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Hepatology Highlights
Ramón A. Kobashi-Margáin, Ylse Gutiérrez-Grobe, Nahum Méndez-Sánchez
Corresponding author
nmendez@medicasur.org.mx

Correspondence and reprint request:
Liver Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical outcomes of liver transplantation for polycystic liver disease A single center experience</span><p id="p0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Chandok N&#44; et al&#46;</span> The polycystic liver disease is a rare and benign disorder &#40;incidence of 0&#46;01&#37;&#41; that is usually asymptomatic&#44; although sometimes it can present symptoms like abdominal pain&#44; early satiety&#44; nausea and vomiting&#44; all of them related to the size of the liver<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and it tends to present along kidney polycystic disease&#46; Even though there are some palliative techniques to ameliorate the symptoms&#44; like fenestration of the cyst&#44; the curative treatment is the transplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">In this issue of the Annals of Hepatology&#44; the group of Chandok N and colleagues reported the results of their cross-sectional study that took place in Ontario&#44; Canada&#44; that evaluated the outcomes of patients that underwent liver transplantation due to polycystic liver disease&#46; They collected a total of 14 patients between 1993 and 2010 and found that they presented a high rate of vascular complications like hepatic artery thrombosis &#40;3 patients that relates to 20&#37;&#41; or stenosis &#40;2 patients&#44; 13&#46;3&#37;&#41;&#44; but 13 of them were also alive and with satisfactory graft function after a 66&#46;8 months follow-up&#46; It is somehow alarming the fact that postsurgical vascular complications rate is high within these patients&#44; which brings to our attention this to consideration in the follow-up&#46; However it has been suggested that patients with polycystic liver disease&#44; orthotopic liver transplantation is technically difficult&#46; The size of the liver&#44; previous invasive procedures&#44; and displacement of vascular and biliary structures and neighboring organs increase the technical difficulty&#44; as well as blood loss and associated morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Fortunately&#44; the long-term patient and graft survival and kidney function were excellent&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comparison of Acoustic Radiation Force Impulse Imaging &#40;ARFI&#41; to Liver Biopsy Histologic Scores in the Evaluation of Chronic Liver Disease&#58; A Pilot Study</span><p id="p0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Mazhar H&#44; et al&#46;</span> Liver chronic diseases are increasing worldwide and the efficacy of diagnosis is nowadays demanding&#46; Liver fibrosis represents the wound healing response to the chronic injury caused by viral hepatitis&#44; excessive alcohol consumption&#44; nonalcoholic steatohepatitis&#44; hemochro-matosis or immune-mediated injury and cirrhosis may be developed if the fibrosis progresses&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> The gold standard for the staging of liver diseases is the biopsy&#46; Nevertheless the invasive nature of it makes this method a restrictive one&#44; most of them because of the patients fear to the procedure or the physicians fear to the complications<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> not only that&#44; the small sample contained in a punch biopsy and the quality of it &#40;ie&#46; small number of portal triads&#41; may not accurately reflect the morphological changes that have developed in the whole organ&#46; Recent studies have been taken place in order to find newer non-invasive techniques that can confidently diagnose fibrosis&#46; In this issue of the journal&#44; Mazhar H and colleagues present their prospective blind pilot comparison study that evaluated the correlation between a new non-invasive method for the assessment of liver fibrosis&#44; the acoustic radiation force impulse imaging &#40;ARFI&#41;&#44; with the biopsy&#46; After evaluating 21 patients with a chronic liver disease through ARFI and biopsy&#44; they found that for predicting severe fibrosis and cirrhosis&#44; ARFI accuracy was maximal compared to earlier stages&#46; In a previous study&#44; Lupsor&#44; <span class="elsevierStyleItalic">et al&#46;</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> prospectively compared in 112 patients with chronic hepatitis C&#44; ARFI with TE &#40;FibroScan&#174;&#44; Echosens&#44; Paris&#44; France&#41;&#44; taking liver biopsy as the reference standard&#46; Those investigators found that diagnostic accuracy of ARFI is similar to that of TE for severe fibrosis and cirrhosis &#40;with AUROCs of 0&#46;87 <span class="elsevierStyleItalic">vs&#46;</span> 0&#46;93 and 0&#46;91 <span class="elsevierStyleItalic">vs&#46;</span> 0&#46;94&#44; respectively&#46; These results suggest that ARFI and TE appears to be excellent tools for early detection of cirrhosis and complications of cirrhosis&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">ARFI imaging is incorporated into a conventional ultrasound &#40;US&#41; machine &#40;Acuson 2000&#174;&#44; Virtual Touch Quantification mode&#44; Siemens Medical Solutions&#44; Mountain View&#44; Ca&#44; USA&#41; and involves the mechanical excitation of tissue using short duration &#40;&#8776; 262 <span class="elsevierStyleItalic">&#956;</span>sec&#41; acoustic pulses producing shear waves propagation generating localized micron-scale displacements in the tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">4</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">Currently we have some non-invasive methods such as transient elastography &#40;FibroScan&#41;&#44; Fibro-Test&#44; and aspartate-toplatelet ratio &#40;a free non-patented score&#41; those are the most widely used and validated non-invasive methods for assessment of liver fibrosis<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">5</span></a> and now we have ARFI&#46; Although Mazhar H et al studied a small group of patients&#46; Their results are stimulating to validate ARFI in a large group of patients with liver fibrosis and in other chronic liver diseases&#46; Finally&#44; with the introduction of more and more effective non-invasive methods to evaluate the chronic liver diseases we will able to perform longitudinal studies to look the disease regression and clinical outcomes&#46;</p></span></span>"
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Article information
ISSN: 16652681
Original language: English
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2019 September 1 1 2
2019 August 1 1 2
2019 July 1 5 6
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos