos García-Pagán

Subjects
Transplantation, 610 Medizin und Gesundheit
Abstract

BACKGROUND AND AIMS Porto-sinusoidal vascular liver disorder (PSVD) is a rare disease that occasionally requires liver transplantation (LT), despite usually presenting preserved liver function. There remains a paucity of data pertaining to LT in PSVD. The aim was to identify features associated with post-LT outcomes in PSVD. METHODS Retrospective multicentre study of 79 patients who received LT for PSVD. RESULTS Median post-LT follow-up was 37 (range 1-261) mo. Refractory ascites 24 (30%), hepatic encephalopathy 16 (20%), and hepatopulmonary syndrome 13 (16.3%) were the most frequent indications for LT. Hepatocellular carcinoma was the indication in only 2 patients. Twenty-four patients died, 7 due to liver and 17 to non-liver related causes. Post-LT survival was 82.2%, 80.7%, and 68.6% at 1, 2, and 5 y, respectively. Post-LT survival was significantly better in patients without (n = 58) than in those with a persistent severe PSVD-associated condition (n = 21). Pre-LT hyperbilirubinemia levels and creatinine >100 µmol/L were also independently associated with poor survival. Six patients (7.6%) required a second LT. Recurrence of PSVD was confirmed by liver biopsy in only 1 patient and in 3 further patients it was likely. CONCLUSIONS LT in PSVD is associated with an acceptable outcome in the absence of associated severe conditions. However, persistence of a severe associated condition, pre-LT high bilirubin levels, or creatinine >100 µmol/L impact outcome, and these are features that should be considered when evaluating PSVD patients for LT. PSVD recurrence is possible after LT and needs to be explored, at least, in cases of posttransplant portal hypertension.

Published
2023

11. Variation of the SOFA score and mortality in patients with severe burns: A cohort study

Author

Julien Calles, Benjamin Cohen, Nathalie Forme, Zahida Guendil, Brice Fermier, Claire Chassier, Laure Elkrief, Antoine Roquilly, Francis Remerand, and Romain Miguel Montanes

Subjects
Cohort Studies, ROC Curve, Organ Dysfunction Scores, Multiple Organ Failure, Emergency Medicine, Humans, Surgery, General Medicine, Middle Aged, Burns, Prognosis, Critical Care and Intensive Care Medicine, Retrospective Studies
Abstract

Multiple organ failure (MOF) is the leading cause of death in patients with burns requiring ICU admission. Quantifying the evolution of MOF, with the SOFA score, over the first few days after a severe burn may provide useful prognostic information. This retrospective cohort study aimed at evaluating the association between the evolution of the SOFA score between day 0 and day 3 and in-hospital mortality. All patients admitted for severe burns at the burn ICU of the Tours University Hospital between 2017 and 2020 and who stayed 3 days or more were included. Severe burns included: total body surface area burned (TBSA) ≥ 20 % or burns of any surface associated with one or more of the following items: (1) organ failure, (2) clinically significant smoke inhalation and/or cyanide poisoning, (3) severe preexisting comorbidities, (4) complex and specialized burn wound care. DeltaSOFA was defined as day 3 minus day 0 SOFA. One hundred and thirty-six patients were included. Median age was 52 years (38-70), median TBSA burned was 24 % (20-38), median day 0 SOFA was 2 (0-4) and median day 3 SOFA was 1 (0-5). In-hospital mortality was 10 %. There was a significant association between deltaSOFA and mortality that persisted after adjustment for age and TBSA (HR 1.37, 95 %CI 1.09-1.72, p 0.01). Area under the receiver operating characteristics curve for the prediction of mortality by day 0 SOFA and deltaSOFA were 0.79 (95 %CI 0.69-0.89) and 0.83 (95 %CI 0.70-0.95) respectively. After exclusion of patients with TBSA burned 15 %, deltaSOFA remained independently associated with mortality (HR 1.42 95 %CI 1.09-1.85, p 0.01). In addition, SOFA variations allowed the identification of subgroups of patients with either very low or very high mortality. In patients with severe burns, SOFA score evolution between day 0 and day 3 may be useful for individualized medical and ethical decisions. Further multicenter studies are required to corroborate the present results.

Published
2023

12. Paroxysmal nocturnal hemoglobinuria and vascular liver disease: Eculizumab therapy decreases mortality and thrombotic complications

Author

Aurélie Plessier, Marina Esposito‐Farèse, Anna Baiges, Akash Shukla, Juan Carlos Garcia Pagan, Emmanuelle De Raucourt, Isabelle Ollivier‐Hourmand, Jean‐Paul Cervoni, Victor De Ledinghen, Zoubida Tazi, Jean‐Baptiste Nousbaum, René Bun, Christophe Bureau, Christine Silvain, Olivier Tournilhac, Mathieu Gerfaud‐Valentin, François Durand, Odile Goria, Luis Tellez, Agustin Albillos, Stefania Gioia, Oliviero Riggio, Andrea De Gottardi, Audrey Payance, Pierre‐Emmanuel Rautou, Louis Terriou, Aude Charbonnier, Laure Elkrief, Regis Peffault de la Tour, Dominique‐Charles Valla, Nathalie Gault, and Flore Sicre de Fontbrune

Subjects
Adult, Male, Liver Diseases, Hemoglobinuria, Paroxysmal, Humans, Female, Thrombosis, Hematology, Antibodies, Monoclonal, Humanized, Retrospective Studies
Abstract

A total of 2%-10% of patients with vascular liver disease (VLD) have paroxysmal nocturnal hemoglobinuria (PNH). Eculizumab reduces complement-mediated haemolytic activity in PNH. This study was aimed at assessing the impact of eculizumab on VLD outcome. Retrospective cohort of PNH patients, in Valdig registry, who had VLD diagnosed between 1997 and 2019 is considered. Eculizumab was the exposure of interest. Studied outcomes were death, venous thrombosis, bleeding, arterial ischemic event, infection, and liver-related complications. We compared survival and new thrombotic events from PNH/VLD cohort to Envie2 non-PNH cohort. Sixty-two patients (33 women), median age 35 years (28-48) and median follow-up VLD diagnosis 4.7 years (1.2-9.5), were included. Clone size was 80% (70-90), median hemoglobin concentration was 10.0 g/dl (8-11), and lactate dehydrogenase (LDH) was 736 IU (482-1744). Forty-two patients (68%) had eculizumab; median exposure time was 40.1 [9.3-72.6] months. Mortality was significantly lower in exposed versus nonexposed period: 2.6 versus 8.7 per 100 (PY), incidence rate ratio (IRR) was 0.29, 95% CI (0.1-0.9), p = .035. Thrombosis recurrence occurred less frequently during the exposure to eculizumab: 0.5 versus 2.8 per 100 PY, IRR 0.22 (0.07-0.64). Other secondary end points (i.e., bleeding, arterial ischemic lesions, infection, and liver complications) were less common during the exposure to eculizumab, although not reaching statistical significance. Six-year thrombosis-free survival was 70%, 95% CI [0.60-0.83] for PNH cohort and 83%, 95% CI [0.70-1.00] for non-PNH Envie 2 patients, (p .001). In conclusion, patients with PNH and VLD are at higher risk of recurrent thrombosis than non-PNH patients. Eculizumab is significantly associated with a lower mortality and less thrombotic recurrence in patients with PNH and VLD.

Published
2022

13. Germline Mutations of Telomere-Related Genes are a Major Risk Factor for Liver Disease: A Multicentric Transversal Study

Author

Sabrina Sidali, Raphaël Borie, Flore Sicre de Fontbrune, Kinan El Husseini, Pierre-Emmanuel Rautou, Elodie Lainey, Odile Goria, Bruno Crestani, Jacques Cadranel, Vincent Cottin, Vincent Bunel, Jérôme Dumortier, Emmanuel Jacquemin, Noémi Reboux, Sandrine Hirschi, Arnaud Bourdin, Magdalena Meszaros, Sébastien Dharancy, Sophie Hilaire, Vincent Mallet, Martine Reynaud-Gaubert, Louis Terriou, Frédéric Gottrand, Wadih Abou Chahla, Jean-Emmanuel Kahn, Paul Carrier, Faouzi Saliba, Laura Rubbia-Brandt, John-David Aubert, Laure Elkrief, Victor de Ledinghen, Armand Abergel, Olivier Tournilhac, Pauline Houssel, Stéphane Jouneau, Ludivine Wemeau, Anne Bergeron, Thierry Leblanc, Isabelle Ollivier-Hourmand, Eric Nguyen-Khac, Hélène Morisse-Pradier, Ibrahima Ba, Catherine Boileau, Françoise Roulot-Thoraval, Valérie Vilgrain, Christophe Bureau, Hilario Nunes, Jean-Marc Naccache, François Durand, Claire Francoz, Dominique Roulot, Dominique-Charles Valla, Valérie Paradis, Caroline Kannengiesser, and Aurélie Plessier

Published
2023

14. Low alcohol consumption influences outcomes in individuals with alcohol-related compensated cirrhosis in a French multicenter cohort

Author

Alexandre Louvet, Valérie Bourcier, Isabelle Archambeaud, Louis d’Alteroche, Cendrine Chaffaut, Frédéric Oberti, Christophe Moreno, Dominique Roulot, Thông Dao, Romain Moirand, Jean-Charles Duclos-Vallée, Odile Goria, Eric Nguyen-Khac, Stanislas Pol, Nicolas Carbonell, Jérôme Gournay, Laure Elkrief, Isabelle Fouchard-Hubert, Sylvie Chevret, Nathalie Ganne-Carrié, null Louis d’Alteroche, Jean-Marie Péron, Victor de Lédinghen, Violaine Ozenne, Jean Henrion, Albert Tran, Gabriel Perlemuter, Xavier Amiot, Jean-Pierre Zarski, CHU Lille, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA) (SBIM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut national du cancer [Boulogne] (INCA)-Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Erasme [Bruxelles], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Pontchaillou [Rennes], Hôpital Paul Brousse, Nutrition, Inflammation et axe Microbiote-Intestin-Cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Amiens-Picardie, Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie du système immunitaire (Inserm U1223), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Département d'hépatologie [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CIRRAL group, École pratique des hautes études (EPHE), CHU Trousseau [Tours], Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hépato-biliaire (CHB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Service d'Hépato-gastro-entérologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Référence des Maladies Rares - Maladies Inflammatoires des Voies Biliaires et Service d’Hépatologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé (CRESS - U1153), and Hopital Saint-Louis [AP-HP] (AP-HP)

