Canadian Liver Journal

Pegylated interferon (Peg-IFN) is recommended as first-line therapy for chronic hepatitis B (CHB) but has significant side effects and is rarely used compared to oral nucleos(t)ide analogues (NA). There are limited recent clinical efficacy or economic analysis data comparing approved CHB therapy in North America.This retrospective study examined clinical outcomes, off-treatment durability, and cost-effectiveness of Peg-IFN versus NA for CHB. Demographic (age, sex, ethnicity), clinical data (i.e., liver tests, hepatitis B virus DNA, serology, transient elastography) and documented side effects were collected by retrospective chart review of patients followed in the University of Calgary Liver Unit who received Peg-IFN therapy from January 2007 to December 2020. The cost-effectiveness of Peg-IFN versus NA therapy was modelled over a 10-year time horizon.Sixty-eight CHB patients were treated with Peg-IFN (median age 45.65, 74% male, 84% Asian); 50/68 (74%) completed 48 weeks of treatment with a median follow-up of 6.54 years (interquartile range 5.07). At the last known follow-up, 23/68 (34%) have not required NA treatment and one had HBsAg loss; 27 have been started on NA. Predictors of obtaining a sustained virological response included being hepatitis B e antigen-negative at treatment end and a quantitative hepatitis B surface antigen <1000 IU/mL. Economic modelling showed that finite Peg-IFN was not cost-effective versus NA at a 10-year time horizon.PEG-IFN remains a potential treatment for CHB although there is a significant intolerance/failure rate. Using PEG-IFN based on patient preference is reasonable and optimal patient selection may improve treatment cost-effectiveness.

Stephen E Congly

Ahsan Syed

Sarah Haylock-Jacobs

Heidi Israelson

Jacqueline Pinto

Sarah Williams

Samuel S Lee

Carla S Coffin

A real-world retrospective single-centre study of the cost-effectiveness and long-term outcomes of pegylated interferon for chronic hepatitis B

聚乙二醇干扰素治疗慢性乙型肝炎的成本效益和长期结果的回顾性单中心真实世界研究

Chronic liver disease (CLD) has become a silent epidemic in our country and has resulted in significant physical, psychosocial, and financial burden. Although other international liver associations have published frameworks for the principal actions required to improve liver health across health systems, Canada does not have a strategy to address the growing concerns of CLD. Thus, a multidisciplinary group of care providers involved in CLD management in Canada gathered to review the current burden of disease, gaps in management, and key opportunities for improving the identification and management of people at risk of developing progressive CLD.

Mayur Brahmania

Mia J Biondi

Supriya Joshi

Elizabeth Lee

Hsiao-Ming Jung

Mohit Kehar

Priority actions for elevating liver health in Canada: A call to action

提升加拿大肝脏健康优先行动：行动呼吁

Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality worldwide. Epidemiological data of HCV infection in the Canadian province of Manitoba are limited.A population-based retrospective study was conducted using data from the Manitoba Centre for Health Policy repository. Using the test results provided by the Cadham provincial laboratory, individuals in Manitoba with a diagnosis of HCV infection were identified. Annual prevalence and incidence rates (crude and standardized) were calculated for the overall population and stratified by sex, regional health authority (RHA), residence area, income quintile, and special population groups (children, older adults, and pregnant persons).A total of 8,721 HCV cases were diagnosed between 1998 and 2018 in Manitoba. Overall crude HCV incidence and prevalence were estimated as 0.03% and 0.37% during the study period, respectively. No significant change was observed in the standardized HCV incidence rate (per 100,000) during the study period (54.3 in 1998 and 54.8 in 2018). However, the standardized HCV prevalence (per 100,000) increased from 52.5 (95% CI 39.2-68.7) in 1998 to 655.2 (95% CI 605.9-707.3) in 2018. An overall average incidence rate based on sex, RHA, region, income, and special population groups was observed to be higher in males (40.1), Winnipeg RHA (42.7), urban region (42.3), low-income quintiles (78.5), and pregnant persons (94.3), respectively.Although incidence rates of HCV infection in Manitoba appeared to have initially declined, rates showed an upward trend by the end of the study period while prevalence increased steadily.

