[Andrea De Gottardi]

Dear Dhiraj,

For the preparation of the VALDIG book that will include a chapter dedicated to this issue, Prof. Paul Richardson was rather supporting the use of DF in this indication. Prevention should be considered in particular in subjects at high risk with UDCA and DF, but data available refer to a limited numnber of patients and therefore need to be confirmed.

Kindest regards

Andrea

[Andrea De Gottardi]

Dear All,
Thank you very much for this further step! Looking forward to critically discussing with you at ILC2021 how to improve our understanding of this condition.
Kindest regards
Andrea

[Andrea De Gottardi]

Dear Antonio and colleagues,
What about the current anticoagulation treatment of this patient? Recanalisation of the splenic vein seems very important (with or without stent) to decrease portal pressure in the left/splenic sector.
Since the portal circulation is patent, as well as the TIPS, in case of failure of recanalisation of the splenic vein, splenectomy should be discussed.
Looking forward to the opinion of others.
Kind regards
Andrea

[Andrea De Gottardi]

Dear Frederike,

Does liver biopsy show any form of porto-sinusoidal vascular disease? Nodular regenerative hyperplasia?

If the liver function is fine, there is basically no need for OLT, because TIPS will decrease portal pressure, however under the condition that the splanchnic veins are open or recanalization will be possible.

Have the advice of a competent interventional radiologist in this case.

Andrea De Gottardi

USI, Lugano, South Switzerland

[Andrea De Gottardi]

Dear Audrey and colleagues,

This young patient already developed complications related to her non-cirrhotic (yet fibrotic) liver disease in terms of clinically significant portal hypertension with variceal bleeding and PVT.

In this situation, prevention of variceal re-bleeding should be performed according to the Baveno recommendations, while prevention of extension of the PVT remains a question mark. Although there is no solid evidence, anticoagulation in prophylactic dose, either with LMWH (enoxaparin 40 mg/day) or DOAC (apixaban 2.5 mg twice/day or rivaroxaban 10 mg once/day) should be considered. Thrombocytopenia is neither protective against thrombosis, nor a risk factor for variceal bleeding in this range.

What’s more is that sevearal questions remain open: what about her risk of rebleeding? if we do not decrease portal hypertension, will her thrombocytopenia progressively worsen? what about covert HE in this case? More and more transjugular or transplenic interventions successfully aimed at recanalysing the cavernoma are reported. Discuss!

Andrea

[Andrea De Gottardi]

Thank you very much Elisa for this important information. Your contribution will be very important and in this perspective Juan Carlos Garcia-Pagan and Aurélie Plessier are the contact persons. They will follow with updates after their contact with the ERN through Joost Drenth and Dave Jones.
Kindest regards
Andrea

[Andrea De Gottardi]

Dear Xingshun

Apologies for not having stated this. ERN means European Reference Networks.
Please find more information at http://www.rare-liver.eu/index.php/erns

Best regards

Andrea

[Andrea De Gottardi]

Dear VALDIG members

The next VALDIG General Assembly will take place during the ILC 2017 in Amsterdam on Wednesday, 19th of April, 6.15 – 7.15 PM, room E108 Forum Centre Amsterdam. Apologies for this mistake.

The provisional program is:
6.15 Welcome and introduction
J-C. Garcia-Pagan

6.20 Proposal of replacement of members of the steering committee (J-C. Garcia-Pagan, Andrea De Gottardi)

6.30 Presentation of the ongoing studies (each 5 minutes)
– Abernethy: Fanny Turon
– Angiosarcoma: David Semela
– INCPH and Pregnancy: Pierre-Emmanuel Rautou
– Fontan Surgery: Agustin Albillos
– VALDIG Database/Registry: Aurélie Plessier, Andrea De Gottardi

6.50 Report of the VALDIG Conference in Ascona

7.00 Proposals for funding and new studies

7.15 Final remarks and closing
J-C. Garcia-Pagan and Andrea De Gottardi

Please let us know if you would like to add any other points to be discussed.

Best regards

Andrea

[Andrea De Gottardi]

Dear Elisa

Thank you very much for your comments on Tim’s patient. This is very helpful for all of us and an excellent learning opportunity. I very much enjoyed this function in the forum.

With kindest regards

Andrea

Secretary of VALDIG
Swiss Liver Center, Bern, Switzerland

[Andrea De Gottardi]

Dear Juan Carlos

The patient had varices that regressed over time and is responding very well to diuretic therapy for ascites. Although I feel somehow unconfortable, I think that anticoagulation could be stopped, because there is no evidence to maintain it. Whether anticoagulation in prophylactic dose makes any sense remains to be established.

Thanks a lot!

Andrea

[Author]

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