Subjects
liver decompensation, [PHYS]Physics [physics], Alcohol-related liver disease, Cirrhosis, Hepatology, Recurrence, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Background and aims: The harmful impact of heavy alcohol recurrence has been confirmed in patients with alcohol-related cirrhosis although this is based on old studies. The drivers of long-term outcome still need to be clearly investigated.Method: All patients with biopsy-proven compensated alcohol-related cirrhosis included in the CIRRAL cohort (22 centers) were prospectively studied. Prognostic variables of survival and liver event-free survival were assessed using multivariable Cox models with stepwise selection. The prognostic impact of alcohol recurrence during follow-up (computed in glasses-years in the same way as pack-years for tobacco) was assessed using a time-dependent covariable.Results: From 2010 to 2016, 650 patients were included. The median age at baseline was 58.4 years old, 67.4% were men and the median BMI was 27.8 kg/m2, 63.8% had a history of liver decompensation, and 70.2% had discontinued alcohol. At 5 years, 30.9% of abstinent patients developed recurrence and this risk was higher in patients with a history of drug abuse and in those with shorter alcohol discontinuation times. Median survival was 97 months. Age, alcohol consumption at baseline, platelet count and Child-Pugh score >5 were associated with overall and liver event-free survival on multivariate analysis. Alcohol consumption during follow-up of more than 25 glasses-year was independently associated with lower survival and with a trend toward significant liver event-free survival, but the risk increased from 1 glass-year, though not significantly. Simon & Makuch plots confirm the benefit of no alcohol consumption (

Published
2022

15. Impact of the presence of median arcuate ligament on biliary complications after liver transplantation

Author

Eleftherios Gialamas, Michela Assalino, Laure Elkrief, Fani Apostolidou‐Kiouti, Arthur Piveteau, Graziano Oldani, Philippe Compagnon, and Thierry Berney

Subjects
Transplantation, Hepatic Artery, Ligaments, Case-Control Studies, Humans, Liver Transplantation, Retrospective Studies
Abstract

The presence of median arcuate ligament (MAL) during orthotopic liver transplantation (OLT) may cause a significant reduction in the arterial hepatic flow. The aim of the present study is to investigate the impact of MAL on biliary complications in patients who underwent OLT.We performed a retrospective case-control study among patients who underwent OLT in Geneva University Hospital between 2007 and 2017, depending on the presence or absence of MAL. The matching was performed according to age, gender, lab-MELD score at the time of OLT and type of donor (living or dead). The presence of MAL was assessed by an expert liver radiologist on the preoperative CT angiographic evaluation.The incidence of MAL was 6.1% (19 patients). Baseline characteristics were comparable between the two groups. No significant difference in biliary complications was found between patients with and without MAL (37% and 24%, respectively). No patient presented hepatic artery thrombosis. After logistic regression, in patients with MAL, the MAL release and gastroduodenal artery preservation compared to no treatment, showed an odds ratio for post-OLT biliary complications of 1.5 and 1.25, respectively. There was no difference in overall graft survival and in hazard for biliary complications between patients with and without MAL.In the present study, we did not find any difference in the prevalence of biliary and arterial complications between patients with and without MAL. The choice of MAL treatment did not influence in a significant way the overall outcome and development of complications. However, if, at the end of arterial reconstruction, the arterial flow is not adequately established, MAL needs to be treated with the least invasive technique.

Published
2022

16. Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure

Author

Carlo Alessandria, Carmine Gambino, Javier Fernández, Hans Van Vlierberghe, Sophie Restellini, Marcos Girala, Luis Colombato, Tae Hee Lee, Nikolaos Pyrsopoulos, Eduardo Fassio, Sang Gyune Kim, Gisela Pinero, Paolo Caraceni, Shivaram Prasad Singh, Do Seon Song, Ji Won Park, Julio Vorobioff, Dong Joon Kim, C. Toledo, Aleksander Krag, Liane Rabinowich, Preetam Nath, Robert A. de Man, Elza Cotrim Soares, Xavier Verhelst, Tiago Sevá Pereira, Gustavo Romero, Macarena Simón-Talero, Sung Eun Kim, Michele Bartoletti, Alexander L. Gerbes, Sebastián Marciano, Tony Bruns, Hyoung Su Kim, Ki Tae Suk, Nicolas M. Intagliata, Annette Dam Fialla, Adrià Juanola, Manuela Merli, Rita de Cassia Ribeiro Barea, Laure Elkrief, Rakhi Maiwall, Laurentius A Lesmana, Pere Ginès, Vikas Gautam, E.L. Yoon, M. Marino, Paolo Angeli, Kalyan Ram Bhamidimarri, Victor Vargas, Virendra Singh, Juan Pablo Roblero, François Durand, Cosmas A. Rinaldi Lesmana, M. V. Maevskaya, Gustavo Navarro, Adrian Gadano, Florence Wong, Pramod Kumar, Tae Hun Kim, Daniela Campion, Salvatore Piano, Giacomo Zaccherini, Barbara Lattanz, Jae Seok Hwang, Sun Young Yim, Thomas D. Boyer, Jeong Han Kim, Carlos Brodersen, Wong F., Piano S., Singh V., Bartoletti M., Maiwall R., Alessandria C., Fernandez J., Soares E.C., Kim D.J., Kim S.E., Marino M., Vorobioff J., Barea R.D.C.R., Merli M., Elkrief L., Vargas V., Krag A., Singh S.P., Lesmana L.A., Toledo C., Marciano S., Verhelst X., Intagliata N., Rabinowich L., Colombato L., Kim S.G., Gerbes A., Durand F., Roblero J.P., Bruns T., Yoon E.L., Girala M., Pyrsopoulos N.T., Kim T.H., Yim S.Y., Juanola A., Gadano A., Angeli P., Bhamidimarri K., Boyer T.D., Brodersen C., Campion D., Caraceni P., de Man R.A., Fassio E., Fialla A.D., Gambino C., Gautam V., Gines P., Hwang J.S., Kim H.S., Kim J.H., Kumar P., Lattanz B., Lee T.H., Rinaldi Lesmana C.A., Maevskaya M., Nath P., Navarro G., Park J.-W., Pinero G., Restellini S., Romero G., Seva -Pereira T., Simon-Talero M., Song D.S., Suk K.T., Van Vlierberghe H., and Zaccherini G.

Subjects
Male, 0301 basic medicine, Cirrhosis, Organ Dysfunction Scores, Antibiotic resistance, medicine.medical_treatment, Liver transplantation, Severity of Illness Index, 0302 clinical medicine, ACLF, MDR, Epidemiology, Cross Infection, Mortality rate, Age Factors, Bacterial Infections, Middle Aged, Prognosis, Community-Acquired Infections, Europe, Hospitalization, Female, 030211 gastroenterology & hepatology, Alcohol-Related Disorders, medicine.medical_specialty, Sepsi, India, Risk Assessment, Sepsis, 03 medical and health sciences, Sex Factors, Spontaneous bacterial peritonitis, Internal medicine, medicine, Humans, XDR, Cirrhosi, Hepatology, business.industry, Acute-On-Chronic Liver Failure, medicine.disease, Pneumonia, 030104 developmental biology, antibiotic resistance, liver transplantation, sepsis, business
Abstract

Background & Aims: Bacterial infections can trigger the development of organ failure(s) and acute-on-chronic liver failure (ACLF). Geographic variations in bacteriology and clinical practice could lead to worldwide differences in ACLF epidemiology, phenotypes and associated outcomes. Herein, we aimed to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital. Methods: This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death. Results: A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p

Published
2021

17. Contrast-enhanced CT and liver surface nodularity for the diagnosis of porto-sinusoidal vascular disorder: A case-control study

Author

Shantha Ram Valainathan, Riccardo Sartoris, Laure Elkrief, Marta Magaz, Fabian Betancourt, Silvia Pellegrino, Arianna Nivolli, Marco Dioguardi Burgio, Yves Flattet, Sylvain Terraz, Nicolas Drilhon, Marie Lazareth, Julia Herrou, Onorina Bruno, Audrey Payance, Aurélie Plessier, François Durand, Maxime Ronot, Dominique‐Charles Valla, Valérie Paradis, Juan Carlos Garcia‐Pagan, Valérie Vilgrain, and Pierre‐Emmanuel Rautou

Subjects
Liver Cirrhosis, Hepatology, Liver, Case-Control Studies, Hypertension, Portal, Humans, Vascular Diseases, Tomography, X-Ray Computed, Fibrosis, Retrospective Studies
Abstract

Porto-sinusoidal vascular disorder (PSVD) is a rare and commonly overlooked cause of portal hypertension. The interest of CT analysis, including quantification of liver surface nodularity (LSN) for PSVD diagnosis has not been established. This study aimed at assessing the performance of LSN and CT features for a PSVD diagnosis in patients with signs of portal hypertension.This retrospective case-control study included a learning cohort consisting of 50 patients with histologically proven PSVD, according to VALDIG criteria, and 100 control patients with histologically proven cirrhosis, matched on ascites. All patients and controls had at least one sign of portal hypertension and CT available within 1 year of liver biopsy. Principal component analysis of CT features separated patients with PSVD from patients with cirrhosis. Patients with PSVD had lower median LSN than those with cirrhosis (2.4 vs. 3.1, p 0.001). Multivariate analysis identified LSN 2.5 and normal-sized or enlarged segment IV as independently associated with PSVD. Combination of these two features had a specificity of 90% for PSVD and a diagnostic accuracy of 84%. Even better results were obtained in an independent multicenter validation cohort including 53 patients with PSVD and 106 control patients with cirrhosis (specificity 94%, diagnostic accuracy 87%).This study that included a total of 103 patients with PSVD and 206 patients with cirrhosis demonstrates that LSN 2.5 combined with normal-sized or enlarged segment IV strongly suggests PSVD in patients with signs of portal hypertension.

