Phenprocoumon for prevention of shunt occlusion after transjugular intrahepatic portosystemic stent shunt: A randomized trial

Abstracts Mutations disease

in the following

hepatitis liver

B virus

precore/core

gene

and

139 core

promoter

in patients

with

severe

recurrent

transplantation

McMillan J.S.; Bowden D.S.; Angus P.W.; McCaughan G.W.; Locarnini S.A. Victorian hfhct. Dis. Refl Lab., Fairjeld Hospital, Yarra Bend Road, Fairfield. Vir. 3078 HEPATOLOGY 1996 24/6 (1371-1378) Recurrent hepatitis B virus (HBV) infection is a major problem in patients undergoing liver transplantation. Previously. we reported that infection with HBV strains containing a mutation in the precore region (G-to-A at nucleotide 1896) was associated with severe recurrent disease posttransplantation. In this study we investigated other mutations in the precore/core gene and core promoter which may be associated with this severe recurrence. The precore/core gene and core promoter of HBV from pre- and post-transplantation sera of 15 patients with HBV recurrence were amplified by polymerase chain reaction (PCR) and sequenced. Pre- and post-transplant sequences were very similar for each patient. HBV from patients who developed severe recurrence had significantly more mutations in both the nucleotide (P < 0.05) and predicted amino acid (P ~0.05) sequences of the precore:core gene, but not in the core promoter, than virus from patients with mild recurrence. There was also an apparent link between severe disease and HBV strains of genotype D (Pi 0.05). The number of nucleotide and amino acid mutations in the precore:core gene was strongly associated with the presence of the precore mutation (P
Phenprocoumon for shunt: A randomized

prevention trial

of

shunt

occlusion

after

transjugular

intrahepatic

portosystemic

stent

Sauer P.; Theilmann L.; Herrmann S.; Bruckner T.; Roeren T.; Richter G.: Stremmel W.; Stiehl A. Department q/’ Internal Medicine, Uniwrsit~~ of’ Heidelberg, Bergheimer Str. 58, D-69 115 Heidelberg HEPATOLOGY 1996 2416 (1433-1436) Development of stenosis or occlusion of the transjugular intrahepatic portosystemic stent shunt (TIPSS) is one of the major limiting factors in the long-term viability of this procedure. The efficacy of anticoagulation with heparin which is used in different centers is still unclear. In the present study, we evaluated the effect of phenprocoumon on shunt patency after TIPSS placement using Palmaz stents; 49 patients with Child’s A and B cirrhosis, who underwent successful TIPSS placement were randomized into the treatment group (n = 24) who received phenprocoumon and a control group (n = 25). After 11- 13 weeks, all patients were admitted and had a reevaluation that included control angiography by transjugular approach. Phenprocoumon treatment was stopped after the first reevaluation and both groups were followed for 1 year after randomization. During the 3-month treatment period 1 I of 22 patients of the treatment group and 12 of 23 patients of the control group required reintervention because of an increased portosystemic gradient. Five of the I2 patients in the control group showed complete occlusion of the shunt, whereas no occlusion in the treatment group was observed (P < 0.05). During the mean follow-up of 8 months after the treatment was stopped, in both groups stenosis occurred in 50% of patients, but no further occlusion of the stent was observed. These data indicate that occlusion of the stent is related to thrombosis, whereas stenosis does not appear to be dependent on blood coagulation. In patients with preserved liver function occlusion of the shunt may be prevented by phenprocoumon treatment in the first 3 months after TIPSS placement. Thereafter shunt occlusion was not observed and further phenprocoumon treatment seemed unnecessary. 96363978