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Article ; Online: Management of alcohol recurrence before and after liver transplantation.

Marroni, Claudio Augusto

Clinics and research in hepatology and gastroenterology

2015 Volume 39 Suppl 1, Page(s) S109–14

Abstract: Alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide and can lead to steatosis, steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma. The primary effective treatment for patients with ALD is total alcohol ... ...

Abstract	Alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide and can lead to steatosis, steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma. The primary effective treatment for patients with ALD is total alcohol abstinence, although sometimes impossible, liver transplant (LT) is the gold standard treatment for end-stage ALD, which represents the second most common diagnosis among patients undergoing this procedure. Liver transplant in ALD has better results than those for other etiologies. The alcohol consumption recidivism after LT is frequent and 10% to 15% of these resume heavy drinking with consequences to the new liver. The "6-month rule" of abstinence is an arbitrary threshold used in many transplant centers and has never been shown to affect survival after LT. The optimal abstinence period in pre-transplant remains unclear. The patients in the pre- and post-transplant period need evaluation of a multidisciplinary team, as psychiatrist, addiction specialists, including counselling and attendance to support groups. The impact of alcohol relapse on post-transplant outcomes is not entirely clear but is worse with continuing heavy drinking, with poorer survival beyond the fifth post-transplant year malignancy and cardiovascular disease and not recurrent liver failure. Acute alcoholic hepatitis, in careful selected cases, should be transplanted and have comparable survival outcomes. Prevention of alcoholic recidivism has proved to be the most important treatment after liver transplantation.
MeSH term(s)	Alcohol Abstinence ; Alcoholism/prevention & control ; Humans ; Liver Diseases, Alcoholic/surgery ; Liver Transplantation ; Patient Compliance ; Patient Selection ; Postoperative Care ; Preoperative Care ; Recurrence
Language	English
Publishing date	2015-09
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	2594333-9
ISSN	2210-741X ; 2210-7401
ISSN (online)	2210-741X
ISSN	2210-7401
DOI	10.1016/j.clinre.2015.06.005
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Article ; Online: EXERCISE IN THE PHYSICAL REHABILITATION OF CIRROTICS: A RANDOMIZED PILOT STUDY.

Rossi, Danusa / D'Avila, André Ferreira / Galant, Lucas Homercher / Marroni, Claudio Augusto

Arquivos de gastroenterologia

2022 Volume 59, Issue 3, Page(s) 408–413

Abstract: Background: Physical exercise delays the sarcopenic process and can reverse the loss of muscle strength, improve quality of life and prognosis in cirrhotic patients.: Objective: The aim was to verify the effects of face-to-face versus home aerobic ... ...

Abstract	Background: Physical exercise delays the sarcopenic process and can reverse the loss of muscle strength, improve quality of life and prognosis in cirrhotic patients. Objective: The aim was to verify the effects of face-to-face versus home aerobic exercise on the variables fatigue, respiratory and peripheral muscle strength, functional capacity and quality of life in patients with compensated cirrhosis. Methods: Patients were selected by convenience, stratified and randomized into supervised face-to-face exercise (n=13) and home exercise without daily supervision (n=12). Patients were submitted to a program of aerobic physical exercises, with progressive duration of 30 to 50 minutes, twice a week for twelve weeks. Before starting the program and every four weeks, all patients in both groups were assessed for fatigue (fatigue severity scale), respiratory (Pimáx and Pemáx) and peripheral (concentric quadriceps peak torque) muscle strength, functional capacity (6-minute walking distance) and quality of life (Short Form-36 Health Survey questionnaire). Results: The face-to-face group showed reduced fatigue (P<0.001), increased inspiratory (P<0.001), expiratory (P<0.001) and peripheral (P<0.001) muscle strength of the 6MWD (P<0.001) and improved quality of life. The home group showed no significant improvement in these variables. Conclusion: A face-to-face program of moderate aerobic exercise in patients with compensated cirrhosis reduces fatigue, improves functional capacity and quality of life and increases respiratory and peripheral muscle strength. Home physical exercises do not cause the same adaptive effects in this population.
MeSH term(s)	Exercise ; Exercise Therapy ; Fatigue ; Humans ; Liver Cirrhosis ; Pilot Projects ; Quality of Life
Language	English
Publishing date	2022-09-09
Publishing country	Brazil
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	137743-7
ISSN	1678-4219 ; 0004-2803
ISSN (online)	1678-4219
ISSN	0004-2803
DOI	10.1590/S0004-2803.202203000-73
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Article: Role of the phase angle in the prognosis of the cirrhotic patient: 15 years of follow-up.

