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Effect of malnutrition on health related quality of life (HRQoL) of patients awaiting liver transplantation
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indian journal of transplantation 9 (2015) 61–64
proximal CpG regions of multiple invasion-suppressor miRNA genes are strongly associated with their transcriptional repression upon miR-494 overexpression, whereas enforced DNAdemethylation can abolish the repression. Furthermore, the TET1 knockdown shows a similar effect as miR-494 overexpression. Conversely, miR-494 inhibition or the enforced TET1 expression is able to restore invasion-suppressor miRNAs and inhibit miR-494 mediated HCC cell invasion. Conclusions: TET1 methylcytosine dioxygenase is a direct target of miR-494. This micro RNA can trigger gene silencing of multiple invasion-suppressor miRNAs via inhibiting genomic DNA demethylation via TET1, thereby leading to tumor vascular invasion. MiR-494 is a potential therapeutic target for HCC.
Conclusions: Patients showed malnutrition and low HRQoL before LT. HRQoL is poorer in patients with malnutrition during pre-liver transplant phase.
http://dx.doi.org/10.1016/j.ijt.2015.09.038
Background: Post-transplant plasma cell hepatitis (PT-PCH) is characterized histologically by marked interface inflammation and centrilobular plasma cell infiltrates, suggesting autoimmune hepatitis, and is associated with poor prognosis. However, autoimmune markers are not consistently present, raising the controversy whether PT-PCH represents a form of de novo autoimmune hepatitis or rejection. Aims: To review the diagnosis, clinical manifestations, and outcomes of PT-PCH from a single center between 2009 and 2015. Methodology: The search term ‘‘plasma cell hepatitis’’ was used to retrieve cases between 2009 and 2015 from the pathology database of liver transplant recipients. Clinical data were obtained from the electronic medical record. Results: We identified four cases of PT-PCH among 182 allograft liver recipients. Two cases, transplanted for primary biliary cirrhosis and alcoholic cirrhosis, were diagnosed with PT-PCH within four months post-transplant, with no acute cellular rejection (ACR) on biopsy. The other two cases, transplanted for Hepatitis C (HCV) cirrhosis and concomitant HCValcoholic cirrhosis, were diagnosed with PT-PCH greater than 18 months post-transplant, with ACR and PT-PCH on biopsy. These patients had documented medication noncompliance and sub-therapeutic tacrolimus levels. Only three cases had autoimmune workups (anti-smooth muscle antibody, IgG level), which were weakly positive. All four cases responded to pulse steroids and increase in baseline immunosuppression, with normalization of hepatic enzymes. All four patients are alive with good graft function (Graft survival: 11–54 months to date, with a median of 15 months). Conclusions: In these four cases, PT-PCH was diagnosed between 3.3 and 48 months after transplant. ACR was also seen in later onset cases, in which medication noncompliance may also have played a role. Outcomes were good with enhanced immunosuppression.
Abstract #: ISOT2015-24 Effect of malnutrition on health related quality of life (HRQoL) of patients awaiting liver transplantation Neha Bakshi, Kalyani Singh Lady Irwin College, New Delhi, India Background: HRQoL is a subjective multidimensional construct reflecting physical and mental health. As Liver Transplantation (LT) is an expensive medical procedure requiring limited resources, HRQoL assessment among LT recipients is an important area of research. Malnutrition is almost universally present in patients undergoing LT. Studies on impact of LT on QoL have not looked at the nutritional aspects. Hitherto, there are no Indian data on QoL in relation to nutritional status in LT patients. Aims: To provide much needed data on the impact of nutrition status by methods recommended by European Society of Enteral and Parenteral Nutrition, 2006 on the HRQoL Assessment of patients awaiting LT. Methodology: 54 adult End Stage Liver Disease patients undergoing Living donor LT after taking informed consent were recruited in study period of September 2013–December 2014 from 3 multispecialty hospitals in Delhi and NCR, India. Ethical clearance was obtained from Lady Irwin College Ethical Committee. Nutrition assessment was performed by body mass index (BMI) for ascites (Campillo et al., 2006), Albumin, Subjective Global Assessment (SGA) by Detsky et al. (1987) and Anthropometry (Mid Arm Muscle Circumference (MAMC), Triceps Skin fold). HRQoL assessment by Short Form-36 has 8 Scales (Physical health, Role limitation by physical problem, Bodily Pain, General Health, Vitality, Social Functioning, Role limitation by Emotional problem and Mental Health) and two summary scores (Physical Component Summary and Mental Component Summary). Exclusion Criteria: Patients below 18 years of age (a completely different protocol for paediatric LT) and acute liver disease patients (require emergency LT). Results: The recipient evaluation of malnutrition showed 88.9% by SGA and 51.9% by MAMC. BMI for Ascites showed malnutrition in 35.2%, triceps evaluation depicted 27.8% of the patients as malnourished. QoL of the eight scales and the two summary scores of recipients were significantly lower than the age and sex matched control from the general population with a p-value <0.05. BMI for Ascites showed significantly lower physical functioning and physical component summary of HRQoL among malnourished patients. Also, low levels of albumin showed a significant positive correlation (r = 0.326, p = 0.016) with emotional wellbeing of the LT recipients. Lower HRQoL scores were also seen in malnourished Pre-LT patients by SGA and MAMC but the results were not significant.
