- Email: [email protected]
P1274 : Supportive and palliative care in advanced liver disease: Patients’ needs and priorities
POSTERS diseases and different clinical settings. There is no validated tool to measure patient satisfaction with liver disease care. Aims of this study were: (1) To validate an 18-item survey for patient satisfaction with cancer care in patients with liver disease. (2) To compare satisfaction with care among patients attending liver clinics in the United States (U.S.) and in urban and rural China and to determine factors associated with satisfaction with liver disease care. Methods: Established adult patients with liver disease seen in the liver clinics at University of Michigan (UM), Peking University (PKU) and Hebei clinic were invited to participate in this study. The “Patient Satisfaction with Cancer Care” questionnaire (Jean-Pierre P, et al. Cancer. 2011; 117: 854–61) was tested for validity in patients with liver disease and for internal consistency. Results from UM, PKU and Hebei patients were compared. PercentofPatients 0%
20%
40%
60%
80%
100%
Healthconcernsunderstood
A B C
Treatedwithcourtesy
A B C
Includedindecisions
A B C
Toldhowtotakecareofdisease
A B C
Encouragedtotalk
A B C
Haveenoughtimewithdoctor
A B C
Questionsansweredtosatisfaction
A B C
Makinganappointmenteasy
A B C
Knowthenextstepinthecare
A B C
ConfidentincommunicatingwithliverƚĞĂŵ
A B C
Gettheadviceneeded
A B C
KnowwhotocontactforƋƵĞƐƚŝŽŶƐ
A B C
Receivedalltheservicesneeded
A B C
Satisfiedwiththecarereceived
A B C
GoodcommunicationsǁŝƚŚŝŶliverteam
A B C
ReceivedhighͲqualitycare
A B C
Wouldrecommendliverdoctor
A B C
Definitelyno
Unlikely
Maybe
A=UD B=W
Possiblyyes
Definitelyyes
C=Hebei
Results: A total of 990 patients were analyzed between 6/2014 and 9/2014, 395 UM, 398 PKU and 197 Hebei. Median age was 53 years and 59.8% were men. Most common liver disease was HCV at UM (43.5%) and HBV at PKU (67.8%) and Hebei (49.2%). 40.3% of patients at UM, 43.2% at PKU and 15.2% at Hebei had been seen at the liver clinics for >5 years. Exploratory factor analysis revealed a 1-dimensional measure with 17 of 18 items forming a coherent set explaining 73% of the variance in patient satisfaction at UM, 62% at PKU and 68% in Hebei. Reliability assessment revealed high internal consistency (0.97 at UM, 0.94 at PKU and 0.95 in Hebei). Mean total satisfaction score (maximum = 85) of patients at UM was higher than at PKU (78 vs. 66, P < 0.001); which in turn was higher than in Hebei (66 vs. 60, P < 0.001). Univariate analyses revealed that site, age, education, type of liver disease, liver disease knowledge, and duration of follow up at liver clinic were S836
associated with satisfaction with liver disease care. Multivariate logistic regression analysis revealed that site was the only factor associated with satisfaction with liver disease care. Conclusions: The Patient Satisfaction with Cancer Care survey is a valid tool for assessing satisfaction with liver disease care. Patient satisfaction with liver disease care in the U.S. is better than in urban China, which in turn is better than in rural China. Understanding these differences may improve patient satisfaction and outcomes. P1273 ACUTE PORTAL VEIN THROMBOSIS: CLINICAL FEATURES, DIAGNOSIS AND OUTCOMES AFTER 5 YEARS OF FOLLOW-UP A. Peixoto1 , M. Silva1 , P. Pereira1 , G. Macedo1 . 1 Gastroenterology, Centro Hospitalar de S˜ ao Jo˜ ao, Oporto, Portugal E-mail: [email protected] Background and Aims: Acute portal vein thrombosis (APVT) is a rare thrombotic obstruction of extrahepatic/intrahepatic portal venous system, associated with local and systemic risk factors. The clinical features APVT are poorly defined in the literature. The proportion that progress to chronic PVT and the influences of various treatments are unknown. The aim was to summarize the clinical features of APVT in a Portuguese reference center as well as their evolution over five years of follow-up. Methods: A total of 5 APVT patients admitted in our hospital from 2008 to 2009 were analyzed retrospectively. Results: APVT was diagnosed in 1 female and 4 males, with a mean age of 47 years old. Most patients (n = 4) presented with abdominal pain and tenderness. Only one patient had cirrhosis by the time of diagnosis. A hereditary thrombofilia was detected in 2 cases, an intra-abdominal infection in 1, a mieloproliferative disease in 1, and nocturnal paroxistic hemoglobinuria in another one. Diagnosis was confirmed by angio-CT in 3 patients (60%) and MRI in another 3 (40%). None of the patients underwent thrombolysis nor thrombectomy. Four patients (80%) were anticoagulated after