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Diagnosis and management of chronic liver disease in older people

Published online by Cambridge University Press:  22 November 2010

Mark Fox ,
Jenny Fox  and
Mervyn Davies
Mark Fox
Affiliation:
Department of Hepatology, St James University Hospital, Leeds
Jenny Fox
Affiliation:
Department of Elderly Medicine, Fairfield General Hospital, Bury, UK
Mervyn Davies*
Affiliation:
Department of Hepatology, St James University Hospital, Leeds
*
Address for correspondence: Dr Mervyn Davies, Merville Building, St James University Hospital, Beckett Street, Leeds LS9 7TF, UK. Email: [email protected]
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Summary

Chronic liver disease is increasingly prevalent and, as the population ages, geriatricians will see an increasing burden. We present an overview of the investigation and management of older adults with chronic parenchymal liver disease and highlight the potential roles of transjugular intrahepatic portosytemic shunts and orthotopic liver transplantation.

Keywords

chronic liver diseaseolder adults
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 1 , February 2011 , pp. 1 - 15
Copyright
Copyright © Cambridge University Press 2010

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References

1British Association for the Study of the Liver & British Society of Gastroenterology (Liver Section). National liver plan for services in the UK. 2009; available at: http://www.bsg.org.uk/attachments/1004_National%20Liver%20Plan%202009.pdf (last accessed 3 September 2010).Google Scholar
2Wynne, HA, Cope, E, Metch, E et al. The effect of age upon liver volume and apparent liver blood flow in healthy man. Hepatology 1989; 9: 297–301.CrossRefGoogle ScholarPubMed
3Le Couteur, DG, McLean, AJ. The ageing liver: Drug clearance and an oxygen diffusion barrier hypothesis. Clin Pharmacokinet 1998; 34: 359–73.CrossRefGoogle Scholar
4Wynne, H, James, O. The ageing liver. Age Ageing 1990; 19: 1–3.CrossRefGoogle ScholarPubMed
5Department of Health. Medicines and Older People. Implementing medicines-related aspects of the NSF for older people. London, Department of Health, 2001.Google Scholar
6Bordet, R, Gautier, S, Le Louet, H, Dupuis, B, Caron, J. Analysis of the direct cost of adverse drug reactions in hospitalised patients. Eur J Clin Pharmocol 2001; 56: 935–41.CrossRefGoogle ScholarPubMed
7Cunningham, G, Dodd, TR, Grant, DJ, McMurdo, ME, Richards, RM. Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Age Ageing 1997; 26: 375–82.CrossRefGoogle ScholarPubMed
8Mannesse, CK, Derkx, FH, de Ridder, MA, Man in ‘t Veld, AJ, Van Der Cammen, TJ. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000; 29: 35–39.CrossRefGoogle ScholarPubMed
9Piromohamed, M, Sally, J, Meakin, S et al. Adverse drug reactions as a cause of admission to hospital. Br Med J 2004; 329: 15–19.CrossRefGoogle Scholar
10Loran, DB, Hyde, BR, Zwischenberg, JB. Perioperative management of special populations: The geriatric patient. Surg Clin North Amer 2005; 85: 1259–66.CrossRefGoogle ScholarPubMed
11Woodhouse, KW, James, OFW. Hepatic drug metabolism and ageing. Br Med Bull 1990; 46: 22–35.CrossRefGoogle ScholarPubMed
12Vestel, RE. Ageing and determinants of hepatic drug clearance. Hepatology 1989; 9: 331–34.CrossRefGoogle Scholar
13Schnegg, MI, Lauterberg, BH. Quantitative liver function in the liver assessed by galactose elimination capacity, aminopyrine demthylation and caffeine clearance. J Hepatol 1986; 3: 164–71.CrossRefGoogle Scholar
14Greenblatt, DJ, Sellers, EM, Shader, RI. Drug disposition in old age. N Eng J Med 1982; 306: 1081–88.Google ScholarPubMed
15Schmucker, DL. Liver function and phase I drug metabolism in the elderly: a paradox. Drugs Aging 2001; 18: 837–51.CrossRefGoogle ScholarPubMed
16James, OF. Parenchymal liver disease in the elderly. Gut 1997; 41: 430–32.CrossRefGoogle ScholarPubMed
