New Delhi, Sep 5 (IANS) While Covid-19 is associated with higher mortality among patients who have co-morbidities, it is scarce among post-liver transplant recipients, finds a study led by Max Super Speciality Hospital, Saket.Typically, Covid-19 is associated with higher mortality among patients who have co-morbidities or pre-existing medical conditions such as obesity, diabetes, coronary artery disease, chronic kidney disease, and non-alcoholic fatty liver disease. Initial studies have also suggested that patients on immunosuppressive medications, such as liver transplant recipients, are at increased risk of severe Covid-19 and mortality.But the findings showed that "uncomplicated liver transplant recipients without co-morbidities who acquire SARS-CoV-2 do not have poor outcomes".The study was conducted on 2,182 adult Indian patients who had undergone liver transplantation at the hospital's Centre for Liver and Biliary Sciences since 2006 and on regular follow-up. Data were recorded related to symptoms and diagnosis of Covid-19, need for hospitalisation, and need for ICU stay and mortality.As many as 81 of the 2,182 adult liver transplant (LT) recipients reported SARS-CoV-2 infection between April 1, last year and May 31, 2021. Thirty five patients had one or more co-morbidities.Twenty one patients underwent transplants less than one year ago. Forty four (54.3 per cent) patients had mild disease only, while 23(28.4 per cent) patients had severe Covid-19 disease. Of the 81, 14 patients died and overall mortality was 17.3 per cent.However, true seroprevalence in the general population is likely to be much higher due to under-testing and a large proportion of asymptomatic cases.Deaths were more common in patients with co-morbidities and advanced age. Presence of diabetes mellitus and chronic kidney disease has been strongly associated with poor outcomes in individuals with SARS-CoV-2 infection. Thus, rather than the post-liver transplantation status, it was the presence of co-morbidities, or other risk factors such as advanced age which may have been responsible for mortality, the study showed."In our study, all patients except one who died had received a liver transplant more than a year ago. After 1-year of transplantation, dose of immunosuppressive medication is usually significantly reduced and therefore the cytokine storm may not be ameliorated. In the study population, Covid-19-related mortality was 17.3 per cent which is comparable to the 18.2 per cent mortality seen in older patients with co-morbidities," Dr Subhash Gupta, Chairman of Centre for Liver and Biliary Sciences at Max."Our study suggests that uncomplicated liver transplant recipients who acquire SARSCoV-2 do not necessarily have a higher mortality as compared to similar non-transplanted populations. However, more studies are needed with larger patient populations and matched control groups to reach a firm conclusion," he added.The study also acknowledged limitations such as the study did not compare mortality in liver transplant recipients with immuno-competent matched Covid-19 patients.Further, they could also not study the impact of individual co-morbidities on mortality due to the limited number of patients.--IANSrvt/vd
New York - Researchers have identified a type of "good cholesterol" that protects the liver by blocking inflammatory signals produced by common gut bacteria.
High-density lipoprotein (HDL) is mostly known for mopping up cholesterol in the body and delivering it to the liver for disposal.
But researchers from the Washington University in St Louis, the US, found that a type of "good cholesterol" called HDL3, when produced in the intestine, protects the liver from inflammation and injury. If not blocked, these bacterial signals travel from the intestine to the liver, where they activate immune cells that trigger an inflammatory state, which leads to liver damage.
"Even though HDL has been considered 'good cholesterol,' drugs that increase overall HDL levels have fallen out of favour in recent years because of clinical trials that showed no benefit in cardiovascular disease," said Gwendalyn J. Randolph, Professor of Immunology at the University's School of Medicine.
"But our study suggests that raising levels of this specific type of HDL, and specifically raising it in the intestine, may hold promise for protecting against liver disease, which, like heart disease, also is a major chronic health problem," Randolph added.
The study, published in the journal Science, showed that HDL3 from the intestine protects the liver from inflammation in mice and in human blood samples.
Any sort of intestinal damage can impact how a group of microbes called Gram-negative bacteria can affect the body. Such microbes produce an inflammatory molecule called lipopolysaccharide that can travel to the liver via the portal vein.
