Urinary BUN and Na excretion were predictive of a response to tolvaptan, and tolvaptan treatment may improve the prognosis of cirrhotic patients.

Objective Hyponatremia is frequently observed in patients with decompensated liver cirrhosis and it is also related to a poor prognosis. The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites and increases the serum sodium (Na) level. In this study, we investigated (i) whether or not correction of the Na level improves the prognosis of cirrhotic patients with ascites and (ii) predictors of normalization of the serum Na level after tolvaptan therapy. Methods This was a single-center retrospective study. A total of 95 Japanese cirrhotic patients (60 men, median age 63 years) were enrolled and received tolvaptan orally after hospitalization for ascites treatment. The serum Na level was monitored during the period of tolvaptan treatment. The laboratory data and survival rates of patients who achieved serum Na levels of <135 and ≥135 mEq/L after 1 week were compared. Results Patients showed serum Na levels of 136 (121-145) mEq/L, and 42.1% had a serum Na level of <135 mEq/L. Among patients with an initial serum Na level <135 mEq/L, 60.0% achieved a normal level after 1 week, and the survival rate was significantly higher in patients with a normalized serum Na level (p<0.01). The pretreatment brain natriuretic peptide (BNP) level was predictive of achieving a serum Na level of ≥135 mEq/L (odds ratio: 0.87, 95% confidence interval: 0.316-0.987, p<0.05). Conclusion Normalization of the Na level after one week was associated with a favorable outcome of tolvaptan therapy, and Na correction improved the prognosis.

Background: Hepatitis C virus (HCV) infection frequently occurs in recipients of liver or kidney transplants (LT/KT). Interferon (IFN)-based therapies are used to treat HCV, but their efficacy is low. Methods: We report 24 patients who received HCV therapy after LT/KT.Design, Setting, and Participants-Twelve LT and 12 KT recipients (median age, 59 years; 15 males; 21 serological type 1) were enrolled, of whom eight (six with LT) were treated with IFN-based therapy. Twelve received direct-acting antiviral drugs [DAAs; daclatasvir (DCV)/asunaprevir (ASV) therapy] for 24 weeks, seven received sofosbuvir (SOF)/ledipasvir (LDV) for 12 weeks, and one received SOF/ribavirin for 12 weeks.Results: In two LT patients, HCV resolved spontaneously after LT. Six patients received IFN, of whom one achieved a sustained virological response for 24 or more weeks (SVR) (16.7%), three cases stopped treatment due to side effects (anemia and infection), and two cases relapsed. Five received DCV/ASV, and four received SOF-based DAA, including those with IFN failure. All patients completed treatment with a SVR. Two KT cases were treated with IFN; one was successfully treated and one discontinued treatment due to renal rejection. All cases, including the one IFN failure, achieved a SVR after DAA therapy. Two who received DCV/ASV showed a low estimated glomerular filtration rate (eGFR), and three who received SOF/LDV contained the NS5A mutation. HCV treatment by DAAs was successful in all patients.Conclusions: DAAs were highly effective and safe in LT/KT recipients who failed IFN-based therapy and had a low eGFR or the NS5A mutation.

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Aims: The vasopressin V2 receptor antagonist, tolvaptan, has been reported to be effective in cirrhotic patients with ascites. Here, we evaluated predictors of the response to tolvaptan. Methods: A total of 97 patients with cirrhosis (60 males; median age, 63 years) who had been treated for ascites with oral tolvaptan were enrolled. Tolvaptan efficacy was defined as urine volume increase of ≥500 mL or a urine volume ≥2000 mL/day on the day following treatment. Normalization of the serum sodium (Na) level after 1 week of treatment and the posttreatment survival rate was analyzed. Results: Tolvaptan therapy resulted in effective urination in 67% of patients. A multivariate analysis revealed that the blood urea nitrogen/creatinine (BUN/Cr) ratio and urinary Na/potassium (Na/K) ratio were predictive of the tolvaptan response (p <0.05). The serum Na level was 135 (121-145) mEq/L, and normal levels were recovered in 50.0% of the patients with an initial Na level of <135 mEq/L. The posttreatment survival rate was significantly higher in patients who responded to tolvaptan therapy (p <0.05). Conclusions: The combination of the initial BUN/Cr and urine Na/K ratios and a normalized serum Na level after 1 week was predictive of a favorable outcome to tolvaptan therapy.