Changing trends in the etiology of liver transplantation in Turkiye: A multicenter study.

Background and Aim: This study aimed to identify the indications for liver transplantation (LT) based on underlying etiology and to characterize the patients who underwent LT. Materials and Methods: We conducted a multicenter cross-sectional observational study across 11 tertiary centers in Turkiye from 2010 to 2020. The study included 5,080 adult patients. Results: The mean age of patients was 50.3±15.2 years, with a predominance of female patients (70%). Chronic viral hepatitis (46%) was the leading etiological factor, with Hepatitis B virus infection at 35%, followed by cryptogenic cirrhosis (24%), Hepatitis C virus infection (8%), and alcohol-related liver disease (ALD) (6%). Post-2015, there was a significant increase in both the number of liver transplants and the proportion of living donor liver transplants (p<0.001). A comparative analysis of patient characteristics before and after 2015 showed a significant decline in viral hepatitis-related LT (p<0.001), whereas fatty liver disease-related LT significantly increased (p<0.001). Conclusion: Chronic viral hepatitis continues to be the primary indication for LT in Turkiye. However, the proportions of non-alcoholic fatty liver disease (NAFLD) and ALD-related LT have seen an upward trend over the years.

Dieulafoy lesions: One patient, two different localizations.

Dieulafoy lesions (DLs) are dilated submucosal arterial structures visualized on endoscopy as bleeding foci on the superficial mucosa without erosion or ulceration. DLs account for 1-5.8% of acute non-variceal upper gastrointestinal bleeding cases. A 72-year-old male patient with known Alzheimer's disease and coronary artery disease, being followed up at a nursing home, presented to our emergency department with foul-smelling, loose, and tarry stool. Esophagogastroduodenoscopy revealed a 3 mm DL immediately adjacent to the Z line in the distal esophagus, demonstrating a fresh blood clot without the appearance of a surrounding ulcer. Two endoscopic hemo-clips were applied to this lesion. The patient was monitored at the intensive care unit for the following 2 days and later transferred to internal medicine inpatient unit. He developed hematochezia on the 8th day of hospitalization. Emergent rectosigmoidoscopy was performed showing two separate 3 and 4 mm sized DLs, located immediately proximal to the dentate line. These lesions were successfully treated using two endoscopic band ligations. DLs can occur synchronously, albeit very rarely, and a careful search for multiple lesions is necessary to avoid further bleeding.

Baseline characteristics associated with survival in patients with hepatocellular carcinoma.

Background and Aim: Hepatocellular carcinoma (HCC) is one of the most common and most lethal cancers worldwide. The objective of this study was to investigate the relationship between basal parameters and survival characteristics in patients with HCC. Materials and Methods: The records of 1447 HCC patients of a tertiary center during the period 2000-2017 were screened retrospectively. The demographic details; basal clinical, laboratory, and radiological characteristics; treatments; and survival time were recorded and prognostic scores were calculated. Results: A total of 788 patients with HCC (male/female: 623/165; mean age: 60.5±10.9 years) were included in the study. The median length of survival was 26.3 months (95% confidence interval [CI], 22.3-30.4 months). The 5-year survival rate was 28.1%. The number and diameter of the tumors; platelet count; platelet-to-lymphocyte ratio; level of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase; portal and hepatic vein involvement; and an alpha-fetoprotein level of <9.6 ng/mL were found to be independently related to survival. Conclusion: The positive predictive value of the prognostic index derived from independent survival-related parameters for 5- and 10-year survival or overall survival was approximately 86%. Integration of this prognostic index to the criteria used in making treatment decisions for patients with HCC should be considered.

Outcomes of Patients with Acute Hepatotoxicity Caused by Mushroom-Induced Poisoning.

BACKGROUND: This study aimed to investigate the characteristics of severe hepatitis (SH), acute liver injury (ALI), and acute liver failure (ALF) in patients with mushroom-induced hepatotoxicity. METHODS: Data of patients between 2010 and 2019 were retrospectively reviewed. Twenty-four patients with mushroom-induced hepatotoxicity were included and divided into 3 groups: SH, ALI, and ALF. SH was defined as transaminase level ≥10 times ULN, international normalized ratio (INR) ≤1.5, and the absence of hepatic encephalopathy (HE). ALI was defined as INR > 1.5, presumed acute illness onset, and the absence of HE. ALF was diagnosed based on the presence of HE of any degree, with INR > 1.5, presumed acute illness onset, and the absence of cirrhosis. RESULTS: The mean age of the patients was 51.6 years; 13 (54.2%) were female. At admission, 18 patients (75%) had SH, 5 (21%) had ALI, and 1 (4.1%) had ALF. During follow-up, 6 of the 18 SH (33%) patients progressed to ALI and 2 of the 5 ALI (40%) patients progressed to ALF. No progression to ALI or ALF was observed in the 8 SH cases with a baseline MELD score of <15. One patient with grade 4 HE died (4.1%). None underwent liver transplantation. CONCLUSION: The survival was 100% in the ALI and SH groups. A MELD score of <15 at admission may be used as a predictor of no progression to ALI or ALF in patients with SH. However, since 40% of ALI cases may progress to ALF, these cases should be followed up in a tertiary care center that is equipped to perform liver transplantation and advanced therapies.

Hepatitis E virus IgG seroprevalence in liver transplant patients: A retrospective single-center experience.

Background and Aim: Hepatitis E virus (HEV) may cause chronic liver disease in solid organ transplant recipients. We determined HEV seroprevalence and associated factors in liver transplant recipients. Materials and Methods: Patients followed at the outpatient clinic of liver transplantation between January 2019 and January 2020 were screened retrospectively for HEV serology (HEV immunoglobulin M [IgM] and HEV immunoglobulin G [IgG]). Results: Of the 150 patients (male/female, 104/46; age, 55.4±13.2 years), anti-HEV IgG was positive in 31 (20.7%), and anti-HEV IgM was negative in all. The mean time after liver transplantation (72 [48%] deceased and 78 [52%] living donors) was 81±78.5 months. Drinking water consisted of carboy and tap water in 88 (58.7%) and 62 patients (41.3%), respectively. Of the patients, 120 (80%) and 30 (20%) lived in urban and rural areas, respectively. On comparison, the difference between positive and negative anti-HEV IgG groups in terms of age, place of birth, water supply, and donor type was statistically significant (p=0.007, p=0.000, p=0.034, and p=0.049, respectively). Conclusion: HEV seroprevalence was more frequent in liver transplant recipients compared with the normal population. Older age, water supply, and place of birth were risk factors for HEV seroprevalence.