Hepatitis: Li PK

Abboud O, Becker G, Bellorin-Font E, Field M, Johnson R, Li PK, Wanner C, Anonymous00051. · Clinical Practice Guidelines Committee of the International Society of Nephrology. · Nat Clin Pract Nephrol. · Pubmed #18813232 No free full text.

This publication has no abstract.

Chow KM, Szeto CC, Wu AK, Leung CB, Kwan BC, Li PK. · Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China. · Perit Dial Int. · Pubmed #16623428 links to  free full text

Abstract: OBJECTIVE: We hypothesized that patients with hepatitis B virus infection and cirrhosis are more susceptible to peritonitis as a complication of peritoneal dialysis (PD). METHODS: A retrospective study was carried out to compare peritonitis rates between cirrhotic and non-cirrhotic patients with hepatitis B virus infection. RESULTS: Between 1994 and 2004, 25 PD patients with hepatitis B cirrhosis and 36 patients with hepatitis B without cirrhosis were included for analysis. Mean follow-up duration was 52 months. Subjects with hepatitis B cirrhosis consisted of more males and had higher total body weight. No cirrhotic patients (20 of them being Child-Pugh class A, 2 class B, and 3 class C) had undergone portosystemic shunting or liver transplantation. Cirrhotic patients had slightly higher bilirubin concentration than the non-cirrhotic group (22 +/- 50 vs 9 +/- 4 micromol/L, p = 0.16). There was no difference in median peritonitis-free survival between cirrhotic and non-cirrhotic patients (40 vs 37 months, p = 0.64 by log-rank test). The average peritonitis rate was 1 episode every 19.2 patient-months in the cirrhotic group and 1 episode every 20.5 patient-months in the non-cirrhotic group. Time to first peritonitis did not differ between the two groups with respect to gram-negative organisms (p = 0.88) or gram-positive organisms (p = 0.52). Cirrhotic patients had more frequent Streptococcus species peritonitis, which accounted for 13% of all peritonitis episodes, as opposed to 2% among the non-cirrhotic patients (p = 0.01). Overall treatment response rate and outcome did not differ between patients with and patients without cirrhosis. CONCLUSIONS: Peritonitis-free survival of cirrhosis patients infected by hepatitis B virus compares favorably with thatin patients without cirrhosis. The presence of liver cirrhosis does not appear to compromise PD outcome.

Chow KM, Law MC, Leung CB, Szeto CC, Li PK. · Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China. · Nephron Clin Pract. · Pubmed #16534237 No free full text.

Abstract: BACKGROUND: This retrospective and comparative study evaluated the relationship between different factors which may contribute to suboptimal immunological response to intramuscular recombinant hepatitis B vaccine in end-stage renal disease (ESRD) subjects. METHODS: From a cohort of 64 dialysis subjects undergoing primary vaccination with Engerix-B, we determined the predictive factors that impinged on patients' response to vaccine, as defined by anti-HBs level > or = 10 mIU/l. Dose efficacy was further evaluated by comparing three historical cohorts vaccinated by the regimens of 20, 40 and 80 microg/dose, respectively. RESULTS: We identified 64 ESRD patients (mean age 43 +/- 12 years, 81% receiving peritoneal dialysis) who received primary vaccination from April 1997 to September 2004. Median follow-up was 6.5 years. They achieved 81% seroconversion rate. Older age, diabetes mellitus, obesity and low Engerix-B dose were risk factors of inadequate anti-HBs response by univariate analysis. By stepwise logistic regression analysis, hepatitis B vaccine dose was the only independent predictive factor of impaired antibody response. An Engerix-B vaccine dose of 20 microg was associated with more than tenfold increase in risk of non-response to hepatitis B vaccine (hazards ratio 32.2 (95% CI 3.85-250.0)). Immunization with 80 microg of Engerix-B increased the likelihood of persistent protective antibody (log-rank test, p = 0.014). Immunization with Engerix-B 80-microg dose is estimated to prevent one extra ESRD subject who would lose seroprotective anti-HBs level at 1 year for every 5.6 patients treated (number needed to treat to benefit, 5.6 (95% CI 5.4-5.8)). CONCLUSIONS: Our results suggest the potential for the three-dose schedule of recombinant vaccine Engerix-B 80 microg to prolong the immune response among ESRD population.

Szeto CC, Wong TY, Leung CB, Leung TW, Wang AY, Lui SF, Li PK. · Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China. · Clin Transplant. · Pubmed #11683824 No free full text.

Abstract: We report a HBsAg-positive patient who developed hepatocellular carcinoma (HCC) 7 years after cadaveric kidney transplantation. The tumor was unresectable because of coexisting cirrhosis. Selective internal radiation (SIR) therapy, a novel therapy with the technique recently perfected, was used. Yttrium-90 microspheres were given via an angiographic catheter under fluoroscopy guidance. Serum alpha-fetal protein (AFP) was normalized within 2 wk. A follow-up abdominal CT scan revealed significant necrosis of the tumor and compensatory hypertrophy of non-diseased liver. The treatment was well tolerated except for transient liver function deterioration. The patient enjoyed 15 months of symptom-free survival before she died of liver failure. Practical aspects and potential applications of SIR therapy in this group of patients are discussed.

Lai FM, To KF, Wang AY, Choi PC, Szeto CC, Li PK, Leung CB, Lai KN. · Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong, Shatin. · Mod Pathol. · Pubmed #10697274 links to  free full text

Abstract: We compared the clinicopathologic features of 22 patients with hepatitis B virus-related membranous nephropathy, all with detectable glomerular hepatitis B e antigen, and of 26 patients with lupus nephritis class V. Both groups of patients similarly presented with heavy proteinuria or nephrotic syndrome; however, the patients with hepatitis B virus-related membranous nephropathy, who were predominantly male, did not have the extrarenal manifestations and autoantibodies seen in systemic lupus erythematosus. The glomerular lesions in both clinical entities were similar and at times indistinguishable, demonstrating polyclonal immunoglobulins and polytypic complements in similar subepithelial ultrastructural distribution. No morphologic feature, single or combined, carrying a high positive predictive value for the diagnosis of either nephritis was identified. Lesions such as hematoxyphil bodies and fingerprint dense deposits, distinctive of systemic lupus erythematosus, were rarely found. At the time of biopsy, when systemic lupus erythematosus is not clinically suspected, the diagnosis between hepatitis B virus-related membranous nephropathy and lupus nephritis may be difficult or impossible to differentiate, especially in geographic areas where both lupus nephritis and hepatitis B surface antigen carriers are common. This study focused on the use of specific monoclonal antisera to detect glomerular hepatitis B virus antigens, which contribute to the diagnosis of hepatitis B virus-related nephritis.