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Article: Management of Fulminant Hepatitis B.

Ichai, Philippe / Samuel, Didier

2019 Volume 21, Issue 7, Page(s) 25

Abstract: Purpose of review: Acute HBV infection and acute exacerbations of chronic HBV infection can cause acute liver injury (ALI) or fulminant hepatitis (FH). At this stage, spontaneous survival is poor, less than 25%. The purpose of this review is to provide ... ...

Abstract	Purpose of review: Acute HBV infection and acute exacerbations of chronic HBV infection can cause acute liver injury (ALI) or fulminant hepatitis (FH). At this stage, spontaneous survival is poor, less than 25%. The purpose of this review is to provide an overview of specific management of patients with HBV-ALI/FH. Recent findings: Acute HBVinfection and acute exacerbations of chronic HBVinfection can cause acute liver injury (ALI) or fulminant hepatitis (FH). Spontaneous survival at this stage is poor. It is urgent to distinguish between these two entities so that antiviral therapy can be initiated rapidly. Although the indications for antiviral therapy are clear for HBV reactivation, there is no true consensus regarding ALI/FH related to acute HBV infection. The global management of HBV-related FH does not differ from that implemented for other causes of FH, i.e. close cardiorespiratory and neurological monitoring, treatment with acetylcysteine, organ support in the event of organ failure (haemodynamic, renal, respiratory) and albumin dialysis. Liver transplantation remains the only alternative when certain criteria for a poor prognosis are met. A recurrence of HBV infection on the graft can be prevented post-transplant by the administration of HBIG and antiviral therapy for HBV, the modalities varying depending on the risk of recurrence.
Keywords	covid19
Language	English
Publishing date	2019-06-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2019948-X
ISSN	1534-3146 ; 1523-3847
ISSN (online)	1534-3146
ISSN	1523-3847
DOI	10.1007/s11908-019-0682-9
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Article: Modalités d'inscription sur liste d'attente de transplantation hépatique.

Ichaï, Philippe

Revue de l'infirmiere

2007 , Issue 136, Page(s) 20

Title translation	Modalities of preparing the list of needs for liver transplantation.
MeSH term(s)	Humans ; Liver Transplantation/methods ; Needs Assessment ; Patient Selection ; Waiting Lists
Language	French
Publishing date	2007-12
Publishing country	France
Document type	Journal Article
ZDB-ID	632538-5
ISSN	1293-8505 ; 0397-7900
ISSN	1293-8505 ; 0397-7900
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Article: Les principales indications de transplantation hépatique.

Ichaï, Philippe

Revue de l'infirmiere

2007 , Issue 136, Page(s) 22

Title translation	Principal indications for liver transplantation.
MeSH term(s)	HIV Infections/surgery ; Hepatitis B/surgery ; Hepatitis C/surgery ; Humans ; Liver Neoplasms/surgery ; Liver Transplantation
Language	French
Publishing date	2007-12
Publishing country	France
Document type	Journal Article
ZDB-ID	632538-5
ISSN	1293-8505 ; 0397-7900
ISSN	1293-8505 ; 0397-7900
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Article ; Online: Efficiency and safety of total plasma exchange in critically ill cirrhotic patients with acute on chronic liver failure: A pilot study.

Kounis, Ilias / Sacleux, Sophie Caroline / Ordan, Marie Amelie / André, Stéphane / Boudon, Marc / Coilly, Audrey / Sobesky, Rodolphe / De Martin, Eleonora / Samuel, Didier / Ichaï, Philippe / Saliba, Faouzi

Clinics and research in hepatology and gastroenterology

2023 Volume 47, Issue 8, Page(s) 102206

Abstract: Background and aims: Treatment of patients with acute on chronic liver failure (ACLF) admitted to the ICU is very limited. The aim of this pilot study was to evaluate the efficiency on liver function and safety of therapeutic plasma exchange (TPE) in ... ...

