Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.

/pdf/asian-pacific-clinical-practice-guidelines-on-the-management-za5qxgu5i6.pdf

Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update.

Pulmonary lymphangitis carcinomatosis (PLC) is a life-threating complication in patients suffering from malignancies. Misleading and nonspecific symptoms often result in a delayed diagnosis. This r...

Pulmonary lymphangitis carcinomatosis: systematic review and meta-analysis of case reports, 1970-2018.

Background/Aims 
The number of people undergoing living donor liver transplantation (LDLT) has increased rapidly in many transplant centres Patients considering LDLT need to know whether LDLT is riskier than deceased donor liver transplantation (DDLT) The aim of this study was to compare the outcomes of patients undergoing LDLT versus DDLT


Methods 
A total of 349 patients with benign liver diseases were recruited from 2005 to 2011 for this study LDLT was performed in 128 patients, and DDLT was performed in 221 patients Pre- and intra-operative variables for the two groups were compared Statistically analysed post-operative outcomes include the postoperative incidence of complication, biliary and vascular complication, hepatitis B virus (HBV) recurrence, long-term survival rate and outcomes of emergency transplantation


Results 
The waiting times were 2210±1531 days for the patients undergoing LDLT versus 3581±2918 days for the patients undergoing DDLT The cold ischemia time (CIT) was 11934±1975 minutes for the LDLT group and 346±15418 for DDLT group LDLT group had higher intraoperative blood loss, but red blood cell (RBC) transfusion was not different Similar ≥ Clavien III complications, vascular complications, hepatitis B virus (HBV) recurrence and long-term survival rates were noted LDLT patients suffered a higher incidence of biliary complications in the early postoperative days However, during the long-term follow-up period, biliary complication rates were similar between the two groups The long-term survival rate of patients undergoing emergency transplantation was lower than of patients undergoing elective transplantation However, no significant difference was observed between emergency LDLT and emergency DDLT


Conclusions 
Patients undergoing LDLT achieved similar outcomes to patients undergoing DDLT Although LDLT patients may suffer a higher incidence of early biliary complications, the total biliary complication rate was similar during the long-term follow-up period

/pdf/outcomes-of-patients-with-benign-liver-diseases-undergoing-tgz4nrghbg.pdf

Outcomes of Patients with Benign Liver Diseases Undergoing Living Donor versus Deceased Donor Liver Transplantation

Long-term experience with lamivudine therapy for hepatitis B virus infection after liver transplantation

BACKGROUND AND AIMS Antiviral prophylaxis with hepatitis B immunoglobulin (HBIg) plus lamivudine reduces the risk of hepatitis B virus (HBV) recurrence after HBV-related liver transplant (LT). However, HBIg is expensive, and lamivudine therapy is limited by drug resistance. This study assessed a pilot study of entecavir plus low-dose, on-demand HBIg in preventing HBV recurrence after LT. METHODS Between 2006 and May 2011, approximately 145 patients undergoing HBV-related LT and receiving entecavir plus low-dose, on-demand HBIg were enrolled and followed for a median of 36 months. A historical control group of 171 patients undergoing HBV-related LT between 1998 and 2010 and receiving lamivudine plus HBIg were followed for a median of 77 months. The primary end point was the proportion of patients with recurrent HBsAg-positivity. RESULTS In the entecavir cohort, 2 (1.37%) of 145 patients experienced HBV recurrence, none of which had evidence of viral resistance. In the lamivudine cohort, 11 (6.4%) of 171 cases of HBV recurrence were observed, 5 of which were associated with lamivudine resistance. The cumulative probabilities of HBV recurrence were significantly different between both cohorts (P=0.055). HBsAg recurrence was associated with lower overall survival (P<0.001), even in patients with undetectable HBV DNA. Using pooled data from both cohorts, predictors of HBV recurrence were nucleoside selection, pre-LT hepatocellular carcinoma, post-LT low anti-HBs, male sex, and HBsAg-positivity in the explant liver tissue. CONCLUSIONS Entecavir plus low-dose, on-demand HBIg resulted in a low rate of HBV recurrence without evidence of resistance development and provided an effective and cost-saving strategy for patients having HBV-related LT.

Section 14. Combination of entecavir plus low-dose on-demand hepatitis B immunoglobulin is effective with very low hepatitis B recurrence after liver transplantation.

Primary liver carcinoma is the most important malignant disease. The nodular metastatic foci of liver carcinoma are usually found in the lung, adrenal gland or abdomen after resection or transplantation. Pulmonary lymphangitic carcinomatosis (PLC) accounts for approximately 6% to 8% of metastatic cancer in the lung. The occurrence of PLC is extremely rare in liver carcinoma. Herein we report the case of a patient with PLC after liver transplantation due to liver carcinoma. PLC was confirmed by clinical manifestations, imaging studies and cytologic examination of exfoliated cells in the pleural effusion.