17Al-Chalabi, T, Boccato, S, Portmann, BC, McFarlane, IG, Heneghan, MA. Autoimmune hepatitis (AIH) in the elderly: A systematic retrospective analysis of a large group of consecutive patients with definite AIH followed at a tertiary referral centre. J Hepatol 2006; 45: 575–83.CrossRefGoogle Scholar
18Schramm, C, Kanzler, S, zum Büschenfelde, KH, Galle, PR, Lohse, AW. Autoimmune hepatitis in the elderly. Am J Gastroenterol 2001; 96: 1587–91.Google ScholarPubMed
19Verslype, C, George, C, Buchel, E, Nevens, F, van Steenbergen, W, Fevery, J. Diagnosis and treatment of autoimmune hepatitis at age 65 and older. Aliment Pharmacol Ther 2005; 21: 695–99.CrossRefGoogle ScholarPubMed
20Green, RM, Flamm, S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 2002; 123: 1367–84.CrossRefGoogle ScholarPubMed
21Cobbold, JFL, Anstee, QM, Thomas, HC. Investigating mildly abnormal serum aminotransferase values. BMJ 2010; 341: 297–98.CrossRefGoogle ScholarPubMed
22Gilmore, IT, Burroughs, A, Murray-Lyon, IM, Williams, R, Jenkins, D, Hopkins, A. Indications, methods and outcomes of percutaneous liver biopsy in England & Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut 1995; 36: 437–41.CrossRefGoogle ScholarPubMed
23Bravo, AA, Sheth, SG, Chopra, S. Liver biopsy. N Engl J Med 2001; 344: 495–500.CrossRefGoogle ScholarPubMed
24Castera, L, Forms, X, Alberti, A. Non-invasive evaluation of liver fibrosis using transient elastograghy. J Hepatol 2008; 48: 835–47.CrossRefGoogle Scholar
25Kamath, PS, Wiesner, RH, Malinchoc, M, Kremers, W, Therneau, TM, Kosberg, CL, D'Amico, G, Dickson, ER, Kim, WR. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464–70.CrossRefGoogle Scholar
26Wiesner, R, Edwards, E, Freeman, R, Harper, A, Kim, R, Kamath, P, Kremers, W, Lake, J, Howard, T, Merion, RM, Wolfe, RA, Krom, R; United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124: 91–96.CrossRefGoogle Scholar
27Kim, WR, Biggins, SW, Kremers, WK, Wiesner, RH, Kamath, PS, Benson, JT, Edwards, E, Therneau, TM. Hyponatraemia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008; 359: 1018–26.CrossRefGoogle ScholarPubMed
28Neuberger, J, Gimson, A, Davies, M, Akyol, M, O'Grady, J, Burroughs, A, Hudson, M; Liver Advisory Group; UK Blood and Transplant. Selection of patients for liver transplantation and allocation of donated livers in the UK. Gut 2008; 57: 252–57.CrossRefGoogle ScholarPubMed
29Smith, JW. Medical manifestations of alcoholism in the elderly. Int J Addict 1995; 30: 1749–98.CrossRefGoogle ScholarPubMed
30Mirand, AL, Welte, JW. Alcohol consumption among the elderly in a general population from Erie County, New York. Am J Public Health 1996; 86: 978–84.CrossRefGoogle Scholar
31Mangion, D, Platt, J, Syam, V. Alcohol and acute medical admissions of elderly people. Age Ageing 1992; 21: 362–67.CrossRefGoogle ScholarPubMed
32Potter, JR, James, OFW. Clinical features and prognosis of alcoholic liver disease in respect of advancing age. Gerontology 1987; 33: 380–87.CrossRefGoogle ScholarPubMed
33Aron, E, Dupin, M, Jopard, P. Les cirrhoses du troisieme age. Ann Gastroenterol Hepatol 1979; 15: 558–63.Google Scholar
34Woodhouse, K, James, O. Alcoholic liver disease in the elderly: Presentation and outcome. Age Ageing 1985; 14: 113–18.CrossRefGoogle ScholarPubMed
35James, OFW. Chapter 59: The Liver. In Brocklehurst's Textbook of Geriatric Medicine & Gerontology, 5th edn.London, Churchill Livingstone, 1998.Google Scholar
36Rafiq, N, Bai, C, Fang, Y, Srishord, M, McCullough, A, Gramlich, T, Younossi, ZM. Long-term follow-up of patients with non-alcoholic fatty liver. Clin Gastroenterol Hepatol 2009; 7: 234–38.CrossRefGoogle Scholar
37Targher, G, Bertolini, L, Padovani, R, Rodella, S, Tessari, R, Zenari, L, Day, C, Arcaro, G. Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care 2007; 30: 1212–18.CrossRefGoogle Scholar
38Amos, A, McCarty, D, Zimmet, P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997; 14: S1–55.3.0.CO;2-R>CrossRefGoogle Scholar
