[in Japanese]

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Introduction: Hepatitis C related cirrhosis (LC-C) is a condition of low hepatic functional reserve and a high risk of hepatocarcinogenesis. The sustained virological response (SVR) rate to interferon (IFN) therapy is low in patients with LC-C. Moreover, its management is difficult because of complications such as portal hypertension and hepatocellular carcinoma (HCC).
Objective: To retrospectively assess virologic outcomes of IFN treatment and development of HCC and/or gastroesophageal varices in 25 LC-C patients from 2005 to 2014.
Results: SVR rates were 100% in patients with low viral load of HCV genotype 1b and high viral load of HCV genotype 2a, 66.7% in patients with high viral load of HCV genotype 2b, and 29.4% in patients with high viral load of HCV genotype 1b. Patients who achieved SVR showed significant reductions in serum alanine aminotransferase and alpha-fetoprotein levels. Prognosis was relatively poor in patients with HCC and/or IFN null responders. Partial splenic embolization before IFN therapy was useful by increasing platelet count.
Conclusions: IFN treatment associated with no, if any, little adverse event could provide a good prognosis in LC-C patients, in case HCC development and/or exacerbation of portal hypertension would be well controlled.

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We investigated clinical features and therapeutic effect of tolvaptan in diuretic-resistant patients with refractory hydrothorax and/or ascites. Data were collected from 22 hospitalized patients with cirrhosis (HBV-positive 1; HCV-positive 8; alcoholic 2; others 11) after adding tolvaptan (3.75-7.5 mg/day) to conventional diuretics. A follow up assessment was conducted 1 week post-tolvaptan treatment for all the patients. Fifity-five percent of the patients decreased their body weight after the administration of tolvaptan. Tolvaptan was also effective against patients with liver failure and portal vein thrombosis. Serum BUN levels of no clinical improvement group were significantly higher than those of improvement group, which is reflecting the state of the underfilling. Furthermore, urine Na concentrations of no clinical improvement group were significantly lower. In addition, we experienced a case where the drinking water restriction exhibited a remarkable effect under tolvaptan treatment. Taking these findings together, it can be speculated that tolvaptan might not be effective on the pathogenesis of underfilling, and serum BUN and urine Na concentration could predict the therapeutic effect of tolvaptan.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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