Published
2022

19. Recurrence of primary sclerosing cholangitis after liver transplantation: a french cohort study including 571 patients

Author

Florian Veyre, Eleonora De Martin, Domitille Erard, Claire Francoz, Laure Elkrief, Camille Besch, Olivier Boillot, Karim Boudjema, Filomena Conti, Sebastien Dharancy, Christophe Duvoux, Jean Gugenheim, Jean Hardwigsen, Marie-Noëlle Hilleret, Isabelle Ollivier-Hourmand, Maryline Debette-Gratien, Pauline Houssel-Debry, Nassim Kamar, Jean-Baptiste Hiriart, Stéphanie Faure, Faouzi Saliba, Didier Samuel, Claire Vanlemmens, Christophe Corpechot, Olivier Chazouillères, and Jérôme Dumortier

Subjects
Hepatology
Published
2022

21. Non-invasive diagnosis and follow-up of vascular liver diseases

Author

Isabelle Ollivier-Hourmand, Christophe Bureau, Marie Decraecker, Aurélie Plessier, Nathalie Ganne-Carrié, Valérie Vilgrain, M. Bourlière, Maxime Ronot, Laure Elkrief, Pierre-Emmanuel Rautou, Victor de Lédinghen, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Bordeaux Research In Translational Oncology [Bordeaux] (BaRITOn), Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de référence des Maladies Vasculaires du Foie [Paris] (FILFOIE), Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Hôpital Saint-Joseph [Marseille], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Avicenne [AP-HP], Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), École pratique des hautes études (EPHE), and Malbec, Odile

Subjects
Liver Cirrhosis, medicine.medical_specialty, Hepatology, medicine.diagnostic_test, business.industry, [SDV]Life Sciences [q-bio], Biopsy, Liver Diseases, Non invasive, Gastroenterology, MEDLINE, [SDV] Life Sciences [q-bio], Liver, Liver biopsy, Medicine, Elasticity Imaging Techniques, Humans, Radiology, Abnormality, business, Follow-Up Studies
Abstract

International audience; Vascular disorders of the liver are rare diseases, some of which are diagnosed mainly with non-invasive tests and others by liver biopsy. Non-invasive methods can be used to diagnose and monitor these diseases. However, their evaluation needs to be performed by expert centers. Liver biopsy is needed each time there is an unexplained abnormality.

Published
2021

23. Systemic treatments with tyrosine kinase inhibitors and platinum-based chemotherapy in patients with unresectable or metastatic hepato-cholangiocarcinoma

Author

Elia Gigante, Christian Hobeika, Brigitte Le Bail, Valérie Paradis, David Tougeron, Marie Lequoy, Mohamed Bouattour, Jean-Frédéric Blanc, Nathalie Ganne-Carrié, Henri Tran, Clemence Hollande, Manon Allaire, Giuliana Amaddeo, Helene Regnault, Paul Vigneron, Maxime Ronot, Laure Elkrief, Gontran Verset, Eric Trepo, Aziz Zaanan, Marianne Ziol, Massih Ningarhari, Julien Calderaro, Julien Edeline, and Jean Charles Nault

Subjects
Hepatology
Published
2022

24. Quantification of Liver Surface Nodularity at CT: Utility for Detection of Portal Hypertension

Author

François Cauchy, Dominique Valla, Riccardo Sartoris, Olivier Soubrane, Gaia Pollorsi, Laurent Spahr, Laure Elkrief, Sylvain Terraz, Valérie Vilgrain, Maxime Ronot, Pierre-Emmanuel Rautou, and François Durand

Subjects
Cirrhosis, Receiver operating characteristic, business.industry, Portal venous pressure, Retrospective cohort study, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Cohort, medicine, Portal hypertension, 030211 gastroenterology & hepatology, Radiology, Nuclear Medicine and imaging, Nuclear medicine, business, Student's t-test, Cohort study
Abstract

Purpose To determine whether quantification of liver surface nodularity (LSN) provides an estimate of the presence of clinically significant portal hypertension (CSPH) in patients with cirrhosis. Materials and Methods This retrospective study included a training cohort (n = 189) and separate external validation cohort (n = 78), both composed of patients with cirrhosis who underwent abdominal CT and hepatic venous pressure gradient (HVPG) measurement between 2010 and 2016. The LSN score, liver and spleen volumes, liver-to-spleen volume ratio, platelet count to spleen diameter ratio, Iranmanesh score, aspartate amino transferase-to-platelet ratio index, and Fibrosis-4 index were derived from CT images and serum laboratories. The accuracy of the various tests for predicting CSPH was evaluated with area under the receiver operating characteristic curve (AUROC) and compared by using the DeLong test. Student t test and Pearson correlation coefficient were used. Results One hundred eighty-nine patients were analyzed (119 men [mean age ± standard deviation, 57 years ± 11; range, 29-81 years] and 70 women [mean age, 61 years ± 10; range, 34-83 years]; overall mean age, 58 years ± 10; range, 29-83 years). A total of 102 patients (54%) had CSPH. LSN score correlated with HVPG (r = 0.75; P < .001). Patients with CSPH had a higher LSN score than did those without CSPH (3.2 ± 0.6 vs 2.4 ± 0.3; P < .001). A cutoff value of 2.8 had a positive predictive value of 88% for CSPH; the AUROC of LSN was 0.88 ± 0.03. This was higher than that of other available noninvasive tests (DeLong, all P < .001). In the validation cohort, LSN score of 2.8 had a positive predictive value of 86% for CSPH; the AUROC was 0.87 ± 0.04. Conclusion The CT-based liver surface nodularity score demonstrated high diagnostic performance for detecting clinically significant portal hypertension and outperformed multiple other noninvasive tests. © RSNA, 2018 Online supplemental material is available for this article.

Published
2018

25. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis

Author

William Bernal, Agustín Albillos, Alex Amoros, Wim Laleman, Michael Manns, Javier Martínez, Maximilian J. Brol, Pere Ginès, Alessandra Pohlmann, Joerg Tobiasch Moritz, Francois Smits, Elisabet Garcia-Lopez, Joan Clària, Jennifer Lehmann, Jonel Trebicka, Christoph Welsch, Vicente Arroyo, Richard Moreau, Tony Bruns, Monica Mesquita, Christian Jansen, Peter Jarcuska, Harald Rupprechter, Martin Janicko, Thierry Gustot, Macarena Simón-Talero, Giacomo Zaccherini, Cristina Ripoll, Luise Aamann, Oliviero Riggio, Martina Rizzo, Karen Vagner Danielsen, Javier Romaní Fernández, Jelte J Schaapman, Frank Erhard Uschner, Juan Acevedo, Miguel Á. Rodríguez, David Semela, Carlo Alessandria, Carmine Gambino, Lise Lotte Gluud, Paolo Caraceni, Emanuela Ciraci, István Altorjay, Cristina Solé, Salvatore Piano, Minneke J. Coenraad, Pierre Nahon, Haluk Tarik Kani, Faouzi Saliba, Agnese Antognoli, Andrea De Gottardi, Osman Ozdogan, Henning Grønbæk, Christian J. Steib, Anna Curto, Hans Van Vlierberghe, Manuel Romero-Gómez, T.M. Welzel, Roland Amathieu, Sylvie Tresson, Carla Pitarch, Frederik Nevens, Alexander Zipprich, Christian Trautwein, Ilaria Giovo, Victor Vargas, Laure Elkrief, Giorgio Maria Saracco, Johannes Chang, Mattias Mandorfer, Paul Horn, Thomas Berg, Nesrine Amari, Sara Mareso, Heinz Zoller, Osagie Akpata, Mária Papp, Adam Herber, Thomas Reiberger, Flemming Bendtsen, Elsa Solà, Ferran Aguilar, Jose Presa Ramos, Miriam Maschmeier, Tamas Tornai, Manuela Merli, Rajiv Jalan, Martina Gagliardi, Cornelius Engelmann, Rafael Bañares, Daniela Campion, Antonella Putignano, Natalie Van den Ende, Claire Francoz, Marco Pavesi, Paola Ponzo, Rita Garcia, Sven Francque, Vish Patel, Esau Moreno, Alessandra Brocca, Rudolf E. Stauber, Zsuzsanna Vitális, Rajeshwar P. Mookerjee, Ahmed Elsharkawy, Eleonora Bertoli, Michael Praktiknjo, Stephen D. Ryder, Cristina Sanchez, Boglarka Balogh, Debbie L. Shawcross, Manuel Tufoni, Paolo Angeli, Florian Rainer, Pavel Strnad, István Tornai, Edilmar Alvarado-Tapias, Alexander L. Gerbes, Didier Samuel, Maurizio Baldassarre, Cesar Jimenez, Stefan Zeuzem, Pietro Gatti, Germán Soriano, Robert Schierwagen, Ana Clemente, Mauro Bernardi, Daniel Markwardt, Trebicka, Jonel, Fernandez, Javier, Papp, Maria, Caraceni, Paolo, Laleman, Wim, Gambino, Carmine, Giovo, Ilaria, Uschner, Frank Erhard, Jansen, Christian, Jimenez, Cesar, Mookerjee, Rajeshwar, Gustot, Thierry, Albillos, Agustin, Bañares, Rafael, Jarcuska, Peter, Steib, Christian, Reiberger, Thoma, Acevedo, Juan, Gatti, Pietro, Shawcross, Debbie L, Zeuzem, Stefan, Zipprich, Alexander, Piano, Salvatore, Berg, Thoma, Bruns, Tony, Danielsen, Karen Vagner, Coenraad, Minneke, Merli, Manuela, Stauber, Rudolf, Zoller, Heinz, Ramos, José Presa, Solé, Cristina, Soriano, Germán, de Gottardi, Andrea, Gronbaek, Henning, Saliba, Faouzi, Trautwein, Christian, Kani, Haluk Tarik, Francque, Sven, Ryder, Stephen, Nahon, Pierre, Romero-Gomez, Manuel, Van Vlierberghe, Han, Francoz, Claire, Manns, Michael, Garcia-Lopez, Elisabet, Tufoni, Manuel, Amoros, Alex, Pavesi, Marco, Sanchez, Cristina, Praktiknjo, Michael, Curto, Anna, Pitarch, Carla, Putignano, Antonella, Moreno, Esau, Bernal, William, Aguilar, Ferran, Clària, Joan, Ponzo, Paola, Vitalis, Zsuzsanna, Zaccherini, Giacomo, Balogh, Boglarka, Gerbes, Alexander, Vargas, Victor, Alessandria, Carlo, Bernardi, Mauro, Ginès, Pere, Moreau, Richard, Angeli, Paolo, Jalan, Rajiv, Arroyo, Vicente, Banares, Rafael, Reiberger, Thomas, Shawcross, Debbie L., Berg, Thomas, Ramos, Jose Presa, Sole, Cristina, Soriano, German, Van Vlierberghe, Hans, Claria, Joan, Gines, Pere, Maschmeier, Miriam, Semela, David, Elkrief, Laure, Elsharkawy, Ahmed, Tornai, Tamas, Tornai, Istvan, Altorjay, Istvan, Antognoli, Agnese, Baldassarre, Maurizio, Gagliardi, Martina, Bertoli, Eleonora, Mareso, Sara, Brocca, Alessandra, Campion, Daniela, Saracco, Giorgio Maria, Rizzo, Martina, Lehmann, Jennifer, Pohlmann, Alessandra, Brol, Maximilian J., Chang, Johannes, Schierwagen, Robert, Sola, Elsa, Amari, Nesrine, Rodriguez, Miguel, Nevens, Frederik, Clemente, Ana, Janicko, Martin, Markwardt, Daniel, Mandorfer, Mattias, Welsch, Christoph, Welzel, Tanja M., Ciraci, Emanuela, Patel, Vish, Ripoll, Cristina, Herber, Adam, Horn, Paul, Bendtsen, Flemming, Gluud, Lise Lotte, Schaapman, Jelte, Riggio, Oliviero, Rainer, Florian, Moritz, Joerg Tobiasch, Mesquita, Monica, Alvarado-Tapias, Edilmar, Akpata, Osagie, Aamann, Luise, Samuel, Didier, Tresson, Sylvie, Strnad, Pavel, Amathieu, Roland, Simon-Talero, Macarena, Smits, Francois, van den Ende, Natalie, Martinez, Javier, Garcia, Rita, Rupprechter, Harald, Engelmann, Cornelius, and Ozdogan, Osman Cavit

