Alcohol-Induced Liver Disease

Risk factors for fibrosis. In order to identify risk factors in alcohol-induced liver disease, Bruno Raynard and colleagues conducted a prospective study in which 268 alcoholic patients with negative hepatitis B virus (HBV) and hepatitis C virus (HCV) serology underwent liver biopsy. The degree of hepatic fibrosis was scored and liver iron overload was assessed by Perls staining. After adjustment for daily alcohol intake and total duration of alcohol abuse, multivariate regression analysis determined that fibrosis was correlated with age (p = 0.001), body mass index (p = 0.002), sex (p <0.05), Perls grade (p <0.05), and blood glucose level (p <0.05). These findings have implications for the management of patients with alcohol-induced liver disease. (Raynard B, et al. Hepatology 2002;35:635-638)

Lower risk of cirrhosis in wine drinkers. Ulrik Becker and associates analyzed data from 3 prospective studies involving 30,630 subjects from the Copenhagen area by means of multiplicative Poisson regression models. They found that individuals who drank more than 5 drinks daily had a relative risk of 14 to 20 for developing cirrhosis. However, compared to those who drank no wine (relative risk = 1.0), individuals for whom wine made up at least 51% of their alcohol intake had a relative risk for developing cirrhosis of 0.3. These data indicate that all types of excessive alcoholic intake increased the risk for cirrhosis, but the risk for wine drinkers was lower. (Becker U, et al. Hepatology 2002;35:868-875)

HCV Infection

Natural history in African Americans. Thelma Wiley and coworkers retrospectively reviewed the records of 355 patients with HCV infection (112 African Americans and 243 non-African Americans). African Americans were more likely to be older at presentation, to be women (p £ 0.02), and to be infected with genotype 1 virus (p = 0.001). In addition, serum baseline alanine aminotransferase (ALT) levels were lower and piecemeal necrosis was less frequently found in African Americans. These findings suggest that the immunologic recognition of HCV infected hepatic cells may not be as strong in African Americans as in non-African Americans. (Wiley TE, et al. Am J Gastroenterol 2002;97:700-706)

Cost-effectiveness of hepatitis A virus (HAV) vaccination in patients with chronic hepatitis C. HAV infection in patients with chronic HCV infection is associated with a high case fatality rate. Thus, Miguel Arguedas et al evaluated the cost-effectiveness of HAV vaccination by cost estimates based on published data and Medicare reimbursement rates. Results were sensitive to the incidence of HAV, the probability of fulminant hepatic failure, and the cost of HAV antibody screening and vaccination. Compared with no vaccination, targeted vaccination was associated with an incremental cost-effectiveness ratio of $51,000 per quality-adjusted life-year (QALY). Compared to targeted vaccination, universal vaccination was associated with an incremental cost-effectiveness ratio of $3,900,000 per QALY. These results indicate that universal HAV vaccination is not a cost-effective strategy, while targeted HAV vaccination may be a cost-effective means to decrease the morbidity and mortality of HAV superinfection in patients with chronic hepatitis C. (Arguedas MR, et al. Am J Gastroenterol 2002;97:721-728)

De Novo Autoimmune Hepatitis (AIH)

Response to steroids. De novo AIH has recently been described in liver transplant recipients as a graft dysfunction with features that resemble those of a conventional AIH. Magdalena Salcedo and coworkers report 12 cases of de novo AIH. All 12 patients presented with an atypical anti-liver/kidney cytosolic autoantibody and there was a high prevalence of HLA-DR3. Histologic studies demonstrated lobular necrosis and inflammatory infiltrates. Graft failure occurred in 5 untreated patients after 5.8 ± 2.6 months while 7 patients treated with steroids were alive without graft failure after 48.4 ± 14 months. Moreover, 5 patients relapsed during steroid tapering. These observations indicate that de novo AIH is a new disease that: 1) should be included in the differential diagnosis of graft dysfunction, 2) responds well to steroid therapy, and 3) usually requires maintenance therapy. (Salcedo M, et al. Hepatology 2002;35:349-356)

Acute Variceal Bleeding (AVB)

Meta-analysis of treatments. A meta-analysis of 8 randomized trials involving 939 patients with AVB showed that combined endoscopic sclerotherapy plus pharmacologic treatment improved the initial control of bleeding compared to endoscopic therapy alone (relative risk, 1.12; 95% CI, 1.02 - 1.23). However, mortality was similar in both treatment groups. (Banares R, et al. Hepatology 2002;35:609-615)

Review

Living-donor liver transplantation. The innovative technique of living-donor liver transplantation has been developed because of the increasing demand for liver transplants. James Trotter et al review the history of living-donor liver transplantation, the selection of donors as well as recipients, outcomes, and controversies. (Trotter JF, et al. N Engl J Med 2002;346:1074)

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