Liver Transplantation in Patients With Cryptogenic Cirrhosis: Long-Term Follow-up

Álamo, J.M.; Bernal, C. Carmona; Barrera, L.; Marín, Luis Miguel; Suárez, G.; Serrano, Juan Bautista Vivero; Gómez, M. A.; Padillo, Francisco J.

doi:10.1016/j.transproceed.2011.05.017

Cited by 14 publications

(15 citation statements)

References 12 publications

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“…Four of these studies have shown a low prevalence of recurrent disease, favorable outcomes, and survival comparable with other recipients. [8][9][10][11] However, in a study by Alamo et al, 12 chronic rejection and postoperative mortality rates were higher and survival rates at 5, 10, and 15 years were lower than other OLT etiologies. Another retrospective study revealed higher recurrence of CC and NASH in post-OLT patients and was associated with the presence of metabolic syndrome, hypertension, and use of insulin.…”

Section: Cryptogenic Cirrhosis Mercado-irizarry and Torresmentioning

confidence: 95%

Patients With NASH and Cryptogenic Cirrhosis Are Less Likely Than Those With Hepatitis C to Receive Liver Transplants

O’Leary

Landaverde

Jennings

et al. 2011

Clinical Gastroenterology and Hepatology

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Background & Aims Many patients with cryptogenic cirrhosis (CC) have other conditions associated with nonalcoholic steatohepatitis (NASH) that put them at risk for complications that preclude orthotopic liver transplantation (OLT). Methods We followed all patients with NASH and CC who were evaluated for OLT (n=218) at Baylor Regional Transplant Institute between March 2002 and May 2008. Data were compared with those from patients evaluated for OLT because of hepatitis C (HCV)-associated cirrhosis (n=646). Results Patients with NASH and CC were older, more likely to be female, had a higher body-mass index, and a greater prevalence of diabetes and hypertension, compared with patients with HCV-associated cirrhosis, but the two groups had similar MELD scores. NASH and CC in patients with MELD scores ≤15 were less likely to progress; these patients were less likely to receive OLT and more likely to die or be taken off the wait list because they were too sick, compared with patients with HCV-associated cirrhosis. The median progression rate among patients with NASH and CC was 1.3 MELD points/year vs. 3.2 MELD points/year for the HCV group (P=0.003). Among patients with MELD scores >15, there were no differences among groups in percentage that received transplants or rate of MELD score progression. Hepatocellular carcinoma occurred in 2.7% of patients with NASH and CC per year, compared with 4.7%/year among those with HCV-associated cirrhosis. Conclusions Patients NASH and CC and low MELD score have slower disease progression than patients with HCV-associated cirrhosis and are less likely to receive OLT.

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Section: Cryptogenic Cirrhosis Mercado-irizarry and Torresmentioning

confidence: 95%

Patients With NASH and Cryptogenic Cirrhosis Are Less Likely Than Those With Hepatitis C to Receive Liver Transplants

O’Leary

Landaverde

Jennings

et al. 2011

Clinical Gastroenterology and Hepatology

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“…Nine percent of all liver transplantations are due to cryptogenic cirrhosis (3). In this group, chronic rejection rate and postoperative mortality rate are higher, and survival rates at 5, 10, and 15 years are lower, compared to other etiologies (4). The end stage liver disease manifests with symptoms such as variceal hemorrhage, ascites, and encephalopathy, and if decompensation happens, survival becomes considerably impaired.…”

Section: Introductionmentioning

confidence: 70%

Therapeutic Effects of Iranian Traditional Medicine on a Patient With Cryptogenic Cirrhosis

Baghbanan

Nazem

Yarjoo

et al. 2014

Iran Red Crescent Med J

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Introduction:There are several disorders that cause hepatic cirrhosis. However, if there is no known cause for cirrhosis, it is called cryptogenic cirrhosis. Cirrhosis is believed to be irreversible in its late stages. In these cases, liver transplantation is the only solution.Case Presentation:The study case was a 29-year-old man, admitted to the hospital four years ago due to esophageal variceal hemorrhage. A biopsy of his liver showed cryptogenic cirrhosis; thus, he was a candidate for liver transplant. The patient visited the outpatient Iranian traditional medicine center, Behesht Clinic, in Tehran, Iran, two years after his bleeding course and began treatment with traditional herbal medicine. In the following month, he stopped taking his previous medications. During the 18-month follow up, he was visited 16 times. During this time, his general health improved and his hemoglobin level increased. Based on the ultrasound reports, the spleen size, the gallbladder wall edema, and the portal vein diameter decreased. Even though the ascites disappeared, the patient gained weight. His model for end-stage liver disease (MELD) score reduced from 10 (prior to the Iranian traditional medicine treatment) to 8. The bilirubin level decreased as well. The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels increased and the serum albumin level and platelet count decreased.Conclusions:In this patient, traditional medicine treatment improved the patient's general well-being, hematopoiesis and portal hypertension. Furthermore, it improved his quality of life, although it had no effect on his liver function. We recommend more clinical trials on therapeutic effects of Iranian traditional medicine on cryptogenic cirrhosis.

