Primary liver cancer is the fifth most common cancer worldwide and the third most common cause of death from cancer, resulting in more than 600,000 deaths per year. The major risk factors for hepatocellular carcinoma are chronic hepatitis B or hepatitis C virus infection, alcoholic cirrhosis, and nonalcoholic steatohepatitis.1 Cancer probably develops in the cirrhotic liver through the induction of accelerated cycles of cell injury, death, and regeneration in an altered fibrotic and inflammatory microenvironment. Abnormal immortalized cell clones arise, and these cells develop genetic and epigenetic alterations that provide a survival and proliferative advantage, resulting in unconstrained proliferation, a . . .
http://content.nejm.org/cgi/content/full/359/4/420
Sorafenib in Liver Cancer — Just the Beginning
Ascites and Renal Dysfunction in Liver Disease: Pathogenesis, Diagnosis, and Treatment
The onset of ascites in a patient with cirrhosis signals the beginning of compromised quality and expectancy of life. This common complication of end-stage liver disease results from a complex pathogenesis that leads to marked renal sodium and water retention. The hepatorenal syndrome is characterized by progression of the renal dysfunction of cirrhotic ascites to a more advanced level of functional renal failure. The evolution of our understanding of the pathogenesis of cirrhosis has been beset by chicken-and-egg conundrums, including dueling theories of circulatory "overflow" as compared with "underfill." The almost metaphysical (but ingenious) concept of reduced "effective blood volume," . . .
http://content.nejm.org/cgi/content/full/354/25/2733
Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients
Hepatitis E virus (HEV) is considered an agent responsible for acute hepatitis that does not progress to chronic hepatitis. We identified 14 cases of acute HEV infection in three patients receiving liver transplants, nine receiving kidney transplants, and two receiving kidney and pancreas transplants. All patients were positive for serum HEV RNA. Chronic hepatitis developed in eight patients, as confirmed by persistently elevated aminotransferase levels, serum HEV RNA, and histologic features of chronic hepatitis. The time from transplantation to diagnosis was significantly shorter and the total counts of lymphocytes and of CD2, CD3, and CD4 T cells were significantly lower in patients in whom chronic disease developed.
http://content.nejm.org/cgi/content/full/358/8/811
