The global incidence of nonalcoholic fatty liver disease(NAFLD)is escalating considerably.NAFLD covers a range of liver conditions from simple steatosis to the more severe form known as nonalcoholic steatohepatitis,wh...The global incidence of nonalcoholic fatty liver disease(NAFLD)is escalating considerably.NAFLD covers a range of liver conditions from simple steatosis to the more severe form known as nonalcoholic steatohepatitis,which involves chronic liver inflammation and the transformation of hepatic stellate cells into myofibroblasts that generate excess extracellular matrix,leading to fibrosis.Hepatocyte ballooning is a key catalyst for fibrosis progression,potentially advancing to cirrhosis and its decompensated state.Fibrosis is a critical prognostic factor for outcomes in patients with NAFLD;therefore,those with substantial fibrosis require timely intervention.Although liver biopsy is the most reliable method for fibrosis detection,it is associated with certain risks and limitations,particularly in routine screening.Consequently,various noninvasive diagnostic techniques have been introduced.This review examines the increasing prevalence of NAFLD,evaluates the noninvasive diagnostic techniques for fibrosis,and assesses their efficacy in staging the disease.In addition,it critically appraises current and emerging antifibrotic therapies,focusing on their mechanisms,efficacy,and potential in reversing fibrosis.This review underscores the urgent need for effective therapeutic strategies,given the dire consequences of advanced fibrosis.展开更多
The aim of this review is to assess the evidence regarding racial differences in the prevalence and severity of nonalcoholic fatty liver disease(NAFLD).We reviewed the published literature that reported prevalence,sev...The aim of this review is to assess the evidence regarding racial differences in the prevalence and severity of nonalcoholic fatty liver disease(NAFLD).We reviewed the published literature that reported prevalence,severity,and genetic associations of NAFLD in different ethnic groups.The metabolic syndrome(MetS)has been associated with NAFLD,but each component of the MetS is present in various races in different percentages and their effect on NAFLD appears to be dissimilar.An elevated triglyceride(TG)level seems to have the strongest association with NAFLD.The latter is more prevalent in Hispanic patients;Blacks have lower TG levels and a lower NAFLD prevalence,compared to Caucasians or Hispanics.The severity of liver fibrosis is lower in some,but not all biopsy-based studies of Black patients.No study has evaluated the severity of liver disease controlling for the individual components of MetS,especially TG.Important racial differences in the prevalence of selected genetic polymorphisms,particularly PNPLA-3 and MBOAT7 have been documented,together with their effects on the prevalence of liver steatosis and fibrosis.Data on overall and liver mortality have found no significant differences according to race/ethnicity,with the possible exception of one paper reporting lower cirrhosis mortality in Black patients.We conclude that NAFLD is more prevalent in Hispanics and less in Blacks.This is supported by differences in key genetic polymorphisms associated with hepatic fat storage.However,there is presently insufficient evidence to firmly conclude that race,per se,plays a role in the development of liver fibrosis and its complications.Further studies,appropriately controlled for diet,exercise,and individual MetS parameters are needed.展开更多
HCC prognosis after OLT is associated with criteria related to the number and size. However, the degree of differentiation and efficacy of locoregional therapies may also influence outcome. Aim: Characterize patients ...HCC prognosis after OLT is associated with criteria related to the number and size. However, the degree of differentiation and efficacy of locoregional therapies may also influence outcome. Aim: Characterize patients with and without HCC and compare outcomes according to tumor characteristics. Methods: Retrospective query of an electronic medical record of 328 patients transplanted at California Pacific Medical Center (CPMC) in 2001-2007. HCC was defined by pre-OLT listing data as well as the finding of a tumor consistent with HCC at liver explant. Milan and UCSF criteria were applied to the lesions as described by pathology upon explant examination. Results: 328 patients were evaluated, with 109 liver malignancies, 103 females (26 (25%) HCC) and 225 males (83 (37%) HCC p = 0.04). HCC patients were older (56 ± 7.2 yr) than non HCC patients (51 ± 9.2, p 0.001). The age of the donor and cold ischemia time was not different in the 2 groups. Survival was shorter in HCC (mean 984 ± 599 days) vs. non HCC (1103 ± 642) but not statistically significant (p = 0.10). Kaplan Meier survivals were superposable when comparing patients with or without malignancy and when patients with low (≤22) vs. high MELD (>22) were compared. Survival curves in patients that fulfilled Milan vs. UCSF criteria were identical. However, more patients outside Milan died of metastatic disease (5/6, 83%) vs. within Milan (6/14, 43%, p = 0.01). Cox proportional hazards regression showed that MELD, but not malignancy, differentiation or necrosis, was associated with mortality;HR = 6% (95% C.I. 1%-10%) per additional MELD point (p = 0.02). 69 pts had TACE pre-OLT, 17 had RFA ± any other modality. There was no difference in survivals in pts who received any locoregional therapy vs. those who did not (p展开更多