Subjects
0301 basic medicine, Liver Cirrhosis, Male, Cirrhosis, Organ Dysfunction Scores, acute complication, Chronic liver disease, Acute complications, Non-elective admission, Outcome, Risk factors, 0302 clinical medicine, Preventive Health Services, Medicine and Health Sciences, Gastro-entérologie, risk factors, 610 Medicine & health, Medical History Taking, factors, Toxic encephalopathy, Bacterial Infections, Middle Aged, Prognosis, Europe, Cohort, Disease Progression, outcome, 030211 gastroenterology & hepatology, Female, medicine.symptom, Needs Assessment, Risk, medicine.medical_specialty, Alcoholic hepatitis, 03 medical and health sciences, Internal medicine, medicine, Humans, Decompensation, Medical history, Inflammation, Hepatology, business.industry, Hepatitis, Alcoholic, Organ dysfunction, Acute-On-Chronic Liver Failure, chronic liver disease, medicine.disease, Precipitating Factors, 030104 developmental biology, Human medicine, business, non-elective admission
Abstract

Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF phenotype (AD-ACLF) defined by organ failure(s). Precipitants may induce AD. This multicenter, prospective, observational PREDICT study (NCT03056612) analyzes and characterizes the precipitants leading to both of these AD phenotypes., info:eu-repo/semantics/published

Published
2021

26. International French-speaking multicentre practice survey on hepatic hydrothorax (HH) : Results of the 'Hep Hep' study among 529 hepatogastroenterologist (HG) or pneumologist (PN) respondents

Author

Nathalie Ganne-Carrié, Eric Nguyen-Khac, Laure Elkrief, Isabelle Ollivier, Jean-Baptiste Nousbaum, Chantal Raherison, Marc Bourlière, Jean-François Cadranel, Véronique Loustaud-Ratti, Christophe Bureau, Xavier Causse, Manon Allaire, Jean-Marie Péron, Philippe Sogni, Bernard Maitre, Thong Dao, Bertrand Hanslik, Tristan Le Magoarou, Thierry Thevenot, Cadranel Jacques, Groupe Hospitalier Public du Sud de l'Oise [Creil] (GHPSO), Theranoscan [CHU Tenon] (GRC 4), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Pneumologie = Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Hépatologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Soins Primaires, Santé Publique, Registre des cancers de Bretagne Occidentale (SPURBO), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation (IPPRITT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Centre Hospitalier Régional d'Orléans (CHRO), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Saint-Joseph [Marseille], Génomique fonctionnelle des tumeurs solides = Functional Genomics of Solid Tumors [CRC] (FunGeST), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, Hepatic hydrothorax, business.industry, Internal medicine, [SDV]Life Sciences [q-bio], Medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2021

27. COVID-19 in liver transplant candidates

Author

Luca Saverio Belli, Christophe Duvoux, Paolo A. Cortesi, Rita Facchetti, Speranta Iacob, Giovanni Perricone, Sylvie Radenne, Sara Conti, Damiano Patrono, Gabriela Berlakovich, Angus Hann, Luisa Pasulo, Lluis Castells, François Faitot, Olivier Detry, Federica Invernizzi, Giulia Magini, Paolo De Simone, Ilias Kounis, Maria Cristina Morelli, Fernando Diáz Fontenla, Bo Goran Ericzon, Carmelo Loinaz, Chris Johnston, Liliana Gheorghe, Mickael Lesurtel, Renato Romagnoli, Dagmar Kollmann, M. Thamara P.R. Perera, Stefano Fagiuoli, Darius Mirza, Audrey Coilly, Christian Toso, Krzysztof Zieniewicz, Laure Elkrief, Vincent Karam, René Adam, C.M. (Caroline) den Hoed, Marco Merli, Massimo Puoti, Luciano G. De Carlis, Gabriel C. Oniscu, Salvatore Piano, Paolo Angeli, Costantino Fondevila, W.G. (Wojtek) Polak, Luca Saverio Belli, Christophe Duvoux, Paolo A. Cortesi, Rita Facchetti, Speranta Iacob, Giovanni Perricone, Sylvie Radenne, Sara Conti, Damiano Patrono, Gabriela Berlakovich, Angus Hann, Luisa Pasulo, Lluis Castells, François Faitot, Olivier Detry, Federica Invernizzi, Giulia Magini, Paolo De Simone, Ilias Kounis, Maria Cristina Morelli, Fernando Diáz Fontenla, Bo Goran Ericzon, Carmelo Loinaz, Chris Johnston, Liliana Gheorghe, Mickael Lesurtel, Renato Romagnoli, Dagmar Kollmann, M. Thamara P.R. Perera, Stefano Fagiuoli, Darius Mirza, Audrey Coilly, Christian Toso, Krzysztof Zieniewicz, Laure Elkrief, Vincent Karam, René Adam, C.M. (Caroline) den Hoed, Marco Merli, Massimo Puoti, Luciano G. De Carlis, Gabriel C. Oniscu, Salvatore Piano, Paolo Angeli, Costantino Fondevila, and W.G. (Wojtek) Polak

Abstract

Objective Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. Design Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. Results From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). Conclusions Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failu

Published
2021
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28. REPLY

Author

Laure Elkrief, Lazareth M, and Pierre-Emmanuel Rautou

Subjects
Pathology, medicine.medical_specialty, Liver disease, Hepatology, Liver stiffness, business.industry, medicine, Transient elastography, medicine.disease, business
Published
2021

29. REPLY

Author

Pierre-Emmanuel Rautou, Lazareth M, and Laure Elkrief

Subjects
0301 basic medicine, Pathology, medicine.medical_specialty, Cirrhosis, Hepatology, business.industry, Vascular disease, Non invasive, medicine.disease, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Text mining, Medicine, 030211 gastroenterology & hepatology, business
Published
2021

30. Evolution and phenotypic characterization of whole HBV genome in compliant patients experiencing unexplained entecavir treatment failure

Author

Denys Brand, Laure Elkrief, Morgan Maugey, Pascal Potier, Alain Moreau, Catherine Gaudy-Graffin, Louis d’Alteroche, Clément Lier, Sandrine Lefeuvre, Emmanuelle Roch, Benjamin Combe, Lynda Handala, and Julien Marlet

Subjects
0301 basic medicine, Adult, Male, Hepatitis B virus, Guanine, 030106 microbiology, Drug resistance, Genome, Viral, Genome, Antiviral Agents, Deep sequencing, 03 medical and health sciences, symbols.namesake, Virology, Drug Resistance, Viral, medicine, Humans, Treatment Failure, Selection, Genetic, Aged, Pharmacology, Sanger sequencing, business.industry, Entecavir, Hepatitis B, medicine.disease, Resistance mutation, Phenotype, 3. Good health, 030104 developmental biology, Mutation, symbols, Patient Compliance, Female, business, medicine.drug
Abstract

Entecavir treatment failure can be observed in compliant patients despite an absence of detectable resistance mutations by Pol/RT Sanger sequencing. We hypothesized that these unexplained treatment failures could rely on other mechanisms of viral resistance, especially on mutations selected outside of the Pol/RT domain. Partial virological response to entecavir was observed in three patients treated with immunosuppressive drugs, without selection of Pol/RT resistance mutations. Mutations selected in the whole HBV genome during entecavir treatment and potentially associated with resistance were searched for using deep sequencing and characterized using a phenotypic resistance assay. Mutations Q206K (pre-core/core), Q120K (pre-S1/pre-S2, T-cell epitope) and A300E (spacer domain) were selected during entecavir treatment in patient #1 but were not associated with an increased level of resistance to entecavir or an increase in HBV replication capacity. Core promoter mutations T1753G, A1762T and G1764A were present as major mutations before and after treatment in patient #1. HBs Ag immune escape mutations were present as major mutations before and after treatment in patients #2 (sK122R, sT126I, sP127S and sG145R) and #3 (sM133I). We demonstrated that PVR to entecavir does not require selection of any resistance mutation in the whole HBV genome. Our results demonstrate that major mutations can be selected outside of the Pol/RT domain before or during entecavir treatment. These mutations could contribute to entecavir treatment failure by other mechanisms than an increased level of resistance.

Published
2020

31. Portal cavernoma or chronic non cirrhotic extrahepatic portal vein obstruction

Author

Virginia Hernández-Gea, Laure Elkrief, Christophe Bureau, Danielle Dutheil, Aurélie Plessier, Sophie Hillaire, Stéphanie Franchi-Abella, Pauline Houssel-Debry, Sophie Branchereau, Oanez Ackermann, and Dominique Valla

Subjects
medicine.medical_specialty, Hepatology, Venous catheterization, business.industry, Portal Vein, Gastroenterology, Portal vein, Congenital malformations, Portal vein obstruction, medicine.disease, Thrombosis, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Chronic Disease, Hypertension, Portal, Practice Guidelines as Topic, medicine, Humans, 030211 gastroenterology & hepatology, Radiology, Acute thrombosis, business, Myeloproliferative neoplasm
Abstract

Chronic non cirrhotic extrahepatic portal vein obstruction (EHPVO) refers to the cavernomatous transformation of the portal vein (the so-called "portal cavernoma") which occurs following acute thrombosis of the portal vein in the absence of recanalization. In adults, EHPVO mainly occurs following thrombosis, while in children it may be related to congenital malformations and/or neonatal umbilical venous catheterization. However, 50% of the cases of EHPVO remain idiopathic [1]. Risk factors and associated diseases should be investigated (chapter 1). Indeed, the presence of a thrombophilic alteration, in particular myeloproliferative neoplasm impacts prognosis and determine a causal treatment.

