AASLD position paper

Polson, Julie; Lee, William M.

doi:10.1002/hep.20703

Cited by 838 publications

(635 citation statements)

References 177 publications

(177 reference statements)

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“…MRI of the latter patients was indicated to investigate the presence of intracranial hypertension (patient 4 second time), intracranial lesions in syndrome of Alagille (patients 6,8), structural defects as the cause of headaches (patient 7) or ischemic lesions after an epileptic episode (patient 9). Patients 2-5 were diagnosed with ALF, illustrated by a vitamin K-resistant coagulation abnormality (an international normalized ratio INR ≥1.5) [10] and any degree of mental alteration (encephalopathy) at the time of MRS. Strictly speaking, patient 1 had "acute on chronic" liver failure, with hepatic encephalopathy.…”

Section: Patientsmentioning

confidence: 99%

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

et al. 2008

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Acute liver failure (ALF)-related encephalopathy was previously characterized by MR spectroscopy of single voxels containing both grey and white matter brain tissue. Quantitative multivoxel MRS was used here to compare grey and white matter brain tissue concentrations of glutamate/glutamine (Glx) and lactate in ALF and associate the results with other liver function parameters. Five pediatric patients with ALF-related encephalopathy and five controls, examined after successful liver transplantation, were examined by brain MRI/MRS. ALF patients had higher Glx and lactate concentrations in brain white matter than controls (Glx + 125%: P<0.01; lactate + 33%, P<0.05) and higher Glx in grey matter (Glx + 125%: P< 0.01). Within the group of ALF patients positive correlations were found between grey or white matter lactate concentration and serum ammonia (P<0.05), and negative correlations between grey or white matter Glx and venous pH (P<0.001). This is the first study presenting evidence of high Glx levels in both white and grey matter brain tissue in ALF-related encephalopathy. The elevations in CNS Glx and lactate concentrations appear to relate to hepatic detoxification (ammonia, venous pH), rather than to liver parenchymal integrity (aspartate aminotransferase, alanine aminotransferase) or biliary cholestasis (bilirubin, γ-glutamyl transpeptidase, alkaline phosphatase).

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Section: Patientsmentioning

confidence: 99%

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

et al. 2008

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“…This classification of LF proposed by the author might be more suitable for determining therapy and estimating prognosis. The connotation of ALF and CLF in this classification are different from that of the EASL, AASLD, APASL and China although the name of ALF and CLF are as same as the previous reports [3][4][5][6][7]. Hence, our classifications are new and more rational classification scheme.…”

Section: Resultsmentioning

confidence: 78%

“…In recent years, international organizations or societies have issued several guidelines or consensuses about the diagnosis and classification of LF [3][4][5]. In China, Guidelines for Liver Failure Diagnosis and Treatment were released in 2006 and updated in 2012 by the Liver Failure and Artificial Liver Group of the Chinese association of Infectious Diseases, and the Severe Liver Disease and Artificial Liver Group of the Chinese association of Hepatology [6,7].…”

Section: Introductionmentioning

confidence: 99%

Clinical Classification of Liver Failure: Consensus, Contradictions and New Recommendations

Xing¹

2017

J Clin Gastroenterol Hepatol

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Liver failure (LF) is a clinical syndrome with complex clinical manifestations. The clinical diagnosis and classification of LF are still considerably different internationally. Based on the pace of the disease progression and its possible reversibility, LF can be divided into two categories: acute and chronic LF. However, a great difference exists in the diagnostic criteria between China, Europe, and the United States. These differences might be related to the various causes of LF, the complexity of clinical manifestations, and different experiences of experts from different centers. The main source of differences lies in the varied understanding of LF diagnostic standards.The pathologic basis of various types of LF is different also. This article discusses the clinical diagnosis and classification of LF internationally and suggests new recommendations for classification of LF. According to this classification, ALF is divided into fulminant type and subacute type, and CLF is divided into acute exacerbative type and slowly progressive type. This classification, if adopted worldwide, could help achieve uniformity in the classification and therapeutic guidelines for liver failure. However, the validity of the classification should be further tested in clinical practice.

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“…First, patient selection will be made according to the criteria defining acute liver failure, namely, coagulation abnormalities (i.e., the coagulation parameter International Normalized Ratio (INR) ! 1.5) and encephalopathy without preexisting cirrhosis, and an illness course of less than 26 weeks [66]. Conditions related to acute liver failure will typically include acetaminophen overdose, idiosyncratic drug-induced liver injury, viral hepatitis, mushroom intoxication, vascular disease, alcoholic hepatitis or autoimmune disease.…”

Section: Provisional Clinical Trials With a Porcine Hepatocyte Productmentioning

confidence: 99%

Current status of hepatocyte xenotransplantation

Meier

Navarro-Alvarez

Morel

et al. 2015

International Journal of Surgery

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The treatment of acute liver failure, a condition with high mortality, comprises optimal clinical care, and in severe cases liver transplantation. However, there are limitations in availability of organ donors. Hepatocyte transplantation is a promising alternative that could fill the medical need, in particular as the bridge to liver transplantation. Encapsulated porcine hepatocytes represent an unlimited source that could function as a bioreactor requiring minimal immunosuppression. Besides patients with acute liver failure, patients with alcoholic hepatitis who are unresponsive to a short course of corticosteroids are a target for hepatocyte transplantation. In this review we present an overview of the innate immune barriers in hepatocyte xenotransplantation, including the role of complement and natural antibodies; the role of phagocytic cells and ligands like CD47 in the regulation of phagocytic cells; and the role of Natural Killer cells. We present also some illustrations of physiological species incompatibilities in hepatocyte xenotransplantation, such as incompatibilities in the coagulation system. An overview of the methodology for cell microencapsulation is presented, followed by proof-of-concept studies in rodent and nonhuman primate models of fulminant liver failure: these studies document the efficacy of microencapsulated porcine hepatocytes which warrants progress towards clinical application. Lastly, we present an outline of a provisional clinical trial, that upon completion of preclinical work could start within the upcoming 2-3 years

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AASLD position paper

Cited by 838 publications

References 177 publications

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

Clinical Classification of Liver Failure: Consensus, Contradictions and New Recommendations

Current status of hepatocyte xenotransplantation

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