39Frith, J, Day, CP, Henderson, E, Burt, AD, Newton, JL. Non-alcoholic fatty liver disease in older people. Gerontology 2009; 55: 607–13.CrossRefGoogle ScholarPubMed
40Ekstedt, M, Franzén, LE, Mathiesen, UL, Thorelius, L, Holmqvist, M, Bodemar, G, Kechagias, S. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology 2006; 44: 802–5.CrossRefGoogle ScholarPubMed
41Angulo, P. Non-alcoholic fatty liver disease. N Engl J Med 2002; 346: 1221–31.CrossRefGoogle Scholar
42Neuschwander-Tetri, BA, Caldwell, SH. Non-alcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology 2003; 37: 1202–19.CrossRefGoogle Scholar
43Kugelmas, M, Hill, DB, Vivian, B, Marsano, L, McClain, CJ. Cytokines and NASH: a pilot study of the effects of lifestyle modification and vitamin E. Hepatology 2003; 38: 413–19.CrossRefGoogle Scholar
44Palmer, M, Schaffner, F. Effect of weight reduction on hepatic abnormalities in overweight patients. Gastroenterology 1990; 99: 1408–13.CrossRefGoogle ScholarPubMed
45Quoilin, S, Hutse, V, Vandenberghe, H, Claeys, F, Verhaegen, E, De Cock, L, Van Loock, F, Top, G, Van Damme, P, Vranckx, R, Van Oyen, H. A population-based prevalence study of hepatitis A, B and C virus using oral fluid in Flanders, Belgium. Eur J Epidemiol 2007; 22: 195–202.CrossRefGoogle Scholar
46Braconier, J, Nordenfelt, E. Serum hepatitis at a home for the aged. Scand J Infect Dis 1972; 4: 72–82.CrossRefGoogle Scholar
47Chiaramante, M, Floreani, A, Naccarato, R. Hepatitis B virus infection in homes for the aged. J Med Virol 1982; 9: 247–55.CrossRefGoogle Scholar
48Wright, R. Hepatitis B and the HBsAg carrier: an outbreak related to sexual contact. JAMA 1975; 232: 717–21.CrossRefGoogle Scholar
49Cook, JM, Gualde, N, Hessel, L, Mounier, M, Michel, JP, Denis, F, Ratinaud, MH. Alterations in the human immune response to the hepatitis B vaccine among the elderly. Cell Immunol 1987; 109: 89–96.CrossRefGoogle Scholar
50Looney, RJ, Hasan, MS, Coffin, D, Campbell, D, Falsey, AR, Kolassa, J, Agosti, JM, Abraham, GN, Evans, TG. Hepatitis B immunisation of elderly adults: relationship between naïve CD4+ T cells and primary immune response and evaluation of GM-CSF as an adjuvant. J Clin Immunol 2001; 21: 30–36.CrossRefGoogle ScholarPubMed
51McMahan, B, Alward, W, Hall, D et al. Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state. J Infect Dis 1985; 151: 599–603.CrossRefGoogle Scholar
52European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B. J Hepatol 2009; 50: 227–42.Google Scholar
53Yeo, W, Johnson, PJ. Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology 2006; 43: 209–20.CrossRefGoogle ScholarPubMed
54Booth, JCL, O'Grady, J, Neuberger, J. Clinical guidelines on the management of hepatitis C. British Society of Gastroenterology, 2001.Google Scholar
55Alter, MJ, Margolis, HS, Krawczynski, K et al. The natural history of community-acquired hepatitis C in the United States. N Engl J Med 1992; 327: 1899–905.CrossRefGoogle ScholarPubMed
56Di Bisceglie, AM. Hepatitis C and hepatocellular carcinoma. Seminar Liver Disease 1995; 15: 64–69.CrossRefGoogle ScholarPubMed
57Hoofnagle, JH. Hepatitis C: the clinical spectrum of disease. Hepatology 1997; 26 (suppl 1): 15–20S.CrossRefGoogle ScholarPubMed
58Poynard, T, Yen, MF, Ratzui, V et al. Viral hepatitis C. Lancet 2003; 362: 2095–100.CrossRefGoogle ScholarPubMed
59Chien, M, Dundoo, G, Horani, M et al. Seroprevalence of viral hepatitis in an older nursing home population. J Am Geriatr Soc 1999; 47: 1110–113.Google Scholar
60Poynard, T, Bedossa, P, Opolon, P. For the OBSVIR, CLINIVIR and DOSVIRC groups. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet 1997; 349: 825–32.CrossRefGoogle ScholarPubMed
61Zarski, JP, McHutchison, J, Bronowicki, JP et al. Rate of natural disease progression in patients with chronic hepatitis C. J Hepatol 2003; 38: 307–14.CrossRefGoogle ScholarPubMed