Abstract	Background and aims: Treatment of patients with acute on chronic liver failure (ACLF) admitted to the ICU is very limited. The aim of this pilot study was to evaluate the efficiency on liver function and safety of therapeutic plasma exchange (TPE) in critically ill cirrhotic patients admitted with ACLF in a liver ICU. Methods: This is a prospective cohort of patients with ACLF grade > 2 treated by TPE admitted to the ICU that was matched to a control group. TPE was performed using a plasma filter (TPE2000, BAXTER®) on a CRRT machine (Prismaflex®, Baxter®). Ratio and type of fluid replacement were 50 % with 5 % albumin solution followed by 50 % with fresh frozen plasma. Results: Seven patients with a mean age of 50.6 ± 7.8 years (all males) and 14 controls matched to age, sex, etiology and cause of decompensation were recruited. At ICU admission, mean MELD score was 39.1 ± 2.7, mean SOFA score was 11.6 ± 5.2 and mean CLIF SOFA score was 12.9 ± 2.6. The grade of ACLF was 3 for 3 patients (42.9 %) and 2 for 4 patients (57.1 %). The TPE group had significantly higher levels of bilirubin (392.3 ± 117.1μmol/l vs. 219 ± 185μmol/l , p = 0.04), and INR values (5.7 ± 3.4 vs. 3.5 ± 0.9, p < 0.005) compared to the control group. Patient survival was respectively 28.6 % and 14.3 % at 30 and 90 days in the TPE group and 35.7 % and 7.14 % in the control group respectively (HR: 1 (95 % CI 0.19- 5.2; p = 1). One patient in the TPE group had a liver transplantation 13 days after admission to ICU and is still alive and none in the control group. Two (28.6 %) patients died from complications related to the double lumen catheter used for TPE. Conclusion: This pilot study of TPE in patients with ACLF grade 2 and 3 showed a marked but transient improvement in liver function tests. TPE worth to be evaluated in large trials in ACLF patients, with a liver transplant project, and less organ failure.
Language	English
Publishing date	2023-09-14
Publishing country	France
Document type	Journal Article
ZDB-ID	2594333-9
ISSN	2210-741X ; 2210-7401
ISSN (online)	2210-741X
ISSN	2210-7401
DOI	10.1016/j.clinre.2023.102206
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Article ; Online: Dynamic outcome prediction for paracetamol-related acute liver failure.

Ichai, Philippe / Samuel, Didier

The lancet. Gastroenterology & hepatology

2016 Volume 1, Issue 3, Page(s) 177–178

Language	English
Publishing date	2016-11
Publishing country	Netherlands
Document type	Journal Article
ISSN	2468-1253
ISSN (online)	2468-1253
DOI	10.1016/S2468-1253(16)30021-8
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Article ; Online: Body composition and short-term mortality in patients critically ill with acute-on-chronic liver failure.

Mangana Del Rio, Thomas / Sacleux, Sophie-Caroline / Vionnet, Julien / Ichaï, Philippe / Denys, Alban / Schneider, Antoine / Coilly, Audrey / Fraga, Montserrat / Wetzel, Alexandre / Koerfer, Joachim / Chiche, Jean-Daniel / Saliba, Faouzi / Moradpour, Darius / Becce, Fabio / Artru, Florent

JHEP reports : innovation in hepatology

2023 Volume 5, Issue 8, Page(s) 100758

Abstract: Background & aims: Body composition is sex dependent and associated with an increased mortality risk in patients with cirrhosis. We evaluated whether it was also associated with short-term mortality in patients critically ill with acute-on-chronic liver ...

Abstract	Background & aims: Body composition is sex dependent and associated with an increased mortality risk in patients with cirrhosis. We evaluated whether it was also associated with short-term mortality in patients critically ill with acute-on-chronic liver failure (ACLF). Patients and methods: We retrospectively included all patients with cirrhosis and ACLF hospitalised in the intensive care unit (ICU) of Lausanne University Hospital between 2010 and 2019 for whom an abdominal computed tomography (CT) scan performed ±7 days from admission was available. Patients from the ICU of Paul Brousse University Hospital admitted between 2017 and 2020 served as an external cohort. All body composition parameters at the third lumbar vertebral level (L3) were quantified using a deep learning-based method. Results: In total, 192 patients from Lausanne were included. Median age was 62 years and 28-day survival rate was 58.2%. In males, variables independently associated with 28-day mortality on days 1 and 3 were Chronic Liver Failure Consortium (CLIF-C) ACLF-lactate and sarcopenia. In females, CLIF-C ACLF-lactate on days 1 and 3 was the only predictor of 28-day survival. We derived two scores combining sarcopenia and the CLIF-C ACLF-lactate score on days 1 and 3, with area under the receiver operating characteristic outperforming the CLIF-C ACLF-lactate score alone in male but not in female patients. Comparable results were found in the external cohort of 58 patients and supported the sex specificity of the performance of the model. Patients with sarcopenia had increased risks of invasive fungal infection and renal replacement therapy. Conclusion: Sarcopenia was associated with 28-day mortality in male but not in female patients critically ill with ACLF. Although screening for sarcopenia could impact the management of male patients, further studies are needed in female cohorts to investigate whether other body composition parameters are associated with outcomes. Impact and implications: Body composition, easily assessed by CT, is altered in patients with cirrhosis and associated with outcome; it has never been investigated in patients critically ill with ACLF. The results of the present study, underlining the benefit of sarcopenia evaluation to improve prognosis prediction in males critically ill with ACLF, are of importance for physicians managing such patients to optimise the decision-making process toward continued treatment, liver transplantation, or limitation of care. In a wider sense, besides the number and course of organ failures, the results recall the weight of the general condition of males with ACLF at admission to ICU. In females critically ill with ACLF, in analyses limited by the sample size, none of the body composition parameters was associated with short-term mortality independently of organ failures; this suggests that the number and course of organ failures are the main determinant of mortality in these patients.
Language	English
Publishing date	2023-04-07
Publishing country	Netherlands
Document type	Journal Article
ISSN	2589-5559
ISSN (online)	2589-5559
DOI	10.1016/j.jhepr.2023.100758
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Article: Impact of DSA and immunosuppression minimization on rejection, graft, and patient survival after simultaneous liver-kidney transplantation.

