Recurrence of hepatitis C virus genotype-4 infection following orthotopic liver transplantation: natural history and predictors of outcome

There are few reports on hepatitis C virus genotype 4 [HCV-4] recurrences after orthotopic liver transplantation [OLT]. Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes. All patients who underwent OLT [locally or abroad] for HCV related hepatic cir-rhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed. Of 116 patients who underwent OLT for hepatitis C, 46 [39.7%] patients satisfied the criteria of recur-rent hepatitis C. Twenty-nine [63%] patients were infected with HCV genotype 4. Mean [SD] for age was 54.9 [10.9] years. Nineteen of the HCV genotype 4 patients [65.5%] were males, 21 [72.4%] received deceased donor grafts, and 7 [24.1%] developed >1 acute rejection episodes. Pathologically, 7 [24.1%] and 4 [13.8%] patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 [31%] HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease. This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes

prevalence of neurological complications among adult Sudanese patients with chronic liver disease

We aimed to study the prevalence of neurological complications among adult Sudanese patients with chronic liver disease [CLD] seen in Ibn Sina Hospital [Sudan] [February 2005 - February 2006]. This is a prospective descriptive cross sectional hospital based study. Ninety six adult Sudanese patients with CLD were included in the study. All patients had been subjected to full detailed history, proper clinical examination and necessary investigations including EEG, Brain CT, MRI, NCS and EMG. Male to female ratio was [2.5:1]. Splenomegally was observed in 71 patients [74%], shrunken liver in 83 [86.5%], 74 [77.1%] had ascites. Sixty percent had liver cirrhosis, 24% had cirrhosis with periportal fibrosis [PPF]. Hepatocellular Carcinoma [HCC] was detected in 12 patients. Out of 96 patients with CLD, neurological complications were detected in 44 [45.8%], acute hepatic encephalopathy ranging from grade I to grade IV was found to be the most common neurological complication [29 patients]. Neurological complications were common among adult Sudanese patient with chronic liver disease

Prevalence of gastric varices and portal hypertensive gastropathy in patients with Symmers' peri portal fibrosis

Symmers' periportal fibrosis secondary to schistosomiasis is a common cause of portal hypertension worldwide. Data on the prevalence of gastric varices and portal hypertensive gastropathy in this group of patients with portal hypertension is relatively scarce. The aim of this study was to determine the prevalence of gastric varices and portal hypertensive gastropathy in patients presenting with portal hypertension secondary to Symmers' periportal fibrosis. In a prospective study, upper gastrointestinal endoscopy was carried out to determine the prevalence of gastric varices and portal hypertensive gastropathy in patients with portal hypertension secondary to Symmers' periportal fibrosis. Of 143 patients studied, 24 patients [16.8%] had gastric varices [grade I in 10.5%, grade II in 6.3%] and 31 patients [21.7%] had portal hypertensive gastropathy [mild in 11.2%, severe in 10.5%]. Gastric varices were more prevalent in patients with grade I and II esophageal varices and portal hypertensive gastropathy was more prevalent in those with grade III and IV esophageal varices, but the differences were not statiscally signifant. We concluded that both gastric varices and portal hypertensive gastropathy seem to have a lower prevalence in patients with portal hypertension secondary to Symmers' periportal fibrosis when compared to reported data in patients with portal hypertension secondary to liver cirrhosis and non-cirrhotic portal fibrosis