[in Japanese]

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A total of 39 hepatitis C virus-positive cirrhotic patients with hypersplenism received partial splenic embolization (PSE). Because PSE increased platelet and white blood cell counts compered to baseline levels, all the patients were treated with interferon (IFN)-based therapy. The transient virological response (TVR) rate was 53.8% (21 of 39). In univariate analysis, the significant factors associated with TVR were as follows: age ≤ 62 years, platelet counts ≥ 8.3×10⁴/µl, alpha-fetoprotein levels ≤ 18.4 ng/dl, IL28B (rs8099917) TT genotype, and telaprevir-based therapy. The sustained virological response (SVR) rate was 37.8% (14 of 37). In univariate analysis, the significant factors associated with SVR were as follows: cholinesterase levels ≥ 180 U/l, IL28B TT genotype, platelet counts ≥ 8.3×10⁴/µl, albumin levels ≥ 3.8 g/dl, age ≤ 61 years, and indocyanine green retention rates at 15 min ≤ 30.5%. In patients who achieved TVR, IFN-based therapy increased albumin and cholinesterase levels and decreased alpha-fetoprotein levels, compared to those of baseline levels. The incidence of hepatocellular carcinoma was lower in patients who achieved TVR than in those who failed. In conclusion, if the cirrhotic patients with hypersplenism would achieve TVR by IFN-based therapy after PSE, improvement of liver functions and prevention of hepatocarcinogenesis might be expected.

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Main object of the treatment for intractable ascites is a palliative care rather than a radical treatment, because a radical treatment often leads to a decrease in patient's quality of life. Since the peritoneo-venous shunt is widely accepted as a palliative care for intractable ascites, we analyzed sixty-two patients who had been given a peiritoneo-venous shunt between 1998 and 2012. We evaluated overall survival (OS), laboratory data relating to the performance of the peritoneovenous shunt, urine volume, body weight and abdomen girth. Cohort of the patients was divided into two groups; the liver cirrhosis (LC) group and the malignant ascites group. The former group was further divided into the Child-Pugh grade B (CP-B) sub-group and the C-P grade C (CP-C) sub-group. The LC group and the CP-B sub-group exhibited significantly longer OS than any other group. None of the groups indicated any remarkable changes in laboratory data relating to performance of the peritoneovenous shunt. However, there was a significant increase in urine volume and a significant decrease in abdomen girth fourteen days after the procedure for all the groups. In conclusion, irrespective of etiology and/or functional classification of LC, peritoneovenous shunt could improve the quality of life for patients with intractable ascites.

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[in Japanese]

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[in Japanese]

View full abstract