文摘The global incidence of nonalcoholic fatty liver disease(NAFLD)is escalating considerably.NAFLD covers a range of liver conditions from simple steatosis to the more severe form known as nonalcoholic steatohepatitis,which involves chronic liver inflammation and the transformation of hepatic stellate cells into myofibroblasts that generate excess extracellular matrix,leading to fibrosis.Hepatocyte ballooning is a key catalyst for fibrosis progression,potentially advancing to cirrhosis and its decompensated state.Fibrosis is a critical prognostic factor for outcomes in patients with NAFLD;therefore,those with substantial fibrosis require timely intervention.Although liver biopsy is the most reliable method for fibrosis detection,it is associated with certain risks and limitations,particularly in routine screening.Consequently,various noninvasive diagnostic techniques have been introduced.This review examines the increasing prevalence of NAFLD,evaluates the noninvasive diagnostic techniques for fibrosis,and assesses their efficacy in staging the disease.In addition,it critically appraises current and emerging antifibrotic therapies,focusing on their mechanisms,efficacy,and potential in reversing fibrosis.This review underscores the urgent need for effective therapeutic strategies,given the dire consequences of advanced fibrosis.
文摘The aim of this review is to assess the evidence regarding racial differences in the prevalence and severity of nonalcoholic fatty liver disease(NAFLD).We reviewed the published literature that reported prevalence,severity,and genetic associations of NAFLD in different ethnic groups.The metabolic syndrome(MetS)has been associated with NAFLD,but each component of the MetS is present in various races in different percentages and their effect on NAFLD appears to be dissimilar.An elevated triglyceride(TG)level seems to have the strongest association with NAFLD.The latter is more prevalent in Hispanic patients;Blacks have lower TG levels and a lower NAFLD prevalence,compared to Caucasians or Hispanics.The severity of liver fibrosis is lower in some,but not all biopsy-based studies of Black patients.No study has evaluated the severity of liver disease controlling for the individual components of MetS,especially TG.Important racial differences in the prevalence of selected genetic polymorphisms,particularly PNPLA-3 and MBOAT7 have been documented,together with their effects on the prevalence of liver steatosis and fibrosis.Data on overall and liver mortality have found no significant differences according to race/ethnicity,with the possible exception of one paper reporting lower cirrhosis mortality in Black patients.We conclude that NAFLD is more prevalent in Hispanics and less in Blacks.This is supported by differences in key genetic polymorphisms associated with hepatic fat storage.However,there is presently insufficient evidence to firmly conclude that race,per se,plays a role in the development of liver fibrosis and its complications.Further studies,appropriately controlled for diet,exercise,and individual MetS parameters are needed.
文摘HCC prognosis after OLT is associated with criteria related to the number and size. However, the degree of differentiation and efficacy of locoregional therapies may also influence outcome. Aim: Characterize patients with and without HCC and compare outcomes according to tumor characteristics. Methods: Retrospective query of an electronic medical record of 328 patients transplanted at California Pacific Medical Center (CPMC) in 2001-2007. HCC was defined by pre-OLT listing data as well as the finding of a tumor consistent with HCC at liver explant. Milan and UCSF criteria were applied to the lesions as described by pathology upon explant examination. Results: 328 patients were evaluated, with 109 liver malignancies, 103 females (26 (25%) HCC) and 225 males (83 (37%) HCC p = 0.04). HCC patients were older (56 ± 7.2 yr) than non HCC patients (51 ± 9.2, p 0.001). The age of the donor and cold ischemia time was not different in the 2 groups. Survival was shorter in HCC (mean 984 ± 599 days) vs. non HCC (1103 ± 642) but not statistically significant (p = 0.10). Kaplan Meier survivals were superposable when comparing patients with or without malignancy and when patients with low (≤22) vs. high MELD (>22) were compared. Survival curves in patients that fulfilled Milan vs. UCSF criteria were identical. However, more patients outside Milan died of metastatic disease (5/6, 83%) vs. within Milan (6/14, 43%, p = 0.01). Cox proportional hazards regression showed that MELD, but not malignancy, differentiation or necrosis, was associated with mortality;HR = 6% (95% C.I. 1%-10%) per additional MELD point (p = 0.02). 69 pts had TACE pre-OLT, 17 had RFA ± any other modality. There was no difference in survivals in pts who received any locoregional therapy vs. those who did not (p
