[12, 13, 22, 28, 29] Moreover, the distribution of fibrosis is reported to be patchy in CHC and small-needle biopsies may not reliably estimate the extent of the overall fibrosis, which may also explain the finding of regression in a few of our patients.[12, 13, 27-29] It is well recognized that the staging system often demonstrates a nonlinear progression of fibrosis.[12, 13] see more Prospective randomized controlled studies in untreated children to address the adequacy and heterogeneity in biopsy sizes are challenging because of the

decreasing number of HCV-infected patients, the benign clinical course during the first two decades of life, and the risks involved in liver biopsy. This clearly highlights the need for noninvasive markers of fibrosis,

which should be specifically validated for use in infants and children. Until they are available, liver biopsy will remain the gold standard for assessment of disease severity.[12, 13, 28] In this era of expanding treatment options for children and adolescents with CHC, the role of an initial or repeat liver biopsy for treatment decisions needs to be examined. In the past, many treatment trials mandated a liver biopsy; this approach is now being questioned since children tolerate treatment well and the outcome of treatment is excellent, especially in nongenotype 1 patients.[8-11] The current North American Society of Pediatric Gastroenterology, Hepatology U0126 cell line and Nutrition (NASPGHAN) guidelines for management of pediatric patients with chronic HCV recommend a liver biopsy if the result influences medical decision-making, such as initiation of treatment in genotype 1, or in the event of sudden hepatic decompensation in a previously stable patient.[21] These guidelines have been supported by other investigators who advocate a liver biopsy in the presence of autoimmune markers, obesity, or suspected cirrhosis, and recognize that markers such as ALT or viral load

may not be predictive of severity or treatment outcomes.[8, MCE公司 9, 30] It may be argued that treatment of a slowly progressing disease in an asymptomatic child may be deferred given the side effects and limitations of the currently available therapy. On the other hand, some might favor early treatment of a population with very little comorbidity, facing many decades with the potential unpredictability of the course of CHC liver disease.[8-11] A liver biopsy finding is one of the critical factors which may influence decisions regarding therapy.[21, 31] Based on the data from this retrospective study, we conclude that, in the absence of specific noninvasive predictive tools and more robust mathematical models of fibrosis estimation, a follow-up biopsy after more than 5 years may be justified to evaluate CHC liver disease severity and progression for treatment decisions, particularly in genotype 1 patients. “
“Aim:  Recurrence of hepatocellular carcinoma (HCC) after liver transplantation decreases patient survival.