Review article: maximising quality of life while aspiring for quantity of life in end-stage liver disease.

BACKGROUND: With recent advances in the management of chronic liver disease and its complications, the long-term survival in cirrhosis has improved. Therefore, the number of individuals who will spend a significant proportion of their life with end-stage liver disease (ESLD) may continue to rise. Thus, more attention to quality of life (QOL) and its integration with traditional clinical endpoints is needed. AIMS: Recently, there have been many studies looking at treatment outcomes and their impact on the QOL in patients with ESLD. The aim of this review was to summarise and compare the insights gained from these intervention studies and to make concise recommendations to further promote and improve QOL in this patient population. METHODS: A literature search was conducted using PubMed and Web of Science. Search terms "Quality of life" "Cirrhosis" and "end-stage liver disease" were used as MeSH terms or searched in the title of the article. RESULTS: These studies uniformly show significant improvement in health-related QOL (HRQOL) with management of malnutrition, hepatic encephalopathy and ascites. Thus, early recognition and management of these complications are keys to better serve our patients. Early involvement of palliative care also leads to improved quality of end-of-life care. CONCLUSIONS: Complications of cirrhosis including malnutrition, encephalopathy, ascites and variceal bleeding lead to a decrease in HRQOL. Assessment of HRQOL has an important implication for the patient. The findings of this review illuminate the importance of using consistent tools to accurately assess QOL in patients with ESLD.

Systematic review: recurrent autoimmune liver diseases after liver transplantation.

BACKGROUND: Autoimmune liver diseases (AILD) constitute the third most common indication for liver transplantation (LT) worldwide. Outcomes post LT are generally good but recurrent disease is frequently observed. AIMS: To describe the frequency and risk factors associated with recurrent AILD post-LT and provide recommendations to reduce the incidence of recurrence based on levels of evidence. METHODS: A systematic review was performed for full-text papers published in English-language journals, using the keywords 'autoimmune hepatitis (AIH)', 'primary biliary cholangitis and/or cirrhosis (PBC)', 'primary sclerosing cholangitis (PSC)', 'liver transplantation' and 'recurrent disease'. Management strategies to reduce recurrence after LT were classified according to grade and level of evidence. RESULTS: Survival rates post-LT are approximately 90% and 70% at 1 and 5 years and recurrent disease occurs in a range of 10-50% of patients with AILD. Recurrent AIH is associated with elevated liver enzymes and IgG before LT, lymphoplasmacytic infiltrates in the explants and lack of steroids after LT (Grade B). Tacrolimus use is associated with increased risk; use of ciclosporin and preventive ursodeoxycholic acid with reduced risk of PBC recurrence (all Grade B). Intact colon, active ulcerative colitis and early cholestasis are associated with recurrent PSC (Grade B). CONCLUSIONS: Recommendations based on grade A level of evidence are lacking. The need for further study and management includes active immunosuppression before liver transplantation and steroid use after liver transplantation in autoimmune hepatitis; selective immunosuppression with ciclosporin and preventive ursodeoxycholic acid treatment for primary biliary cholangitis; and improved control of inflammatory bowel disease or even colectomy in primary sclerosing cholangitis.

Effects of displacement resulting from ethnic/religious conflict on the growth and body composition of Fulani children in northern Nigeria.

This study, which was carried out in the Jos Plateau in Nigeria, analysed the changes in growth and body composition that occurred among 17 male and 13 female Fulani children (aged 4-13 years) in the 7-month period which followed their displacement from their homes into a temporary camp due to ethnic/religious violence. The heights and weights of the children, as well as their fat, fat-free mass, and phase angle were determined 3 weeks before the crisis and 7 months post-crisis using standard anthropometric methods and bioelectrical impedance analysis. In terms of mean values and relative to growth curves established during the tranquil period immediately preceding the crisis, all but one of the girls grew taller and gained more weight than predicted; two-thirds of the weight gained by the girls was due to fat. With regard to the male subjects, on average, while they grew taller, they gained 30 per cent less in height than predicted. However, the boys did gain 50 per cent more weight than predicted. Unexpectedly, fat accounted for one-half or more of the weight gain in both the boys and girls. In general, the boys did less well than the girls in the months following the crisis. The phase angle of all subjects did not decline significantly during the pre- and post-crisis interval. In general, from the nutritional perspective, the Fulani children coped relatively well during the 7-month period of displacement. The fact that neither the growth nor body composition of the Fulani children deteriorated significantly following the crisis was attributed to the fact that during that period they were receiving adequate and continuous supplies of food. Furthermore, the displacement camp into which the children and their families migrated was located in a secure region of the country and one that was controlled by people whose culture and ethnicity were similar to theirs. Finally, at no time during their 7 months as a displaced population were the children separated from their mothers. In conclusion, this study shows that displacement in general may not necessarily lead to deleterious effects on the growth of children.