http://dx.doi.org/10.1016/j.ijt.2015.09.039 Abstract #: ISOT2015-36 Post-transplant plasma cell hepatitis – Rejection or autoimmunity? Chunwei Walter Lai, Manjula Balasubramanian, Victor Navarro Einstein Healthcare Network, Philadelphia, PA, USA
http://dx.doi.org/10.1016/j.ijt.2015.09.040 Abstract #: ISOT2015-79 Plasma cell-rich cellular infiltrate in liver allograft biopsy: A case study and differential diagnostic consideration with review of literature S. Sivaselvam, Rajasekar Perumulla SRM Institutes for Medical Science No: 1. Jawaharlal Nehru Salai, Vadapalani, Chennai 600026, Tamil Nadu, India Background: Liver transplantation is the only effective therapy for end-stage liver disease. Acute cellular rejection (ACR) occurs in 50% to 75% of allografts post-transplantation. Infiltration of the portal tract by a mixture of lymphocytes, neutrophils and eosinophils together with endothelialitis and lymphocytic cholangitis is the histologic hallmark of ACR.
indian journal of transplantation 9 (2015) 61–64
proximal CpG regions of multiple invasion-suppressor miRNA genes are strongly associated with their transcriptional repression upon miR-494 overexpression, whereas enforced DNAdemethylation can abolish the repression. Furthermore, the TET1 knockdown shows a similar effect as miR-494 overexpression. Conversely, miR-494 inhibition or the enforced TET1 expression is able to restore invasion-suppressor miRNAs and inhibit miR-494 mediated HCC cell invasion. Conclusions: TET1 methylcytosine dioxygenase is a direct target of miR-494. This micro RNA can trigger gene silencing of multiple invasion-suppressor miRNAs via inhibiting genomic DNA demethylation via TET1, thereby leading to tumor vascular invasion. MiR-494 is a potential therapeutic target for HCC.
Conclusions: Patients showed malnutrition and low HRQoL before LT. HRQoL is poorer in patients with malnutrition during pre-liver transplant phase.
http://dx.doi.org/10.1016/j.ijt.2015.09.038
Background: Post-transplant plasma cell hepatitis (PT-PCH) is characterized histologically by marked interface inflammation and centrilobular plasma cell infiltrates, suggesting autoimmune hepatitis, and is associated with poor prognosis. However, autoimmune markers are not consistently present, raising the controversy whether PT-PCH represents a form of de novo autoimmune hepatitis or rejection. Aims: To review the diagnosis, clinical manifestations, and outcomes of PT-PCH from a single center between 2009 and 2015. Methodology: The search term ‘‘plasma cell hepatitis’’ was used to retrieve cases between 2009 and 2015 from the pathology database of liver transplant recipients. Clinical data were obtained from the electronic medical record. Results: We identified four cases of PT-PCH among 182 allograft liver recipients. Two cases, transplanted for primary biliary cirrhosis and alcoholic cirrhosis, were diagnosed with PT-PCH within four months post-transplant, with no acute cellular rejection (ACR) on biopsy. The other two cases, transplanted for Hepatitis C (HCV) cirrhosis and concomitant HCValcoholic cirrhosis, were diagnosed with PT-PCH greater than 18 months post-transplant, with ACR and PT-PCH on biopsy. These patients had documented medication noncompliance and sub-therapeutic tacrolimus levels. Only three cases had autoimmune workups (anti-smooth muscle antibody, IgG level), which were weakly positive. All four cases responded to pulse steroids and increase in baseline immunosuppression, with normalization of hepatic enzymes. All four patients are alive with good graft function (Graft survival: 11–54 months to date, with a median of 15 months). Conclusions: In these four cases, PT-PCH was diagnosed between 3.3 and 48 months after transplant. ACR was also seen in later onset cases, in which medication noncompliance may also have played a role. Outcomes were good with enhanced immunosuppression.