Sai Krishna Gudi

Sherif Eltonsy

Joseph Delaney

Carla Osiowy

Carole Taylor

Kelly Kaita

Silvia Alessi-Severini

Annual trends of hepatitis C virus infection in Manitoba between 1998 and 2018: A focus on special populations

1998年至2018年曼尼托巴省丙型肝炎病毒感染的年度趋势：重点关注特殊人群

We applied the Confusion Assessment Method (CAM)-Intensive Care Unit (ICU)-7 delirium scale to patients who underwent liver transplant (LT).Retrospective cohort including patients who underwent LT for cirrhosis admitted to the ICU from June 2013 to June 2016 at the University of Alberta Hospital, Canada. Delirium was assessed using the CAM-ICU-7 scale (0-7 points) twice daily on days one and 3 post LT, with the highest score being considered. Primary endpoint was hospital mortality.Among all patients, 101/150 (67.3%) were men and mean age was 52.4 (SD 11.8) years. On days 1 and 3 post LT, mean CAM-ICU-7 scores were 1.8 (SD 1.3) and 1.6 (SD 1.8), respectively. Therefore, on days 1 and 3 post LT, 38/150 (25.3%) and 26/95 (27.4%) patients had delirium. While delirium on day 3 post LT was associated with higher hospital mortality (11.5% versus 0%; p = 0.019), it was not associated with length-of-hospital stay (29.2 versus 34.4 days; p = 0.36). Following adjustment for APACHEII score, delirium on day 3 post LT was associated with higher odds of hospital mortality (adjusted odds ratio [aOR] 1.89 [95% CI 1.02-3.50]). Following adjustment for Glasgow Coma Scale and mechanical ventilation, serum creatinine was associated with higher odds of delirium on day 3 post LT (aOR 2.02 [95% CI 1.08-3.77]).Using the CAM-ICU-7 scale, delirium was diagnosed in a fourth of patients who underwent LT. Delirium on day 3 post LT was associated with higher odds of hospital mortality.

Filipe S Cardoso

Beverley Kok

Victor Dong

Minjee Kim

Constantine J Karvellas

Post liver transplantation delirium assessment using the CAM-ICU-7 scale: A cohort analysis

肝移植术后谵妄评估使用CAM-ICU-7量表的队列分析

Patients with chronic hepatitis C are at increased risk for hyperferritinemia (HF). Abnormalities of serum iron parameters are frequently observed in patients with chronic hepatitis C (CHC). About a third of patients have increased iron parameters. Recently, studies on the effect of direct-acting antiviral agents (DAAs) in HCV eradication in patients with increased serum iron has been published, demonstrating the restoration of normal iron status. The aim of this study was to evaluate the effect of viral eradication with DDAs in patients with CHC and HF.Retrospective study conducted from January 2018 to December 2020 including patients treated with DAAs for HCV. Pre-treatment (PreT) and post-treatment (PostT) serum ferritin values were evaluated in all patients. Inclusion criteria: Pret HF (>400 μg/L); CHC patients treated with DAA achieving sustained viral response (SVR). Exclusion criteria: No PreT or PostT HF available; no SVR; lost patients.From 621 patients treated with DAAs for CHC, 77 presented HF (12.40%), and 74 were included in the study. Fifty nine were men (79.73%) with a mean age 58.33, SD 8.68; PreT mean ferritin: 893.20 (SD 1037.09); PostT: 264.17 (SD 161.33); PreT mean transferrin saturation: 40.96 (SD 15.71); PostT: 29.82 (SD 11.17); PreT mean serum iron 152.32 (SD 62.07), PostT: 109.32 (SD 39.49). When we compared PreT and PostT iron parameters, significant statistical differences were present considering ferritin (p = 0.0000), transferrin saturation (p = 0.0000), and iron (p = 0.0002) determinations.SVR after DAAs for CHC induces a statistically significant reduction on iron parameters.

Agustin Castiella

María José Sánchez-Iturri

Iratxe Urreta

Silvia Torrente

Ana Alcorta

Eva Zapata

Effect of viral eradication with direct-acting antiviral agents on iron parameters in patients with chronic hepatitis c and hyperferritinemia

直接抗病毒药物清除病毒对慢性丙型肝炎伴高血清铁蛋白患者铁参数的影响

Background: The surge of end-stage liver disease among older individuals challenges traditional age-based criteria for liver transplantation (LT), historically capped at 65 years. Our Canadian center shifted away from using chronologic age as an absolute refusal criterion since 2019, enabling those aged 65 years and older to seek LT. This study aimed to investigate temporal trends in the transplant care cascade for patients aged 65 and older at our center, pre- and post-clinical shift. Methods: A retrospective study in a single Canadian transplant center reviewed LT referrals between 2015 and 2023, analyzing proportions of patients aged 65 and above at each stage. Specific intervals, 2015–2018 and 2019–2023, were defined for pre- and post-comparisons. Results: Among the 1,007 LT referrals, 11% (n = 110) were patients aged ≥65 years, with 74% ( n = 81) of them being referred after 2019. From 2015 to 2023, older patient proportions increased at all stages of the transplant care cascade: referrals (7.4% to 12.6%), evaluations (7.6% to 11.4%), waitlisting (5.6% to 15.4%), and transplantations (5.8% to 17.5%). Post-clinical shift, the proportion of older patients referred nearly doubled (7.5% vs 13.7%; p &lt; 0.05), with a similar increase in transplants (5.7% vs. 11.5%; p &lt; 0.05). Conclusions: Removing the age cap increased older patient engagement in the LT care cascade. This emphasizes the crucial role of actively promoting awareness of evolving LT eligibility criteria. Concerted efforts should focus on improving transplantation accessibility in older patients, ensuring age alone does not impede the process.

