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| 1 | Liver transplantation and alcoholic liver disease:History,controversies,and considerations显示文摘Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation(LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a 'self-inflicted disease'. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this '6-mo rule' is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy. | Claudio Augusto Marroni Alfeu de Medeiros Fleck Jr Sabrina Alves Fernandes Lucas Homercher Galant Marcos Mucenic Mario Henrique de Mattos Meine Guilherme Mariante-Neto Ajacio Bandeira de Mello Brandao | 2018 | World Journal of Gastroenterology2018，24，26： | 7 |
| 2 | Treatment by Splenectomy of a Portal Vein Aneurysm in Hepatosplenic Schistosomiasis显示文摘 | Mucenic M Rocha Md Mde S Laudanna AA | 2002 | Rev Inst Med Trop Sao Paulo2002，44，5： | 1 |
| 3 | Mannose- binding lectin gene polymorphisms in Brazilian patients with systemic lupus erythematosus 显示文摘 | Monticielo OA Chics JA Mucenic T | 2010 | Lupus2010，19，3： | 1 |
| 4 | Glu298Asp eNOS polymorphism is not associated with SLE显示文摘 | Mucenic T Brenol JC Bredemeier M Paiva Dos Santos B Chies JA Monticielo OA Xavier RM | | 0，，05： | 1 |
| 5 | Expression of CD55 and CD59 on peripheral blood ceils from systemic lupus erythematosus (SLE) patients 显示文摘 | Alegretti AP Mucenic T Merzoni J | 2010 | Cell Immunol2010，265，2： | 1 |
| 6 | Association of the HLA-G 14bp polymorphism with systemic lupus erythematosus 显示文摘 | Veit TD Cordero EA Mucenic T | 2009 | Lupus2009，18，5： | 1 |
| 7 | Mannosebinding lectin gene polymorpbisms in Brazilian patients with systemic lupus erythematosus 显示文摘 | Monticielo OA Chies JA Mucenic T | 2010 | Lupus2010，19，3： | 1 |
| 8 | Expression of CD55 and CD59 on peripheral blood cells from systemic lupus erythematosus (SLE) patients 显示文摘 | Alegretti AP Mucenic T Merzoni J | 2010 | Cell Immunol2010，265，2： | 1 |
| 9 | Association of the HLA -G 14 bp polymorphism with systemic lupus erythematosus显示文摘 | Veit T Cordero E Mucenic T | 2009 | Lupus2009，18，5： | 1 |
| 10 | Artificial intelligence and human liver allocation:Potential benefits and ethical implications显示文摘Since its implementation almost two decades ago,the urgency allocation policy has improved the survival of patients on the waiting list for liver transplantation worldwide.The Model for End-Stage Liver Disease score is widely used to predict waiting list mortality.Due to some limitations related to its use,there is an active investigation to develop other prognostic scores.Liver allocation(LA)entails complex decision-making,and grafts are occasionally not directed to the recipients who are more likely to survive.Prognostic scores have,thus far,failed to predict post-operatory survival.Furthermore,the increasing use of marginal donors is associated with worse outcomes.Adequate donor-recipient pairing could help avoid retransplantation or futile procedures and reduce postoperative complications,mortality,hospitalization time,and costs.Artificial intelligence has applications in several medical fields.Machine learning algorithms(MLAs)use large amounts of data to detect unforeseen patterns and complex interactions between variables.Artificial neural networks and decision trees were the most common forms of MLA tested on LA.Some researchers have shown them to be superior for predicting waiting list mortality and graft failure than conventional statistical methods.These promising techniques are increasingly being considered for implementation. | Marcos Mucenic Ajacio Bandeira de Mello Brandão Claudio Augusto Marroni | 2022 | Artificial Intelligence in Gastroenterology2022，3，1： | 0 |
| 11 | Advancements in autoimmune hepatitis management:Perspectives for future guidelines显示文摘The first-line treatment for autoimmune hepatitis involves the use of prednisone or prednisolone either as monotherapy or in combination with azathioprine(AZA).Budesonide has shown promise in inducing a complete biochemical response(CBR)with fewer adverse effects and is considered an optional first-line treatment,particularly for patients without cirrhosis;however,it is worth noting that the design of that study favored budesonide.A recent real-life study revealed higher CBR rates with prednisone when equivalent initial doses were administered.Current guidelines recommend mycophenolate mofetil(MMF)for patients who are intolerant to AZA.It is important to mention that the evidence supporting this recommendation is weak,primarily consisting of case series.Nevertheless,MMF has demonstrated superiority to AZA in the context of renal transplant.Recent comparative studies have shown higher CBR rates,lower therapeutic failure rates,and reduced intolerance in the MMF group.These findings may influence future guidelines,potentially leading to a significant modification in the first-line treatment of autoimmune hepatitis.Until recently,the only alternative to corticosteroids was lifelong maintenance treatment with AZA,which comes with notable risks,such as skin cancer and lymphoma.Prospective trials are essential for a more comprehensive assessment of treatment suspension strategies,whether relying on histological criteria,strict biochemical criteria,or a combination of both.Single-center studies using chloroquine diphosphate have shown promising results in significantly reducing relapse rates compared to placebo.However,these interesting findings have yet to be replicated by other research groups.Additionally,second-line drugs,such as tacrolimus,rituximab,and infliximab,should be subjected to controlled trials for further evaluation. | Marcos Mucenic | 2024 | World Journal of Hepatology2024，16，2： | 0 |
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