62Watson, JP, Brind, AM, Chapman, CE, Bates, CL, Gould, FK, Johnson, SJ, Burt, AD, Ferguson, J, Simmonds, P, Bassendine, MF. Hepatitis C virus: epidemiology and genotypes in the North East of England. Gut 1996; 38: 269–76.CrossRefGoogle ScholarPubMed
63Pagliaro, L, D'Amico, G, Puleo, A. Meta-analysis as a source of evidence in gastroenterology: a critical approach. Ital J Gastroenterol Hepatol 1999; 31: 723–42.Google ScholarPubMed
64Honda, T, Katano, Y, Urano, F, Murayama, M, Hayashi, K, Ishigami, M, Nakano, I, Yoshioka, K, Toyoda, H, Kumada, T, Goto, H. Efficacy of ribavarin plus interferon-alpha in patients aged >60 years with chronic hepatitis C. Hepatology 2007; 22: 989–95.Google Scholar
65Goa, B, Hong, F, Radeva, S. Host factors and failure of interferon-α treatment of hepatitis C virus. Hepatology 2004; 39: 880–90.Google Scholar
66Poynard, T, Marcellin, P, Lee, SS, Niederau, C, Minuk, GS, Ideo, G, Bain, V, Heathcote, J, Zeuzem, S, Trepo, C, Albrecht, J. Randomised trial of interferon α2b plus ribavirin for 48 weeks or for 24 weeks for treatment of chronic infection with hepatitis C virus. Lancet 1998; 352: 1426–32.CrossRefGoogle ScholarPubMed
67Parker, D, Kingham, J. Type 1 autoimmune hepatitis is primarily a disease of later life. Q J Med 1997; 90: 289–96.CrossRefGoogle ScholarPubMed
68Newton, JL, Burt, AD, Park, JB, Mathew, J, Bassendine, MF, James, OF. Autoimmune hepatitis in the elderly. Age Ageing 1997; 26: 441–44.CrossRefGoogle Scholar
69Kirk, AP, Jain, S, Pocock, S, Thomas, HC, Sherlock, S. Late results of Royal Free Hospital controlled trial of prednisolone therapy in hepatitis B surface antigen-negative chronic active hepatitis. Gut 1980; 21: 78–83.CrossRefGoogle Scholar
70Metcalf, JV, Bhopal, RS, Gray, J, Howel, D, James, OF. Incidence and prevalence of primary biliary cirrhosis in the city of Newcastle upon Tyne, England. Int J Epidemiol 1997; 26: 830–36.CrossRefGoogle ScholarPubMed
71Grambasch, PM, Dickson, ER, Kaplan, MM et al. Extra-mural cross-validation of the Mayo PBC model. Hepatology 1989; 10: 846–50.Google Scholar
72Newton, JL, Jones, DE, Metcalf, JV, Park, JB, Burt, AD, Bassendine, MF, James, OF. Presentation and mortality of primary biliary cirrhosis in older patients. Age Ageing 2000; 29: 305–9.CrossRefGoogle ScholarPubMed
73Zein, CO, McCullough, AJ. Association between fatigue and decreased survival in primary biliary cirrhosis. Gut 2007; 56: 1165–66; author reply 6.Google ScholarPubMed
74Solerio, E, Isaia, R, Innarella, R et al. Osteoporosis: still a typical complication of primary biliary cirrhosis? Digestive Liver Dis 2003; 35: 339–46.CrossRefGoogle Scholar
75Jeffrey, G, Adams, PC. Hemochromatosis and Wilson disease: diagnosis and treatment. In McDonald, J, Burroughs, A, Feagan, B (eds). Evidence-based gastroenterology and hepatology. London, BMJ Books, 1999.Google Scholar
76Rosenberg, W, Howell, M, Roderick, P, Eccles, D, Day, I. Hereditary haemochromatosis should be more widely known about. BMJ 1999; 318: 1486–87.CrossRefGoogle ScholarPubMed
77Niederau, C, Fischer, R, Pürschel, A, Stremmel, W, Häussinger, D, Strohmeyer, G. Long-term survival in patients with hereditary haemochromatosis. Gastroenterology 1996; 110: 1107–19.CrossRefGoogle Scholar
78Willis, G, Wimperis, JZ, Smith, KC, Fellows, IW, Jennings, BA. Haemochromatosis gene C282Y homozygotes in an elderly male population. Lancet 1999; 354: 221–222.CrossRefGoogle Scholar
79Sheldon, JH.Haemochromatosis. Oxford, Oxford University Press, 1935.Google Scholar
80Demarquay, G, Setiey, A, Morel, Y, Trepo, C, Chazot, G, Broussolle, E. Clinical report of three patients with hereditary hemochromatosis and movement disorders. Mov Disord 2000; 15: 1204–9.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
81European Association for the Study of the Liver. EASL Clinical Practice Guidelines for HFE haemochromatosis. J Hepatol 2010; 53: 3–22.CrossRefGoogle Scholar
82Adams, PC. Factors affecting the rate of iron mobilisation during venesection therapy for genetic haemochromatosis. Am J Hematol 1998; 58: 16–19.3.0.CO;2-3>CrossRefGoogle Scholar