Abstract #: ISOT2015-24 Effect of malnutrition on health related quality of life (HRQoL) of patients awaiting liver transplantation Neha Bakshi, Kalyani Singh Lady Irwin College, New Delhi, India Background: HRQoL is a subjective multidimensional construct reflecting physical and mental health. As Liver Transplantation (LT) is an expensive medical procedure requiring limited resources, HRQoL assessment among LT recipients is an important area of research. Malnutrition is almost universally present in patients undergoing LT. Studies on impact of LT on QoL have not looked at the nutritional aspects. Hitherto, there are no Indian data on QoL in relation to nutritional status in LT patients. Aims: To provide much needed data on the impact of nutrition status by methods recommended by European Society of Enteral and Parenteral Nutrition, 2006 on the HRQoL Assessment of patients awaiting LT. Methodology: 54 adult End Stage Liver Disease patients undergoing Living donor LT after taking informed consent were recruited in study period of September 2013–December 2014 from 3 multispecialty hospitals in Delhi and NCR, India. Ethical clearance was obtained from Lady Irwin College Ethical Committee. Nutrition assessment was performed by body mass index (BMI) for ascites (Campillo et al., 2006), Albumin, Subjective Global Assessment (SGA) by Detsky et al. (1987) and Anthropometry (Mid Arm Muscle Circumference (MAMC), Triceps Skin fold). HRQoL assessment by Short Form-36 has 8 Scales (Physical health, Role limitation by physical problem, Bodily Pain, General Health, Vitality, Social Functioning, Role limitation by Emotional problem and Mental Health) and two summary scores (Physical Component Summary and Mental Component Summary). Exclusion Criteria: Patients below 18 years of age (a completely different protocol for paediatric LT) and acute liver disease patients (require emergency LT). Results: The recipient evaluation of malnutrition showed 88.9% by SGA and 51.9% by MAMC. BMI for Ascites showed malnutrition in 35.2%, triceps evaluation depicted 27.8% of the patients as malnourished. QoL of the eight scales and the two summary scores of recipients were significantly lower than the age and sex matched control from the general population with a p-value <0.05. BMI for Ascites showed significantly lower physical functioning and physical component summary of HRQoL among malnourished patients. Also, low levels of albumin showed a significant positive correlation (r = 0.326, p = 0.016) with emotional wellbeing of the LT recipients. Lower HRQoL scores were also seen in malnourished Pre-LT patients by SGA and MAMC but the results were not significant.
http://dx.doi.org/10.1016/j.ijt.2015.09.039 Abstract #: ISOT2015-36 Post-transplant plasma cell hepatitis – Rejection or autoimmunity? Chunwei Walter Lai, Manjula Balasubramanian, Victor Navarro Einstein Healthcare Network, Philadelphia, PA, USA
http://dx.doi.org/10.1016/j.ijt.2015.09.040 Abstract #: ISOT2015-79 Plasma cell-rich cellular infiltrate in liver allograft biopsy: A case study and differential diagnostic consideration with review of literature S. Sivaselvam, Rajasekar Perumulla SRM Institutes for Medical Science No: 1. Jawaharlal Nehru Salai, Vadapalani, Chennai 600026, Tamil Nadu, India Background: Liver transplantation is the only effective therapy for end-stage liver disease. Acute cellular rejection (ACR) occurs in 50% to 75% of allografts post-transplantation. Infiltration of the portal tract by a mixture of lymphocytes, neutrophils and eosinophils together with endothelialitis and lymphocytic cholangitis is the histologic hallmark of ACR.