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Liver Enzyme Elevation (liver + enzyme_elevation)
Selected AbstractsRecurrent hepatitis C after retransplantation: Factors affecting graft and patient outcome,LIVER TRANSPLANTATION, Issue 12 2005Michal Carmiel-Haggai Retransplantation (re-LT) of patients with recurrent hepatitis C virus (HCV) carries significant morbidity and mortality, negatively impacting on an already scarce donor allograft pool. In this study, we investigated the outcome of allografts and patients after re-LT due to recurrent HCV. Between 1989 and 2002, 47 patients were retransplanted at our institution due to HCV-related graft failure. Clinical HCV recurrence after re-LT was diagnosed when patients had acute liver enzyme elevation correlated with histological recurrence. The independent influence of these variables on survival was tested using Cox regression model. Chi-squared tests were used to examine the influence of individual demographic and pre/perioperative variables on recurrence. Thirty-one (66%) patients died after re-LT (median 2.2 months). Donor age >60, clinical HCV recurrence, and graft failure due to cirrhosis were significant risk factors for mortality (risk ratios of 3.6, 3.3, and 2.4, respectively). Pre-LT MELD score was lower among survivors (22± 5 vs. 27± 8). Following re-LT, 38 patients had at least one biopsy due to acute liver dysfunction; 19 of them (50%) had recurrence within the first 3 months. High-dose solumedrol was correlated with early recurrence. No association was found between time of recurrence after the first LT and time of recurrence after re-LT. In conclusion, patients with cirrhosis due to recurrent HCV undergoing re-LT have an extremely high mortality rate; older allografts should be avoided in retransplanting these patients. The timing of clinical recurrence after initial liver transplantation is not predictive of the timing of recurrence after re-LT. Patients experiencing early graft failure due to accelerated forms of HCV should not be denied re-LT with the expectation that a similar disease course will occur after re-LT. (Liver Transpl 2005;11:1567,1573.) [source] Change of symptoms and perceived health in acromegalic patients on pegvisomant therapy: a retrospective cohort study within the German Pegvisomant Observational Study (GPOS)CLINICAL ENDOCRINOLOGY, Issue 1 2010Caroline Sievers Summary Objective, This study aimed at investigating how symptoms and perceived health changes in acromegalic patients during pegvisomant treatment in respect to IGF-1 levels and disease characteristics. Design/patients, Retrospective, multicentre cohort study in 131 acromegalic patients within the German Pegvisomant Observational Study (GPOS). Measurements, Outcome measure was the change of perceived health evaluated by the Patient-Assessed Acromegaly Symptom Questionnaire (PASQ) between baseline and after 1 year of pegvisomant therapy. Predictors were change in IGF-1 levels, maximal pegvisomant dosage, adverse events and comorbidities. Results, Perspiration, soft tissue swelling and perceived health improved after 1 year of pegvisomant therapy while other symptoms such as headache, fatigue and joint pain remained largely unchanged over time. The highest mean IGF-1/upper limit of normal (ULN) values before pegvisomant therapy were found in those patients with a reported amelioration in perspiration and soft tissue swelling after 1 year of pegvisomant treatment. The highest mean decrease of IGF-1/ULN was found in those patients with reported amelioration of numbness and tingling of limbs. Other factors such as decrease in fasting glucose may play a role as independent predictor for some symptoms such as the improvement of headache, perspiration and perceived health, while other factors such as maximal pegvisomant dosage, occurrence of adverse events, tumour growth, or liver enzyme elevation did not play a predictive role. Conclusions, Patients' symptoms and perceived health are in part an independent construct, not merely reflecting IGF-1 status or biochemical control. Subjective measures should therefore be regularly documented in acromegalic patients as a patient-oriented indicator for treatment success. [source] Liver dysfunction in Turner's syndrome: prevalence, natural history and effect of exogenous oestrogenCLINICAL ENDOCRINOLOGY, Issue 2 2008Olympia Koulouri Summary Objectives, Raised liver enzymes are a common feature of Turner's syndrome (TS), but the cause remains unclear. We studied the hepatic function in a large cohort of women with TS and tested the effect of increasing doses of hormone replacement therapy (HRT) on liver function tests (LFTs). Design and patients, LFTs were assessed in three studies. A cross-sectional