Hemodynamics in the immediate post-transplantation period in alcoholic and viral cirrhosis

AIM:To study the hemodynamics in the immediate post transplant period and compare patients with alcoholic vs viral cirrhosis. METHODS:Between 2000-2003,38 patients were transplanted for alcoholic cirrhosis and 28 for postviral cirrhosis.Heart rate(HR),central venous pressure(CVP), mean arterial pressure(MAP),pulmonary capillary wedge pressure(PCWP),cardiac index(CI),systemic vascular resistance index(SVRI),pulmonary artery pressure(PAP),and pulmonary vascular resistance index(PVRI)were measured immediately and 24 h post transplantation. RESULTS:Hyperdynamic circulation persisted at 24 hfollowing transplantation with an elevated CI of 5.4± 1.3 L/(min×m 2 )and 4.9±1.0 L/(min×m 2 )in the viral and alcoholic groups,respectively,and was associated with a decreased SVRI.Within the first 24 h, there was a significant decrease in HR and increase in MAP;the extent of the change was similar in both groups.The CVP,PCWP,and SVRI increased,and CI decreased in the viral patients,but not the alcoholic patients.Alcoholics showed a lower PVRI(119±52 dynes/(cm 5 ×m 2 )vs 166±110 dynes/(cm5×m2),P< 0.05)and PAP(20±7 mmHg vs 24±7 mmHg,P< 0.05)compared to the viral group at 24 h. CONCLUSION:Hyperdynamic circulation persists in the immediate post-transplant period with a faster improvement in the viral group.Alcoholic patients have a more pronounced pulmonary vasodilatation.

Severe autoimmune hepatitis triggered by varicella zoster infection

Autoimmune hepatitis (AIH) is a chronic disease of unknown etiology that is characterized by the presence of circulatory autoantibodies and inflammatory histological changes in the liver. Although the pathogenesis of AIH is not known, it is thought that, in a genetically predisposed individual, environmental factors such as viruses can trigger the autoimmune process. Herpes simplex virus, Epstein-Barr virus, measles virus, and hepatitis viruses are thought to play a role in the etiology of AIH. Proteins belonging to these viruses may be similar to the amino acid chains of different autoantigens in the liver, this causes immune cross reactions and liver tissue damage. We report a case of severe AIH following varicella zoster infection in a 23-year-old man, and speculate that, based on the molecular mimicry hypothesis, the liver damage was caused by an immune cross reaction to the viral proteins. Varicella-zoster-induced AIH has not been reported previously.