Pinto, Letícia Pereira / Marroni, Claudio Augusto / Czermainski, Juliana / Dahlem, Maria Luiza Fernandes / Carteri, Randhall B / Fernandes, Sabrina Alves

World journal of methodology

2023 Volume 13, Issue 4, Page(s) 238–247

Abstract: Background: In 2019, cirrhosis accounted for 2.4% of global deaths. The projection for 2030 is an increase in this index. In recent years, hospitalization costs have escalated by 36% for compensated cirrhosis and 24% for decompensated cirrhosis. ... ...

Abstract	Background: In 2019, cirrhosis accounted for 2.4% of global deaths. The projection for 2030 is an increase in this index. In recent years, hospitalization costs have escalated by 36% for compensated cirrhosis and 24% for decompensated cirrhosis. Therefore, it is necessary to identify a tool capable of predicting the mortality of these patients according to their clinical condition and consequently extending their survival time. Different studies have shown that the phase angle (PA) can be a feasible method in clinical practice, with the potential to guide assertive patient management in the therapeutic of chronic liver disease. Aim: To evaluate the prognostic role of PA in cirrhotic patients over a 15-year follow-up period. Methods: Retrospective cohort study with 129 cirrhotic patients of both sexes over 18 years old. Diagnosis of cirrhosis by liver biopsy. The first year of data collection was 2007, and data regarding outcomes was collected in 2023. Data were gathered from medical records, such as esophageal varices (EV), EV bleeding, ascites, spontaneous bacterial peritonitis (SBP), encephalopathy, laboratory findings and PA. The cut-off value for the PA was 5.4°, a value described in 2012 by Fernandes Results: Patients were divided into two groups according to the PA 5.4th (PA > 5.4°, Conclusion: PA is a good predictor of morbidity and mortality for cirrhotic patients. The PA by percentile showed greater sensitivity in predicting mortality compared to the cut-off point of 5.4º.
Language	English
Publishing date	2023-09-20
Publishing country	United States
Document type	Journal Article
ISSN	2222-0682
ISSN	2222-0682
DOI	10.5662/wjm.v13.i4.238
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Article: Correction: Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant.

Brandão, Ajacio Bandeira de Mello / Rodriguez, Santiago / Fleck, Alfeu de Medeiros / Marroni, Claudio Augusto / Wagner, Mário B / Hörbe, Alex / Fernandes, Matheus V / Cerski, Carlos Ts / Coral, Gabriela Perdomo

World journal of clinical oncology

2023 Volume 14, Issue 6, Page(s) 227–229

Abstract: This corrects the article on p. 688 in vol. 13, PMID: 36160465.]. ...

Abstract	[This corrects the article on p. 688 in vol. 13, PMID: 36160465.].
Language	English
Publishing date	2023-06-26
Publishing country	United States
Document type	Published Erratum
ZDB-ID	2587357-X
ISSN	2218-4333
ISSN	2218-4333
DOI	10.5306/wjco.v14.i6.227
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Article: Treatment of recurrent hepatitis C post-liver transplantation.

Marroni, Claudio Augusto

Annals of hepatology

2010 Volume 9 Suppl, Page(s) 84–91

Abstract: Recurrent hepatitis C after liver transplantation is universal. Graft reinfection occurs rapidly, with chronic hepatitis and rapid evolution from end-stage liver disease. Within 5 years until 30% of patients with recurrent disease ultimately progress to ... ...

