Evaluation of renal arterial resistive index in patients with extrahepatic cholestasis.

OBJECTIVE: Biliary obstruction has been shown to cause acute renal failure. The Renal Resistive Index (RRI) has been recognized to be an important index for evaluating changes in renal plasma flow and renal damage in cholestatic patients. We aimed to investigate the effects of cholestasis on renal hemodynamics in patients with extrahepatic cholestasis by RRI. PATIENTS AND METHODS: The prospective study included patients with extrahepatic cholestasis due to benign biliary stricture, choledocholithiasis, or periampullary tumor between January 1, 2022, and December 31, 2022. Renal and liver function tests, as well as renal doppler ultrasound for RRIs, were conducted before and after cholestasis treatment. RESULTS: Patients who experienced cholestasis resolution after treatment showed lower cholestasis enzymes and bilirubin values and higher glomerular filtration rates compared to pre-treatment values. RRI values significantly decreased in patients with resolved cholestasis compared to pre-treatment levels (p=0.009). Patients with malignant cholestasis had higher RRI values than those with benign cholestasis (p=0.006). Bilirubin levels were higher (p=0.001), and glomerular filtration rates were lower (p=0.046) in patients with malignant cholestasis compared to those with benign cholestasis. CONCLUSIONS: Acute renal injury in cholestatic patients can be demonstrated non-invasively by RRI and is reversible once cholestasis has resolved. Patients with benign cholestasis had lower RRI values than those with cholestasis due to periampullary tumors.

Biochemical predictors of hepatocellular cancer development after one year in patients who achieved HCV clearance by direct-acting antiviral treatment.

OBJECTIVE: The continued risk of hepatocellular cancer (HCC) following HCV clearance by direct-acting antivirals (DAAs), even if a sustained viral response (SVR) is achieved, has been previously reported. This study's objective was to identify biochemical predictors for HCC occurrence in patients who achieved HCV clearance by DAA treatment after one year. PATIENTS AND METHODS: Patients who achieved SVR at week 24 with DAA between November 2015 and January 2021 and had no evidence of HCC were evaluated retrospectively. Biochemical parameters such as serum AFP (Alpha-fetoprotein), AST (Aspartate Aminotransferase), ALT (Alanine aminotransferase), albumin, PLT (platelet) count, FIB-4 and APRI indexes (non-invasive fibrosis indexes) were analyzed before starting the DAA treatment, at the end of the treatment (EOT), and 24th-week post-treatment. RESULTS: Throughout a median follow-up time of 43±16.2 months, it was observed that HCC occurred in 14 (5.6%) of 248 CHC patients who reached SVR at the 24th week after DAA treatment. According to multivariate analysis, AFP levels were >7.08 ng/ml before treatment (HR, 3.8; p=0.050), >5.15 ng/ml at the EOT (HR, 6.8; p=0.019), and >5.68 ng/ml at the 24th week post-treatment (HR, 21.2; p=0.002); albumin levels were <3.75 g/dl before treatment (HR, 3.6; p=0.042), <4.05 g/dl at the EOT (HR, 6.9; p=0.005), and <4.15 g/dl at week 24 post-treatment (HR, 8.8; p=0.002); PLT counts <153.000/mm3 at the 24th week post-treatment (HR, 12.1; p=0.001) were determined to be independent biochemical predictors for the development of HCC after one year of ending DAA treatment. CONCLUSIONS: AFP and albumin levels before treatment, at the EOT, and post-treatment at week 24, and PLT numbers at week 24 post-treatment can be used to foresee the risk of developing HCC one year after ending of DAA treatment.

Comparison of the side effects of antivirals in chronic hepatitis B patients: a single-center experience.

Background and study aim: Entecavir (ETV), Tenofovir Disoproxil Fumarate (TDF), and Tenofovir Alafenamide (TAF) have been approved for treating Chronic Hepatitis B (CHB) and recommended due to their high safety profile and high resistance barriers. This study aimed to evaluate the kidney functions, bone, and metabolic parameters in CHB patients receiving ETV, TDF, and TAF treatment. Patients and methods: In this retrospective cohort study, a total of 469 CHB patients who were treated with TDF (n = 256), ETV (n = 184), or TAF (n = 129) for at least six months between March 2012 and March 2022, were enrolled. Results: No significant difference was observed between three groups regarding ALT normalization, HBV DNA suppression, and HBs Ag seroconversion (p = 0.15, p = 0.26, p = 0.72). After the treatment, there was a significant decrease in GFR values in the TDF, ETV, and TAF groups (p<0.01, p = 0.01, p = 0.01, respectively). No significant improvement was observed in the GFR values after TAF treatment in 77 patients who had switched from TDF to TAF (p = 0.51). Moreover, no significant decrease in bone mineral densities was observed in the TDF, ETV, and TAF groups (p = 0.24, p = 0.41, p = 0.95, respectively). There was no significant difference between the three groups in metabolic parameters (serum glucose, lipid profile, calcium and phosphorus levels, etc.) when the data were adjusted for underlying comorbidities. Conclusions: ETV, TDF, and TAF are comparably safe and effective antiviral agents against CHB.

Distribution of chronic hepatitis C genotype and evaluation of clinical factors affecting direct-acting antiviral treatment responses in the Western Black Sea Region, Turkey.

OBJECTIVE: Chronic Hepatitis C (CHC) is a substantial global public health issue with significant variation between countries because of the genotypic differences. A sustained viral response (SVR) is essential to reduce the complications associated with CHC and can be achieved in most patients via direct-acting antivirals (DAAs). The present study aimed at determining the genotype distribution in patients with CHC in our region and the SVR in DAA therapy patients. PATIENTS AND METHODS: The study was conducted retrospectively on 272 patients treated with DAA between September 2016 and 2021. Data including demographic and clinical characteristics of the patients (HCV RNA level, genotype, hepatitis B and HIV serology, cirrhosis and decompensation, presence of hepatocellular cancer, degree of hepatosteatosis, previous anti-HCV treatment experience, comorbidities) were recorded. The study's primary endpoint was to determine the SVR at week 24. RESULTS: Genotype 1 was the most common genotype (94.5%), with genotype 1b accounting for most patients (78%) among those. It was observed that the patients received Ombitasvir/Paritaprevir/Ritonavir/Dasabuvir (OPRD) (47%), Ledipasvir/sofosbuvir (LDS) (38%), and Glecaprevir/pibrentasvir (GCP) (15%) as DAA treatment. SVR was observed in 92% (223) of the 240 patients at the end of 24 weeks. SVR-24 was significantly higher in the patient group with serum HCV RNA level ≤ 852.533 (p=0.002), in the hypertensive group (p=0.018), and without the psychiatric disease group (p<0.001). CONCLUSIONS: A high rate of SVR-24 was achieved by DAAs in CHC patients, most of whom were genotype 1 in the Western Black Sea Region, Turkey. Also, high viral load, hypertension, and psychiatric disease affected SVR-24, and clinical factors, such as cirrhosis, cirrhosis complications, hepatosteatosis, and other comorbidities did not.