Dekeyser, Manon / Taupin, Jean-Luc / Elias, Michelle / Ichaï, Philippe / Herr, Florence / Boudon, Marc / Brunel, Melanie / Sa Cunha, Antonio / Coilly, Audrey / Saliba, Faouzi / Durrbach, Antoine

Frontiers in medicine

2022 Volume 9, Page(s) 949833

Abstract: Background: Acute rejection rate is low after simultaneous liver-kidney transplantation (SLKT), leading some groups to minimize immunosuppressive (IS) regimens. However, the impact of preformed (pDSA) or : Methods: We performed a retrospective ... ...

Abstract	Background: Acute rejection rate is low after simultaneous liver-kidney transplantation (SLKT), leading some groups to minimize immunosuppressive (IS) regimens. However, the impact of preformed (pDSA) or Methods: We performed a retrospective analysis of 102 consecutive SLKT patients to study the impact of anti-HLA antibodies. Results: Anti-HLA antibodies were detected in 75 recipients (class I 23.8%, both classes I and II 23.8%, and class II 14.3%). In total, 42.8% of the patients had pDSA and 21.7% developed dnDSA. Overall patient survival at 1-3 and 5 years, was respectively 88, 84, and 80%. Acute rejection occurred respectively in 3 (2.9%) liver and 6 kidney (5.9%) recipients. pDSA with titers over 10,000 mean fluorescence intensity (14.3%) was associated with lower patient survival (40 vs. 82%) but not with acute rejection. In a multivariable Cox regression analysis, the risk of death was associated with maleness, the highest titer of pDSA ( Conclusion: In SLKT, high levels of pDSA >10,000 were associated with lower patient survival, but not rejection or graft survival. Minimization of maintenance immunosuppression regimen was not associated with a poorer outcome.
Language	English
Publishing date	2022-08-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2022.949833
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Article ; Online: Impact of negative air pressure in ICU rooms on the risk of pulmonary aspergillosis in COVID-19 patients.

Ichai, Philippe / Saliba, Faouzi / Baune, Patricia / Daoud, Asma / Coilly, Audrey / Samuel, Didier

Critical care (London, England)

2020 Volume 24, Issue 1, Page(s) 538

MeSH term(s)	Aged ; Air Microbiology ; Air Pressure ; Antifungal Agents/therapeutic use ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Disease Outbreaks ; Environmental Monitoring/methods ; Female ; Hospital Design and Construction ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/complications ; Pulmonary Aspergillosis/drug therapy ; Pulmonary Aspergillosis/transmission ; Risk Factors ; SARS-CoV-2 ; Ventilation
Chemical Substances	Antifungal Agents
Keywords	covid19
Language	English
Publishing date	2020-09-01
Publishing country	England
Document type	Letter
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-020-03221-w
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Article ; Online: Outcome of patients with cirrhosis requiring mechanical ventilation in ICU.

Levesque, Eric / Saliba, Faouzi / Ichaï, Philippe / Samuel, Didier

Journal of hepatology

2014 Volume 60, Issue 3, Page(s) 570–578

Abstract: Introduction: Mortality rate of patients with cirrhosis admitted to the intensive care unit (ICU) and requiring mechanical ventilation varies between 60 and 91%. The aim of our study is to assess the prognosis of these patients, their 1-year outcome and ...