Abstract	Recurrent hepatitis C after liver transplantation is universal. Graft reinfection occurs rapidly, with chronic hepatitis and rapid evolution from end-stage liver disease. Within 5 years until 30% of patients with recurrent disease ultimately progress to cirrhosis, and survival of transplanted patients with recurrent hepatitis C virus has been shown to be lower than of patients transplanted for other indications. Antiviral therapy in this patient population is generally recommended, but indication, optimal timing, dose and duration of therapy are not clearly defined. There are two major indications of therapy in that patients: pre-transplant antiviral therapy aiming to prevent reinfection, and post-transplant therapy with the goal of eradicating the recurrent infection. The first is limited by poor tolerance and drug side effects, and the second achieves only sustained virologic response in 25-45% of patients. Combination therapy with PEG INF and ribavirin showed the better results. Dose reduction and interruption of therapy occurs in 30 to 60% by side effects. There are no prospective randomized trials with confidence of results. More efficacious and better tolerable antiviral therapies are needed.
MeSH term(s)	Antiviral Agents/administration & dosage ; Antiviral Agents/adverse effects ; Drug Administration Schedule ; Drug Therapy, Combination ; Graft Survival/drug effects ; Hepatitis C/diagnosis ; Hepatitis C/drug therapy ; Hepatitis C/surgery ; Humans ; Interferon-alpha/administration & dosage ; Liver Transplantation/adverse effects ; Practice Guidelines as Topic ; Recurrence ; Ribavirin/administration & dosage ; Treatment Outcome
Chemical Substances	Antiviral Agents ; Interferon-alpha ; Ribavirin (49717AWG6K)
Language	English
Publishing date	2010
Publishing country	Mexico
Document type	Journal Article
ZDB-ID	2188733-0
ISSN	1665-2681
ISSN	1665-2681
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Article ; Online: PSYCHOMETRIC PROPERTY OF FATIGUE SEVERITY SCALE AND CORRELATION WITH DEPRESSION AND QUALITY OF LIFE IN CIRRHOTICS.

Rossi, Danusa / Galant, Lucas Homercher / Marroni, Claudio Augusto

Arquivos de gastroenterologia

2017 Volume 54, Issue 4, Page(s) 344–348

Abstract: Background: Fatigue is a common complaint in cirrhotic patients and may be considered a debilitating symptom with negative impact on quality of life. Research on its etiology and treatment has been hampered by the lack of relevant and reproducible ... ...

Abstract	Background: Fatigue is a common complaint in cirrhotic patients and may be considered a debilitating symptom with negative impact on quality of life. Research on its etiology and treatment has been hampered by the lack of relevant and reproducible measures of fatigue. Objective: To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in cirrhotic patients and to correlate with depressive symptomatology and quality of life. Methods: Cross-sectional study with a convenience sample of 106 cirrhotic patients, aged between 18 and 70 years, both genders, literate, pre and post liver transplantation in outpatient follow-up. Internal consistency, reproducibility, discriminant validity, criterion validity, construct validity, responsiveness criterion, depressive symptomatology and quality of life were evaluated through questionnaires between January and October 2015. Results: The mean age was 54.75±9.9 years, 65.1% male and 32.1% of the sample had cirrhosis due to hepatitis C virus. The mean FSS score was 4.74±1.64. Cronbach's alpha was 0.93, and the Intraclass Correlation Coefficient was 0.905 (95% CI: 0.813-0.952). For discriminant validity, FSS differentiated scores from different groups (P=0.009) and presented a correlation with the Modified Fatigue Impact Scale (r=0.606, P=0.002). FSS correlated significantly and positively with depressive symptomatology and correlated negatively with the SF-36 domains for construct validity. For responsiveness, no significant changes were observed in the fatigue scores in the pre and post-liver transplantation periods (P=0.327). Conclusion: FSS showed good psychometric performance in the evaluation of fatigue in patients with cirrhosis. Fatigue presented a strong correlation with depressive symptomatology and quality of life.
Language	English
Publishing date	2017-12
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	137743-7
ISSN	1678-4219 ; 0004-2803
ISSN (online)	1678-4219
ISSN	0004-2803
DOI	10.1590/s0004-2803.201700000-85
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Article: Performance of eight predictive models for hepatocellular carcinoma recurrence after liver transplantation: A comparative study.

