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Article ; Online: Liver Cirrhosis and Portal Hypertension: How to Deal with Esophageal Varices?

Jothimani, Dinesh / Rela, Mohamed / Kamath, Patrick S

2023 Volume 107, Issue 3, Page(s) 491–504

Abstract: The understanding of pathogenesis of portal hypertension in patients with liver cirrhosis continues to evolve. In addition to progressive fibrosis, cirrhosis is characterized by parenchymal extinction and vascular remodelling, causing architectural ... ...

Abstract	The understanding of pathogenesis of portal hypertension in patients with liver cirrhosis continues to evolve. In addition to progressive fibrosis, cirrhosis is characterized by parenchymal extinction and vascular remodelling, causing architectural distortion. Existence of prothrombotic state and more recently, intestinal bacterial dysbiosis are recently described in the pathogenesis of portal hypertension. Clinically significant portal hypertension (CSPH) is an important prognostic milestone in patients with liver cirrhosis. This is a pre-symptomatic phase that predicts the development of varices, ascites and importantly increased risk of Hepatocellular carcinoma (HCC). CSPH is associated with significantly reduced survival. Endoscopic surveillance is necessary in these patients. Non-selective Beta-blocker is the preferred therapy for primary prophylaxis in the management of portal hypertension. Patients with acute variceal bleed should be resuscitated appropriately, followed by vasoactive drugs and endoscopic therapy. Early TIPS should be considered in those with refractory bleed or in endoscopic treatment failure. Application of artificial intelligence and machine learning may be useful in future for identifying patients at risk of variceal hemorrhage.
MeSH term(s)	Humans ; Esophageal and Gastric Varices/diagnosis ; Esophageal and Gastric Varices/etiology ; Esophageal and Gastric Varices/therapy ; Carcinoma, Hepatocellular/complications ; Artificial Intelligence ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/therapy ; Liver Neoplasms/complications ; Hypertension, Portal/complications ; Hypertension, Portal/diagnosis ; Hypertension, Portal/therapy ; Liver Cirrhosis/complications
Language	English
Publishing date	2023-02-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	215710-x
ISSN	1557-9859 ; 0025-7125
ISSN (online)	1557-9859
ISSN	0025-7125
DOI	10.1016/j.mcna.2023.01.002
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Article: An Unusual Presentation of Posterior Reversible Encephalopathy Syndrome Following Liver Transplantation.

Rajakumar, Akila / Paulin, Susan / Devarajan, Dinesh / Jothimani, Dinesh / Subramanian, Shubha / Kalyanasundaram, Srinivasan / Rela, Mohamed

Transplantation direct

2022 Volume 8, Issue 2, Page(s) e1269

Language	English
Publishing date	2022-01-05
Publishing country	United States
Document type	Journal Article
ISSN	2373-8731
ISSN	2373-8731
DOI	10.1097/TXD.0000000000001269
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Article: Letter: Parvovirus B19 Related Severe Aplastic Anaemia following Liver Transplantation

Paghadar, Sameer / Jain, Mayank / Raju, Swati / Jothimani, Dinesh

Journal of Gastrointestinal Infections

2023 Volume 13, Issue 01, Page(s) 56–58

Language	English
Publishing date	2023-01-01
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2583-844X
ISSN (online)	2583-844X
DOI	10.1055/s-0042-1757489
Database	Thieme publisher's database

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Article: Liver Transplantation for Dengue-induced Acute Liver Failure.

Rajakumar, Akila / Gupta, Prateek / Rammohan, Ashwin / Devarajan, Vidya / Jothimani, Dinesh / Shanmugam, Naresh / Kaliamoorthy, Ilankumaran / Rela, Mohamed

Journal of clinical and experimental hepatology

2024 Volume 14, Issue 5, Page(s) 101405

Abstract: Although liver involvement has been observed in over two-third cases of dengue viral infection, less than 1% cases progress to dengue-related acute liver failure (D-ALF). Various aspects of management of this disease remain debated including the need and ...

