Green tea (Camellia sinensis)-associated hepatotoxicity is reported. However, the presence of alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated drug-induced liver injury (DILI) is unkno...Green tea (Camellia sinensis)-associated hepatotoxicity is reported. However, the presence of alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated drug-induced liver injury (DILI) is unknown. A previously healthy woman with alpha-1 antitrypsin MZ phenotype who took SlimQuick?, an herbal supplement containing green tea extract, developed severe hepatotoxicity requiring corticosteroid treatment. Green tea-associated hepatotoxicity is reviewed and alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated DILI is discussed. Liver biopsy demonstrated marked inflammation with necrosis suggestive of toxic injury with diffuse alpha-1 antitrypsin globule deposition on immunostaining. Corticosteroid therapy resulted in rapid clinical improvement. Alpha-1 antitrypsin MZ phenotype may increase vulnerability to herbal hepatotoxicity.展开更多
Aim:We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma recurrence.Methods:We reviewed the data for 26 patients who had tumor recurrence after d...Aim:We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma recurrence.Methods:We reviewed the data for 26 patients who had tumor recurrence after deceased donor liver transplant for hepatocellular carcinoma at the Johns Hopkins Hospital from January 2005 to December 2015.Results:In total,88%of recipients were males.The mean age was 59 years.On explant,poor differentiation was detected in 43%,while 73%had microvascular invasion.Overall,62%were diagnosed to be outside of Milan criteria.Out of these,15%met the criteria for downstaging.Twenty(77%)patients had pre-transplant alpha fetoprotein levels≥20 ng/mL.In 54%of patients,the location of hepatocellular carcinoma(HCC)recurrence was extrahepatic,followed by intrahepatic in 31%and both intra-and extrahepatic in 15%.The post-transplant tumor recurrence was diagnosed at a mean of 427 days(range 34-1502).Fifty percent of HCC recurrences were diagnosed within one year following liver transplant.Twenty(77%)patients received treatment for their recurrent HCC:external radiation(n=10),surgical resections(n=8;brain 4,spine 2,bone 1,and Whipple surgery 1),sorafenib(n=7),locoregional therapy(n=5).Overall,24 out of 26(92%)recipients died within four years after the transplant.Conclusion:HCC recurrence after liver transplant is infrequent.More than fifty percent of HCC recurrences following liver transplant are extrahepatic.Despite better recipient selection for liver transplant,the curative options are limited in recurrent cases and associated with extremely poor outcomes.展开更多
基金Supported by in part by Grant Number 1 K23 DK089008-01 from the National Institutes of Health(NIH)National Institute of Diabetes and Digestive and Kidney Diseases to Ayse L Mindikoglu,MD,MPH and its contents are solely the responsibility of the authors and do not necessarily represent the off icial views of the National Institute of Diabetes and Digestive and Kidney Diseases or the NIH
文摘Green tea (Camellia sinensis)-associated hepatotoxicity is reported. However, the presence of alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated drug-induced liver injury (DILI) is unknown. A previously healthy woman with alpha-1 antitrypsin MZ phenotype who took SlimQuick?, an herbal supplement containing green tea extract, developed severe hepatotoxicity requiring corticosteroid treatment. Green tea-associated hepatotoxicity is reviewed and alpha-1 antitrypsin MZ phenotype as a predisposing factor to green tea-associated DILI is discussed. Liver biopsy demonstrated marked inflammation with necrosis suggestive of toxic injury with diffuse alpha-1 antitrypsin globule deposition on immunostaining. Corticosteroid therapy resulted in rapid clinical improvement. Alpha-1 antitrypsin MZ phenotype may increase vulnerability to herbal hepatotoxicity.
基金This Research is partially supported by NIH GrantsR44 CA165312-Development of a urine test for the early detection of liver cancer.U01 CA230690-Pathway Specific Functional Biomarkers for the Early Detection of Liver Cancer
文摘Aim:We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma recurrence.Methods:We reviewed the data for 26 patients who had tumor recurrence after deceased donor liver transplant for hepatocellular carcinoma at the Johns Hopkins Hospital from January 2005 to December 2015.Results:In total,88%of recipients were males.The mean age was 59 years.On explant,poor differentiation was detected in 43%,while 73%had microvascular invasion.Overall,62%were diagnosed to be outside of Milan criteria.Out of these,15%met the criteria for downstaging.Twenty(77%)patients had pre-transplant alpha fetoprotein levels≥20 ng/mL.In 54%of patients,the location of hepatocellular carcinoma(HCC)recurrence was extrahepatic,followed by intrahepatic in 31%and both intra-and extrahepatic in 15%.The post-transplant tumor recurrence was diagnosed at a mean of 427 days(range 34-1502).Fifty percent of HCC recurrences were diagnosed within one year following liver transplant.Twenty(77%)patients received treatment for their recurrent HCC:external radiation(n=10),surgical resections(n=8;brain 4,spine 2,bone 1,and Whipple surgery 1),sorafenib(n=7),locoregional therapy(n=5).Overall,24 out of 26(92%)recipients died within four years after the transplant.Conclusion:HCC recurrence after liver transplant is infrequent.More than fifty percent of HCC recurrences following liver transplant are extrahepatic.Despite better recipient selection for liver transplant,the curative options are limited in recurrent cases and associated with extremely poor outcomes.