review of liver function of 125 women (median age: 31 years), a longitudinal study of 30 women (mean follow-up period: 8 years) and a dose,response study of 14 women with TS and 11 controls with hypogonadism, who received oral 17-,-oestradiol (E2) 1, 2 and 4 mg daily in a cyclical formulation for 12 weeks each. Measurements, Clinical features, oestrogen use and metabolic parameters were compared to liver enzymes (,-glutamyl transferase (GGT), alanine aminotransferase (ALT) and alkaline phosphatase (ALP)), albumin and bilirubin. LFTs were also measured during each treatment interval of the dose,response study. Hepatic autoimmunity was sought in the cross-sectional study. Results, When compared to the control population, as opposed to reference ranges, 91% of women with TS demonstrated liver enzyme elevation, with a yearly incidence of 2·1%. LFTs correlated positively with cholesterol (P < 0·001), BMI (P = 0·004) and type of oestrogen therapy (P = 0·04). Increasing doses of HRT resulted in a significant decrease in GGT, ALT, bilirubin and albumin. No evidence of excessive hepatic autoimmunity was found. Conclusion, The prevalence of raised liver enzymes in TS may have been underestimated by the use of reference ranges rather than matched controls. Obesity and hyperlipidaemia are associated with raised LFTs, as well as the use of HRT compared to the oral contraceptive pill (OCP). Exogenous oestrogen both as OCP and HRT improves liver function. Liver dysfunction in TS is likely to be a form of hepatic steatosis and intervention trials are now indicated. [source] Safety and Immunogenicity of Varicella-Zoster Virus Vaccine in Pediatric Liver and Intestine Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2006A. Weinberg Primary varicella-zoster virus (VZV) infections following organ transplantation may cause significant morbidity. We examined the safety and immunogenicity of Varivax® after transplantation as a potential prophylactic tool. Pediatric liver and intestine transplant recipients without history of chickenpox received one dose of Varivax®. VZV humoral and cellular immunity were assessed before and ,12 weeks after vaccination. Adverse events (AE) and management of exposure to wild type VZV were monitored. Sixteen VZV-naïve subjects, 13,76 months of age, at 257,2045 days after transplantation were immunized. Five children developed mild local AE of short duration. Four subjects developed fever and four developed non-injection site rashes, three of whom received acyclovir. Liver enzymes did not increase during the month after vaccination. Eighty-seven percent and 86% of children developed humoral and cellular immunity, respectively. There were five reported exposures to varicella in four children, none of which resulted in chickenpox. One subject received VZV-immunoglobulin and another subject with liver enzyme elevations after exposure received acyclovir; all remained asymptomatic. Varivax® was safe and immunogenic in pediatric liver and intestine transplant recipients. Larger studies are needed to establish the efficacy and role of varicella vaccination after transplantation. [source] Long-term safety aspects of systemic therapy with fumaric acid esters in severe psoriasisBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2003J.J. Hoefnagel Summary Background Therapy with fumaric acid esters (FAE) has been shown to be safe and effective in patients with severe psoriasis in several clinical studies with limited follow-up periods. In view of the chronic character of psoriasis, long-term safety aspects are of major importance in determining the suitability of a drug during prolonged periods of treatment. Objectives To investigate adverse events of therapy with systemic FAE with follow-up periods of up to 14 years, in order to determine safety aspects of their long-term use in patients with severe psoriasis. Methods Current and/or past therapeutic use of FAE was reviewed in 66 patients with severe psoriasis. Results Forty-one of 66 patients had received FAE for at least 1 year, and 12 of these 41 patients had received FAE for between 10 and 14 years. Adverse events were reported in 73% of the patients. These were usually mild and mainly consisting of flushing (55%), diarrhoea (42%), nausea (14%), tiredness (14%) and stomach complaints (12%). A relative lymphocytopenia was observed in 76% of patients during therapy with FAE, resulting in a permanent discontinuation of therapy with FAE in four patients. A transient eosinophilia and moderate liver enzyme elevations were observed in 14% and 25% of patients, respectively. Conclusions The present study indicates that FAE can be considered as a safe long-term treatment in patients with severe psoriasis. [source] | ||||||||||