83Milman, N, Pederson, P, Steig, T et al. Clinically overt hereditary hemochromatosis in Denmark 1948–1985: epidemiology, factors of significance for long-term survival, and causes of death in 179 patients. Ann Hematol 2001; 80: 737–44.CrossRefGoogle Scholar
84Falize, L, Guillygomarch, A, Perrin, M et al. Reversibility of hepatic fibrosis in treated genetic hemochromatosis: a study of 36 cases. Hepatology 2006; 44: 472–77.CrossRefGoogle ScholarPubMed
85Powell, LW, Kerr, JF. Reversal of ‘cirrhosis’ in idiopathic haemochromatosis following long-term intensive venesection therapy. Australas Ann Med 1970; 19: 54–57.CrossRefGoogle ScholarPubMed
86Hutchison, C, Geissler, CA, Powell, JJ et al. Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis. Gut 2007; 56: 1291–95.CrossRefGoogle Scholar
87Adams, PC, Speechley, M, Kertesz, AE. Long-term survival analysis in hereditary haemochromatosis. Gastroenterology 1991; 101: 368–72.CrossRefGoogle Scholar
88Woodhouse, KW, Mortimer, O, Wilholm, BE. Hepatic adverse drug reactions – the effect of age. In Kitani, K. Liver and Ageing. Amsterdam, Elsevier, 1986.Google Scholar
89Benhamous, JP. Drug-induced hepatitis: clinical aspects. In Fillastre, JP (ed). Hepatotoxicity of Drugs. Rouen, University of Rouen, 1986.Google Scholar
90http://info.cancerresearchuk.org/cancerstats/types/liver/Google Scholar
91Bosch, FX, Ribes, J, Díaz, M, Cléries, R. Primary liver cancer: worldwide incidence and trends. Gastroenterology 2004; 127: 5–16.CrossRefGoogle ScholarPubMed
92Kumagi, T, Hiasa, Y, Hirschfield, GM. Hepatocellular carcinoma for the non-specialist. BMJ 2009; 339: 1366–70.CrossRefGoogle ScholarPubMed
93Michielson, PP, Sven, MF, Van Dongen, JL. Viral hepatitis and hepatocellular carcinoma. World J Surg Oncol 2005; 3: 27.CrossRefGoogle Scholar
94Ikeda, K, Saitoh, S, Suzuki, Y, Kobayashi, M, Tsubota, A, Koida, I, Arase, Y, Fukuda, M, Chayama, K, Murashima, N, Kumada, H. Disease progression and hepatocellular carcinogenesis in patients with chronic viral hepatitis: a prospective observation of 2215 patients. J Hepatol 1998; 28: 930–38.CrossRefGoogle ScholarPubMed
95Collier, J, Curless, R, Bassendine, M, James, OF. Clinical features and prognosis of hepatocellular carcinoma in Britain in relation to age. Age Ageing 1994; 23: 22–27.CrossRefGoogle ScholarPubMed
96Nomura, F, Ohnishi, K, Honda, M, Satomura, Y, Nakai, T, Okuda, K. Clinical features of hepatocellular carcinoma in the elderly: a study of 91 patients older than 70-years. Br J Cancer 1994; 70: 690–93.CrossRefGoogle ScholarPubMed
97Schöniger-Hekele, M, Müller, C, Kutilek, M, Oesterreicher, C, Ferenci, P, Gangl, A. Hepatocellular carcinoma in Central Europe: prognostic features and survival. Gut 2001; 48: 103–9.CrossRefGoogle ScholarPubMed
98Bugianesi, E. Non-alcoholic steato-hepatitis and cancer. Clin Liver Dis 2007; 11: 191–207.CrossRefGoogle Scholar
99Cammà, C, Giunta, M, Andreone, P, Craxì, A. Interferon and prevention of hepatocellular carcinoma in viral cirrhosis: An evidence-based approach. J Hepatol 2001; 34: 593–602.CrossRefGoogle ScholarPubMed
100Mirici-Cappa, F, Gramenzi, A, Santi, V, Zambruni, A, Di Micoli, A, Frigerio, M, Maraldi, F, Di Nolfo, MA, Del Poggio, P, Benvegnù, L, Rapaccini, G, Farinati, F, Zoli, M, Borzio, F, Giannini, EG, Caturelli, E, Bernardi, M, Trevisani, F; Italian Liver Cancer Group. Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: a 20-year multicentre experience. Gut 2010; 59: 387–96.CrossRefGoogle ScholarPubMed
101Trevisani, F, Cantarini, MC, Wands, JR, Bernardi, M. Recent advances in the natural history of hepatocellular carcinoma. Carcinogenesis 2008; 29: 1229–305.CrossRefGoogle ScholarPubMed
102Llovet, JM, Bruix, J. Systematic review of randomised controlled trials for unresectable hepatocellular carcinoma: chemoembolisation improves survival. Hepatology 2003; 37: 429–42.CrossRefGoogle ScholarPubMed