diagnosis (warfarin). The one patient with cirrhosis was not anticoagulated because of previous hemorrhagic events, and died soon after. The mean duration time of anticoagulation was 39 months, and was effective in half of the patients (n = 4). Intestinal infarction was the solo complication reported in one patient. No other patient died within the period of follow-up. Conclusions: Our data reveals to be similar to that found in the literature, showing the value of following the available recommendations regarding diagnosis and therapeutics. It also confirms that anticoagulation therapy is the treatment of choice in this rare disease, with real impact on long time survival. P1274 SUPPORTIVE AND PALLIATIVE CARE IN ADVANCED LIVER DISEASE: PATIENTS’ NEEDS AND PRIORITIES B.M. Kimbell1 , M. Kendall1 , K. Boyd1 , S.A. Murray1 . 1 Primary Palliative Care Research Team, University of Edinburgh, Edinburgh, United Kingdom E-mail: [email protected] Background and Aims: The number of people dying with advanced liver disease is rising rapidly, yet little is known about the support needs and priorities of patients and their families as they approach the last year of life. Palliative care services are increasingly recognising the needs of non-cancer patients, but liver disease remains relatively neglected. This study aimed to illuminate the needs and experiences of people with advanced liver disease and those of their lay and professional carers to inform their appropriate supportive and palliative care. Specifically, it explored the dynamic physical, psychosocial, existential and information needs of patients and their lay and professional carers, and their use and perceptions of health, social and voluntary services.
Journal of Hepatology 2015 vol. 62 | S263–S864
POSTERS Methods: Multi-perspective, serial in-depth interviews. Patients with advanced liver disease of different aetiologies were recruited in hospital. Patients and their lay carers were interviewed up to 3 times over one year. Case-linked professionals were interviewed once. Interviews were recorded, transcribed and analysed using grounded theory techniques and NVivo 9 software. Results: 15 patients and their lay and professional carers were recruited, and 53 interviews conducted. Uncertainty emerged as the central factor dominating experiences across all dimensions of need, at all stages of the illness, and for all participants: patients, lay carers and professionals. This uncertainty related to the nature of the illness, the unpredictability of physical deterioration and prognosis, poor communication and information-sharing, and complexities of care. Current care arrangements were a poor fit with the high levels of physical and psychosocial need identified. The pervasive uncertainty meant that planning for deterioration and death was largely neglected. Conclusions: Uncertainty lies at the heart of the experiences of patients, lay and professional carers. As a result, the needs of this patient group are currently poorly met from diagnosis to bereavement. Uncertainty makes it especially important to plan ahead to help people live and, in due course, die as well as possible. Professionals must acknowledge and actively manage this uncertainty to improve liver patients’ quality of life and facilitate their appropriate and timely supportive and palliative care. P1275 STIGMA AND DISCRIMINATION IN VIRAL HEPATITIS – THE VOICE OF THE PATIENT C.N. Varaldo1 , J. Costa2 , A.R. Pascom3 , V.M. Postigo4 . 1 Director, Grupo Otimismo de Apoio a Portadores de Hepatite, Rio de Janeiro, 2 Departamento DST/AIDS/Hepatitis, 3 Departamento DAST/AIDES/Hepatites, Ministerio da Saude – Brazil, Brasilia, 4 Doutora em Teoria Psicanal´ıtica, Private, Rio de Janeiro, Brazil E-mail: [email protected] Background and Aims: Stigma and discrimination affect the quality of life of those infected with viral hepatitis. Few studies have evaluated the circumstances and the degree to which stigma and discrimination are present, but these studies are based on the view of health professionals. In the present study, we have tried to listen to the voice of the patient in order to find out from the own infected in what contexts, and with what intensity stigma and discrimination affect their quality of life. Methods: A questionnaire with 12 items was used to evaluate how the carrier of hepatitis feels stigmatized and discriminated against. 