Liver Regeneration with Entecavir in Cirrhosis Patients

Q: Liver Regeneration with Entecavir in Cirrhosis Patients

Hello： My father has cirrhosis and underwent embolization two years ago. <br>After that, the embolized area was surgically removed. <br>He has been developing tumors every six months, which have been treated with alcohol injections. <br>In October 2006, with the physician's permi

Regarding the liver regeneration function associated with the use of "Belac" (Bepotastine besilate)?

Dear Dr.
Chen,
I have purchased your book and would like to consult you regarding my father, who is 60 years old and has related health issues.
Two years ago, he was hospitalized due to ascites, which led to the discovery of liver cirrhosis (he was diagnosed with hepatitis B at the age of 22 during his military service) and the presence of tumors.
Initially, he underwent embolization treatment, followed by partial resection of the tumor.
Since then, tumors have been detected every six months, and he has been treated with alcohol injections.
Recently, in November of this year, after injecting alcohol into two tumors, we encountered a situation where the third tumor needed treatment, but he has been experiencing high levels of jaundice (ranging from 7.5 to 9.2) and fever (diagnosed as spontaneous bacterial peritonitis).
Additionally, he started taking Entecavir in mid-October, and after about 110 days, blood tests have shown that the virus is now negative.
I would like to ask you, Dr.
Chen:
1.
If the hepatitis B virus is gradually being controlled or even reduced, will the newly regenerated liver tissue avoid fibrosis? I have searched various websites, and they all state that cirrhosis is irreversible.
I do not expect the existing liver to revert to normal; I only hope that the newly grown liver tissue will trend towards normalcy, which would gradually improve liver function.
Is this line of thinking correct?
2.
I have also shared my father's medical information (such as blood test results and MRI scans) with Dr.
Chen Chao-Lung at Chang Gung Memorial Hospital in Kaohsiung.
After reviewing the information, he suggested a liver transplant.
My father's albumin level is usually around 2.5, and he receives albumin supplementation for the deficiency.
He also takes lactulose daily.
The report indicates that his cirrhosis is classified as Child A.
I noticed that Dr.
Chen often recommends liver transplants for his patients, which leaves me somewhat confused.
Is my father's condition urgent enough to require an immediate liver transplant?
3.
I have also found literature indicating that PPC (phosphatidylcholine) can effectively improve liver cirrhosis.
Can I consider having my father try this?
Thank you, Dr.
Chen, for taking the time to respond.
I appreciate it greatly.

Xiao Guo, 30~39 year old female. Ask Date: 2007/01/27

Dr. Chen Jianhong reply Gastroenterology and Hepatology

Hello: My father has cirrhosis and underwent embolization two years ago.
After that, the embolized area was surgically removed.
He has been developing tumors every six months, which have been treated with alcohol injections.
In October 2006, with the physician's permission, he started taking "Baraclude (Entecavir)" and has been on it for nearly 110 days.
However, due to complications from cirrhosis, such as ascites (with an albumin level of about 2.5, which is supplemented with albumin solution to above 3), jaundice levels have recently ranged between 7 and 9.5, and he has experienced spontaneous bacterial peritonitis twice in the last month.
My question is: Currently, while taking Baraclude, blood tests have shown negative antigen results.
If treatment continues until the viral load decreases, will the newly regenerated liver cells be less likely to develop fibrosis, and can liver function improve? *Is the antigen referring to the E antigen? Even with cirrhosis, the newly regenerated liver cells will still have fibrosis.
I have helped my father make an appointment with Dr.
Chen Chao-Lung (liver transplant) at Kaohsiung Chang Gung Memorial Hospital.
He briefly reviewed the blood test reports and CT scans I brought and directly stated that a liver transplant is needed.
In the outpatient clinic, since there were many people waiting, most patients received a straightforward response about needing a transplant, which felt somewhat superficial.
Naturally, I have some concerns.
Given my father's condition, is it urgent enough to require a liver transplant? What are the ways to improve jaundice? *Given that your father has developed ascites and his jaundice levels are continuously rising, it is indeed necessary to consider the option of a liver transplant.

Reply Date: 2007/01/27

More Info

Understanding liver regeneration in patients with cirrhosis, particularly those undergoing treatment with Entecavir, is a complex topic that intertwines the biology of liver disease, the effects of antiviral therapy, and the potential for liver regeneration.

1. Liver Regeneration and Fibrosis: It is important to recognize that liver cirrhosis is characterized by extensive fibrosis and architectural distortion of the liver tissue, which is generally considered irreversible. However, the liver has a remarkable ability to regenerate, especially if the underlying cause of liver damage is addressed. In the case of your father, the use of Entecavir, an antiviral medication that effectively suppresses the hepatitis B virus (HBV), can lead to a reduction in liver inflammation and potentially halt the progression of fibrosis. If the viral load decreases significantly and liver inflammation subsides, there is a possibility that new liver cells may regenerate with less fibrosis. However, it is crucial to understand that while new liver cells can form, they may still be affected by the existing fibrotic environment, and complete reversal of cirrhosis is unlikely. Your hope that new liver tissue could approach normal function is reasonable, but it is essential to manage expectations regarding the extent of recovery.

2. Liver Transplant Consideration: The recommendation for a liver transplant by Dr. Chen Zhaolong is based on your father's overall clinical picture, including his low albumin levels and the presence of complications such as jaundice and spontaneous bacterial peritonitis. The Child-Pugh classification, which categorizes the severity of liver disease, indicates that your father is at Child-Pugh Class A, which is the least severe category. However, the presence of complications and the ongoing risk of tumor recurrence may necessitate a more aggressive approach, such as transplantation. It is essential to weigh the urgency of the transplant against the potential benefits of continued antiviral therapy and supportive care. Consulting with a transplant hepatologist can provide clarity on whether immediate transplantation is warranted or if there are alternative management strategies that could be pursued first.

3. Use of PPC (Phosphatidylcholine): The literature on the use of phosphatidylcholine (PPC) in liver disease suggests that it may have some benefits in improving liver function and reducing fibrosis. However, the evidence is not universally accepted, and the effectiveness can vary from patient to patient. Before introducing any new supplement or treatment, it is crucial to discuss it with your father's healthcare provider to ensure it does not interfere with his current treatment regimen or overall health status.

In summary, while Entecavir can significantly improve liver health by controlling HBV, the potential for liver regeneration in the context of established cirrhosis is limited. Continuous monitoring and a multidisciplinary approach involving hepatologists, transplant surgeons, and supportive care teams are essential for managing your father's condition effectively. Regular follow-ups, imaging studies, and laboratory tests will help guide treatment decisions and assess the need for potential liver transplantation.

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