The portal vein is the major vessel that supplies blood to the liver, and it carries most nutrients to the liver after food is absorbed in the intestine.
Substances from gut microbes may travel along with nutrients from food to activate immune cells that trigger inflammation. In this way, elements of the gut microbiome may drive liver disease, including fatty liver disease and liver fibrosis, in which the liver develops scar tissue.
"We are hopeful that HDL3 can serve as a target in future therapies for liver disease. We are continuing our research to better understand the details of this unique process," Randolph said. (IANS)
Lucknow, July 14 (IANS) A 43-year-old man, who underwent a liver transplant in the surgical gastroenterology department of King George's Medical University (KGMU) last month, has been discharged after recovery. This was the first liver transplant in the university after Covid-19 pandemic outbreak and done almost free.Prof Abhijeet Chandra, head, surgical gastroenterology, said, "It was a challenge to conduct the transplant in limited resources. Five more patients are waiting in the queue and next transplant will be done in another 15 days."The patient, who was discharged on Tuesday, is a small-time shopkeeper with meagre financial means.He was unable to afford the transplant at a private hospital where it costs between Rs 30-40 lakh.In KGMU, the transplant was funded by the UP government's Asadhya Rog scheme and another donation of Rs 4 lakh came from Awadh International Foundation.Prof Chandra said that the patient was suffering from advanced stage liver cirrhosis with severe jaundice and bleeding.His wife donated a part of her liver and was discharged after a week. Post-transplant, about four-six litres of fluid was drained daily from the patient's abdomen for a few days, till the liver grew to the normal size.KGMU spokesperson Dr Sudhir Singh said that KGMU has conducted 11 liver transplants so far with over 90 per cent success rate.It is the only medical institute in UP to perform multi-organ donation and has provided over 50 cadaveric organs to other institutes in north India for needy patients.The transplant team comprising over 100 doctors/staff was led by vice-chancellor Lt Gen (retd) Dr Bipin Puri.The surgical gastroenterology team included Prof Chandra and Prof Vivek Gupta.--IANS amita/skp/
New Delhi, July 8 (IANS) The Ministry of AYUSH has rejected a study published in the Journal of Clinical and Experimental Hepatology, a peer reviewed journal of the Indian National Association for the Study of the Liver.
This study mentions that use of the herb Tinospora Cordifolia (TC), commonly known as 'Giloy' or 'Guduchi', resulted in liver failure in six patients in Mumbai.
The ministry said "the authors of the study failed in placing all needful details of the cases in a systematic format. Apart from this, relating Giloy or TC to liver damage would be misleading and disastrous to the traditional medicine system of India as Guduchi or Giloy has been used in Ayurveda since long. The efficacy of TC in managing various disorders is well established."
"It becomes the responsibility of the authors to ascertain that the herb consumed by the patients is TC and not any other herb. To build upon the soundness, the authors would have taken the opinion of a botanist or would have consulted an Ayurveda expert.
"In fact, there are many studies that point out that not identifying the herb correctly could lead to wrong results. A similar looking herb TinosporoCrispa might have a negative effect on the liver. So, before labelling a herb such as Giloy with such toxic nature, the authors should have tried to correctly identify the plants following the standard guidelines, which they did not," the ministry said.
Publications based on "incomplete information" will open the door for misinformation and defame the age-old practices of Ayurveda, the ministry said.
"It would not be out of context to state here that scientific evidence on medical applications of TC or Giloy as protective to liver, nerves etc. is available," it said.
"There are other hundreds of studies on Giloy and its safe use. Giloy is one of the most commonly prescribed medicines in Ayurveda. It has proper pharmacopoeia standards in place for established safety of hepatoprotective properties. No adverse event is noted in any clinical practice by pharmacovigilance or in any clinical study," it said.
Read More ► Giloy Health Benefits, Uses, Dosage and Side Effects
Mandi, June 14 (IANS) A team of researchers from IIT Mandi has identified the underlying biochemical relationship between the consumption of excessive sugar and the development of afatty liver', medically known as Non-Alcoholic Fatty Liver Disease (NAFLD).