Published
2020

32. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

Author

Sylvie Tresson, Sara Mareso, Daniela Campion, Agustín Albillos, Alex Amoros, Hans Van Vlierberghe, Manuel Romero-Gómez, Andrea De Gottardi, Thomas Reiberger, Vicente Arroyo, Boglarka Balogh, Miriam Maschmeier, Marco Pavesi, Javier Martínez, Harald Rupprechter, Sara Montagnese, Alessandra Pohlmann, Minneke J. Coenraad, Pierre Nahon, Agnese Antognoli, Jose Presa Ramos, Christoph Welsch, Alexander L. Gerbes, Pietro Gatti, Richard Moreau, Wim Laleman, Mauro Bernardi, Karen Vagner Danielsen, Laure Elkrief, Christian Jansen, Alexander Zipprich, Lise Lotte Gluud, Paul Horn, Ilaria Giovo, Roland Amathieu, Martina Rizzo, Elisabet Garcia, Joan Clària, Oliviero Riggio, Cristina Sanchez, Rita Garcia, Florian Rainer, Sven Francque, Manuela Merli, Giorgio Maria Saracco, Javier J.M. Fernández, Mária Papp, Martina Gagliardi, Antonella Putignano, Claire Francoz, Debbie L. Shawcross, Manuel Tufoni, Ferran Aguilar, Paola Ponzo, Heinz Zoller, Elsa Solà, Faouzi Saliba, Pavel Strnad, Stefan Zeuzem, Miguel Á. Rodríguez, David Semela, Peter Lykke Eriksen, Anna Curto, Rajiv Jalan, Emanuela Ciraci, Alessandra Brocca, István Altorjay, István Tornai, Edilmar Alvarado-Tapias, Jennifer Lehmann, Rajeshwar P. Mookerjee, Paolo Angeli, Rudolf E. Stauber, Ahmed Elsharkawy, Cristina Solé, Didier Samuel, Daniel Markwardt, Maurizio Baldassarre, Cornelius Engelmann, Cesar Jimenez, Pere Ginès, Frederik Nevens, Osagie Akpata, Germán Soriano, Robert Schierwagen, Eleonora Bertoli, Adam Herber, Jörg Tobiasch Moritz, Michael Praktiknjo, Natalie Van den Ende, William Bernal, Nesrine Amari, Stephen D. Ryder, Ana Clemente, Martin Janicko, Victor Vargas, Mattias Mandorfer, Flemming Bendtsen, Peter Jarcuska, Juan Acevedo, Vish Patel, Esau Moreno, Zsuzsanna Vitális, Tamas Tornai, Rafael Bañares, Christian J. Steib, Christian Trautwein, Thomas Berg, Michael Manns, Paolo Caraceni, Jelte J Schaapman, Carlo Alessandria, Carmine Gambino, Salvatore Piano, Carla Pitarch, Thierry Gustot, Osman Ozdogan, Francois Smits, Henning Grønbæk, Giacomo Zaccherini, Cristina Ripoll, Tony Bruns, Jonel Trebicka, Macarena Simón-Talero, Frank Erhard Uschner, Monica Mesquita, PREDICT STUDY Group, EASL-CLIF Consortium, Trebicka, Jonel, Fernandez, Javier, Papp, Maria, Caraceni, Paolo, Laleman, Wim, Gambino, Carmine, Giovo, Ilaria, Uschner, Frank Erhard, Jimenez, Cesar, Mookerjee, Rajeshwar, Gustot, Thierry, Albillos, Agustin, Banares, Rafael, Janicko, Martin, Steib, Christian, Reiberger, Thomas, Acevedo, Juan, Gatti, Pietro, Bernal, William, Zeuzem, Stefan, Zipprich, Alexander, Piano, Salvatore, Berg, Thomas, Bruns, Tony, Bendtsen, Flemming, Coenraad, Minneke, Merli, Manuela, Stauber, Rudolf, Zoller, Heinz, Ramos, Jose Presa, Sole, Cristina, Soriano, German, de Gottardi, Andrea, Gronbaek, Henning, Saliba, Faouzi, Trautwein, Christian, Ozdogan, Osman Cavit, Francque, Sven, Ryder, Stephen, Nahon, Pierre, Romero-Gomez, Manuel, Van Vlierberghe, Hans, Francoz, Claire, Manns, Michael, Garcia, Elisabet, Tufoni, Manuel, Amoros, Alex, Pavesi, Marco, Sanchez, Cristina, Curto, Anna, Pitarch, Carla, Putignano, Antonella, Moreno, Esau, Shawcross, Debbie, Aguilar, Ferran, Claria, Joan, Ponzo, Paola, Jansen, Christian, Vitalis, Zsuzsanna, Zaccherini, Giacomo, Balogh, Boglarka, Vargas, Victor, Montagnese, Sara, Alessandria, Carlo, Bernardi, Mauro, Gines, Pere, Jalan, Rajiv, Moreau, Richard, Angeli, Paolo, Arroyo, Vicente, Trebicka J., Fernandez J., Papp M., Caraceni P., Laleman W., Gambino C., Giovo I., Uschner F.E., Jimenez C., Mookerjee R., Gustot T., Albillos A., Banares R., Janicko M., Steib C., Reiberger T., Acevedo J., Gatti P., Bernal W., Zeuzem S., Zipprich A., Piano S., Berg T., Bruns T., Bendtsen F., Coenraad M., Merli M., Stauber R., Zoller H., Ramos J.P., Sole C., Soriano G., de Gottardi A., Gronbaek H., Saliba F., Trautwein C., Ozdogan O.C., Francque S., Ryder S., Nahon P., Romero-Gomez M., Van Vlierberghe H., Francoz C., Manns M., Garcia E., Tufoni M., Amoros A., Pavesi M., Sanchez C., Curto A., Pitarch C., Putignano A., Moreno E., Shawcross D., Aguilar F., Claria J., Ponzo P., Jansen C., Vitalis Z., Zaccherini G., Balogh B., Vargas V., Montagnese S., Alessandria C., Bernardi M., Gines P., Jalan R., Moreau R., Angeli P., Arroyo V., Maschmeier M., Semela D., Elkrief L., Elsharkawy A., Tornai T., Tornai I., Altorjay I., Antognoli A., Baldassarre M., Gagliardi M., Bertoli E., Mareso S., Brocca A., Campion D., Saracco G.M., Rizzo M., Lehmann J., Pohlmann A., Praktiknjo M., Schierwagen R., Sola E., Amari N., Rodriguez M., Nevens F., Clemente A., Jarcuska P., Gerbes A., Mandorfer M., Welsch C., Ciraci E., Patel V., Ripoll C., Herber A., Horn P., Danielsen K.V., Gluud L.L., Schaapman J., Riggio O., Rainer F., Moritz J.T., Mesquita M., Alvarado-Tapias E., Akpata O., Lykke Eriksen P., Samuel D., Tresson S., Strnad P., Amathieu R., Simon-Talero M., Smits F., van den Ende N., Martinez J., Garcia R., Markwardt D., Rupprechter H., and Engelmann C.

Subjects
Liver Cirrhosis, Male, CHRONIC LIVER-FAILURE, Cirrhosis, medicine.medical_treatment, Trasplantament hepàtic, Liver transplantation, Chronic liver disease, Severity of Illness Index, Acute complications, Non-elective admission, Outcome, Risk factors, acute complications, Ascites, Medicine and Health Sciences, Prospective Studies, 610 Medicine & health, Hepatic encephalopathy, Mortality rate, Sciences bio-médicales et agricoles, Middle Aged, Prognosis, Europe, Survival Rate, Hepatic cirrhosis, Portal hypertension, Female, medicine.symptom, medicine.medical_specialty, Cirrosi hepàtica, Gastrointestinal hemorrhage, INFLAMMATION, Internal medicine, Hypertension, Portal, SCORE, medicine, Humans, Decompensation, Hepatology, business.industry, MORTALITY, Acute-On-Chronic Liver Failure, Acute complication, Hemorràgia gastrointestinal, medicine.disease, Human medicine, Hepatic transplantation, business, Follow-Up Studies
Abstract

Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF., info:eu-repo/semantics/published

Published
2020

33. 2D shear wave liver elastography by aixplorer to detect portal hypertension in cirrhosis: an individual patient data meta-analysis

Author

Sven Franque, Laure Elkrief, Yongsoo Kim, Juan Carlos García-Pagán, Annalisa Berzigotti, Laurent Castera, Giulia Allegretti, Maja Thiele, Horia Stefanescu, Christian Jansen, Pierre-Emmanuel Rautou, Woo Kyoung Jeong, Wim Verlinden, Aleksander Krag, Jonel Trebicka, Fabio Piscaglia, Mads Israelsen, Mie Balle Hugger, Thiele M., Hugger M.B., Kim Y., Rautou P.-E., Elkrief L., Jansen C., Verlinden W., Allegretti G., Israelsen M., Stefanescu H., Piscaglia F., Garcia-Pagan J.C., Franque S., Berzigotti A., Castera L., Jeong W.K., Trebicka J., and Krag A.

