Diminishing Use of Liver Biopsy among Liver Transplant Recipients for Hepatitis C

Background and Aims:Hepatitis C virus (HCV) cirrhosis is the leading indication for liver transplantation in the United States and recurrent HCV following liver transplantation is a major cause of allograft loss and mortality.Liver biopsies are commonly used to identify recurrent HCV and determine the need for antiviral therapy.The introduction of directacting antiviral agents (DAAs) has changed the management of recurrent HCV infection.This study aimed to describe the role of liver biopsies in liver transplant recipients with HCV after the introduction of DAAs.Methods:A retrospective analysis was performed looking at the rate of liver biopsies post-liver transplantation for HCV.The analysis included 475 adult liver transplants for hepatitis C performed at the University of California,Los Angeles from January 1,2006 to October 1,2015.Patients were divided into two eras,pre-and post-introduction of DAAs on December 1,2013.Results:In the era before the introduction of DAAs,the percentage of patients biopsied was significantly higher compared to the era after the introduction of DAAs (56.1% vs.26.9%,p < 0.001).Conclusion:The introduction of DAAs has changed the management of liver biopsy following liver transplantation and the management of recurrent HCV.Given that DAAs are well tolerated and have high efficacy,liver biopsies are no longer routinely used to justify the use antiviral therapy following liver transplantation.

Preneoplastic foci in mice fed diethyl 1, 4-dihydro, 1,4,6-trimethyl 3,5-pyridine decarboxylate are resistant toprotoporphyrin accumulation

It has been shown that preneoplastic liver cell foci and hepatic nodules generated by thioacetamide(TAA)in drug-primed mice,which were first fed diethyl 1,4-dihydro,1,4,6-trimethyl 3,5-pyridine decarboxylate(DDC)or griseofulvin(GF)for 5 months were resistant to protoporphyrin accumulation.[1]DDC or GF are potent porphyrinogenic drugs and accumulate protoporphyrin in the mouse liver.Although DDC or GF are withdrawn for 1 month,when treated with TAA,the nodules formed on the 5th or 7th day of treatment were devoid of protoporphyrin deposits.Feeding DDC or GF for 8 months induced liver tumors which were devoid of protoporphyrin deposits.In contrast,the surrounding liver tissue contained numerous protoporphyrin deposits.This could be attributed to the decreased activity of delta-aminolevulinate synthase,the first rate-limiting enzyme in protoporphyrin synthesis.