Concomitant use of sorafenib with ombitasvir/paritaprevir/ritonavir and dasabuvir: Effectiveness and safety in clinical practice.

WHAT IS KNOWN AND OBJECTIVE: No studies have evaluated the use of sorafenib with the direct-acting antiviral ombitasvir/paritaprevir/ritonavir and dasabuvir (OBV/PTV/r+DSV). CASE SUMMARY: Three hepatitis C virus genotype 1b-infected patients with well-preserved liver function were included in this prospective case series. The patients were taking sorafenib for advanced hepatocellular carcinoma and received OBV/PTV/r+DSV for 12 weeks. One patient discontinued sorafenib while concomitant treatment due to grade 2 fatigue and muscular pain. The other two patients reported only grade 1 adverse effects. Sustained virologic response at 24 weeks was achieved, and no tumour recurrences were found. WHAT IS NEW AND CONCLUSION: The concurrent use of OBV/PTV/r+DSV with sorafenib was considered safe and effective.

Downstaging of bilobar hepatocellular carcinoma after radioembolization with 90Y microspheres as a bridge to liver transplantation. / Downstaging de carcinoma hepatocelular bilobar tras radioembolización con microesferas de 90Y como puente al trasplante hepático.

Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation.

Management of liver transplantation waiting list for decompensated cirrhosis in a Spanish tertiary hospital: differences between hepatitis C virus recipients and other etiologies.

BACKGROUND: Decompensated cirrhosis due to hepatitis C virus (HCV) is one of the main indications for liver transplantation (LT) in Spain. Recurrence of HCV after LT is the main cause of graft loss and death in HCV-positive recipients. Advanced donor age determines a more aggressive recurrence of HCV and a shorter survival. In this setting, in our liver unit, grafts from younger donors are allocated to HCV-positive recipients. The aim of this study was a comparative analysis of allocation of grafts in HCV-positive recipients versus other etiologies and the impact on waiting list time, Model for End-Stage Liver Disease (MELD) score progression until LT, need of admission in a hospital, survival until LT. METHODS: This was a retrospective study from the cohort of patients included in the waiting list for LT owing to decompensated cirrhosis in the Hospital Gregorio Marañón from January 2008 to June 2013. RESULTS: A total of 91 patients were included; 63 patients (69.23%) received LT; 19 (20.88%) retired from the waiting list: 6 because of improvement, 11 (12.08%) because of death. In both groups, the age of recipients was similar (HCV 52 y vs other 53 y; P = .549). HCV patients were included in the waiting list with lower MELD score than other etiologies (HCV 16.1 vs other 19.4; P = .010); nevertheless, MELD score was similar at the time of LT in both groups (HCV 18.9 vs other 19.4; P = .675). Time on waiting list was significantly longer in HCV patients (198 d vs 86 d; P = .002) and they were admitted in hospital more days (30 d vs 12 d; P = .03). Donor age in the HCV group was significantly lower (64.3 y vs 54.7 y; P = .006). The intention-to-treat survival analysis did not show differences between the groups (log rank = 0.504). CONCLUSIONS: HCV patients with decompensated cirrhosis receive grafts from younger donors. HCV patients remain waiting longer for an optimal organ and suffer MELD deterioration and more days admitted in hospital. These differences in allocation of grafts did not affect final survival. In our experience, designating younger organs to HCV-positive patients does not penalize neither HCV recipients nor recipients with other etiologies.

Peritonitis bacteriana espontánea y Listeria monocytogenes / No disponible

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Pancreatitis aguda como presentación de una panarteritis nodular asociada a hepatitis C: reactivación tuberculosa por triple terapia inmunosupresora / Acute pancreatitis as a presentation of panarteritis nodosa associated with hepatitis C: tuberculous reactivation due to triple immunosuppressive therapy

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Tumoral response factors after radiofrequency ablation of hepatocellular carcinoma in cirrhotic liver.

OBJECTIVE: Hepatocellular carcinoma (HCC) ablation by radiofrequency (RFA) is a novel technique with a great variety of methods whose efficacy and predictive factors have not been completely studied. Some of the main predictive factors in this type of treatment are analyzed in the present study. PATIENTS AND METHODS: Ninety-three patients with hepatocellular carcinoma over cirrhosis, and with no indication for surgical resection were treated by RFA. Two different types of electrodes were used for RFA (refrigerated-"Cool-Tip" and perfusion with saline solution, the approach was percutaneous, by laparoscopy or laparotomy. RESULTS: Overall survival at 1, 2 and 3 years was 88, 81, and 76%, with a free-disease survival (FDS) of 66, 31 and 17%, respectively. For tumors less than 3 cm, FDS at 1,2 and 3 years was 74, 44 and 30%, while for more than 3 cm in size FDS was 55, 12 and 0% (p = 0.02). FDS for HCC with one nodule was 70, 36 and 22%, and for more than one nodule it decreased to 50, 17 and 0% at 1, 2 and 3 years, respectively (p = 0.07). Surprisingly, the method employed for RFA has a main influence in FDS, with 0% at 3 years for perfusion electrodes and 26% for cool-tip electrodes at the same period. CONCLUSIONS: In this series, overall survival at three years was relatively high; however, tumoral size, number of nodules and RFS method were independent variables associated with disease-free survival.