103El-Serag, H, Siegal, A, Davila, J et al. Treatment and outcomes of treating hepatocellular carcinoma among Medicare recipients in the United States: a population based study. J Hepatol 2006; 44: 158–66.CrossRefGoogle ScholarPubMed
104Ryder, SD. BSG: Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut 2003; 52 (suppl III): iii1–8.CrossRefGoogle Scholar
105Bruix, J, Sherman, M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005; 42: 1208–36.CrossRefGoogle Scholar
106Morgan, MY, Blei, A, Grüngreiff, K, Jalan, R, Kircheis, G, Marchesini, G, Riggio, O, Weissenborn, K. The treatment of hepatic encephalopathy. Metab Brain Dis 2007; 22: 389–405.CrossRefGoogle ScholarPubMed
107Prasad, S, Dhiman, RK, Duseja, A, Chawla, YK, Sharma, A, Agarwal, R. Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy [see comment]. Hepatol 2007; 45: 549–59.CrossRefGoogle ScholarPubMed
108Romero, Y, Evans, JM, Fleming, KC, Phillips, SF. Constipation and faecal incontinence in the elderly population. Mayo Clin Proc 1996; 71: 81–92.CrossRefGoogle ScholarPubMed
109Bass, NM, Mullen, KD, Sanyal, A, Poordad, F, Neff, G, Leevy, CB, Sigal, S, Sheikh, MY, Beavers, K, Frederick, T, Teperman, L, Hillebrand, D, Huang, S, Merchant, K, Shaw, A, Bortey, E, Forbes, WP. Rifaximin treatment in hepatic encephalopathy. NEJM 2010; 362: 1071–81.CrossRefGoogle ScholarPubMed
110Ginés, P, Quintero, E, Arroyo, V, Terés, J, Bruguera, M, Rimola, A, Caballería, J, Rodés, J, Rozman, C. Compensated cirrhosis: natural history and prognostic factors. Hepatology 1987; 7: 12–18.CrossRefGoogle ScholarPubMed
111Arroyo, V, Ginès, P, Gerbes, AL, Dudley, FJ, Gentilini, P, Laffi, G, Reynolds, TB, Ring-Larsen, H, Schölmerich, J. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International ascites club. Hepatology 1996; 23: 164–76.CrossRefGoogle ScholarPubMed
112Moore, KP, Aithal, GP. Guidelines on the management of ascites in cirrhosis. Gut 2006; 55 (suppl 6): 1–12.CrossRefGoogle ScholarPubMed
113Gerbes, AI. The patient with refractory ascites. Best Pract Res Clin Gastroenterol 2007; 21: 551–60.CrossRefGoogle ScholarPubMed
114Grabau, CM, Crago, SF, Hoff, LK, Simon, JA, Melton, CA, Ott, BJ, Kamath, PS. Performance standards for therapeutic abdominal paracentesis. Hepatology 2004; 40: 484–88.CrossRefGoogle ScholarPubMed
115Gines, P, Arroyo, V, Quintero, E et al. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomised study. Gastroenterology 1987; 93: 234–41.CrossRefGoogle Scholar
116Peltekian, KM, Wong, F, Lui, PP et al. Cardiovascular, renal, and neurohumoral responses to single large-volume paracentesis in cirrhotic patients with diuretic resistant ascites. Am J Gastroenterol 1997; 92: 394–99.Google Scholar
117Gines, P, Tito, L, Arroyo, V et al. Randomised comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988; 94: 1493–502.CrossRefGoogle ScholarPubMed
118Sola-Vera, J, Miñana, J, Ricart, E, Planella, M, González, B, Torras, X, Rodríguez, J, Such, J, Pascual, S, Soriano, G, Pérez-Mateo, M, Guarner, C. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology 2003; 37: 1147–53.CrossRefGoogle ScholarPubMed
119Plauth, M, Scheutz, T, Buckendahl, DP et al. Weight gain after transjugular intrahepatic portosystemic shunt (TIPS) is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism. J Hepatol 2004; 40: 228–33.CrossRefGoogle ScholarPubMed
120Allard, JP, Chau, J, Sandokji, K, Blendis, LM, Wong, F. Effect of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites. Am J Gastroenterol 2001; 96: 2442–47.CrossRefGoogle ScholarPubMed
121Peng, S, Plank, LD, McCall, JL, Gillanders, LK, McIlroy, K, Gane, EJ. Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr 2007; 85: 1257–66.CrossRefGoogle ScholarPubMed
122Salerno, F, Cammà, C, Enea, M, Rössle, M, Wong, F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007; 133: 825–34.CrossRefGoogle ScholarPubMed
123Moore, KP, Wong, F, Gines, P, Bernardi, M, Ochs, A, Salerno, F, Angeli, P, Porayko, M, Moreau, R, Garcia-Tsao, G, Jimenez, W, Planas, R, Arroyo, V. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003; 38: 258–66.CrossRefGoogle ScholarPubMed