Brandão, Ajacio Bandeira de Mello / Rodriguez, Santiago / Marroni, Cláudio Augusto / Junior, Alfeu de Medeiros Fleck / Fernandes, Matheus V / Mucenic, Marcos

Annals of hepatology

2023 Volume 29, Issue 2, Page(s) 101184

Abstract: Introduction and objectives: Liver transplantation is the optimal treatment for patients with early hepatocellular carcinoma and cirrhosis. However, hepatocellular carcinoma recurs in approximately 15 % of individuals. This study aimed to assess the ... ...

Abstract	Introduction and objectives: Liver transplantation is the optimal treatment for patients with early hepatocellular carcinoma and cirrhosis. However, hepatocellular carcinoma recurs in approximately 15 % of individuals. This study aimed to assess the efficacy of predictive models for hepatocellular carcinoma recurrence after liver transplantation. Patients and methods: This retrospective study included 381 patients with HCC and evaluated the performance of the following models: R3-AFP score, alpha-fetoprotein (AFP) model, University of California, Los Angeles (UCLA) nomogram, Pre-Model of Recurrence after Liver Transplantation (MORAL), Post-MORAL, and Combo MORAL models, Risk Estimation of Tumor Recurrence (RETREAT) model and Platelet to Lymphocyte Ratio (PLR) model. Results: The R3-AFP score, UCLA nomogram, AFP model, RETREAT, Combo MORAL, and Post-MORAL models exhibited comparable AUROCs, ranging from 0.785 to 0.733. The AUROCs for the R3-AFP model and AFP model were superior to those of the Pre-MORAL and PLR models. The UCLA nomogram, RETREAT score, Combo MORAL model, and Post-MORAL model performed similarly to the first two models, but were only superior to the PLR model. Conclusions: The R3-AFP model, UCLA nomogram, AFP model, RETREAT, Combo MORAL, and Post-MORAL models demonstrated a moderate predictive capacity for hepatocellular carcinoma recurrence following transplantation. No significant differences were observed among these models in their ability to predict recurrence.
MeSH term(s)	Humans ; Carcinoma, Hepatocellular/pathology ; alpha-Fetoproteins ; Liver Neoplasms/pathology ; Liver Transplantation/adverse effects ; Retrospective Studies ; Risk Factors ; Neoplasm Recurrence, Local
Chemical Substances	alpha-Fetoproteins
Language	English
Publishing date	2023-11-24
Publishing country	Mexico
Document type	Journal Article
ZDB-ID	2188733-0
ISSN	1665-2681
ISSN	1665-2681
DOI	10.1016/j.aohep.2023.101184
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Article ; Online: Treatment of recurrent hepatitis C post-liver transplantation

Claudio Augusto Marroni

Annals of Hepatology, Vol 9, Iss , Pp S84-S

2010 Volume 91

Abstract	Recurrent hepatitis C after liver transplantation is universal. Graft reinfection occurs rapidly, with chronic hepatitis and rapid evolution from end-stage liver disease. Within 5 years until 30% of patients with recurrent disease ultimately progress to cirrhosis, and survival of transplanted patients with recurrent hepatitis C virus has been shown to be lower than of patients transplanted for other indications. Antiviral therapy in this patient population is generally recommended, but indication, optimal timing, dose and duration of therapy are not clearly defined. There are two major indications of therapy in that patients: pre-trans-plant antiviral therapy aiming to prevent reinfection, and post-transplant therapy with the goal of eradicating the recurrent infection. The first is limited by poor tolerance and drug side effects, and the second achieves only sustained virologic response in 25-45% of patients. Combination therapy with PEG INF and ri-bavirin shown the better results. Dose reduction and interruption of therapy occurs in 30 to 60% by side effects. There are no prospective randomized trials with confidence of results. More efficacious and better tolerable antiviral therapies are needed.
Keywords	Recurrent hepatitis C ; Liver transplantation ; HCV treatment ; Specialties of internal medicine ; RC581-951
Subject code	610
Language	English
Publishing date	2010-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: RELIABILITY OF THE FATIGUE SEVERITY SCALE IN CIRRHOTIC AND CORRELATION WITH DEPRESSION AND QUALITY OF LIFE: preliminary assessment.

