The burden of liver disease in Europe. A review of available epidemiological data.

The past 30 years have witnessed major progress in the knowledge and management of liver disease, yet approximately 29 million people in the European Union still suffer from a chronic liver condition. Difficulties in accessing data from individual countries hinder global evaluation of liver disease in Europe. This report reviews 260 epidemiological studies published in the last five years to survey the current state of evidence on the burden of liver disease in Europe and its causes. The four leading causes of cirrhosis and primary liver cancer in Europe are harmful alcohol consumption, viral hepatitis B and C and metabolic syndromes related to overweight and obesity. Chronic alcohol consumption is the main cause of cirrhosis in Europe. Alcohol consumption decreased in the 1990s, but has increased again in the last decade to stabilize at a high level of >9 litres of pure alcohol per year on average, although there are large variations among European countries. According to WHO, liver cirrhosis accounted for 1.8% of all deaths in Europe (using WHO’s wide geographical definition), causing around 170,000 deaths per year. In the last decades of the 20th century, a very strong east-west gradient in mortality rates was observed, with the level of liver cirrhosis mortality in south-eastern Europe (especially in Hungary and Moldova but also in Slovakia, Slovenia and Romania) and in northeastern European countries achieving rates never before seen in Europe (figs. 1 and 2, see page 9 and 11). However, in recent years, liver cirrhosis has also become a serious health threat in some Western European countries, such as the United Kingdom and Ireland, where over the last 10 years the associated mortality has increased

Hepatic veins as a site of clot formation following liver resection

Pulmonary embolism occurs more frequently after hepatectomy than previously thought but is infrequently associated with peripheral deep vein thrombosis. In this paper, we report 2 cases of postoperative hepatic vein thrombosis after liver resection. Both patients had undergone major hepatectomy of a non-cirrhotic liver largely exposing the middle hepatic vein. Clots were incidentally found in the middle hepatic vein 4 and 17 d after surgery despite routine systemic thrombo-prophylaxis with low molecular weight heparin. Coagulation of the transition plan in a context of mutation of the prothrombin gene and inflammation induced biloma were the likely predisposing conditions. Clots disappeared following curative anticoagulation. We conclude that thrombosis of hepatic veins may occur after liver resection and is a potential source of pulmonary embolism

Small hepatic veins Budd-Chiari syndrome

Budd-Chiari syndrome is a rare disorder characterized by hepatic venous outflow obstruction at any level from the small hepatic veins to the atrio-caval junction, in the absence of heart failure or constrictive pericarditis. Various imaging modalities are available for investigating the gross hepatic vascular anatomy but there are rare forms of this disease where the obstruction is limited to the small intrahepatic veins, with normal appearance of the large hepatic veins at imaging. In this cases only a liver biopsy can demonstrate the presence of a small vessels outflow block. We report two cases of small hepatic veins Budd-Chiari syndrome

Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system

Model for End-Stage Liver Disease (MELD) score-based allocation systems have been adopted by most countries in Europe and North America. Indeed, the MELD score is a robust marker of early mortality for patients with cirrhosis. Except for extreme values, high pretransplant MELD scores do not significantly affect posttransplant survival. The MELD score can be used to optimize the allocation of allografts according to a sickest first policy. Most often, patients with small hepatocellular carcinomas (HCCs) and low MELD scores receive extra points, which allow them appropriate access to transplantation comparable to the access of patients with advanced cirrhosis and high MELD scores. In addition to patients with advanced cirrhosis and HCC, patients with a number of relatively uncommon conditions have low MELD scores and a poor prognosis in the short term without transplantation but derive excellent benefits from transplantation. These conditions, which correspond to the so-called MELD score exceptions, justify the allocation of a specific score for appropriate access to transplantation. Here we report the conclusions of the French consensus meeting. The goals of this meeting were (1) to identify which conditions merit MELD score exceptions, (2) to list the criteria needed for defining each of these conditions, and (3) to define a reasonable time interval for organ allocation for each MELD exception in the general context of organ shortages. MELD exceptions were discussed in an attempt to reconcile the concepts of transparency, equity, justice, and utility