[Massive abdominal vein thrombosis with acute liver failure and toxic megacolon as onset of ulcerative colitis]. / Trombosis venosa masiva abdominal con insuficiencia hepática aguda y megacolon tóxico como presentación de colitis ulcerosa.

The prevalence of systemic thromboembolic complications is higher in patients with inflammatory bowel disease than in the general population. This hypercoagulable state is due to an increased production of procoagulant substances proportionally related to the inflammatory activity of the disease, although recent reports have focused on the presence of inherited thrombophilic disorders in this entity. We present the case of a 32-year-old woman with no relevant medical history who presented with massive abdominal vein thrombosis, including suprahepatic, portal, splenic and superior mesenteric veins, and secondary acute liver failure in her first ulcerative colitis flare and who later developed toxic megacolon requiring emergency total colectomy despite steroids and cyclosporine. Anticoagulant therapy achieved complete resolution of suprahepatic thrombosis and partial resolution in the splenic and superior mesenteric veins, with final cavernous transformation of the portal vein.

[Hepatoportal sclerosis and liver angiosarcoma: an infrequent association with a possible common etiology]. / Esclerosis hepatoportal y angiosarcoma hepático: una asociación infrecuente y una posible etiología común.

Hepatoportal sclerosis is characterized by fibrosis of the intima of the portal vein and its branches leading to the development of presinusoidal portal hypertension. We describe the case of a 58-year-old woman with idiopathic hepatoportal sclerosis, who was admitted to our service due to impairment of liver function, with rapid clinical worsening and finally the development of multiorgan failure. Autopsy showed a diffuse liver angiosarcoma with splenic metastases. The patient had no history of domestic or occupational exposure to substances involved in the development of hepatoportal sclerosis or liver angiosarcoma. The development of liver angiosarcoma in a patient with hepatoportal sclerosis is exceptional, even though both diseases may have a common etiology.

Trombosis venosa masiva abdominal con insuficiencia hepática aguda y megacolon tóxico como presentación de colitis ulcerosa / Massive abdominal vein thrombosis with acute liver failure and toxic megacolon as onset of ulcerative colitis

Los pacientes con enfermedad inflamatoria intestinal (EII) presentan una prevalencia superior de complicaciones tromboembólicas sistémicas que la población general. Este estado de hipercoagulabilidad se debe a una producción excesiva de sustancias procoagulantes relacionada proporcionalmente con la actividad de la enfermedad, aunque ciertas publicaciones recientes han revelado un número creciente de mutaciones genéticas predisponentes a la trombofilia en estos enfermos. Se presenta el caso de una mujer de 32 años, sin antecedentes patológicos de interés, en la que su primer brote de EII se presentó clínicamente como una trombosis venosa masiva abdominal (que afectaba a las venas suprahepáticas, porta, esplénica y mesentérica superior), con una insuficiencia hepática aguda y el desarrollo posterior de un megacolon tóxico, a pesar de la administración de esteroides y ciclosporina, por lo que se realizó a la paciente una colectomía total urgente. La anticoagulación consiguió la resolución completa de la trombosis de las venas suprahepáticas y parcial de la esplénica y mesentérica superior, con transformación cavernomatosa de la porta

The prevalence of systemic thromboembolic complications is higher in patients with inflammatory bowel disease than in the general population. This hypercoagulable state is due to an increased production of procoagulant substances proportionally related to the inflammatory activity of the disease, although recent reports have focused on the presence of inherited thrombophilic disorders in this entity. We present the case of a 32-year-old woman with no relevant medical history who presented with massive abdominal vein thrombosis, including suprahepatic, portal, splenic and superior mesenteric veins, and secondary acute liver failure in her first ulcerative colitis flare and who later developed toxic megacolon requiring emergency total colectomy despite steroids and cyclosporine. Anticoagulant therapy achieved complete resolution of suprahepatic thrombosis and partial resolution in the splenic and superior mesenteric veins, with final cavernous transformation of the portal vein

Esclerosis hepatoportal y angiosarcoma hepático: una asociación infrecuente y una posible etiología común / Hepatoportal sclerosis and liver angiosarcoma: an infrequent association with a possible common etiology

