We conducted a questionnaire-based survey on referral indications for liver transplantation. Questionnaire was sent to each regional clinics/hospitals that has referred at least one liver transplant candidate to our institution in the past. Two hundred and fifty-two such clinics/hospitals were identified. Among them, 103 (40.8%) returned their responses. The majority were hepatologists (47%), followed by gastroenterologists (29%) and surgeons (18%). Responders mainly dealt with chronic liver diseases, with a median volume (IQR) of 960 (360-1920) outpatient clinic visits per year. However, as less as two patients per year who may be considered indicated for liver transplantation were encountered in average. Seventy-six percent felt that Child-Pugh-Turcotte score ≥10 was threshold for referral. This survey revealed that opportunity for primary physicians to experience patients eligible for liver transplantation may be very much limited. Continuing effort is necessary to disseminate practical clinical knowledge on liver transplantation to hepato-gastroenteorlogy specialists in Japan.
IFN therapy for chronic hepatitis C is associated with significant neuropsychiatric side effects. In Japan, the patients with shizophrenia are less likely to receive IFN therapy, despite limited data regarding the influence of IFN therapy on their psychiatric symptoms. We present three patients with shizophrenia who had the treatment with IFN for chronic hepatitis C in cooperation with psychiatrists. They were able to tolerate IFN therapy, resulting in sustained viral response (SVR). The key components which enabled them to complete the coarse of treatment are the following: 1) initial stabilization of psychiatric symptoms prior to treatment; 2) close collaboration between the patient, the psychiatric team and the internal medicine team; and 3) close observation for changes in mental status with several psychiatric scoring systems.