Rossi, Danusa / Galant, Lucas Homercher / Marroni, Claudio Augusto

Arquivos de gastroenterologia

2016 Volume 53, Issue 3, Page(s) 203–205

Abstract: Background: Fatigue is a common complaint in patients with liver disease and may be considered a disabling symptom, affecting their quality of life and mental health. The Brazilian version of the Fatigue Severity Scale showed sensitivity to assess ... ...

Abstract	Background: Fatigue is a common complaint in patients with liver disease and may be considered a disabling symptom, affecting their quality of life and mental health. The Brazilian version of the Fatigue Severity Scale showed sensitivity to assess fatigue in some populations, but has not been tested in cirrhotic individuals. Objective: The aim of this study was to evaluate the reliability of the Fatigue Severity Scale and association with depression and quality of life in patients with liver cirrhosis. Methods: A prospective cohort study where the same interviewer applied to 25 patients Fatigue Severity Scale questionnaires, Brazilian version of the Beck Depression Inventory II (BDI- II) and Brazilian version of the Short Form Health Survey II (SF-36 v.II). Evaluating the reliability of the Fatigue Severity Scale through internal consistency and reproducibility was conducted. Results: Statistical analysis showed strong internal consistency (Cronbach's alpha = 0.917) and intraobserver reproducibility test, there was no significant difference between both moments (P=0.828). Fatigue Severity Scale was significantly associated with BDI- II (r=0.478; P=0.016) and quality of life in areas PF (r=-0.484; P=0.014), BP (r=-0.402; P=0.046) and GH (r=-0.406; P=0.044) and SF (r=-0.520; P=0.008). Conclusion: The Fatigue Severity Scale showed satisfactory reliability in evaluation of fatigue in cirrhotic and can be used as a tool for this purpose. Fatigue is related to depression and quality of life in the physical aspects domains, pain, general health and social aspects.
MeSH term(s)	Depression/complications ; Depression/diagnosis ; Fatigue/classification ; Fatigue/diagnosis ; Fatigue/etiology ; Female ; Humans ; Liver Cirrhosis/complications ; Liver Cirrhosis/psychology ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Reproducibility of Results ; Sensitivity and Specificity ; Severity of Illness Index ; Surveys and Questionnaires
Language	English
Publishing date	2016-07
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	137743-7
ISSN	1678-4219 ; 0004-2803
ISSN (online)	1678-4219
ISSN	0004-2803
DOI	10.1590/S0004-28032016000300015
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Article: Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant.

World journal of clinical oncology

2022 Volume 13, Issue 8, Page(s) 688–701

Abstract: Background: Cholangiocarcinoma (CC) is a rare tumor that arises from the epithelium of the bile ducts. It is classified according to anatomic location as intrahepatic, perihilar, and distal. Intrahepatic CC (ICC) is rare in patients with cirrhosis due ... ...

Abstract	Background: Cholangiocarcinoma (CC) is a rare tumor that arises from the epithelium of the bile ducts. It is classified according to anatomic location as intrahepatic, perihilar, and distal. Intrahepatic CC (ICC) is rare in patients with cirrhosis due to causes other than primary sclerosing cholangitis. Mixed hepatocellular carcinoma-CC (HCC-CC) is a rare neoplasm that shows histologic findings of both HCC and ICC within the same tumor mass. Due to the difficulties in arriving at the correct diagnosis, patients eventually undergo liver transplantation (LT) with a presumptive diagnosis of HCC on imaging when, in fact, they have ICC or HCC-CC. Aim: To evaluate the outcomes of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma on pathological examination after liver transplant. Methods: Propensity score matching was used to analyze tumor recurrence (TR), overall mortality (OM), and recurrence-free survival (RFS) in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with HCC. Progression-free survival and overall mortality rates were computed with the Kaplan-Meier method using Cox regression for comparison. Results: Of 475 HCC LT recipients, 1.7% had the diagnosis of ICC and 1.5% of HCC-CC on pathological examination of the explant. LT recipients with ICC had higher TR (46% Conclusion: Patients with ICC had worse outcomes than patients undergoing LT for HCC. The outcomes of patients with HCC-CC did not differ significantly from those of patients with HCC.
Language	English
Publishing date	2022-09-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2587357-X
ISSN	2218-4333
ISSN	2218-4333
DOI	10.5306/wjco.v13.i8.688
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