La esclerosis hepatoportal es una enfermedad caracterizada por la fibrosis de la íntima de la vena porta y de sus ramas, que conduce al desarrollo de hipertensión portal presinusoidal. A continuación describimos el caso de una paciente de 58 años de edad, diagnosticada de esclerosis hepatoportal idiopática, que ingresó en nuestro servicio por presentar un deterioro de la función hepática, con un rápido empeoramiento clínico y el desarrollo de un fallo multiorgánico. El estudio de la necropsia demostró la presencia de un angiosarcoma hepático difuso con metástasis esplénicas. La paciente no presentaba antecedentes de exposición a sustancias de riesgo para el desarrollo de esclerosis hepatoportal ni angiosarcoma hepático en su entorno laboral y doméstico. El desarrollo de un angiosarcoma hepático sobre una esclerosis hepatoportal es un hecho excepcional a pesar de que ambas enfermedades poseen una posible etiología común

Hepatoportal sclerosis is characterized by fibrosis of the intima of the portal vein and its branches leading to the development of presinusoidal portal hypertension. We describe the case of a 58-year-old woman with idiopathic hepatoportal sclerosis, who was admitted to our service due to impairment of liver function, with rapid clinical worsening and finally the development of multiorgan failure. Autopsy showed a diffuse liver angiosarcoma with splenic metastases. The patient had no history of domestic or occupational exposure to substances involved in the development of hepatoportal sclerosis or liver angiosarcoma. The development of liver angiosarcoma in a patient with hepatoportal sclerosis is exceptional, even though both diseases may have a common etiology

Factores de respuesta tumoral tras ablación mediante radiofrecuencia del carcinoma hepatocelular sobre cirrosis / Tumoral response factors after radiofrequency ablation of hepatocellular carcinoma in cirrhotic liver

Objetivo: la ablación por radiofrecuencia del hepatocarcinoma(ARF) es una técnica de reciente adquisición, cuya eficacia yfactores predictivos no han sido suficientemente evaluados. Elpresente estudio fue diseñado para este análisis.Pacientes y métodos: se han tratado 93 pacientes con hepatocarcinomasobre hígado cirrótico sin criterios de resección nide trasplante hepático. El tratamiento se realizó mediante abordajepercutáneo, laparoscópico o mediante laparotomía con dos tiposde electrodos de radiofrecuencia, electrodo refrigerado y deperfusión respectivamente.Resultados: la supervivencia global a los 1, 2 y 3 años fue del88, 81 y 76%, con una supervivencia-libre de enfermedad (SLE)de 66, 31 y 17% respectivamente. El análisis multivariante demostrótres variables predictivas independientes: tamaño tumoral( 3 cm; SLE a 1,2 y 3 años de 74, 44 y 30%,frente a 55, 12 y 0%; HR= 2,02; IC 95% 1,10-3,70; p = 0,02),número de nódulos (uno frente a más de uno; SLE a 1,2 y 3 añosde 70, 36 y 22, frente a 50, 17 y 0%; HR= 1,92 IC 95% 0,95-3,93; p = 0,07) y tipo de electrodo (refrigerado frente a perfusión;SLE 80, 43 y 26% a 1, 2 y 3 años frente a 49, 12 y 0%;HR = 2,06; IC 95% 1,12-3,79; p = 0,02).Conclusiones: a pesar de que la ARF proporciona una supervivenciaglobal aceptable, la SLE es notablemente inferior. El tamañodel tumor, el número de nódulos y el tipo de electrodo deARF fueron variables independientes asociadas a la SLE

Objective: hepatocellular carcinoma (HCC) ablation by radiofrequency(RFA) is a novel technique with a great variety ofmethods whose efficacy and predictive factors have not beencompletely studied. Some of the main predictive factors in thistype of treatment are analyzed in the present study.Patients and methods: ninety-three patients with hepatocellularcarcinoma over cirrhosis, and with no indication for surgicalresection were treated by RFA. Two different types of electrodeswere used for RFA (refrigerated-“Cool-Tip” and perfusion withsaline solution, the approach was percutaneous, by laparoscopyor laparotomy.Results: overall survival at 1, 2 and 3 years was 88, 81, and76%, with a free-disease survival (FDS) of 66, 31 and 17%, respectively.For tumors less than 3 cm, FDS at 1,2 and 3 years was74, 44 and 30%, while for more than 3 cm in size FDS was 55,12 and 0% (p = 0.02). FDS for HCC with one nodule was 70, 36and 22%, and for more than one nodule it decreased to 50, 17and 0% at 1, 2 and 3 years, respectively (p = 0.07). Surprisingly,the method employed for RFA has a main influence in FDS, with0% at 3 years for perfusion electrodes and 26% for cool-tip electrodesat the same period.Conclusions: in this series, overall survival at three years wasrelatively high; however, tumoral size, number of nodules andRFS method were independent variables associated with diseasefreesurvival