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Hepatology Highlights
Eric M. Yoshida*,*, Nahum Méndez-Sánchez**
* Division of Gastroenterology, University of British Columbia
** Liver Research Unit. Medica Sur Clinic and Foundation, Mexico City, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Anti-parietal cell autoantibodies &#40;PCA&#41; in primary biliary cirrhosis&#58; a putative marker for recurrence after orthotopic liver transplantation&#63;</span><p id="p0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Ciesek S&#44; et al&#46;</span></span> Efficacy of maintenance subcutaneous hepatitis B immune globulin &#40;HBIG&#41; post-transplant for prophylaxis against hepatitis B recurrence&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Singham&#44; et al&#46;</span></span> Throughout most of its history&#44; primary biliary cirrhosis &#40;PBC&#41; and chronic hepatitis B &#40;HBV&#41;&#44; were considered the &#8220;yin and yang&#8221; of indications for liver transplantations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Transplantation was considered virtually curative for the former disease and&#44; until the mid-1990s&#44; the latter was considered futile and an absolute contraindication for transplantation due to a very high incidence of graft re-infection resulting in poor outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Needless to say&#44; much has changed since the early days of transplantation&#46; Graft recurrence of primary biliary cirrhosis is a well-recognized phenomenon<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> that usually occurs late post-transplant and is typically mild&#44; although graft loss can rarely occur&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> With the introduction of passive immunization with hepatitis B immune globulin &#40;HBIG&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> liver transplantation has become very feasible for those suffering from HBV&#46; Initially most centers employed protocols requiring high dose intravenous HBIG&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> however&#44; the development of relatively effective antiviral agents has allowed for the use of combination prophylaxis protocols utilizing low dose intramuscular HBIG<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> in combination with oral antiviral agents&#46; The low dose intramuscular HBIG protocols were an improvement in prophylaxis delivery that became more convenient&#44; albeit sometimes painful&#44; for patients and easier for the post-transplant clinic nursing staff&#46; Today&#44; liver transplant recipients undergoing transplantation for PBC and HBV enjoy excellent post-transplant outcomes&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">In this current issue of the Annals&#44; two liver transplant papers appear that explore post-transplant PBC recurrence and HBIG administration post-transplant even further&#46; Dr&#46; Ciesek and colleagues from Hannover Germany report an interesting paper studying the possible role of anti-parietal cell autoan-tibodies &#40;PCA&#41; as a marker for post-transplant PBC recurrence&#46; PCA are well-known to be present in atrophic gastritis and can also be found in PBC&#46; Cie-sek et al reported that PCA were present in just under half of their PBC pre-transplant patients but appeared in 1007 of liver transplant recipients with PBC recurrence&#46; Although it remains to be explained why this has occurred&#44; especially given the post-transplant immunosuppression that liver transplant recipients require &#40;and Cisek et al did not find any significant differences in immunosuppressive regi-mins amongst their PBC recurrence patients&#41;&#44; this finding has not been previously reported and is both hypothesis generating and worthy of future studies&#46; With regards to post-transplant HBIG administration&#44; Dr&#46; Singham and colleagues from the University of British Columbia&#44; report on a pilot study of a subcutaneous &#40;SC&#41; HBIG maintenance protocol&#46; The SC protocol achieved the HBIG maintenance titres and was very well-tolerated&#46; In fact&#44; all of the patients enrolled in the SC protocol preferred the study protocol compared to their previous intramuscular protocol because of less pain at the injection site&#46; Although a SC maintenance protocol will require further clinical studies before it can be considered standard of care&#44; it may represent an improvement on existing HBIG protocols&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Serum concentrations of substance P in cholestasis</span><p id="p0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Trivedi M&#44; Bergasa NV&#46;</span></span> Both patients suffering from cholestatic liver disease &#40;e&#46;g&#46; primary biliary cirrhosis&#41; and their hepatologists&#47;gas-troenterologists are all too familiar with pruritis that ranges from mild to severe and debilitating&#46; Relatively effective medications are often prescribed including rifampin<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and&#44; in rifampin-refrac-tory cases&#44; naltrexone&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Although these medications often work&#44; sometimes surprisingly so&#44; the truth is that they are prescribed empirically and clinicians do not know the precise cause&#47; mediator of the pruritis of cholestasis&#46; In this issue of the Annals&#44; Drs&#46; Trevedi and Bergasa&#44; from the State University of New York and the New York Medical College respectively&#44; report an interesting paper that studied the serum concentrations of substance P in pruritic patients with choles-tatic liver disease&#44; non-pruritic patients with cho-lestatic liver disease and a control group that did not have liver disease at all&#46; Serum levels of substance P were markedly elevated in the cholestatic patients with pruritis but not in the two other comparator groups&#46; Trevedi and Bergasa then followed this clinical study with an animal model utilizing rats that had undergone bile duct liga-tion&#46; Again&#44; they found that the rats that underwent bile duct ligation had elevated serum substance P compared to rats that did not undergo bile duct ligation&#46; This interesting paper may shed some light on the mechanism of cholestatic associated pruritis&#46; From a clinical perspective&#44; it may also suggest a relatively simple laboratory test that can distinguish pruritis of cholestastic liver disease from the common non-liver disease causes of itching &#40;ie&#46; dry skin etc&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pegylated interferon alfa 2b plus ribavirin for the treatment of chronic hepatitis C genotype 4 in adolescents</span><p id="p0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Al Ali J&#44; et al&#46;</span></span> Hepatitis C &#40;HCV&#41; is a common infection throughout North America&#44; Latin America and the rest of the world&#44; a fact that is all too well known to the readers of the Annals&#46; Many&#44; many clinical trials of its treatment have been published as part of the drug registration process of interfe-ron-based therapy in combination with ribavirin&#46; HCV genotype 4&#44; however&#44; is relatively uncommon in North America and Latin America&#44; but is a very common&#44; as well as serious&#44; clinical problem in the Middle East&#46; Despite the fact that a few clinical studies of peginteferon and ribavirin in genotype 4 adult patients have been published from Egypt10 and Saudi Arabia&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> the published outcomes of genotype 4 patients in the pediatric&#47;adolescent population are distinctly rare&#46; In this issue of the Annals&#44; Dr&#46; Al Ali and colleagues from the Kuwait University report on the outcomes of peginterferon and ri-bavirin combination therapy in a group of adolescents&#46; Similar to the adult genotype 4 therapeutic experience&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> the outcomes in the adolescent population are also excellent with a 75&#37; sustained virologic response and excellent patient compliance&#46; The publication of interesting paper&#44; aside from its contribution to the pediatric hepatology literature&#44; also signifies the truly international nature of the Annals and that the audience of the Annals is a world-wide one that goes well beyond North America and&#44; Latin America&#46;</p></span></span>"
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Article information
ISSN: 16652681
Original language: English
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es en pt

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

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