1,217 people infected with hepatitis B or C in Europe and Americas were interviewed, by the electronic system SurveyMonkey® . Participation was voluntary, anonymous, and each participant has accepted a term of consent. Results: The results show that 49.6% of those infected have suffered some kind of discrimination. Of the 94.1% who reported the infection to the family, 24.6% said that relatives started to avoid physical contact. Of the 73.7% who reported their condition to friends, 46.9% claims to have suffered discrimination and 23.8% were no longer invited to social events. Of the 57.4% who reported their condition to their partners, 33.3% had their relationships affected. 42.7% of infected had their sexual life affected. Of the 46.1% who reported their condition to work colleagues, 10.1% lost their jobs. Their self-image was affected in 55.8% of the cases and 41.4% felt ashamed of their condition. Although the survey indicates that 70% of health professionals attended carriers properly, 24.6% of those professionals have maintained a certain distance from the patient and 6.9% denied care to people infected with hepatitis. 21.2% also claim to have suffered some kind of discrimination at the dentists, 10.8% when they were taking tests at a laboratory and 17.1% claim to have been discriminated against in the beauty segment
(manicure / pedicure). Thus, 38.7% of respondents said that the population has some degree of rejection in the face of illness and that 33.5% of people do not show solidarity and understanding. Conclusions: The results are extremely important because they allow us to identify the situations and population segments where discriminatory behavior and stigma are more frequent, enabling the design of strategies and action plans to fight these adverse situations that much impair the quality of life of those infected with viral hepatitis. P1276 VITAMIN D SUPPLEMENTATION FOR CHRONIC LIVER DISEASE – A COCHRANE HEPATO-BILIARY GROUP SYSTEMATIC REVIEW G. Bjelakovic1,2 , D. Nikolova2 , M. Bjelakovic3 , C. Gluud2 . 1 Department of Internal Medicine – Gastroenterology and Hepatology, Medical Faculty, University of Nis, Nis, Republic of Serbia, 2 The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 3 Institute of Anatomy, Medical Faculty, University of Nis, Nis, Republic of Serbia E-mail: [email protected] Background and Aims: Vitamin D deficiency seems common in patients with chronic liver disease. Our aim was to assess the effects of vitamin D supplementation in patients with chronic liver disease. Methods: We searched databases until Feb 2014 for randomised clinical trials that compared vitamin D3 (cholecalciferol), vitamin D2 (ergocalciferol), 1a-hydroxyvitamin D (alfacalcidol), 25-hydroxyvitamin D (calcidiol), or 1,25-dihydroxyvitamin D (calcitriol) supplementation at any dose, duration, and route of administration versus placebo or no intervention in patients with any chronic liver disease. We conducted meta-analyses, using intention-to treat. We used risk ratios (RR) and risk difference (RD) for dichotomous outcomes, and mean difference for continuous outcomes, all with 95% confidence intervals (CI). Results: Six randomised trials with 325 participants provided data for analyses. All trials were with high risk of bias. Vitamin D supplementation had no significant effect on all-cause mortality (RD 0.01, 95% CI −0.02 to 0.04; 6 trials, 325 participants) (vitamin D3 800 to 2,000 IU; vitamin D2 14,286 to 21,429 IU; calcitriol 0.25 to 1 mg daily) or on liver-related mortality (RR 1.62, 95% CI 0.08 to 34.7; 1 trial, 18 participants). Vitamin D3 had no significant effect on rapid virological response (RR 0.24, 95% CI 0.01 to 4.58), but showed significant beneficial effect on early (RR 0.09, 95% CI 0.03 to 0.25) and sustained virological response (RR 0.23, 95% CI 0.11 to 0.52) in the two trials with 122 chronic hepatitis C patients. Calcitriol had no significant effect on acute cellular rejection in liver transplant recipients (RR 0.33, 95% CI 0.04 to 2.62; 1 trial, 75 participants). Vitamin D2 had no significant effect on liver function tests in patients with alcoholic cirrhosis (1 trial, 18 participants). Conclusions: The lack of sufficient number of trials and sample size, low quality and paucity of data prevents us from drawing firm conclusions regarding effects of vitamin D supplementation on the meta-analysed outcomes in chronic liver disease patients. Vitamin D supplements have no statistically significant effects on survival, liver-related mortality, adverse events, the number of patients with rapid virological response, or acute cellular rejection in liver transplant patients, but data were sparse. Vitamin D3 might improve early and sustained virological response in chronic hepatitis C patients. Further trials with low risks of systematic and random errors seem warranted.