Subjects
Liver Cirrhosis, medicine.medical_specialty, Cirrhosis, Cirrosi hepàtica, Portal venous pressure, Subgroup analysis, Aixplorer, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Ascites, Hypertension, Portal, medicine, Humans, Malalties cròniques, Hepatology, medicine.diagnostic_test, business.industry, Decompensated liver disease, medicine.disease, Portal Pressure, 3. Good health, compensated advanced chronic liver disease, Liver, Hepatic cirrhosis, 030220 oncology & carcinogenesis, Meta-analysis, Chronic diseases, Portal hypertension, Elasticity Imaging Techniques, 030211 gastroenterology & hepatology, supersonic shear imagine, Elastography, liver vein catheterization, Human medicine, medicine.symptom, Varices, business
Abstract

Background & Aims: Liver stiffness measured with 2-dimensional shear wave elastography by Supersonic Imagine (2DSWE-SSI) is well-established for fibrosis diagnostics, but non-conclusive for portal hypertension. Methods: We performed an individual patient data meta-analysis of 2DSWE-SSI to identify clinically significant portal hypertension (CSPH), severe portal hypertension and large varices in cirrhosis patients, using hepatic venous pressure gradient and upper endoscopy as reference. We used meta-analytical integration of diagnostic accuracies with optimized rule-out (sensitivity-90%) and rule-in (specificity-90%) cut-offs. Results: Five studies from seven centres shared data on 519 patients. After exclusion, we included 328 patients. Eighty-nine (27%) were compensated and 286 (87%) had CSPH. 2DSWE-SSI&nbsp

Published
2020

34. Safety of variceal band ligation in patients with cirrhosis and portal vein thrombosis treated with anticoagulant therapy: A retrospective study

Author

Simon Ponthus, Thierry Berney, Alessandro Casini, Pietro Majno, Laurent Spahr, Jean-Louis Frossard, and Laure Elkrief

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Liver transplantation, Esophageal and Gastric Varices, Gastroenterology, Variceal band ligation, 03 medical and health sciences, Anticoagulation, 0302 clinical medicine, Internal medicine, medicine, Humans, Decompensation, Ligation, Retrospective Studies, Venous Thrombosis, ddc:616, Hepatology, medicine.diagnostic_test, ddc:617, business.industry, Portal Vein, Bleeding, Anticoagulants, Retrospective cohort study, Middle Aged, medicine.disease, Portal vein thrombosis, Endoscopy, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Upper gastrointestinal bleeding, business, Gastrointestinal Hemorrhage
Abstract

Background and aims Anticoagulant therapy has been recommended in patients with cirrhosis and portal vein thrombosis especially in candidates for liver transplantation. These patients are also likely to need variceal band ligation. This study aimed to assess the incidence of upper gastrointestinal bleeding after elective variceal band ligation in patients with cirrhosis receiving anticoagulant therapy for portal vein thrombosis. Methods Patients with cirrhosis and nontumoral portal vein thrombosis treated with anticoagulant therapy undergoing elective variceal band ligation were retrospectively included. We recorded upper gastrointestinal bleeding events occurring within two weeks after variceal band ligation. Postvariceal band ligation bleeding was defined as active bleeding on at least one site of previous ligation at endoscopy. Results Between 2014 and 2017, 32 patients with cirrhosis had scheduled variceal band ligations while on anticoagulant therapy [men 75%; median age 59 years; aetiology of cirrhosis: alcohol (50%), viral (34%), alcohol and viral (16%); and Child-Pugh score: A (31%), B (44%), and C (25%)]. Three (9%) patients presented postvariceal band ligation bleeding during the follow-up. None of these events led to haemorrhagic shock or death. Factors associated with postvariceal band ligation bleeding included variceal band ligation performed as secondary prophylaxis (P = 0.05) and previous decompensation of cirrhosis (P = 0.03). Conclusion In this small group of patients under anticoagulation therapy undergoing variceal band ligation, only a minority presented postendoscopic bleeding of minor importance. Nevertheless, particular attention should be paid to patients with previous decompensation of cirrhosis.

Published
2020

35. Pre-therapy liver transcriptome landscape in Indian and French patients with severe alcoholic hepatitis and steroid responsiveness

Author

Saggere Muralikrishna Shasthry, Emmanuel Weiss, Richard Moreau, Shvetank Sharma, Pierre-Emmanuel Rautou, Shiv Kumar Sarin, Ashwani K. Mishra, Valérie Paradis, Christophe Junot, Pierre de la Grange, C. Sharma, Sukanta Das, Jaswinder Singh Maras, Laure Elkrief, Hélène Gilgenkrantz, S. Hussain, and Sophie Lotersztajn

Subjects
Adult, Male, 0301 basic medicine, Senescence, medicine.medical_specialty, Science, Alcoholic hepatitis, Biology, Article, Transcriptome, 03 medical and health sciences, Receptors, Glucocorticoid, Glucocorticoid receptor, Internal medicine, Ethnicity, medicine, Humans, Progenitor cell, Glucocorticoids, Cell Proliferation, Multidisciplinary, Fatty liver, Middle Aged, medicine.disease, 3. Good health, 030104 developmental biology, Endocrinology, Nuclear receptor, Immunology, Hepatocytes, Medicine, Female, Glucocorticoid, Fatty Liver, Alcoholic, medicine.drug
Abstract

Patients with severe alcoholic hepatitis (SAH) not responding to glucocorticoid therapy have higher mortality, though they do not differ in their baseline clinical characteristics and prognostic scores from those who respond to therapy. We hypothesized that the baseline hepatic gene expression differs between responders (R) and non-responders (NR). Baseline liver transcriptome was compared between R and NR in Indian (16 each) and French (5 NR, 3 R) patients with SAH. There were differentially expressed genes (DEGs) between NR and R, in Indian (1106 over-expressed, 96 under-expressed genes) and French patients (65 over-expressed, 142 under-expressed genes). Indian NR had features of hepatocyte senescence and French NR exhibited under-expression of genes involved in cell division, indicating a central defect in the capacity of hepatocytes for self-renewal in both populations. Markers of hepatic progenitor cell proliferation were either very few (Indian patients) or absent (French patients). No DEGs were enriched in inflammatory pathways and there were no differences in nuclear receptor subfamily 3 group C member 1 (NR3C1) transcript expression and splicing between NR and R. Our results reveal that baseline hepatic transcriptome is reflective of subsequent glucocorticoid non-response and indicate impaired regenerative potential of the liver as an underlying phenomenon in NR.

Published
2017

37. Combination Treatment With Letermovir and Ganciclovir for Maintenance Therapy of Multidrug-resistant CMV Infection in a Liver Transplant Recipient

Author

Ilona Kronig, Christian van Delden, Thierry Berney, Laure Elkrief, and Dionysios Neofytos

Subjects
ddc:616, Ganciclovir, Oncology, Transplantation, medicine.medical_specialty, ddc:617, Combination therapy, business.industry, Congenital cytomegalovirus infection, virus diseases, 030230 surgery, medicine.disease, Multiple drug resistance, Liver transplant recipient, 03 medical and health sciences, Letermovir, surgical procedures, operative, 0302 clinical medicine, Combined treatment, Maintenance therapy, Internal medicine, medicine, 030211 gastroenterology & hepatology, business, medicine.drug
Abstract

We report the case of a liver transplant recipient, cytomegalovirus (CMV) donor-positive (D+), recipient-negative (R−), with primary multidrug-resistant CMV infection treated with a combination therapy of letermovir and (val)ganciclovir.

Published
2020

38. Liver involvement in patients with telomere-related genes mutations: prevalence, clinical, radiological, pathological features, outcome and risk factors

Author

Sabrina Sidali, Raphaël Borie, Sicre Flore, Elodie Lainey, Pierre-Emmanuel Rautou, Jacques Cadranel, Jean-marc Naccache, Vincent Cottin, Jérôme Dumortier, Emmanuel Jacquemin, Nousbaum Jean Baptiste, Sandrine Hirschi, Arnaud Bourdin, Magdalena Meszaros, Sebastien Dharancy, Sophie Hilaire, Vincent Mallet, Reynaud-Gaubert Martine, Louis Terriou, Frédéric Gottrand, Wadih Abou Chahla, Jean Emmanuel Khan, Paul Carrier, Faouzi Saliba, Laura Rubbia-Brandt, Laure Elkrief, Victor de Lédinghen, Armand Abergel, Tournilhac Olivier, Yasmina Chouik, Antoine Coupier, Thierry Leblanc, Isabelle Ollivier-Hourmand, Eric Nguyen Khac, Hélène Morisse-Pradier, Kinan El Husseini, Odile Goria, Ba Ibrahima, Dominique Roulot, Christophe Bureau, Hilario Nunes, Dominique Valla, Valérie Paradis, Kannengiesser Caroline, and Aurélie Plessier

Subjects
Hepatology
Published
2020

40. [Outpatient follow-up of liver transplant recipients: the essential role of the general practitioner]

Author

Sarah, Henchoz, Montserrat, Fraga, Anne-Catherine, Saouli, Laure, Elkrief, Thierry, Berney, Christian, Toso, Philippe, Compagnon, Axel, Andres, Alban, Denys, Manuel, Pascual, Darius, Moradpour, Emiliano, Giostra, and Julien, Vionnet

Subjects
General Practitioners, Humans, Switzerland, Transplant Recipients, Follow-Up Studies, Liver Transplantation
Abstract

The population of liver transplant recipients has increased in Switzerland over the last few years. Morbidity and mortality after liver transplantation are due, in the early post-transplant period, to surgical and infectious complications as well as to rejection, whereas cardiovascular, metabolic, renal and oncologic complications are the most frequent complications in the late post-transplant period. The role of the general practitioner in the long-term follow-up of liver transplant recipients is of the highest importance and can represent the first-line care of these patients as soon as 6 to 12 months post-transplantation, while maintaining a close and regular collaboration with the transplant center. Multidisciplinary and structured follow-up, along with some specific screening tests, is warranted in order to refine patient management in a timely manner and to optimize outcomes.Les patients greffés hépatiques représentent une population croissante en Suisse. La morbidité et la mortalité après cette procédure sont liées

Published
2019

41. [Abdominal surgery in patients with portal hypertension : clinical implication and management]

Author

Laure, Elkrief, Philippe, Compagnon, Axel, Andres, Nicolas, Goossens, Laura, Rubbia-Brandt, Thierry, Berney, and Christian, Toso

Subjects
Adult, Hypertension, Portal, Liver Neoplasms, Hepatectomy, Humans, Morbidity, Digestive System Surgical Procedures
Abstract

Abdominal surgery is sometimes needed in patients with portal hypertension. The indication may be related to the underlying liver disease, including liver resection for liver cancer and parietal surgery. Surgery may also be performed for another indication, unrelated to the liver disease. Portal hypertension increases both morbidity and mortality after abdominal surgery, and it should be taken into account when planning surgery timing and surgical strategy. This article provides an overview of the main etiologies of portal hypertension, and the post-operative outcomes after liver resection and non-hepatic abdominal surgery, underlining the importance of a multidisciplinary approach.Une chirurgie abdominale est parfois nécessaire chez les patients atteints d’hypertension portale. Son indication peut être en lien avec une complication de la maladie du foie, comme une résection de tumeur hépatique ou une chirurgie pariétale, ou avec une affection non liée à la pathologie hépatique. L’hypertension portale augmente la morbidité et la mortalité de cette chirurgie, et l’indication ainsi que la stratégie doivent être définies avec soin. Cet article décrit les causes d’hypertension portale, les risques associés à sa présence lors d’une résection hépatique ou d’une chirurgie abdominale non hépatique. Enfin, il propose une approche multidisciplinaire, associant les chirurgiens, les hépatologues, les anatomopathologistes et les anesthésistes-réanimateurs.