124Russo, MW, Sood, A, Jacobson, IM, Brown, RS Jr.Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity, and mortality. Am J Gastroenterol 2003; 98: 2521–27.CrossRefGoogle ScholarPubMed
125Ochs, A, Rössle, M, Haag, K, Hauenstein, KH, Deibert, P, Siegerstetter, V, Huonker, M, Langer, M, Blum, HE. The transjugular intrahepatic porto-systemic shunt procedure for refractory ascites. N Engl J Med 1995; 332: 1192–97.CrossRefGoogle ScholarPubMed
126Gulberg, V, Lib, L, Bilzer, M et al. Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts. Digestion 2002; 66: 127–30.CrossRefGoogle ScholarPubMed
127Riggio, O, Merli, M, Pedretti, G et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Incidence and risk factors. Dig Dis Sci 1996; 41: 578–84.CrossRefGoogle ScholarPubMed
128Sanyal, AJ, Freedman, AM, Shiffman, ML, Purdum, PP 3rd, Luketic, VA, Cheatham, AK. Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: results of a prospective controlled study. Hepatology 1994; 20: 46–55.Google ScholarPubMed
129Rossle, M, Piotraschke, J. Transjugular intrahepatic portosystemic shunt and hepatic encephalopathy. Dig Dis 1996; 14 (suppl 1): 12–19.CrossRefGoogle ScholarPubMed
130Somberg, KA, Riegler, JL, LaBerge, JM, Doherty-Simor, MM, Bachetti, P, Roberts, JP, Lake, JR. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunts: incidence and risk factors. Am J Gastroenterol 1995; 90: 549–55.Google ScholarPubMed
131Riggio, O, Angeloni, S, Salvatori, FM, De Santis, A, Cerini, F, Farcomeni, A, Attili, AF, Merli, M. Incidence, natural history, and risk facors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts. Am J Gastroenterol 2008; 103: 2738–46.Google Scholar
132Moller, S, Henrikson, JH. Cardiovascular complications of cirrhosis. Gut 2008; 57: 268–78.CrossRefGoogle ScholarPubMed
133Pozzi, M, Carugo, S, Boari, G, Pecci, V, de Ceglia, S, Maggiolini, S, Bolla, GB, Roffi, L, Failla, M, Grassi, G, Giannattasio, C, Mancia, G. Evidence of functional and structural cardiac abnormalities in cirrhotic patients with an without ascites. Hepatolgy 1997; 26: 1131–37.Google ScholarPubMed
134Bullimore, DW, Miloszewski, KJ, Losowsky, MS. The prognosis of elderly subjects with oesophageal varices. Age Ageing 1989: 18: 35–38.CrossRefGoogle ScholarPubMed
135Ben-Ari, Z, Cardin, F, McCormick, AP, Wannamethee, G, Burroughs, AK. A predictive model for failure to control bleeding during acute variceal haemorrhage. J Hepatol 1999; 31: 443–50.CrossRefGoogle ScholarPubMed
136Garcia-Pagan, JC, Teres, J, Calvert, X et al. Factors which influence the prognosis of the first episode of variceal haemorrhage in patients with cirrhosis. In Bosch, J, Rodes, J (eds). Recent advances in the pathophysiology and therapy of portal hypertension. Barcelona: Ares Serono Symposia, 2004: pp. 287–301.Google Scholar
137Goulis, J, Armonis, A, Patch, D, Sabin, C, Greenslade, L, Burroughs, AK. Bacterial infection is independently associated with failure to control bleeding in cirrhotic patients with gastrointestinal haemorrhage. Hepatology 1998; 27: 1207–12.CrossRefGoogle Scholar
138Garcia-Tsao, G, Sanyal, AJ, Grace, ND, Carey, WD; Practice Guidelines Committee of American Association for Study of Liver Diseases; Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastrointestinal varices and variceal haemorrhage in cirrhosis. Am J Gastroenterol 2007; 102: 2086–102.CrossRefGoogle Scholar
139De Franchis, R. Evolving consensus in portal hypertension: report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005; 43: 167–76.CrossRefGoogle ScholarPubMed
140Cooper, BT, Neumann, CS. Upper gastrointestinal endoscopy in patients aged 80 years or more. Age Ageing 1986; 15: 343–49.CrossRefGoogle ScholarPubMed
141Roberts, CM, Carey, B, Faizallah, R, Walker, RJ, Krasner, N, Morris, AI, Marcus, SN. Injection sclerotherapy for oesophageal varices in the elderly. Age Ageing 1983; 12: 139–43.CrossRefGoogle ScholarPubMed