Journal of Hepatology 2015 vol. 62 | S263–S864
S837
20%
40%
60%
80%
100%
Healthconcernsunderstood
A B C
Treatedwithcourtesy
A B C
Includedindecisions
A B C
Toldhowtotakecareofdisease
A B C
Encouragedtotalk
A B C
Haveenoughtimewithdoctor
A B C
Questionsansweredtosatisfaction
A B C
Makinganappointmenteasy
A B C
Knowthenextstepinthecare
A B C
ConfidentincommunicatingwithliverƚĞĂŵ
A B C
Gettheadviceneeded
A B C
KnowwhotocontactforƋƵĞƐƚŝŽŶƐ
A B C
Receivedalltheservicesneeded
A B C
Satisfiedwiththecarereceived
A B C
GoodcommunicationsǁŝƚŚŝŶliverteam
A B C
ReceivedhighͲqualitycare
A B C
Wouldrecommendliverdoctor
A B C
Definitelyno
Unlikely
Maybe
A=UD B=W
Possiblyyes
Definitelyyes
C=Hebei
Results: A total of 990 patients were analyzed between 6/2014 and 9/2014, 395 UM, 398 PKU and 197 Hebei. Median age was 53 years and 59.8% were men. Most common liver disease was HCV at UM (43.5%) and HBV at PKU (67.8%) and Hebei (49.2%). 40.3% of patients at UM, 43.2% at PKU and 15.2% at Hebei had been seen at the liver clinics for >5 years. Exploratory factor analysis revealed a 1-dimensional measure with 17 of 18 items forming a coherent set explaining 73% of the variance in patient satisfaction at UM, 62% at PKU and 68% in Hebei. Reliability assessment revealed high internal consistency (0.97 at UM, 0.94 at PKU and 0.95 in Hebei). Mean total satisfaction score (maximum = 85) of patients at UM was higher than at PKU (78 vs. 66, P < 0.001); which in turn was higher than in Hebei (66 vs. 60, P < 0.001). Univariate analyses revealed that site, age, education, type of liver disease, liver disease knowledge, and duration of follow up at liver clinic were S836
associated with satisfaction with liver disease care. Multivariate logistic regression analysis revealed that site was the only factor associated with satisfaction with liver disease care. Conclusions: The Patient Satisfaction with Cancer Care survey is a valid tool for assessing satisfaction with liver disease care. Patient satisfaction with liver disease care in the U.S. is better than in urban China, which in turn is better than in rural China. Understanding these differences may improve patient satisfaction and outcomes. P1273 ACUTE PORTAL VEIN THROMBOSIS: CLINICAL FEATURES, DIAGNOSIS AND OUTCOMES AFTER 5 YEARS OF FOLLOW-UP A. Peixoto1 , M. Silva1 , P. Pereira1 , G. Macedo1 . 1 Gastroenterology, Centro Hospitalar de S˜ ao Jo˜ ao, Oporto, Portugal E-mail: [email protected] Background and Aims: Acute portal vein thrombosis (APVT) is a rare thrombotic obstruction of extrahepatic/intrahepatic portal venous system, associated with local and systemic risk factors. The clinical features APVT are poorly defined in the literature. The proportion that progress to chronic PVT and the influences of various treatments are unknown. The aim was to summarize the clinical features of APVT in a Portuguese reference center as well as their evolution over five years of follow-up. Methods: A total of 5 APVT patients admitted in our hospital from 2008 to 2009 were analyzed retrospectively. Results: APVT was diagnosed in 1 female and 4 males, with a mean age of 47 years old. Most patients (n = 4) presented with abdominal pain and tenderness. Only one patient had cirrhosis by the time of diagnosis. A hereditary thrombofilia was detected in 2 cases, an intra-abdominal infection in 1, a mieloproliferative disease in 1, and nocturnal paroxistic hemoglobinuria in another one. Diagnosis was confirmed by angio-CT in 3 patients (60%) and MRI in another 3 (40%). None of the patients underwent thrombolysis nor thrombectomy. Four patients (80%) were anticoagulated after diagnosis (warfarin). The one patient with cirrhosis was not anticoagulated because of previous hemorrhagic events, and died soon after. The mean duration time of anticoagulation was 39 months, and was effective in half of the patients (n = 4). Intestinal infarction was the solo complication reported in one patient. No other patient died within the period of follow-up. Conclusions: Our data reveals to be similar to that found in the literature, showing the value of following the available recommendations regarding diagnosis and therapeutics. It also confirms that anticoagulation therapy is the treatment of choice in this rare disease, with real impact on long time survival. P1274 SUPPORTIVE AND PALLIATIVE CARE IN ADVANCED LIVER DISEASE: PATIENTS’ NEEDS AND PRIORITIES B.M. Kimbell1 , M. Kendall1 , K. Boyd1 , S.A. Murray1 . 