Published
2019

42. Hepatic Venous Outflow Syndromes and Splanchnic Venous Thrombosis

Author

Laure Elkrief and Dominique Valla

Subjects
Noninvasive imaging, medicine.medical_specialty, Cirrhosis, business.industry, medicine.disease, Portal vein thrombosis, Venous thrombosis, Hepatic venous outflow, Internal medicine, Budd–Chiari syndrome, medicine, Cardiology, Splanchnic, business
Published
2019

43. Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

Author

Florence Wong, Luis Colombato, Giacomo Zaccherini, Dong Joon Kim, Rita de Cassia Ribeiro Barea, Adrià Juanola, Aleksander Krag, Julio Vorobioff, Javier Romaní Fernández, Jae Seok Hwang, Richard Moreau, Salvatore Piano, Gustavo Romero, Juan Pablo Roblero, Adrián Gadano, Gustavo Navarro, Rakhi Maiwall, Cosmas A. Rinaldi Lesmana, E.L. Yoon, Virendra Singh, M. Marino, Shiv Kumar Sarin, Carlos Brodersen, Carlo Alessandria, François Durand, Victor Vargas, Carmine Gambino, Ji Won Park, Pramod Kumar, Sophie Restellini, M. V. Maevskaya, Nikolaos Pyrsopoulos, Eduardo Fassio, Marcos Girala, Macarena Simón-Talero, Tony Bruns, Paolo Caraceni, Vikas Gautam, Laure Elkrief, Tae Hee Lee, Manuela Merli, Hyoung Su Kim, Tae Hun Kim, Preetam Nath, Ki Tae Suk, Elza Cotrim Soares, Xavier Verhelst, Tiago Sevá-Pereira, Paolo Angeli, C. Toledo, Sebastián Marciano, Barbara Lattanzi, Robert A. de Man, Annette Dam Fialla, Gisela Pinero, Sung Eun Kim, Nicolas M. Intagliata, Hans Van Vlierberghe, Pere Ginès, Kalyan Ram Bhamidimarri, Liane Rabinowich, Do Seon Song, Shivaram Prasad Singh, Michele Bartoletti, Alexander L. Gerbes, Marco Sacco, Laurentius A. Lesmana, Sang Gyune Kim, Jeong Han Kim, Sun Young Yim, Thomas D. Boyer, Piano, Salvatore, Singh, Virendra, Caraceni, Paolo, Maiwall, Rakhi, Alessandria, Carlo, Fernandez, Javier, Soares, Elza Cotrim, Kim, Dong Joon, Kim, Sung Eun, Marino, Monica, Vorobioff, Julio, de Cassia Ribeiro Barea, Rita, Merli, Manuela, Elkrief, Laure, Vargas, Victor, Krag, Aleksander, Singh, Shivaram Prasad, Lesmana, Laurentius Adrianto, Toledo, Claudio, Marciano, Sebastian, Verhelst, Xavier, Wong, Florence, Intagliata, Nicola, Rabinowich, Liane, Colombato, Lui, Kim, Sang Gyune, Gerbes, Alexander, Durand, Francoi, Roblero, Juan Pablo, Bhamidimarri, Kalyan Ram, Boyer, Thomas D, Maevskaya, Marina, Fassio, Eduardo, Kim, Hyoung Su, Hwang, Jae Seok, Gines, Pere, Gadano, Adrian, Sarin, Shiv Kumar, Angeli, Paolo, and Gastroenterology & Hepatology

Subjects
Liver Cirrhosis, Male, 0301 basic medicine, Time Factors, Cirrhosis, Cross-sectional study, medicine.medical_treatment, Resistance, Antibiotics, Drug Resistance, GLOBAL, resistance, sepsis, stewardship, Liver Cirrhosis/epidemiology, Liver transplantation, Global Health, 0302 clinical medicine, Risk Factors, Drug Resistance, Multiple, Bacterial, Epidemiology, Prevalence, Hospital Mortality, Prospective Studies, Incidence (epidemiology), Global, Sepsis, Stewardship, Adult, Aged, Anti-Bacterial Agents, Bacterial Infections, Cross-Sectional Studies, Female, Humans, Liver Transplantation, Middle Aged, Mycoses, Prognosis, Bacterial, Gastroenterology, sepsi, 030211 gastroenterology & hepatology, Multiple, medicine.medical_specialty, medicine.drug_class, 03 medical and health sciences, Spontaneous bacterial peritonitis, Internal medicine, medicine, Hepatology, business.industry, medicine.disease, Anti-Bacterial Agents/therapeutic use, 030104 developmental biology, Mycoses/epidemiology, business, Bacterial Infections/epidemiology
Abstract

Background & Aims: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. Methods: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. Results: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%–37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. Conclusions: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

Published
2019

44. Diabetes mellitus in patients with cirrhosis: clinical implications and management

Author

Dominique Valla, Shiv Kumar Sarin, Richard Moreau, Valérie Paradis, Laure Elkrief, and Pierre-Emmanuel Rautou

Subjects
Liver Cirrhosis, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, medicine.medical_treatment, Gastroenterology, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Insulin resistance, Internal medicine, Diabetes mellitus, Ascites, medicine, Hypoglycemic Agents, Insulin, Life Style, Randomized Controlled Trials as Topic, Glucose tolerance test, Hepatology, medicine.diagnostic_test, business.industry, Liver Neoplasms, Glucose Tolerance Test, Prognosis, medicine.disease, Metformin, Diabetes Mellitus, Type 2, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Insulin Resistance, medicine.symptom, business, medicine.drug
Abstract

Disorders of glucose metabolism, namely glucose intolerance and diabetes, are frequent in patients with chronic liver diseases. In patients with cirrhosis, diabetes can be either a classical type 2 diabetes mellitus or the so-called hepatogenous diabetes, i.e. a consequence of liver insufficiency and portal hypertension. This review article provides an overview of the possible pathophysiological mechanisms explaining diabetes in patients with cirrhosis. Cirrhosis is associated with portosystemic shunts as well as reduced hepatic mass, which can both impair insulin clearance by the liver, contributing to peripheral insulin resistance through insulin receptors down-regulation. Moreover, cirrhosis is associated with increased levels of advanced-glycation-end products and hypoxia-inducible-factors, which may play a role in the development of diabetes. This review also focuses on the clinical implications of diabetes in patients with cirrhosis. First, diabetes is an independent factor for poor prognosis in patients with cirrhosis. Specifically, diabetes is associated with the occurrence of major complications of cirrhosis, including ascites and renal dysfunction, hepatic encephalopathy and bacterial infections. Diabetes is also associated with an increased risk of hepatocellular carcinoma in patients with chronic liver diseases. Last, the management of patients with concurrent diabetes and liver disease is also addressed. Recent findings suggest a beneficial impact of metformin in patients with chronic liver diseases. Insulin is often required in patients with advanced cirrhosis. However, the favourable impact of controlling diabetes in patients with cirrhosis has not been demonstrated yet.

Published
2016

45. A return to harmful alcohol consumption impacts on portal hemodynamic changes following alcoholic hepatitis

Author

Laura Rubbia-Brandt, Jean-Louis Frossard, Melissa Dupuis, Nicolas Goossens, Flavie Furrer, Sandrine Elisabeth Vijgen, Emiliano Giostra, Laure Elkrief, and Laurent Spahr

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Alcohol Drinking, Portal venous pressure, Biopsy, Hemodynamics, Alcoholic hepatitis, ddc:616.07, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Internal medicine, Hypertension, Portal, medicine, Humans, Prospective Studies, Aged, ddc:616, Hepatitis, Hepatology, biology, business.industry, Alcohol Abstinence, Hepatitis, Alcoholic, Portal Vein, C-reactive protein, Recovery of Function, Middle Aged, medicine.disease, C-Reactive Protein, 030220 oncology & carcinogenesis, Case-Control Studies, biology.protein, Portal hypertension, 030211 gastroenterology & hepatology, Female, Inflammation Mediators, business, Alcohol consumption, Venous Pressure
Abstract

Increased hepatic venous pressure gradient (HVPG) plays a role in the clinical manifestations of alcoholic hepatitis (AH). The evolution of HVPG and the influence of alcohol use in the intermediate term are unclear.The aim of this study was to explore HVPG modifications following AH taking into consideration alcohol use and clinical manifestations.Patients with AH (n=37; age 52 years; model for end-stage liver disease: 18.5; Maddrey score: 43) and chronic excessive drinkers with compensated cirrhosis (n=19; age: 54 years; model for end-stage liver disease: 9.2) underwent HVPG measurement and liver biopsy. Ten long-standing abstinent alcoholic cirrhotics served as controls. After discharge, patients were monitored for alcohol use and clinical complications, with repeated HVPG after a median duration of 100 days. Inflammation was determined using plasma C-reactive protein.At baseline, compared with chronic excessive drinkers and alcoholic cirrhotics, patients with AH had increased HVPG (18.1±0.6 vs. 13.8±1.4 vs. 15±1.3 mmHg, P0.05). During follow-up, patients who became abstinent or reported occasional drinking were more likely to achieve a greater than 20% reduction in HVPG compared with those returning to harmful alcohol (45 vs. 0%, P0.01), and suffered from fewer complications (25 vs. 68%, P0.03). High baseline C-reactive protein levels correlated to the Maddrey (r=0.38), but no relationship was observed between changes in inflammation and HVPG.Elevated HVPG is a feature of AH, with a clinically significant reduction in values in abstinent or occasional drinkers after weeks of follow-up. A return to harmful alcohol has a negative impact on portal hemodynamics and associated clinical complications.