NAFLD is a condition in which excess fat deposits in the liver. The disease starts silently, with no overt symptoms for as much as two decades. If left untreated, the excess fat can irritate the liver cells, resulting in scarring of the liver (cirrhosis), and in advanced cases, can even lead to liver cancer. The treatment of advanced stages of NAFLD is difficult.
One of the causes for NAFLD is the overconsumption of sugar -- both table sugar (sucrose) and other forms of carbohydrates. The consumption of excess sugar and carbohydrates causes the liver to convert them into fat in a process called hepatic De Novo Lipogenesis or DNL, which leads to fat accumulation in the liver.
The molecular mechanisms that increase hepatic DNL due to overconsumption of sugar, which is is key to developing therapeutics for the NAFLD, have not been clear yet, said lead scientist Prosenjit Mondal, Associate Professor, School of Basic Sciences, IIT Mandi.
The team used a complementary experimental approach involving mice models, and identified the unknown link between the carbohydrate-induced activation of a protein complex called NF-KB and increased DNL.
"Our data indicates that the sugar-mediated shuttling of hepatic NF-KB p65 reduces the levels of another protein, sorcin, which in turn activates liver DNL through a cascading biochemical pathway," explained Mondal. The findings are published in the Journal of Biological Chemistry.
The team showed that drugs that can inhibit NF-KB can prevent sugar-induced hepatic fat accumulation. They have also shown that the knockdown of sorcin reduces the lipid-lowering ability of the NF-KB inhibitor.
The finding that NF-KB plays a key role in lipid accumulation in the liver opens up a new avenue of therapeutics for NAFLD. NF-KB also plays a role in other diseases that involve inflammation, such as cancer, Alzheimer's disease, atherosclerosis, IBS, stroke, muscle wasting and infections.
The research comes at a time when India has included NAFLD in the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS).
India is the first country in the world to identify the need for action on NAFLD and with good reason. The prevalence of NAFLD in India is about 9 per cent to 32 per cent of the population, with the state of Kerala alone having a prevalence of 49 per cent and a staggering 60 per cent prevalence among obese school-going children.
The study has conclusively shown that excessive sugar intake leads to a fatty liver. This should offer incentive to the public to reduce sugar intake to stop NAFLD in its early stages, the team said.
Chennai, June 10 (IANS) Perhaps in a first of its kind, doctors at the MGM Healthcare, on Thursday said they have successfully performed a live-donor liver transplant on a Covid positive national kabaddi player in coma with liver failure.The 26-year-old patient, Raghul Gandhi, hailing from Puducherry developed acute liver failure and his condition worsened due to sudden onset of jaundice.He slipped into a deep coma within two days after being diagnosed with the disease and was shifted to MGM Healthcare.The situation was complicated as Gandhi also tested positive for Covid-19. Fortunately, his lung was not affected by coronavirus."We took up the challenge to do the emergency liver transplant bearing in mind the complicated nature of the patient's health condition," Thiagarajan Srinivasan, Director, Institute of Liver Diseases, Transplant and HPB surgery said.Normally a liver transplant is performed on Covid free end stage liver disease patient or 4-5 weeks post Covid recovery with 2 successive negative RTPCR tests.However, Gandhi's condition was critical and the transplant had to be done within 24 hours.The other problem the doctors faced was the availability of liver as there was only one liver donation in May in Tamil Nadu.According to Srinivasan, it was then decided to do a living donor liver transplant in which a part of the donor's liver is transplanted after removal of the diseased liver.The live donor was Gandhi's brother.Srinivasan and his team conducted the emergency liver transplant within 12 hours.A bio-bubble was implemented in place to avoid non-mixture of donor and recipient teams, building of separate Covid-proof transport corridors, ICUs, wards and Operation Theatres throughout the entire hospital stay of 15 days for the patient and the team.Doctors said Gandhi has recovered well with the new liver and has successfully defeated Covid infection and his condition will be monitored for a few days.--IANSvj/in