1 Primary Palliative Care Research Team, University of Edinburgh, Edinburgh, United Kingdom E-mail: [email protected] Background and Aims: The number of people dying with advanced liver disease is rising rapidly, yet little is known about the support needs and priorities of patients and their families as they approach the last year of life. Palliative care services are increasingly recognising the needs of non-cancer patients, but liver disease remains relatively neglected. This study aimed to illuminate the needs and experiences of people with advanced liver disease and those of their lay and professional carers to inform their appropriate supportive and palliative care. Specifically, it explored the dynamic physical, psychosocial, existential and information needs of patients and their lay and professional carers, and their use and perceptions of health, social and voluntary services.
Journal of Hepatology 2015 vol. 62 | S263–S864
POSTERS Methods: Multi-perspective, serial in-depth interviews. Patients with advanced liver disease of different aetiologies were recruited in hospital. Patients and their lay carers were interviewed up to 3 times over one year. Case-linked professionals were interviewed once. Interviews were recorded, transcribed and analysed using grounded theory techniques and NVivo 9 software. Results: 15 patients and their lay and professional carers were recruited, and 53 interviews conducted. Uncertainty emerged as the central factor dominating experiences across all dimensions of need, at all stages of the illness, and for all participants: patients, lay carers and professionals. This uncertainty related to the nature of the illness, the unpredictability of physical deterioration and prognosis, poor communication and information-sharing, and complexities of care. Current care arrangements were a poor fit with the high levels of physical and psychosocial need identified. The pervasive uncertainty meant that planning for deterioration and death was largely neglected. Conclusions: Uncertainty lies at the heart of the experiences of patients, lay and professional carers. As a result, the needs of this patient group are currently poorly met from diagnosis to bereavement. Uncertainty makes it especially important to plan ahead to help people live and, in due course, die as well as possible. Professionals must acknowledge and actively manage this uncertainty to improve liver patients’ quality of life and facilitate their appropriate and timely supportive and palliative care. P1275 STIGMA AND DISCRIMINATION IN VIRAL HEPATITIS – THE VOICE OF THE PATIENT C.N. Varaldo1 , J. Costa2 , A.R. Pascom3 , V.M. Postigo4 . 1 Director, Grupo Otimismo de Apoio a Portadores de Hepatite, Rio de Janeiro, 2 Departamento DST/AIDS/Hepatitis, 3 Departamento DAST/AIDES/Hepatites, Ministerio da Saude – Brazil, Brasilia, 4 Doutora em Teoria Psicanal´ıtica, Private, Rio de Janeiro, Brazil E-mail: [email protected] Background and Aims: Stigma and discrimination affect the quality of life of those infected with viral hepatitis. Few studies have evaluated the circumstances and the degree to which stigma and discrimination are present, but these studies are based on the view of health professionals. In the present study, we have tried to listen to the voice of the patient in order to find out from the own infected in what contexts, and with what intensity stigma and discrimination affect their quality of life. Methods: A questionnaire with 12 items was used to evaluate how the carrier of hepatitis feels stigmatized and discriminated against. 1,217 people infected with hepatitis B or C in Europe and Americas were interviewed, by the electronic system SurveyMonkey® . Participation was voluntary, anonymous, and each participant has accepted a term of consent. Results: The results show that 49.6% of those infected have suffered some kind of discrimination. Of the 94.1% who reported the infection to the family, 24.6% said that relatives started to avoid physical contact. Of the 73.7% who reported their condition to friends, 46.9% claims to have suffered discrimination and 23.8% were no longer invited to social events. Of the 57.4% who reported their condition to their partners, 33.3% had their relationships affected. 