Published
2018

46. Contributors

Author

Nezam H. Afdhal, Alina M. Allen, Aditya Ambade, Quentin M. Anstee, Sumeet K. Asrani, Davis N. Assis, Jasmohan Singh Bajaj, William F. Balistreri, Jesus M. Banales, Richard Bendall, Ariel Benson, Antonio Bertoletti, Jorge A. Bezerra, Scott W. Biggins, Herbert L. Bonkovsky, Christopher Bowlus, Thomas D. Boyer, David A. Brenner, Elizabeth M. Brunt, Stephen H. Caldwell, Naga Chalasani, Jonathan R. Cogley, Massimo Colombo, Min Cong, David W. Crabb, James M. Crawford, Harry R. Dalton, Srinivasan Dasarathy, Christopher P. Day, Laurie D. DeLeve, Kalpana M. Devaraj, Harshad Devarbhavi, Anna Mae Diehl, Joost P.H. Drenth, Razan El Ramahi, Tamer Mahmoud Elbaz, Laure Elkrief, Gamal Esmat, Gregory Thomas Everson, Phillip Factor, Michael B. Fallon, Sandy Feng, Stuart Forbes, Bin Gao, Guadalupe Garcia-Tsao, Aiman Ghufran, Patrick Martin Gillevet, Jeffrey S. Glenn, David Goldberg, Stuart C. Gordon, Gregory J. Gores, Shahid Habib, Stephen A. Harrison, Theo Heller, Steve M. Helmke, Deborah Holtzman, Nicolas M. Intagliata, Jacques Izopet, Syed-Mohammed Jafri, Harry L.A. Janssen, Jidong Jia, Bobby T. Kalb, Patrick S. Kamath, Saul J. Karpen, Constantine J. Karvellas, Tatiana Kisseleva, Stephen A. Klotz, Christopher Koh, Rohit Kohli, Monica A. Konerman, Shyamasundaran Kottilil, Laura Kulik, Asha C. Kuruvilla, Frank Lammert, Konstantinos N. Lazaridis, Riccardo Lencioni, Cynthia Levy, Hongxia Li, Suthat Liangpunsakul, Ansgar W. Lohse, Anna S. Lok, Georgios Loudianos, Michael R. Lucey, Mariana Verdelho Machado, Diego R. Martin, Eric G. Meissner, Frank H. Miller, Andrew J. Muir, Moises I. Nevah, Erin K. O'Neill, Ran Oren, Kavish R. Patidar, Mark M. Pence, David Perlmutter, Antonello Pietrangelo, Stacey Prenner, Puneet Puri, Lihui Qin, Nataliya Razumilava, Jurrien Reijnders, Eve A. Roberts, Lewis R. Roberts, Jayanta Roy-Chowdhury, Namita Roy-Chowdhury, Mark Russo, Sammy Saab, Banishree Saha, Angelo Sangiovanni, Varun Saxena, Kathleen B. Schwarz, Seth N. Sclair, Susana Seijo, Kenneth D.R. Setchell, Vijay H. Shah, Obaid S. Shaikh, Kenneth E. Sherman, Douglas A. Simonetto, Ashwani K. Singal, Milan Sonneveld, James E. Squires, Richard K. Sterling, Amy N. Stratton, R. Todd Stravitz, Stephen Strom, Gyongyi Szabo, Jayant A. Talwalkar, Lydia Tang, Elliot B. Tapper, Norah A. Terrault, Dawn M. Torres, Parsia A. Vagefi, Dominique C. Valla, Douglas C. Vander Kooi, John W. Ward, Joel P. Wedd, Christina Weiler-Normann, Florence Wong, Ju Dong Yang, Samir Zakhari, Tirdad T. Zangeneh, Naglaa Zayed, and Fabien Zoulim

Published
2018

47. Portal and Splenic Vein Thrombosis

Author

Laure Elkrief and Dominique Valla

Subjects
medicine.medical_specialty, business.industry, Medicine, Radiology, Splenic vein thrombosis, business
Published
2018

48. Left-liver Adult-to-Adult Living Donor Liver Transplantation: Can It Be Improved? A Retrospective Multicenter European Study

Author

Antonio Sa Cunha, Thierry Berney, Nikdokht Rashidian, Josep Fuster, Aude Vanlander, Constantino Fondevila, Christian Toso, Pietro Majno, Laure Elkrief, Daniel Cherqui, Xavier Rogiers, Denis Castaing, Gabriella Pittau, Roberto Troisi, Bernard de Hemptinne, René Adam, Juan Carlos García-Valdecasas, Santiago Sánchez-Cabús, Sánchez-Cabús, Santiago, Cherqui, Daniel, Rashidian, Niki, Pittau, Gabriella, Elkrief, Laure, Vanlander, Aude, Toso, Christian, Fondevila, Constantino, Cunha, Antonio Sa, Berney, Thierry, Castaing, Deni, de Hemptinne, Bernard, Fuster, Josep, Rogiers, Xavier, Adam, René, Majno, Pietro, García-Valdecasas, Juan Carlo, and Troisi, Roberto I

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Left liver, 030230 surgery, Liver transplantation, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Hepatic lobectomy, Liver Function Tests, Risk Factors, medicine, Graft selection, Living Donors, Humans, Laparoscopy, Retrospective Studies, ddc:617, medicine.diagnostic_test, business.industry, Background data, Graft Survival, Middle Aged, Surgery, Liver Transplantation, Europe, Treatment Outcome, 030211 gastroenterology & hepatology, Female, Right liver, business, Living donor liver transplantation
Abstract

OBJECTIVE: To evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT). SUMMARY BACKGROUND DATA: LL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe. METHODS: This is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT. RESULTS: Seventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 ± 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3%) without any 90-day complication, and 4 (8.7%) presenting major complications. One, 3, and 5-year recipient survival was 90.9%, 82.7%, and 82.7%, respectively. However, graft survival was of 59.4%, 56.9%, and 56.9% at 1, 3, and 5 years respectively, due to a 26.1% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) 0.6% was associated with a lower ReLT rate (0% vs. 33%, P = 0.044). CONCLUSIONS: Our analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.

Published
2018

49. Effects of Long-term Norfloxacin Therapy in Patients With Advanced Cirrhosis

Author

Richard, Moreau, Laure, Elkrief, Christophe, Bureau, Jean-Marc, Perarnau, Thierry, Thévenot, Faouzi, Saliba, Alexandre, Louvet, Pierre, Nahon, Adrien, Lannes, Rodolphe, Anty, Sophie, Hillaire, Blandine, Pasquet, Violaine, Ozenne, Marika, Rudler, Isabelle, Ollivier-Hourmand, Marie Angèle, Robic, Louis, d'Alteroche, Vincent, Di Martino, Marie-Pierre, Ripault, Arnaud, Pauwels, Jean-Didier, Grangé, Nicolas, Carbonell, Jean-Pierre, Bronowicki, Audrey, Payancé, Pierre-Emmanuel, Rautou, Dominique, Valla, Nathalie, Gault, and Didier, Lebrec

Subjects
Liver Cirrhosis, Male, Time Factors, Incidence, Ascites, Kaplan-Meier Estimate, Middle Aged, Anti-Bacterial Agents, Treatment Outcome, Double-Blind Method, Humans, Female, France, Prospective Studies, Gram-Negative Bacterial Infections, Norfloxacin, Proportional Hazards Models
Abstract

There is debate over the effects of long-term oral fluoroquinolone therapy in patients with advanced cirrhosis. We performed a randomized controlled trial to evaluate the effects of long-term treatment with the fluoroquinolone norfloxacin on survival of patients with cirrhosis.We performed a double-blind trial of 291 patients with Child-Pugh class C cirrhosis who had not received recent fluoroquinolone therapy. The study was performed at 18 clinical sites in France from April 2010 through November 2014. Patients were randomly assigned to groups given 400 mg norfloxacin (n = 144) or placebo (n = 147) once daily for 6 months. Patients were evaluated monthly for the first 6 months and at 9 months and 12 months thereafter. The primary outcome was 6-month mortality, estimated by the Kaplan-Meier method, censoring spontaneous bacterial peritonitis, liver transplantation, or loss during follow-up.The Kaplan-Meier estimate for 6-month mortality was 14.8% for patients receiving norfloxacin and 19.7% for patients receiving placebo (P = .21). In competing risk analysis that took liver transplantation into account, the cumulative incidence of death at 6 months was significantly lower in the norfloxacin group than in the placebo group (subdistribution hazard ratio, 0.59; 95% confidence interval, 0.35-0.99). The subdistribution hazard ratio for death at 6 months with norfloxacin vs placebo was 0.35 (95% confidence interval, 0.13-0.93) in patients with ascites fluid protein concentrations15 g/L and 1.39 (95% confidence interval, 0.42-4.57) in patients with ascites fluid protein concentrations ≥15 g/L. Norfloxacin significantly decreased the incidence of any and Gram-negative bacterial infections without increasing infections caused by Clostridium difficile or multiresistant bacteria.In a randomized controlled trial of patients with advanced cirrhosis without recent fluoroquinolone therapy, norfloxacin did not reduce 6-month mortality, estimated by the Kaplan-Meier method. Norfloxacin, however, appears to increase survival of patients with low ascites fluid protein concentrations. ClinicalTrials.gov ID: NCT01037959.

Published
2017

50. [Splanchnic vein thrombosis]

Author

Bobby, Gouin, Helia, Robert-Ebadi, Alessandro, Casini, Yan, Beauverd, Pierre, Fontana, Marc, Righini, and Laure, Elkrief

Subjects
Humans, Thrombosis, Splanchnic Circulation, Venous Thromboembolism, Budd-Chiari Syndrome
Abstract

Splanchnic vein thromboses include thrombosis of the portal venous system (including the portal, mesenteric and splenic vein) and hepatic vein thrombosis (also called Budd-Chiari syndrome). They are rare manifestations of venous thromboembolism. These thromboses are frequently associated with local or systemic factors. The therapeutic approach is often complex due to heterogeneity of patients and limited available data in the literature. The cornerstone of treatment is anticoagulation. However, the bleeding risk, related to portal hypertension, should be accurately assessed to individualize the treatment. A multidisciplinary consultation team including several specialists is provided at the University Hospitals of Geneva for the optimal management of those patients.Les thromboses veineuses splanchniques sont une forme rare de maladie thromboembolique veineuse. Elles incluent les thromboses porto-mésentériques (thrombose de la veine porte et/ou de la veine mésentérique supérieure et/ou de la veine splénique) et les thromboses des veines hépatiques (Budd-Chiari). Elles peuvent être favorisées par des causes locales ou systémiques. L’approche thérapeutique est souvent complexe en raison de l’hétérogénéité des patients et des données limitées sur le sujet. Le traitement repose sur l’anticoagulation, qui doit être individualisée en fonction du risque hémorragique du patient, notamment en présence d’hypertension portale concomitante. Une consultation multidisciplinaire est en place aux Hôpitaux universitaires de Genève et permet d’optimiser la prise en charge de ces patients.

Published
2017

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