Abstract	Although liver involvement has been observed in over two-third cases of dengue viral infection, less than 1% cases progress to dengue-related acute liver failure (D-ALF). Various aspects of management of this disease remain debated including the need and timing of liver transplantation (LT). Moreover, the outcomes of LT for D-ALF have been suboptimal. We present four contrasting cases of D-ALF, two managed with LT and the other two conservatively to highlight the management dilemmas concerning LT in D-ALF. Based on our 4 cases, we would consider dengue shock syndrome, multisystem involvement and neurological deficit not completely accounted for by the ALF as potential contraindications for LT. These would need to be revisited on a case-to-case basis till larger studies define objective selection criteria for LT in D-ALF.
Language	English
Publishing date	2024-04-03
Publishing country	India
Document type	Case Reports
ISSN	0973-6883
ISSN	0973-6883
DOI	10.1016/j.jceh.2024.101405
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Article ; Online: COVID-19 in decompensated cirrhosis.

Rela, Mohamed / Patil, Vaibhav / Narasimhan, Gomathy / Jothimani, Dinesh

Hepatology international

2020 Volume 14, Issue 6, Page(s) 1125–1127

MeSH term(s)	Aged ; COVID-19/epidemiology ; Comorbidity ; Fatal Outcome ; Humans ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/epidemiology ; Male ; Middle Aged ; Pandemics ; Radiography, Thoracic ; SARS-CoV-2 ; Severity of Illness Index ; Tomography, X-Ray Computed
Keywords	covid19
Language	English
Publishing date	2020-09-29
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	2270316-0
ISSN	1936-0541 ; 1936-0533
ISSN (online)	1936-0541
ISSN	1936-0533
DOI	10.1007/s12072-020-10092-4
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Article ; Online: Post liver transplant recurrent and de novo viral infections.

Jothimani, Dinesh / Venugopal, Radhika / Vij, Mukul / Rela, Mohamed

Best practice & research. Clinical gastroenterology

2020 Volume 46-47, Page(s) 101689

Abstract: Survival following liver transplantation has changed dramatically owing to improvement in surgical techniques, peri-operative care and optimal immunosuppressive therapy. Post-Liver transplant (LT) de novo or recurrent viral infection continues to cause ... ...

Abstract	Survival following liver transplantation has changed dramatically owing to improvement in surgical techniques, peri-operative care and optimal immunosuppressive therapy. Post-Liver transplant (LT) de novo or recurrent viral infection continues to cause major allograft dysfunction, leading to poor graft and patient survival in untreated patients. Availability of highly effective antiviral drugs has significantly improved post-LT survival. Patients transplanted for chronic hepatitis B infection should receive life-long nucleos(t)ide analogues, with or without HBIg for effective viral control. Patients with chronic hepatitis C should be commenced on directly acting antiviral (DAA) drugs prior to transplantation. DAA therapy for post-LT recurrent hepatitis C infection is associated with close to 100% sustained virological response (SVR), irrespective of genotype. De novo chronic Hepatitis E infection is an increasingly recognised cause of allograft dysfunction in LT recipients. Untreated chronic HEV infection of the graft may lead to liver fibrosis and allograft failure. CMV and EBV can reactivate leading to systemic illness following liver transplantation. With COVID-19 pandemic, post-transplant patients are at risk of SARS-Co-V2 infection. Majority of the LT recipients require hospitalization, and the mortality in this population is around 20%. Early recognition of allograft dysfunction and identification of viral aetiology is essential in the management of post-LT de novo or recurrent infections. Optimising immunosuppression is an important step in reducing the severity of allograft damage in the treatment of post-transplant viral infections. Viral clearance or control can be achieved by early initiation of high potency antiviral therapy.
MeSH term(s)	Humans ; Liver Transplantation/adverse effects ; Liver Transplantation/mortality ; Recurrence ; Risk Factors ; Survival Analysis ; Virus Diseases/etiology
Keywords	covid19
Language	English
Publishing date	2020-09-26
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2048181-0
ISSN	1532-1916 ; 1521-6918
ISSN (online)	1532-1916
ISSN	1521-6918
DOI	10.1016/j.bpg.2020.101689
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Article: Post-COVID-19 cholangiopathy: Current understanding and management options.

Veerankutty, Fadl H / Sengupta, Kushan / Vij, Mukul / Rammohan, Ashwin / Jothimani, Dinesh / Murali, Ananthavadivelu / Rela, Mohamed

World journal of gastrointestinal surgery

2023 Volume 15, Issue 5, Page(s) 788–798

Abstract: Post-coronavirus disease 2019 (COVID-19) cholangiopathy (PCC) is a rare but life-threatening complication of COVID-19 infection. PCC typically presents when patients recovering from the contagion and manifests as cholestasis in patients with no history ... ...