142Bosch, J, Abraldes, JG, Berzigotti, A, Garcia-Pagan, JC. Portal hypertension and gastrointestinal bleeding. Semin Liver Dis 2008; 28: 3–25.CrossRefGoogle ScholarPubMed
143D'Amico, G, de Franchis, R. Upper digestive bleeding in cirrhosis: post-therapeutic outcome and prognostic indicators. Hepatology 2003; 38: 599–612.CrossRefGoogle ScholarPubMed
144Azoulay, D, Castaing, D, Majno, P, Saliba, F, Ichaï, P, Smail, A, Delvart, V, Danaoui, M, Samuel, D, Bismuth, H. Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis. J Hepatol 2001; 35: 590–97.CrossRefGoogle ScholarPubMed
145García-Pagán, JC, Caca, K, Bureau, C, Laleman, W, Appenrodt, B, Luca, A, Abraldes, JG, Nevens, F, Vinel, JP, Mössner, J, Bosch, J; Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362: 2370–79.CrossRefGoogle Scholar
146Transplant UK. UK transplant activity report,2007–08. http://www.uktransplant.org.uk/ukt/statistics/transplant_activity_report/transplant_activity_report.jsp.Google Scholar
147Montalti, R, Rompianesi, G, Di Benedetto, F, Ballarin, R, Gerring, RC, Busani, S, De Pietri, L, De Ruvo, N, Iemmolo, RM, Guerrini, GP, Smerieri, N, Gerunda, GE. Liver transplantation in patients aged 65 and over: a case-control study. Clin Transplant 2010; Epub ahead of print (4 March).CrossRefGoogle Scholar
148http://www.eltr.org.Google Scholar
149Collins, BH, Pirsch, JD, Becker, YT, Hanaway, MJ, Van Der Werf, WJ, D'Alessandro, AM, Knechtle, SJ, Odorico, JS, Leverson, G, Musat, A, Armbrust, M, Becker, BN, Sollinger, HW, Kalayoglu, M. Long-term results of liver transplantation in patients 60 years of age and older. Transplant 2000; 70: 780–83.CrossRefGoogle ScholarPubMed
150Audet, M, Piardi, T, Panaro, F, Cag, M, Ghislotti, E, Habibeh, H, Giulini, SM, Jaeck, D, Wolf, P. Liver transplantation in recipients over 65-years old: a single center experience. Clin Transplant 2010; 24: 84–90.CrossRefGoogle Scholar
151Dawwas, MF, Gimson, AE, Lewsey, JD, Copley, LP, Van Der Meulen, JH. Survival after liver transplantation in the United Kingdom and Ireland compared with the United States. Gut 2007; 56: 1606–13.CrossRefGoogle ScholarPubMed
152Pomfret, EA, Fryer, JP, Sima, CS, Lake, JR, Merion, RM. Liver and intestine transplantation in the United States,1996–2005; Am J Transplant 2007; 7: 1376–89.CrossRefGoogle ScholarPubMed
153Sheiner, PA, Magliocca, JF, Bodian, CA, Kim-Schluger, L, Altaca, G, Guarrera, JV, Emre, S, Fishbein, TM, Guy, SR, Schwartz, ME, Miller, CM. Long-term medical complications in patients surviving > or = 5 years after liver transplantation. Transplantation 2000; 69: 781–89.CrossRefGoogle ScholarPubMed
154Ojo, AO, Held, PJ, Port, FK, Wolfe, RA, Leichtman, AB, Young, EW, Arndorfer, J, Christensen, L, Merion, RM. Chronic renal failure after transplantation of a non-renal organ. N Engl J Med 2003; 349: 931–40.CrossRefGoogle Scholar
155Everhart, JE, Lombardero, M, Lake, JR, Wiesner, RH, Zetterman, RK, Hoofnagle, JH. Weight change and obesity after liver transplantation: incidence and risk factors. Liver Transpl Surg 1998; 4: 285–96.CrossRefGoogle ScholarPubMed
156Fung, JJ, Jain, A, Kwak, EJ, Kusne, S, Dvorchik, I, Eghtesad, B. De novo malignancies after liver transplantation: a major cause of late death. Liver Transpl 2001; 7: S109–18.CrossRefGoogle Scholar
157Johnson, P, Hayllar, K, Metivier, E et al. Survival in cirrhosis: importance of age as an indicator of disease duration, abstracted. J Hepatol 1989; 9: 546.CrossRefGoogle Scholar
158Adams, LA, Lymp, JF, St Sauver, J, Sanderson, SO, Lindor, KD, Feldstein, A, Angulo, P. The natural history of non-alcoholic fatty liver disease: a population-based cohort study. Gastroenterology 2005; 126: 113–21.CrossRefGoogle Scholar
159Monica, F, Lirussi, F, Pregun, I, Vasile, F, Fabris, L, Okolicsanyi, L. Hepatitis C virus infection in a resident elderly population: a 10-year follow-up study. Dig Liver Dis 2006; 38: 336–40.CrossRefGoogle Scholar