Gabrielle Jutras

Genevieve Huard

Marc Bilodeau

Julien Bissonnette

Helene Castel

Jeanne-Marie Giard

Julian Hercun

Catherine Vincent

Bernard Willems

Philippe Willems

Jennifer C. Lai

Evolving trends in liver transplantation eligibility: A shift toward inclusivity for older adults at a Canadian Transplant Center

肝移植适应症的演变趋势：加拿大移植中心对老年患者包容性的转变

Eric M Yoshida

In appreciation of service and sacrifice

致敬服务与牺牲

Hepatitis B virus (HBV) infection affects &gt;290 million people worldwide, including ∼250,000 Canadians, and it stands as a leading cause of end-stage liver disease and liver cancer. The World Health Assembly has set goals for HBV elimination by 2030, aiming for a &gt;90% reduction in incidence and a 65% reduction in deaths compared to 2015. However, as of 2023, no countries were on track to achieve these targets. In Canada, challenges in HBV elimination persist due to the lack of a universal birth dose vaccine and interprovincial disparities in screening and care linkage. The Canadian Association for the Study of the Liver (CASL) and the Canadian Hepatitis B Network hosted the Inaugural Progress toward Hepatitis B Elimination Meeting in Calgary, Alberta, Canada (September 29, 2023 to October 1, 2023). This collaborative platform brought together national and international clinicians, laboratory providers, public health researchers, policymakers, and community-based organizations interested in HBV and hepatitis Delta virus (HDV) / HBV coinfection. The workshop was held during the National Day of Truth and Reconciliation (September 30, 2023) to commemorate the tragic legacy of residential schools in Canada, and it highlighted the need to promote meaningful reconciliation with Indigenous peoples. Key outcomes of the summit included establishing objectives for HBV elimination, advocating for adherence to global targets, universal screening and birth dose vaccination, equitable access to antiviral treatment across all provinces/territories, and addressing special populations. This overview highlights the presentations and emphasizes the importance of collaboration among stakeholders, public health agencies, and government entities to strive for HBV elimination in Canada.

Golasa Samadi Kochaksaraei

Simmone D'souza

Rachel Talavlikar

Jennifer Van Gennip

Harley Crowshoe

Canadian Association for the Study of the Liver Single Topic Conference on Hepatitis B Virus: ‘Progress toward hepatitis B elimination in Canada’

加拿大肝病研究协会乙型肝炎病毒专题会议：“加拿大乙型肝炎消除进展”

Kate P R Dunn

Bonnie Weasel Moccasin

Knowledge and wisdom in healthcare practice

医疗实践中的知识与智慧

Background: Fosfomycin is an antibiotic often used to treat urinary tract infections (UTIs) with only rare transient hepatotoxicity. We present a case of fosfomycin-induced liver injury and describe the histopathologic findings on biopsy. Methods: A 64-year-old female patient with no prior liver disease or risk factors was started on fosfomycin as prophylaxis for recurrent UTIs. Within a week of her first dose, she presented with fatigue, jaundice, and mixed liver enzyme elevation. Clinical workup for acute liver injury was unremarkable, and biopsy showed panacinar and portal necroinflammation with predominantly lymphocytic infiltrate and cholestasis, with no evidence of cirrhosis. This was thought to be likely related to fosfomycin exposure. Although liver enzymes trended down, bilirubin initially remained elevated. However, within 3 months the patient achieved clinical and biochemical recovery. Results: Only two other reports of fosfomycin-induced liver injury requiring biopsy were found. Both developed acute cholestatic hepatitis within days of exposure, and subsequent biopsy similarly showed lymphocytic necroinflammation. Although one patient initially developed acute liver failure, both recovered fully within a few months. Conclusion: Overall, these cases suggest potentially an idiosyncratic or immune-mediated liver toxicity of Fosfomycin, which is typically self-limited but may take months to fully resolve. Liver biopsy may be useful in confirming the diagnosis.

短名
Journal Impact	0.89
国际分区	GASTROENTEROLOGY & HEPATOLOGY(Q4)

出版信息	出版商: John Wiley and Sons Inc，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2018，原创研究文献占比: 90.32%，自引率:， Gold OA占比: 1.09%

Canadian Liver Journal

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