Abstract	Post-coronavirus disease 2019 (COVID-19) cholangiopathy (PCC) is a rare but life-threatening complication of COVID-19 infection. PCC typically presents when patients recovering from the contagion and manifests as cholestasis in patients with no history of pre-existing liver disease. The pathogenesis of PCC is little understood. Hepatic injury in PCC could be mediated by the predilection of severe acute respiratory syndrome coronavirus 2 for cholangiocytes. Though PCC shows some resemblance to secondary sclerosing cholangitis in critically ill patients, it is considered as a separate and unique entity in the literature. Various treatment options like ursodeoxycholic acid, steroids, plasmapheresis, and endoscopic retrograde cholangiopancreatography guided interventions have been tried but with limited success. We have noticed significant improvement in liver function with antiplatelet therapy in a couple of patients. PCC can progress to end-stage liver disease necessitating liver transplantation. In this article, we discuss the current knowledge of PCC focusing on its pathophysiology, clinical manifestations, and management strategies.
Language	English
Publishing date	2023-06-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v15.i5.788
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Article ; Online: Auto-immune hepatitis following COVID vaccination.

Rela, Mohamed / Jothimani, Dinesh / Vij, Mukul / Rajakumar, Akila / Rammohan, Ashwin

Journal of autoimmunity

2021 Volume 123, Page(s) 102688

Abstract: Unprecedented loss of life due to the COVID pandemic has necessitated the development of several vaccines in record time. Most of these vaccines have received approval without being extensively whetted for their adverse effect and efficacy profiles. Most ...

Abstract	Unprecedented loss of life due to the COVID pandemic has necessitated the development of several vaccines in record time. Most of these vaccines have received approval without being extensively whetted for their adverse effect and efficacy profiles. Most adverse effects have been mild, nonetheless, more serious thromboembolic events have also been reported. Autoimmune hepatitis (AIH) can occur in predisposed individuals where an immune mediated reaction against hepatocytes is triggered by environmental factors. Vaccines are a very rare cause of AIH. We report two such cases of AIH triggered by COVID (Covishield) vaccination. While one patient made an uneventful recovery, another succumbed to the liver disease. Ours is the first report of Covishield vaccination related AIH and second ever after any form of COVID vaccination. We hope that our report does not deter COVID vaccination drives. However, we also hope to raise awareness of its potential side effects and the increased role of pharmacovigilance in guiding treatment.
MeSH term(s)	Adult ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; Fatal Outcome ; Female ; Hepatitis B, Chronic/complications ; Hepatitis, Autoimmune/etiology ; Hepatitis, Autoimmune/immunology ; Hepatitis, Autoimmune/pathology ; Humans ; Hypothyroidism/complications ; Jaundice/etiology ; Male ; Middle Aged ; Models, Immunological ; Pandemics ; Pharmacovigilance ; SARS-CoV-2/immunology ; Vaccination/adverse effects
Chemical Substances	COVID-19 Vaccines ; ChAdOx1 COVID-19 vaccine (B5S3K2V0G8)
Language	English
Publishing date	2021-07-03
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	639452-8
ISSN	1095-9157 ; 0896-8411
ISSN (online)	1095-9157
ISSN	0896-8411
DOI	10.1016/j.jaut.2021.102688
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Zs.A 2368: Show issues

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Article ; Online: Frequent expression of PD-L1 in lymphocyte-rich hepatocellular carcinoma: A report of 4 cases.

Vij, Mukul / Veerankutty, Fadl H / Raju, Lexmi Priya / Gowrishankar, Gowripriya / Rajalingam, Rajesh / Jothimani, Dinesh / Kaliamoorthy, Ilankumaran / Rammohan, Ashwin / Rela, Mohamed

Annals of diagnostic pathology

2023 Volume 66, Page(s) 152172

Abstract: Background: Programmed death ligand 1 (PD-L1) is an immune checkpoint inhibitor. PD-L1 binds to its receptor programmed death receptor (PD-1) expressed by immune cells and plays a key role in regulating immune responses. Engagement of PD-L1 on cancer ... ...