42.7% of infected had their sexual life affected. Of the 46.1% who reported their condition to work colleagues, 10.1% lost their jobs. Their self-image was affected in 55.8% of the cases and 41.4% felt ashamed of their condition. Although the survey indicates that 70% of health professionals attended carriers properly, 24.6% of those professionals have maintained a certain distance from the patient and 6.9% denied care to people infected with hepatitis. 21.2% also claim to have suffered some kind of discrimination at the dentists, 10.8% when they were taking tests at a laboratory and 17.1% claim to have been discriminated against in the beauty segment
(manicure / pedicure). Thus, 38.7% of respondents said that the population has some degree of rejection in the face of illness and that 33.5% of people do not show solidarity and understanding. Conclusions: The results are extremely important because they allow us to identify the situations and population segments where discriminatory behavior and stigma are more frequent, enabling the design of strategies and action plans to fight these adverse situations that much impair the quality of life of those infected with viral hepatitis. P1276 VITAMIN D SUPPLEMENTATION FOR CHRONIC LIVER DISEASE – A COCHRANE HEPATO-BILIARY GROUP SYSTEMATIC REVIEW G. Bjelakovic1,2 , D. Nikolova2 , M. Bjelakovic3 , C. Gluud2 . 1 Department of Internal Medicine – Gastroenterology and Hepatology, Medical Faculty, University of Nis, Nis, Republic of Serbia, 2 The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 3 Institute of Anatomy, Medical Faculty, University of Nis, Nis, Republic of Serbia E-mail: [email protected] Background and Aims: Vitamin D deficiency seems common in patients with chronic liver disease. Our aim was to assess the effects of vitamin D supplementation in patients with chronic liver disease. Methods: We searched databases until Feb 2014 for randomised clinical trials that compared vitamin D3 (cholecalciferol), vitamin D2 (ergocalciferol), 1a-hydroxyvitamin D (alfacalcidol), 25-hydroxyvitamin D (calcidiol), or 1,25-dihydroxyvitamin D (calcitriol) supplementation at any dose, duration, and route of administration versus placebo or no intervention in patients with any chronic liver disease. We conducted meta-analyses, using intention-to treat. We used risk ratios (RR) and risk difference (RD) for dichotomous outcomes, and mean difference for continuous outcomes, all with 95% confidence intervals (CI). Results: Six randomised trials with 325 participants provided data for analyses. All trials were with high risk of bias. Vitamin D supplementation had no significant effect on all-cause mortality (RD 0.01, 95% CI −0.02 to 0.04; 6 trials, 325 participants) (vitamin D3 800 to 2,000 IU; vitamin D2 14,286 to 21,429 IU; calcitriol 0.25 to 1 mg daily) or on liver-related mortality (RR 1.62, 95% CI 0.08 to 34.7; 1 trial, 18 participants). Vitamin D3 had no significant effect on rapid virological response (RR 0.24, 95% CI 0.01 to 4.58), but showed significant beneficial effect on early (RR 0.09, 95% CI 0.03 to 0.25) and sustained virological response (RR 0.23, 95% CI 0.11 to 0.52) in the two trials with 122 chronic hepatitis C patients. Calcitriol had no significant effect on acute cellular rejection in liver transplant recipients (RR 0.33, 95% CI 0.04 to 2.62; 1 trial, 75 participants). Vitamin D2 had no significant effect on liver function tests in patients with alcoholic cirrhosis (1 trial, 18 participants). Conclusions: The lack of sufficient number of trials and sample size, low quality and paucity of data prevents us from drawing firm conclusions regarding effects of vitamin D supplementation on the meta-analysed outcomes in chronic liver disease patients. Vitamin D supplements have no statistically significant effects on survival, liver-related mortality, adverse events, the number of patients with rapid virological response, or acute cellular rejection in liver transplant patients, but data were sparse. Vitamin D3 might improve early and sustained virological response in chronic hepatitis C patients. Further trials with low risks of systematic and random errors seem warranted.
Journal of Hepatology 2015 vol. 62 | S263–S864
S837