German researchers have reported a case of hepatic amyloidosis as a rare differential diagnosis of progressive liver failure.

A 63-year-old man presented with newly diagnosed ascites to the researchers’ department. The patient reported occasional alcohol consumption. Viral hepatitis, genetic-metabolic causes as well as hepatic vascular disorders were excluded and ultrasound did not show any signs of liver cirrhosis or intraabdominal malignancy.

Initially, alcoholic hepatitis was suspected. Because of the rapid deterioration of liver function, however, transjugular liver biopsy was performed, showing light chain amyloidosis of kappa isotype.

The researchers suggest that, as the diagnosis of hepatic amyloidosis is challenging, early liver biopsy is mandatory in patients with unexplained acute or chronic liver disease to exclude rare diseases with high mortality.

Reference

Hepatic amyloidosis as a rare differential diagnosis of progressive liver failure. Bettinger D, Lutz L, Schultheiß M et al. Dtsch Med Wochenschr. 2016 Sep;141(19):1387-1389

While six weeks of sofosbuvir and ribavirin therapy was safe and well tolerated in HCV patients, its efficacy was sub-optimal, a study concluded.

In this open-label study conducted in Australia and New Zealand, 19 adults with recent HCV (68% genotype 1; duration of infection median 37 weeks) received sofosbuvir 400mg daily and weight-based ribavirin for six weeks.

Four reported a symptomatic HCV seroconversion illness, including two with jaundice. At baseline, the median HCV RNA was 5.4 log10 IU/mL and at the end-of-treatment, it was non-quantifiable in 89%. SVR4 and SVR12 were 42% and 32%, respectively.

Treatment failure was because of non-response in two, post-treatment relapse in nine, re-infection in one, and with one loss to follow up.

The regimen was well tolerated with minimal haematological toxicity. SVR12 was related to baseline HCV RNA (≤6 log10 IU/mL, p=0.018) and early on-treatment viral kinetics.

The researchers suggest that further research is needed to determine whether more potent interferon-free direct-acting antiviral regimens will allow treatment duration to be shortened in recent, predominantly asymptomatic, HCV infection.

Reference

Sofosbuvir and ribavirin for six weeks is not effective among people with recent HCV infection: The DARE-C II study. Martinello M, Gane E, Hellard M et al. Hepatology. 2016 Sep 17 [Epub ahead of print]

A small number of UK citizens are undergoing liver transplants abroad but their management is of a lower standard than in the UK.

These were the conclusions of researchers at Sheffield’s Royal Hallamshire Hospital, who sent questionnaires to all seven UK liver transplant units enquiring about liver patients receiving transplant abroad. Six of the seven centres responded.

A total of 12 patients were identified as having undergone liver transplantation overseas. The top destinations were India, China and Egypt.

Four units responded to questions regarding pre-transplant screening. One unit reported HBV and HCV screening not taking place. Four units responded to questions regarding post-transplant antimicrobial therapy. This revealed examples of patients inappropriately not receiving valganciclovir, co-trimoxazole, anti-fungal treatment and HBV immunoglobulins.

The researchers add that information transfer between overseas and UK based transplant teams is poor.

Reference

A questionnaire based assessment of numbers, motivation and medical care of UK patients undergoing liver transplant abroad. Winter BK, Odedra A, Green S. Travel Med Infect Dis. 2016 Sep 14 [Epub ahead of print]

Applications are invited for these travelling fellowships, which are funded by a donation from Dr Geraint James in memory of his wife, Dame Sheila Sherlock.

The fellowships offer consultants and trainees the opportunity to learn new techniques and acquire new experiences, ideas and stimulation through travel and the exchange of ideas.

Two travelling fellowships are available, covering a period of 1 month each, and will be offered to one consultant and one trainee. Each fellowship will be for a maximum of £2,000, with the recipients being responsible for funding any additional costs.

Who can apply?
You must have current membership of the RCP.

Applications are open until 16 January 2017 and details on how to apply can be found the the RCP website > HERE.

To view the Alcohol Health Alliance news – September 2016 click > HERE. 

SHAAP (Scottish Health Action on Alcohol Problems) has released a report that compares alcohol- related problems and welcomes innovative policy responses in Scotland and Ireland. 

Click > HERE to view the report. 

More than a third of vulnerable people screened for HBV, HCV, HIV and syphilis at out-of-hospital sites, did not return for result, a study in Paris has revealed.

Researchers at nine out-of-hospital screening mobile sites in Paris explored the rates of these infections amongst 341 vulnerable people who were mostly intravenous drug users, sex workers or homeless. 

The proportion of failure to return for results was 38.75%. In multivariate analysis, unemployment was significantly associated with failure to return (odds ratio 4.29), as well as having been screened in the past (odds ratio 4.32). And 18.03% of the patients had a false perception of an immunization against HBV.

In multivariate analysis, having a place of residence protected against a false perception (odds ratio 0.33), while being screened in the past enhanced the risk of a false perception (odds ratio 3.28).

The researchers suggest that using technologies, such as phone texting, might be a partial solution along with rapid diagnostic tests. More information and explanation of the results should be provided, along with specific anti-HBV vaccination campaigns targeting these specific populations.

Reference

Out-of-hospital screening for HIV, HBV, HCV and syphilis in a vulnerable population, a public health challenge. Legoupil C, Peltier A, Henry Kagan V et al. AIDS Care. 2016 Sep 14:1-3 [Epub ahead of print]

Liver transplant patients who receive subsequent cardiac surgery have acceptable short-term and long-term outcomes, researchers have concluded.

The researchers, from the University of Alabama at Birmingham School of Medicine, analysed data on 43 patients (median age 60) who underwent cardiac operations at 63 months, on average, after their liver transplants.

There were three operative deaths and 24 late deaths. The patients with a preoperative Model for End-Stage Liver Disease (MELD) score of 13.8 or less had significantly greater survival rates than those with a MELD score greater than 13.8. Patients with a postoperative MELD score of 17 or less had significantly greater survival rates than those with a MELD score greater than 17.

Further analyses showed that postoperative peak creatinine levels were statistically significant predictors of death (relative risk 1.8). The one, five, and 10 year Kaplan-Meier survival rates were 90%, 51%, and 35%, respectively; postoperative mortality rates followed a constant phase model with a hazard of death of 10% per year.

Reference

Outcomes of patients who undergo cardiac surgical procedures after liver transplantation. Harrington PB, McAlexander WW, Bryant AS et al. Ann Thorac Surg. 2016 Sep 9 [Epub ahead of print]