Abstract	Background: Programmed death ligand 1 (PD-L1) is an immune checkpoint inhibitor. PD-L1 binds to its receptor programmed death receptor (PD-1) expressed by immune cells and plays a key role in regulating immune responses. Engagement of PD-L1 on cancer cells and PD-1 on immune cells avoid destruction of tumour cells by immune cells. Immunostaining with PD-L1 has been suggested as a biomarker predictive of antiPD-L1 immunotherapy. Lymphocyte-rich hepatocellular carcinoma (LrHCC) is a rare histological HCC subtype which is characterised by neoplastic epithelial cells intermixed with numerous immune cells. Methods: Here in we investigated immunohistochemical PD-L1 expression in 4 cases of LrHCC. Tumour proportion score (TPS) and immune cell score was recorded. Immunophenotypic characterization of the tumour and inflammatory cells was also done. Epstein-Barr encoding region (EBER) in situ hybridization (ISH) assay as performed in all four tumours. Results: Expression of PD-L1 was demonstrated in tumour epithelial cells and immune cells in all four cases. Incomplete to membranous staining was demonstrated in the tumour cells. Tumour proportion score (TPS) was 1.2-20 %. Immune cells demonstrated membranous and cytoplasmic immunostaining. Immune cell score was ≥1 % to >10 %. Conclusion: PD-L1 expression in both tumour and immune cells suggests distinct immunogenic feature and potential role of antiPD-L1 therapies in cases with inoperable disease.
MeSH term(s)	Humans ; Carcinoma, Hepatocellular/pathology ; B7-H1 Antigen/metabolism ; Liver Neoplasms/pathology ; Programmed Cell Death 1 Receptor ; Lymphocytes/pathology
Chemical Substances	CD274 protein, human ; B7-H1 Antigen ; Programmed Cell Death 1 Receptor
Language	English
Publishing date	2023-06-17
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1440011-x
ISSN	1532-8198 ; 1092-9134
ISSN (online)	1532-8198
ISSN	1092-9134
DOI	10.1016/j.anndiagpath.2023.152172
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Article: Outcome of Patients Waitlisted for Deceased Donor Liver Transplantation During COVID-19 Pandemic: A Single-Center Experience.

Jothimani, Dinesh / Simon, Evangeline / Palanichamy, Swetha / Murugesan, Sivakumar / Ramachandran, Hemalatha / Sridhar, Vaasudevan / Rajakumar, Akila / Kaliamoorthy, Ilankumaran / Narasimhan, Gomathy / Rela, Mohamed

Journal of clinical and experimental hepatology

2023 Volume 13, Issue 4, Page(s) 601–607

Abstract: Background and aim: COVID-19 pandemic has strained several healthcare resources across the world. While liver transplantation (LT) is the only curative therapy for patients with end-stage liver disease, we aimed to determine the clinical outcome of ... ...

Abstract	Background and aim: COVID-19 pandemic has strained several healthcare resources across the world. While liver transplantation (LT) is the only curative therapy for patients with end-stage liver disease, we aimed to determine the clinical outcome of patients waitlisted for deceased donor liver transplantation (DDLT) during COVID-19 pandemic. Methods: A retrospective comparative observational study of adult patients waitlisted for DDLT from January 2019 to January 2022 at our liver unit (Dr Rela Institute and Medical Center, Chennai, Tamil Nadu, India) was carried out. Patient demographics, disease etiology, Model for End-Stage Liver Disease - Sodium (MELD-Na) score were calculated for all patients listed during the study period. Clinical event was defined as number of DDLT, death in the absence of transplant, and patients awaiting LT were compared. Statistical analysis was performed with SPSS V24.0. Results: In total, 310 patients were waitlisted for DDLT, of whom 148, 63, and 99 patients listed during 2019, 2020, and 2021 (till January 2022), respectively; 22 (53.6%), 10 (24.3%), and 9 (21.9%) patients underwent DDLT in the year 2019, 2020, and 2021 ( Conclusion: COVID-19 pandemic has significantly impacted patients waitlisted for DDLT in India. With limited access to healthcare facilities and decreased organ donation rates during the pandemic, there was a considerable reduction in the patients waitlisted for DDLT, lesser number of patients underwent DDLT, and higher waitlist mortality during the pandemic year. Efforts to improve organ donation in India should be strongly implemented.
Language	English
Publishing date	2023-02-14
Publishing country	India
Document type	Journal Article
ISSN	0973-6883
ISSN	0973-6883
DOI	10.1016/j.jceh.2023.02.001
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