/pdf/pulmonary-lymphangitic-carcinomatosis-in-liver-carcinoma-a-1ltiqzb6mo.pdf

Pulmonary lymphangitic carcinomatosis in liver carcinoma: a rare case report and literature review

Background & Aims
Liver transplantation is the only solution for terminal liver disease. This study aims to determine the association between severity of liver graft steatosis, as well as other risk factors, and poor prognosis of liver transplantation.

Methods
The degree of steatosis was analyzed in 563 consecutive liver transplantation and classified by histological examination as M0 (0%), M1 (<30%), M2-1 (30%–39%), M2-2 (40%–49%), M2-3 (50%–59%) or M3 (≥60%). Recipients were analyzed for in-hospital infection, one-month mortality or graft loss, primary non-function (PNF), biliary complications, acute graft rejection, graft and patient survival.

Results
Compared with M0 livers, M1 and M2-1 livers had no negative impacts on prognosis of liver transplantation. ≥40% steatotic livers significantly increased the prevalence of 1-month mortality and PNF, but diminished graft and patient survival time.

Conclusions
The safety limitations of fatty liver transplantation can be extended to 40%.

This article is protected by copyright. All rights reserved.

Safety limitations of fatty liver transplantation can be extended to 40%: experience of a single center in China.

OBJECTIVE To investigate the risk factors associated with persistent thrombocytopenia after liver transplantation (LT), and to explore effective measures for prevention. METHODS One hundred and twenty-eight adult patients, who received liver transplantation in our hospital between January 2009 and June 2012 and met the inclusive criteria, were enrolled in the study. The clinical data were retrospectively analyzed, including pre-LT spleen volume, main portal vein size, coronary vein size, platelet and white blood cell levels, total bilirubin level and model of end stage liver disease score. The risk factors associated with persistent thrombocytopenia after LT were evaluated by logistic regression analysis. The effect of simultaneous splenic artery coarctation for high risk patients was evaluated with χ2 test. RESULTS Logistic regression analysis showed that per-LT spleen volume larger than 500 ml (P = 0.012, OR=2.789, 95%CI: 1.249-6.227) and portal vein size beyond 15 mm (P = 0.017, OR = 3.124, 95%CI: 1.230-7.933) were independent risk factors for persistent thrombocytopenia after LT. The incidence rate of persistent thrombocytopenia after LT in patients with or without simultaneous splenic artery coarctation were 16.7% (1/6) and 66.7% (32/48), respectively(P < 0.05). CONCLUSION Spleen volume larger than 500 ml and portal vein size beyond 15 mm are risk factors for persistent thrombocytopenia after LT. Simultaneous splenic artery coarctation may reduce the occurrence of persistent thrombocytopenia after LT.

Risk factors of persistent thrombocytopenia after adult liver transplantation and prophylactic measures

Background: Hepatitis B virus (HBV) recurrence is a major risk factor affecting the long-term survival of recipients for liver transplantation (LTx). Therefore, a model that can assess this risk before transplantation is highly desirable.



Methods: One hundred and eighty-five consecutive liver transplant recipients because of HBV-related end-stage liver diseases were selected. Their perioperative laboratory examination results, treatment protocol and the status of HBV recurrence were the primary parameters used to assess their risk of post-transplant HBV recurrence. A model that may be generally used to evaluate the risk of post-transplant HBV recurrence was thus established. A cohort for further validation and a cross-validation were designed.



Results: After a follow-up time of 26.0 ± 10.8 months, the overall HBV recurrence rate was 8.6%. The 1-, 2- and 3-year cumulative survival rates were 98.5, 89.2 and 83.4% respectively. By correlation with the pretransplant presence of hepatocelluar carcinoma (HCC), serum HBV DNA level and status of antiviral treatment (AVT), the risk assessment model can be summarized using the following equation: RISK=−4.378+1.493 × HCC+1.286 × DNA−2.426 × AVT. The HBV recurrence rate and survival were found to be significantly different between the recipients with risk scores≤−2.8 and>−2.8. The model was well validated in this work.



Conclusions: Pretransplant HBV DNA level, presence of HCC, AVT status and post-transplant viral mutation were identified as the major risk factors associated with HBV recurrence after LTx. A novel model incorporating these factors could effectively evaluate the risk of post-transplant HBV recurrence before transplantation.

A novel model for evaluating the risk of hepatitis B recurrence after liver transplantation

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Papers

Pulmonary lymphangitic carcinomatosis in liver carcinoma: a rare case report and literature review

Safety limitations of fatty liver transplantation can be extended to 40%: experience of a single center in China.

Risk factors of persistent thrombocytopenia after adult liver transplantation and prophylactic measures

A novel model for evaluating the risk of hepatitis B recurrence after liver transplantation