Now available online
Current Issue February 2012, Vol. 56, No. 2
Issue Highlights
Hepatotoxicity associated with statins: reports of idiosyncratic liver injury post-marketingStatins can increase ALT concentrations in 10% of patients without liver disease, in 1% of them more than three times the upper limit of normal. Many physicians, including hepatologists, have a bias against statins in patients with liver disease. Bjornsson et al. present a 22-years span report on adverse reactions suspected to be due to statins from the Swedish Adverse Drug Reactions Advisory Committee and analyze it by RUCAM methodology. A statin-related DILI (drug-induced liver injury) was reported in 1.2/100,000 users. Most patients experienced liver injury 3-4 months after start of therapy. Atorvastatin was mostly associated with cholestatic liver injury whereas hepatocellular injury was more common with simvastatin. Two patients died of acute liver failure, one underwent liver transplantation and 25 (34%) had jaundice. In summary, the elevations of ALT values that commonly occur at the start of statin therapy have no meaning with regard to hepatotoxicity. Idiosyncratic liver injury associated with statins is rare but can be severe.
Midodrine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot studySplanchnic arterial vasodilatation plays an important role in the development of ascites in cirrhotics. In patients with refractory ascites, the a1-adrenergic agonist midodrine, along with octreotide and albumin, has been shown to better control ascites in the short term. This randomized pilot study evaluates the effects of long term administration of midodrine in cirrhotics with refractory/recurrent ascites. Forty patients were randomized to receive midodrine plus standard medical therapy (n = 20) or standard medical therapy alone (n = 20). After three months, the addition of midodrine was able to significantly improve systemic hemodynamic and to better control ascites (p = 0.013) compared to standard medical therapy. Frequency of various complications at the end of follow-up was not different in the two groups, but the mortality rate in the standard medical therapy group was significantly higher than the midodrine group (p <0.046).
Special Sections
Clinical Application of Basic Science
New horizons for stem cell therapy in liver disease
There is an increasing range of potential applications of stem cells in liver diseases, with many clinical studies already undertaken. However, despite the role of stem cells in liver damage and repair as well as encouraging results using stem cells as cell therapy in pre-clinical animal models, the precise mode of action and optimal cell usage have not been completely defined. In a comprehensive overview Forbes et al. share the excitement but also challenges of this frontier in Hepatology, offering the potential for a range of new therapeutic interventions.
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TACE treatment in hepatocellular carcinoma: what should we do now?27 January 2012
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Genetic testing for hepatocellular carcinoma: an ambitious goal still to achieve27 January 2012
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Liver transplantation for severe alcoholic hepatitis saves lives27 January 2012
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At the cancer steering wheel: Defining key genomic drivers of liver cancer with next generation sequencing27 January 2012
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Post-liver transplantantion graft biopsies should not be used to assess the IL28B donor genotype in HCV recipients27 January 2012
About EASL
In the forty plus years since EASL was founded, it has grown from a small organization that played host to 70 participants at its first meeting, to becoming the leading liver association in Europe. EASL attracts the foremost hepatology experts as members and has an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in european liver policy.
For more information about EASL (http://www.easl.eu)
