Diagnosis and Treatment of Autoimmune Hepatitis: Questions, Answers, and Illustrative Cases: Endorsed by Autoimmune Liver Diseases Special Interest Group, Turkish Association for the Study of Liver

Autoimmune hepatitis (AIH) is a rare, immune-mediated liver disease. It has a heterogeneous nature with varied clinical presentations. The management of patients with AIH is challenging in many ways. The main difficulties are inexperience due to the rarity of the disease, diagnostic confusion in controversial areas such as variant/overlap cases, acute presentations, the presence of non-alcoholic fatty liver disease or drug-induced liver injury features, and the long and complex course of treatment. Here, we provide a clear, concise, and visualized review regarding the diagnosis and treatment of AIH, including illustrative cases

Covid-19 in liver transplant recipients: A national cohort

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Characteristics of patients with hepatocellular carcinoma: A multicenter study

Background and Aim: The aim of the present study was to examine the etiology of hepatocellular carcinoma (HCC) by underlying cause and determine the characteristics and clinical features of patients with HCC. Materials and Methods: The study comprised 1802 HCC patients diagnosed and followed up by Liver Diseases Outpatient Clinics in 14 tertiary centers in Turkey between 2001 and 2020. Results: The mean age was 62.3 +/- 10.7 years, and 78% of them were males. Of the patients, 82% had cirrhosis. Hepatitis B virus (HBV) infection was the most common etiology (54%), followed by hepatitis C virus (HCV) infection (19%) and nonalcoholic fatty liver disease (NAFLD) (10%). Of the patients, 56% had a single lesion. Macrovascular invasion and extrahepatic spread were present in 15% and 12% of the patients, respectively. The median serum alpha-fetoprotein level was 25.4 ng/mL. In total, 39% of the patients fulfilled the Milan Criteria. When we compared the characteristics of patients diagnosed before and after January 2016, the proportion of NAFLD-related HCC cases increased after 2016, from 6.6% to 13.4%. Conclusion: Chronic HBV and HCV infections remain the main causes of HCC in Turkey. The importance of NAFLD as a cause of HCC is increasing

SARS-CoV-2 vaccination and risk of severe COVID-19 outcomes in patients with autoimmune hepatitis

Background: Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine. Patients and methods: We performed a retrospective study on AIH patients with COVID-19. The outcomes of AIH patients who had acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection after at least one dose of COVID-19 vaccine were compared to unvaccinated patients with AIH. COVID-19 outcome was classified according to clinical state during the disease course as: (i) no hospitalization, (ii) hospitalization without oxygen supplementation, (iii) hospitalization with oxygen supplementation by nasal cannula or mask, (iv) intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v) ICU admission with invasive mechanical ventilation or (vi) death, and data was analyzed using ordinal logistic regression. Results: We included 413 (258 unvaccinated and 155 vaccinated) patients (81%, female) with a median age of 52 (range: 17–85) years at COVID-19 diagnosis. The rates of hospitalization were (36.4% vs. 14.2%), need for any supplemental oxygen (29.5% vs. 9%) and mortality (7% vs. 0.6%) in unvaccinated and vaccinated AIH patients with COVID-19. Having received at least one dose of SARS-CoV-2 vaccine was associated with a significantly lower risk of worse COVID-19 severity, after adjusting for age, sex, comorbidities and presence of cirrhosis (adjusted odds ratio [aOR] 0.18, 95% confidence interval [CI], 0.10–0.31). Overall, vaccination against SARS-CoV-2 was associated with a significantly lower risk of mortality from COVID-19 (aOR 0.20, 95% CI 0.11–0.35). Conclusions: SARS-CoV-2 vaccination significantly reduced the risk of COVID-19 severity and mortality in patients with AIH.Fil: Efe, Cumali. Harran University Hospital; TurquíaFil: Taşçılar, Koray. Universitat Erlangen-Nuremberg; AlemaniaFil: Gerussi, Alessio. San Gerardo Hospital; Italia. Università degli Studi di Milano; ItaliaFil: Bolis, Francesca. Università degli Studi di Milano; ItaliaFil: Lammert, Craig. University School of Medicine; Estados UnidosFil: Ebik, Berat. Gazi Yaşargil Education and Research Hospital; TurquíaFil: Stättermayer, Albert Friedrich. Medizinische Universität Wien; AustriaFil: Cengiz, Mustafa. Gülhane Training and Research Hospital; TurquíaFil: Gökçe, Dilara Turan. Ankara City Hospital; TurquíaFil: Cristoferi, Laura. Università degli Studi di Milano; Italia. San Gerardo Hospital; ItaliaFil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina. Latin American Liver Research Educational And Awareness Network; ArgentinaFil: Massoumi, Hatef. Montefiore Medical Center; Estados UnidosFil: Montes, Pedro. Hospital Nacional Daniel Alcides Carrión; PerúFil: Cerda, Eira. Hospital Central Militar, Mexico City; MéxicoFil: Rigamonti, Cristina. Università del Piemonte Orientale UPO,; Italia. Azienda Ospedaliera Maggiore Della Carita Di Novara; ItaliaFil: Yapalı, Suna. Acıbadem University School of Medicine; TurquíaFil: Adali, Gupse. Umraniye Education and Research Hospital; TurquíaFil: Çalışkan, Ali Rıza. Adiyaman Üniversitesi; TurquíaFil: Balaban, Yasemin. Hacettepe Üniversitesi; TurquíaFil: Eren, Fatih. Uludag University; TurquíaFil: Eşkazan, Tuğçe. Cerrahpaşa School of Medicine; TurquíaFil: Barutçu, Sezgin. University of Gaziantep Medical Faculty; TurquíaFil: Lytvyak, Ellina. University of Alberta; CanadáFil: Zazueta, Godolfino Miranda. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Kayhan, Meral Akdogan. Gülhane Training and Research Hospital; TurquíaFil: Heurgue Berlot, Alexandra. Chu de Reims; FranciaFil: De Martin, Eleonora. Universite Paris-Saclay;Fil: Yavuz, Ahmet. Necmettin Erbakan University; TurquíaFil: Bıyık, Murat. Necmettin Erbakan University; TurquíaFil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina. Universidad Austral; Argentina. Latin American Liver Research Educational and Awareness Network; Argentin

SARS-CoV-2 vaccination and risk of severe COVID-19 outcomes in patients with autoimmune hepatitis

Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine