<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_331"
                     title="Physicians Must Treat Transplant Tourists"
                     score="0.008"
                     href="http://www.medpagetoday.com/Gastroenterology/LiverTransplantation/tb/18203?impressionId=1265772921375"
                     
      &lt;p&gt;Patients who travel to foreign countries for organ transplants may return with more problems than they left with  --  and physicians here have a moral responsibility to treat them, researchers asserted in a transplant journal.&lt;/p&gt;
&lt;p&gt;&quot;Medical tourism&quot; has been on the rise as demand for organs outpaces supply and U.S. healthcare costs skyrocket, Thomas D. Schiano, MD, and Rosamond Rhodes, PhD, of Mount Sinai School of Medicine, reported in &lt;em&gt;Liver Transplantation&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Researchers have estimated that 300 medical tourism transplants occurred between 2004 and 2006, with more than 40% of transplant tourists residing in New York or California, which have only 18% of the total U.S. population. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12564&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12564&quot; target=&quot;_blank&quot;&gt;International Medical Trade Turns Big Business&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Yet physicians have had little guidance on delivering care to these patients, and some transplant centers may turn them away, based on their actions, Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;Their questions about treatment arose with a 46-year-old Chinese patient who had been put on a waiting list for a liver transplant here because of end-stage liver disease.&lt;/p&gt;
&lt;p&gt;The patient waited on the list for a year as his disease progressed from 18 points to 21 points on a 40-point severity scale.&lt;/p&gt;
&lt;p&gt;Rather than wait any longer, the patient flew to China and had a liver transplant there.&lt;/p&gt;
&lt;p&gt;Many transplanted organs in China come from executed prisoners, raising concerns about disease. Also, foreign transplants may be compromised by poor organ matching, unhealthy donors, and post-transplant infections, while some transplant centers abroad may use substandard surgical techniques, the researchers said.&lt;/p&gt;
&lt;p&gt;Foreign centers are also less likely to send patients home with adequate records and education than centers here, they asserted.&lt;/p&gt;
&lt;p&gt;Three months after his transplant in China, the patient came back to the clinic at Mount Sinai for follow-up care because he was about to run out of imunosuppressive medication.&lt;/p&gt;
&lt;p&gt;Two months after that, the patient developed sepsis due to diffuse intrahepatic biliary stricturing related to hepatic artery thrombosis.&lt;/p&gt;
&lt;p&gt;He required three additional hospitalizations for biliary sepsis, and at that point, retransplantation was the only viable option, Schiano said.&lt;/p&gt;
&lt;p&gt;However, members of the medical team had conflicting views about giving the patient another new liver.&lt;/p&gt;
&lt;p&gt;&quot;He was a medically suitable candidate,&quot; Schiano and Rhodes wrote, &quot;but there was disagreement about whether it was morally right to provide him with a transplant.&quot;&lt;/p&gt;
&lt;p&gt;The clinicians had few ethical guidelines to refer to in making their decision because many deal solely with moral issues related to donors and foreign medical standards.&lt;/p&gt;
&lt;p&gt;For example, the International Society for Heart and Lung Transplantation issued a statement against accepting organs from prisoners in April 2007, and the American Association for the Study of Liver Diseases and the International Liver Transplant Society endorsed similar policies.&lt;/p&gt;
&lt;p&gt;The American Medical Association&apos;s guidelines on medical tourism focus on best practices  --  for example, the procedure must be voluntary, it can&apos;t limit the alternatives offered to patients, and patients should only be referred to accredited institutions.&lt;/p&gt;
&lt;p&gt;While the United Network for Organ Sharing (UNOS)&apos;s statement on medical tourism does maintain that the medical community has an obligation to provide care for these patients, it stops short of offering further direction to transplant programs.&lt;/p&gt;
&lt;p&gt;&quot;Little guidance is provided for dealing with the specific problems of patients who choose to become transplant tourists,&quot; Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;Instead, they created some ethical guidance for the &quot;moral quandary.&quot;&lt;/p&gt;
&lt;p&gt;Physicians have a &quot;professional obligation to promote the good of patients&quot; as well as a &quot;professional responsibility to adhere to medicine&apos;s commitment to nonjudgmental regard,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Taken together, the moral principles of beneficence and nonjudgmental regard direct us to treat potential or returning transplant tourists as we would treat other patients under our care by focusing on providing the medical treatment and support they need,&quot; they continued.&lt;/p&gt;
&lt;p&gt;Physicians shouldn&apos;t deny patients post-transplantation care, and they ought to provide emergent care at the very least. They may refer the patient to another transplant center for long-term follow-up if they regard it as unethical to continue treatment.&lt;/p&gt;
&lt;p&gt;Patients should also be informed about the possibility of transplant tourism when they are not eligible for a transplant in the U.S. or when they are likely to die before reaching the top of the transplant list, Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;&quot;Patients should not be threatened with abandonment by a center&apos;s refusal to provide care upon their return,&quot; they added.&lt;/p&gt;
&lt;p&gt;As for the 46-year-old patient who was transplanted in China, the Mount Sinai team decided a transplant program must treat all patients on the basis of their need &quot;regardless of what they might have done or how they secured their transplant organ.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Although [the patient] had a long, complicated transplantation course,&quot; they wrote, &quot;he is currently doing well.&quot;&lt;/p&gt;
&lt;p&gt;Mount Sinai has seen a total of nine patients who pursued transplants in China. Three of those had post-transplant problems but had been turned away elsewhere &quot;because several transplant centers in our region do not render care to transplant tourists,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Seven of those nine patients have hepatitis B. Another three had had a renal transplant in India, and subsequently developed liver failure, the authors reported.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_330"
                     title="Immune Cells Point to Skin Cancer Risk after Transplants (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Nephrology/KidneyTransplantation/tb/18200?impressionId=1265772921375"
                     
      Monitoring two types of immune cells in kidney transplant recipients might identify patients with an increased risk of skin cancer, British investigators reported.&lt;br&gt;
&lt;br&gt;Increased levels of T-regulatory cells (Tregs) more than doubled the risk of squamous cell cancer of the skin. Decreased levels of natural killer (NK) cells were associated with more than a five-fold increased risk of skin cancer.&lt;br&gt;
&lt;br&gt;Both immune parameters had substantially greater predictive power than a history of squamous-cell skin cancer, according to an online report in the &lt;em&gt;Journal of the American Society of Nephrology&lt;/em&gt; by a team of Oxford University investigators.&lt;/p&gt;
&lt;p&gt;&quot;Squamous cell cancer of the skin affects about 30% of kidney transplant patients after 10 years of immunosuppression,&quot; Robert Carroll, MD, currently of Queen Elizabeth Hospital in Woodville, Australia, observed in a statement.&lt;/p&gt;
&lt;p&gt;&quot;A small number of patients develop multiple skin cancers per year, but there is no laboratory test to determine which transplant recipients will develop multiple skin cancers in the future.&quot;&lt;/p&gt;
&lt;p&gt;&quot;If a test can confirm high risk of skin cancer development, this may help clinicians to tailor immunosuppressive regimens for individual patients,&quot; he added.&lt;/p&gt;
&lt;p&gt;Long-term immunosuppression, such as that required for transplant recipients, confers an increased risk of squamous-cell skin cancer.&lt;/p&gt;
&lt;p&gt;Estimates of the magnitude have ranged as high as 200 times greater than the general population, the authors wrote. Additionally, 3% of organ transplant recipients require extensive plastic surgery each year as a result of skin cancer lesions.&lt;/p&gt;
&lt;p&gt;Age at transplantation and the immunosuppression dosage are the principal determinants of skin-cancer risk, and the dosage of immunosuppression also influences the risk of metastasis from squamous-cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;In the general population, cancer has been associated with increased levels of Tregs, including CDR&lt;sup&gt;+&lt;/sup&gt;CD25&lt;sup&gt;high&lt;/sup&gt;FOXP3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt;CD28&lt;sup&gt;-&lt;/sup&gt; cells. The same types of cells could play a role in the risk of skin cancer among organ transplant recipients, the authors wrote.&lt;/p&gt;
&lt;p&gt;Within the tumor microenvironment, Tregs may impair the antitumor activity of CD8&lt;sup&gt;+&lt;/sup&gt; and NK cell. However, in organ transplant recipients, Tregs help control or prevent rejections and may help improve long-term outcomes.&lt;/p&gt;
&lt;p&gt;Different immunosuppressive drugs affect Tregs differently, the authors continued. Sirolimus (Rapamune), for example, increases the number of FOXP3&lt;sup&gt;+&lt;/sup&gt; cells, whereas cyclosporine decreases Treg numbers.&lt;/p&gt;
&lt;p&gt;&quot;Tregs have not been assessed in relation to cancer after transplantation,&quot; the authors wrote. &quot;We therefore investigated the hypothesis that squamous-cell cancer in kidney transplant recipients would be associated with an increased number of Tregs.&quot;&lt;/p&gt;
&lt;p&gt;To examine the hypothesis, investigators phenotyped peripheral blood from 65 kidney transplant recipients with squamous skin cancer and 51 recipients without skin cancer, matched for age, sex, and duration of immunosuppression.&lt;/p&gt;
&lt;p&gt;They also quantified lymphocyte populations in skin cancer lesions from a subset of 25 patients and matched them with 25 other nontransplant patients with squamous cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;The kidney transplant recipients had a median follow-up of 340 days. The investigators found that a concentration of &amp;gt;35 peripheral FOXP3&lt;sup&gt;+&lt;/sup&gt;CD4&lt;sup&gt;+&lt;/sup&gt;CD127&lt;sup&gt;low&lt;/sup&gt; regulatory T cells/&amp;#181;L was associated with a hazard ratio for squamous cell skin cancer of 2.48 (95% CI 1.04 to 5.98).&lt;/p&gt;
&lt;p&gt;An NK cell count &amp;lt;100 cells/&amp;#181;L was associated with a skin cancer hazard ratio of 5.6 (95% CI 1.31 to 24). A history of squamous cell cancer of the skin increased the risk of skin cancer recurrence by a third (HR 1.33, 95% CI 1.15 to 1.53).&lt;/p&gt;
&lt;p&gt;&quot;If similar immune phenotypes are predictive in other kidney transplant recipient populations, then immune phenotype method has the potential to inform immunosuppressive regimen manipulation in kidney transplant recipients at high risk for developing multiple squamous cell cancers,&quot; the authors concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3493"
                     title="AASLD: Survival Lower in HCV-Infected Women after Liver Transplant (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AASLD/tb/16735?impressionId=1265772921375"
                     
      BOSTON  --  Women undergoing liver transplant as a result of hepatitis C virus (HCV) infection show poorer long-term survival rates and more frequent failure of the donor liver, compared with male recipients, a researcher said here.&lt;br&gt;
&lt;br&gt;Female gender was associated with a hazard ratio for five-year mortality of 1.46 (95% CI 1.04 to 2.03) in multivariate analysis of 195 female and 655 male liver recipients, reported Jennifer Lai, MD, of the University of California San Francisco.&lt;br&gt;
&lt;br&gt;Women were also at almost 40% higher risk for overall graft loss (HR 1.39, 95% CI 1.39 to 1.89), Lai said here at the annual meeting of the American Association for the Study of Liver Disease.&lt;/p&gt;
&lt;p&gt;&quot;Further studies are needed to evaluate modifiable donor factors and post-transplant therapies that influence [women&apos;s] outcomes,&quot; she told attendees at a plenary presentation.&lt;/p&gt;
&lt;p&gt;She said previous studies were equivocal on whether gender affects survival and graft loss rates in HCV-infected liver transplant recipients.&lt;/p&gt;
&lt;p&gt;Moreover, the earlier research included patients whose transplants occurred before the current system for allocating donor livers, based on Model for End-Stage Liver Disease (MELD) scores, was instituted earlier in the decade.&lt;/p&gt;
&lt;p&gt;The study conducted by Lai and her colleagues included all adult liver transplant recipients with HCV-related liver disease at a network of four major centers from March 2002 to December 2007.&lt;/p&gt;
&lt;p&gt;A co-diagnosis of hepatocellular carcinoma was not an exclusion, but patients with HIV or who were negative for HCV RNA after transplant were excluded, as were those whose grafts failed within a month of transplant.&lt;/p&gt;
&lt;p&gt;Overall, with median follow-up of 3.1 years, 22% of transplant recipients had died and 25% had sustained graft loss.&lt;/p&gt;
&lt;p&gt;Graft loss with recurrent HCV infection occurred in 10% of patients. Advanced recurrent disease was seen in 26%.&lt;/p&gt;
&lt;p&gt;Lai said that women were at substantially increased risk for these latter outcomes  --  a 44% increased chance of advanced recurrent HCV and 84% higher rates of graft loss associated with recurrent infection.&lt;/p&gt;
&lt;p&gt;In addition to female gender, factors significantly associated with outcomes included: &lt;ul&gt; &lt;li&gt;African-American race: HR for mortality 1.66 (95% CI 1.09 to 2.55); HR for graft loss 1.51 (95% CI 1.00 to 2.26)&lt;/li&gt; &lt;li&gt;Post-transplant antiviral treatment: HR for mortality 0.57 (95% CI 0.40 to 0.80); HR for graft loss 0.70 (95% CI 0.51 to 0.95)&lt;/li&gt; &lt;li&gt;Donor age, per year: HR for mortality 1.03 (95% CI 1.02 to 1.04); HR for graft loss 1.02 (95% CI 1.01 to 1.03)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Lai emphasized that these factors were adjusted for in the hazard ratios calculated for female gender.&lt;/p&gt;
&lt;p&gt;She suggested several potential explanations for the higher risks that women appeared to run: &lt;ul&gt; &lt;li&gt;Differential effects of aging in women compared with men&lt;/li&gt; &lt;li&gt;Gender mismatch between donors and recipients  --  these were more common with female versus male recipients in the study&lt;/li&gt; &lt;li&gt;Renal impairment prior to transplant, also more likely to occur with women than men in the sample&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Gregory Everson, MD, a hepatologist at the University of Colorado in Denver, who was not involved in the study, said he was not entirely surprised by the findings.&lt;/p&gt;
&lt;p&gt;He said one of the first studies to examine the role of gender in liver transplant outcomes had also found a disadvantage for women. &quot;This kind of confirms the finding,&quot; Everson said.&lt;/p&gt;
&lt;p&gt;He added that, at this point, there wasn&apos;t a clear clinical implication. Everson agreed with Lai that more research is needed to identify the factors underlying the gender differences and how they might be alleviated either prior to or after transplantation.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Lai had no potential conflicts of interest. Other co-authors reported relationships with Salix, Gilead, GlaxoSmithKline, Novartis, Schering, Vertex, Roche, Siemens, Schering-Plough, SciClone, and Human Genome Sciences.&lt;/p&gt;&lt;p&gt;Everson reported relationships with Schering-Plough and Ortho Biotech.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3578"
                     title="AASLD: Treating Before Transplant Cuts HCV Recurrence (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AASLD/tb/16848?impressionId=1265772921375"
                     
      BOSTON  --  In patients with advanced liver disease related to hepatitis C, a course of pegylated interferon and ribavirin (Rebetol) before liver transplant may help them avoid recurrence of infection, a researcher said here.&lt;br&gt;
&lt;br&gt;Nearly 30% of patients receiving the drugs showed no signs of the hepatitis C virus (HCV) three months after receiving a new liver, reported Gregory T. Everson, MD, of the University of Colorado in Denver.&lt;br&gt;
&lt;br&gt;He presented results of a prospective, semirandomized component of a larger study called A2ALL at the American Association for the Study of Liver Diseases meeting.&lt;br&gt;
&lt;br&gt;&quot;This experience supports the concept that pretransplant therapy can prevent allograft reinfection,&quot; he said.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Not surprisingly, the best results were achieved in patients whose HCV viral loads were reduced to undetectable levels at the time of transplant, Everson reported. Among 14 patients in whom this was achieved, eight remained virus free at the post-transplant evaluation.&lt;/p&gt;
&lt;p&gt;Duration of the pretreatment regimen was also a significant predictor of post-transplant response, Everson reported.&lt;/p&gt;
&lt;p&gt;Some 44% of patients who received the interferon-ribavirin treatment for more than 15 weeks before transplant had a postprocedure response, compared with 18% of those treated for 10 to 15 weeks and 15% of those getting the drugs for less than 10 weeks (&lt;em&gt;P&lt;/em&gt;=0.04).&lt;/p&gt;
&lt;p&gt;Other factors  --  such as baseline HCV viremia, viral genotype, type of donor (live versus dead), and toxicity-related dose limitations  --  were not significantly associated with post-transplant response, although the study may not have been powered adequately to detect such associations.&lt;/p&gt;
&lt;p&gt;Of the 79 patients enrolled in the trial, 47 with HCV genotypes 1, 4, 5, or 6 were randomized in a 2:1 ratio to receive the pretransplant drug regimen or no treatment. All of the 32 other patients with HCV genotypes 2 or 3 received the treatment.&lt;/p&gt;
&lt;p&gt;The treatment consisted of starting doses of 0.75 mcg/kg/week of pegylated interferon-alfa-2b (PEGIntron) and 600 mg/day of ribavirin, which were both escalated as tolerated over several weeks to standard target levels.&lt;/p&gt;
&lt;p&gt;Median treatment duration was 11.4 weeks for the 44 dead-donor candidates and 14.6 weeks for the 35 able to receive live-donor organs.&lt;/p&gt;
&lt;p&gt;Transplant was actually performed in 41 patients, 25 of whom were dead-donor candidates.&lt;/p&gt;
&lt;p&gt;Everson characterized the effectiveness of the pretransplant drug regimen as &quot;limited.&quot;&lt;/p&gt;
&lt;p&gt;He said it should be considered only for selected patients, particularly those with relatively less severe disease.&lt;/p&gt;
&lt;p&gt;In the trial, those were the patients who were live-donor candidates along with the dead-donor candidates who received a so-called MELD upgrade because of hepatocellular carcinoma.&lt;/p&gt;
&lt;p&gt;&quot;If you take all the patients with HCV going to liver transplant, many of them are too sick to treat with [pegylated interferon] and ribavirin,&quot; he said.&lt;/p&gt;
&lt;p&gt;Data from the study indicated that the treatment was significantly toxic. Three-quarters of the treated patients suffered serious adverse events, compared with half of untreated patients (&lt;em&gt;P&lt;/em&gt;=0.04). These were seen both before and after transplant.&lt;/p&gt;
&lt;p&gt;However, mortality rates were the same in treated and untreated patients, at about 15%.&lt;/p&gt;
&lt;p&gt;Everson said it might be possible in the future to try pretreatment in sicker patients when direct antiviral drugs for HCV become available.&lt;/p&gt;
&lt;p&gt;In the meantime, he said, patients who can tolerate the treatment need to stay on it for at least 12 weeks.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Everson reported relationships with Schering-Plough and Ortho Biotech. Other co-authors reported relationships with Roche, Salix, Gilead, Vertex, Pfizer, GlaxoSmithKline, Amgen, Bayer, Novartis, and Human Genome Sciences, among others.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3584"
                     title="AASLD: Liver Reserve Measured in Breath Test (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AASLD/tb/16856?impressionId=1265772921375"
                     
      &lt;p&gt;BOSTON  --  A simple breath test gives a good overall measure of liver function in patients with chronic viral hepatitis and could help in evaluating potential liver transplant candidates, a researcher said here.&lt;/p&gt;
&lt;p&gt;The test, which measures exhaled carbon dioxide following an oral dose of isotopically labeled methacetin, accurately predicted survival of 395 patients with chronic viral hepatitis during a median of five months of follow-up, reported Gadi Lalazar, MD, of Hadassah Hebrew University in Jerusalem.&lt;/p&gt;
&lt;p&gt;The test predicted death with a sensitivity of 82% and specificity of 89% in the prospective study, Lalazar told attendees at the American Association for the Study of Liver Diseases meeting.&lt;/p&gt;
&lt;p&gt;Although the findings still need additional validation, Lalazar said, it also appeared that the test could improve survival predictions for patients within specific ranges of Model of End-Stage Liver Disease (MELD) scores.&lt;/p&gt;
&lt;p&gt;MELD is now the basis for allocating liver transplants, but is known to be an imperfect predictor of survival, Lalazar explained.&lt;/p&gt;
&lt;p&gt;The breath test, tradenamed Breath ID, is based on the fact that methacetin is metabolized in the liver to produce acetaminophen and carbon dioxide. The speed of that reaction declines with impaired hepatic function.&lt;/p&gt;
&lt;p&gt;The test uses methacetin containing 13C carbon atoms, such that the exhaled carbon dioxide is also labeled with this isotope. Therefore, Lalazar said, the amount of 13C-labeled carbon dioxide in breath correlates closely with hepatic function.&lt;/p&gt;
&lt;p&gt;The technology, being developed by an Israeli company called Exalenz, translates the carbon dioxide measurement into a hepatic impairment score (HIS). For purposes of the study, scores were grouped into tertiles reflecting low, medium, and high risk.&lt;/p&gt;
&lt;p&gt;Patients in the study had mean MELD scores of 8.2, with about 80% having scores below 10, indicating relatively mild liver disease. Close to 90% had hepatitis C virus infection; the remainder had hepatitis B. About 30% had cirrhosis.&lt;/p&gt;
&lt;p&gt;Eleven patients died during follow-up, which ranged from two to 24 months.&lt;/p&gt;
&lt;p&gt;Nine of the deaths occurred in patients with high-risk HIS values; the other two occurred in the medium-risk group.&lt;/p&gt;
&lt;p&gt;Lalazar said the risk of death increased by 34% with each log&lt;sub&gt;10&lt;/sub&gt; unit increase in the HIS (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt;
&lt;p&gt;The accuracy remained strong in patients with normal levels of alanine aminotransferase (ALT), he said.&lt;/p&gt;
&lt;p&gt;Six of the deaths occurred in patients with normal ALT but who were determined to be at high risk on the basis of breath-test results. Two deaths occurred in medium-risk patients with normal ALT, and none in the low-risk patients.&lt;/p&gt;
&lt;p&gt;Four patients with MELD scores under 15 died during the study; three of them were identified as high-risk on the basis of HIS scores.&lt;/p&gt;
&lt;p&gt;Lalazar said only one death was recorded among 10 patients with MELD scores of 15 or higher whose HIS results indicated low risk.&lt;/p&gt;
&lt;p&gt;He said that breath test results were associated with mortality risk, even among patients in a relatively narrow two-point range in MELD scores.&lt;/p&gt;
&lt;p&gt;John Hoefs, MD, of the University of California Irvine, commented that quantitative tests of liver health such as this appear to be more accurate than the usual clinical measures.&lt;/p&gt;
&lt;p&gt;&quot;Quantitative liver function tests trump fibrosis and other measures in predicting clinical outcomes,&quot; he said.&lt;/p&gt;
&lt;p&gt;Hoefs, who was not involved in the study, was part of a group that had reported here on a separate trial involving a panel of other quantitative tests, such as choline and antipyrine clearance and perfused hepatic mass. It also accurately predicted outcomes in patients with chronic viral hepatitis.&lt;/p&gt;
&lt;p&gt;&quot;We think this [methacetin breath test research] supports that effort,&quot; he said.&lt;/p&gt;
&lt;p&gt;Lalazar noted that the study was limited by the low proportion of cirrhotic patients and the small number of deaths. &quot;A validation study is required,&quot; he said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by Exalenz, developer of the methacetin breath test.&lt;/p&gt;&lt;p&gt;Lalazar reported no potential conflicts of interest other than the research funding. One co-author reported relationships with Alcobra, Immuron, Enzo Biochem, and ChiasmaPharma.&lt;/p&gt;&lt;p&gt;Hoefs reported relationships with Roche and Gilead.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>