Abstract	Introduction: Mortality rate of patients with cirrhosis admitted to the intensive care unit (ICU) and requiring mechanical ventilation varies between 60 and 91%. The aim of our study is to assess the prognosis of these patients, their 1-year outcome and to analyze predictive factors of long-term mortality. Methods: From May 2005 to May 2011, we studied 246 consecutive patients with cirrhosis requiring mechanical ventilation either at admission or during their ICU stay. Results: Alcohol was the most common etiology of the cirrhosis (69%). Bleeding related to portal hypertension (30%) and severe sepsis (33%) were the most common reasons for admission. ICU and hospital mortality were respectively 65.9% and 70.3%. Prognostic severity scores, the need for other organ support therapy, infection, and total bilirubin value at ICU admission were significantly associated with ICU mortality. Eighty-four patients (34.1%) were discharged from the ICU. Among these patients, the one-year survival was only of 32%. Logistic regression analysis, using survival at one year as the endpoint, identified two independent risk factors: the length of ventilation (odds ratio [OR] = 1.1; 95% CI, 1.0-1.2; p = 0.02) and total bilirubin at ICU discharge (OR = 1.3; 95% CI, 1.1-1.5; p = 0.006). Conclusion: Patients with cirrhosis admitted to the liver ICU and who required mechanical ventilation have a poor prognosis with a 1-year mortality of 89%. At ICU discharge, a total bilirubin level higher than 64.5 μmol/L and length of ventilation higher than 9 days could help the hepatologists to identify patients at risk of death in the year following the ICU discharge.
MeSH term(s)	Aged ; Cause of Death ; Cohort Studies ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Liver Cirrhosis/mortality ; Liver Cirrhosis/therapy ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Respiration, Artificial ; Severity of Illness Index ; Treatment Outcome
Language	English
Publishing date	2014-03
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	605953-3
ISSN	1600-0641 ; 0168-8278
ISSN (online)	1600-0641
ISSN	0168-8278
DOI	10.1016/j.jhep.2013.11.012
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Article ; Online: Liver transplant selection criteria and outcomes in critically ill patients with ACLF.

JHEP reports : innovation in hepatology

2023 Volume 6, Issue 1, Page(s) 100929

Abstract: Background & aims: Retrospective studies have reported good results with liver transplantation (LTx) for acute-on-chronic liver failure (ACLF) in selected patients. The aim of this study was to evaluate the selection process for LTx in patients with ... ...

Abstract	Background & aims: Retrospective studies have reported good results with liver transplantation (LTx) for acute-on-chronic liver failure (ACLF) in selected patients. The aim of this study was to evaluate the selection process for LTx in patients with ACLF admitted to the intensive care unit (ICU) and to assess outcomes. Methods: This prospective, non-interventional, single high-volume center study collected data on patients with ACLF admitted to the ICU between 2017-2020. Results: Among 200 patients (mean age: 55.0 ± 11.2 years and 74% male), 96 patients (48%) were considered potential candidates for LTx. Unfavourable addictology criteria (n = 76) was the main reason for LTx ineligibility. Overall, 69 patients were listed for LTx (34.5%) and 50 were transplanted (25% of the whole population). The 1-year survival in the LTx group was significantly higher than in the non-transplanted group (94% Conclusion: This prospective analysis of outcomes of patients with ACLF admitted to the ICU highlights the drastic nature of selection in this setting. Unfavourable addictology criteria, mechanical ventilation and increasing number of organ failures since admission were predictive of absence of LTx, futility and death. Impact and implications: Liver transplantation (LT) is the best therapeutic option in selected cirrhotic patients admitted to the ICU with acute on chronic liver failure. However, the selection criteria are poorly described and based on retrospective studies. This is the first prospective study that aimed to describe the selection process for LT in a transplant center. Patients with ACLF should be admitted to the ICU and evaluated within a short period of time for LT. In the context of organ shortage, eligibility for LT and either absence of LT, futility of care or death are better clarified in our study. These are mainly determined by prolonged respiratory failure and worsening of organ failures since ICU admission. Considering worldwide variations in the etiology and definition of ACLF, transplant availability and a narrow therapeutic window for transplant further prospective studies are awaited.
Language	English
Publishing date	2023-10-20
Publishing country	Netherlands
Document type	Journal Article
ISSN	2589-5559
ISSN (online)	2589-5559
DOI	10.1016/j.jhepr.2023.100929
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