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“…Studying explanted livers of cirrhotic patients undergoing liver transplantation and having preoperative diagnosis of cryptogenic cirrhosis, specific cause was identified in 28.6% of cases. The relevant diagnoses included autoimmune hepatitis, sarcoidosis, primary biliary cirrhosis, sclerosing cholangitis, congenital hepatic fibrosis and Wilson's disease [32]. Other data/investigational methods can yield significant information as well.…”

Section: Involved Cells or Molecules Resultsmentioning

confidence: 99%

Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways

Mezale¹,

Štrumfa²,

Vanags³

et al. 2017

Liver Cirrhosis - Update and Current Challenges

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Non-alcoholic steatohepatitis (NASH) is growing into global problem, mainly due to NASH-induced cirrhosis and hepatocellular carcinoma (HCC), that can develop either subsequently to cirrhosis or preceding it. In addition, NASH-induced cirrhosis constitutes a significant fraction of cases diagnosed as cryptogenic cirrhosis. Thus, there is a need for deeper understanding of the molecular basis, leading to liver steatosis, then-to the associated inflammation seen in NASH, loss of liver architecture and cirrhosis, followed or paralleled by carcinogenesis and HCC. Insulin resistance, increased hepatic iron level, and certain cytokines, including TNF-α and IL-6 derived from extrahepatic adipose tissues, can trigger the chain of events. The imbalance between leptin and adiponectin is important as well. These markers remain important during the whole course from NASH through liver cirrhosis to HCC. The molecular pathogenesis substantiates treatment: hypertriglyceridemia can be lowered by low calorie diet; mTOR complex can become inhibited by physical activity and metformin; cholesterol synthesis, RAF/ MAPK1/ERK and p21 pathway by statins; inflammation by pentoxyfillin, and kinases (in HCC) by sorafenib. Bidirectional regulation of telomere attrition, senescence and p21 pathway, restoration of wild-type p53 activity and regulation of miRNA network represent attractive future treatment options. Focusing on relevant molecular pathways allows deeper understanding of NASH pathogenesis, leading to identification of predictive markers and treatment targets.[10] and other Western industrialised countries, facing high occurrence of the major risk factors for NAFLD, namely, central obesity, type 2 diabetes mellitus, dyslipidemia and metabolic syndrome [11]. In a recent meta-analysis of 86 studies, comprising 8,515,431 persons from 22 countries, the global prevalence of NAFLD was 25.24% (95% confidence interval [CI], showing the highest occurrence in the Middle East and South America and the lowest in Africa [5].Liver Cirrhosis -Update and Current Challenges 2 Thus, 90% of patients suffering from morbid obesity (defined as having body mass index 40 kg/m 2 or higher) and 74% patients affected by diabetes mellitus develop NAFLD. In addition, NAFLD has been observed even in non-obese, non-diabetic patients who have increased insulin levels in blood and resistance to insulin action. Consequently, NAFLD affects up to 20-30% of adults in Europe and 46% in the USA: a tremendously high prevalence for a condition that can cause any significant complications [9, 10]. Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways http://dx.doi.org/10.5772/intechopen.68771 3Most patients are diagnosed with NAFLD in their 40s or 50s. Studies vary in regard to the gender distribution of NAFLD, with some suggesting that it is more common in women and others suggesting more frequent occurrence in men [11,12].Since 1998, non-alcoholic fatty liver disease has been considered a condition with a "two-hit" course of...

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Liver Transplantation in Patients With Cryptogenic Cirrhosis: Long-Term Follow-up

Cited by 14 publications

References 12 publications

Patients With NASH and Cryptogenic Cirrhosis Are Less Likely Than Those With Hepatitis C to Receive Liver Transplants

Patients With NASH and Cryptogenic Cirrhosis Are Less Likely Than Those With Hepatitis C to Receive Liver Transplants

Therapeutic Effects of Iranian Traditional Medicine on a Patient With Cryptogenic Cirrhosis

Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways

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