Please select the eligibility criteria that correspond to the clinical trial below.
Title: Clinical Trial of Pentoxifylline Administration Versus Placebo on Survival in Patients With Cirrhosis and Severe Liver Failure
Brief Summary: In patients with cirrhosis and liver failure, pro-inflammatory cytokines (TNF alpha) might be responsible of severe complications and death. Thus, the prevention of cytokine production should prevent complications and mortality.

The aim of this study is to study the 2 months survival rate in patients with severe cirrhosis (Child-Pugh C) with pentoxifylline - an inhibitor of cytokine production. The 6 month mortality, the proportion of transplanted patients, the occurrence of complications (bacterial infection, renal failure, hepatic encephalopathy and gastrointestinal bleeding), plasma cytokine levels and fibrotest - a marker of fibrosis - will be also studied. This is a multicenter double blind randomized trial with a placebo.

All adult patients with severe cirrhosis might be randomized after written consent. Patients with severe carcinoma, intolerance or contraindication to pentoxifylline will not be included. Patients receive either pentoxifylline or placebo 3 times a day for 6 months. Three hundred and forty two patients are necessary to decrease mortality rate by 50% at 2 months in a beta risk of 10% and an alpha risk of 5%. Patients will be seen every month.


Options:
A: Inclusion Criteria:

* Alcohol consumption more than 40 gram/day for women and 50 gram/day for men
* Maddrey discriminant function higher than 32
* Onset of jaundice within the 3 previous months
* Biopsy-proven alcoholic hepatitis

Exclusion Criteria:

* Hypersensitivity to pentoxifylline
* Any severe disease that may potential affect survival such as cardiac failure, ischemic cardiopathy, respiratory failure
* Any neoplasm that occurred within the 2 previous years
* Hepatocellular carcinoma or any previous diagnosis of hepatocellular carcinoma
* Portal thrombosis
* Severe gastrointestinal bleeding
* Uncontrolled sepsis within the 7 previous days
* Hepatorenal syndrome type I
* Viral and fungal infection
* Acute pancreatitis
* Any tuberculosis that occurred within the 5 previous years
* Psychiatric disorders that contraindicate the use of corticosteroids
* Infection related to virus of the hepatites B or C
* HIV infection (Human immunodeficiency virus)
* Any treatment with corticosteroids, immunosuppressive agents, budesonide, thalidomide or pentoxifylline that was given within the previous year
* Pregnancy or breast feeding
B: Inclusion Criteria:

* adult patient of more than 18 years
* child pugh C cirrhosis

Exclusion Criteria:

* pregnant woman
* Patient received anticoagulant
* Patient treated for arterial hypertension
* Patient with severe coronaropathy
* Patient with hyper sensibility of pentoxifylline
* Patient hospitalized for less 24 hours
* Patient admitted for a treatment of hepatocellular-carcinoma or COLLANGIO- carcinoma
* Patient with HIV
* Patient who has been transplanted
* Patient treated with immuno- suppressors
* Patient who has already received pentoxifylline for 3 months before inclusion
* Patient for whom the follow-up is considered impossible
C: Inclusion Criteria:

* Patients with clinical and biochemical criteria for severe alcoholic hepatitis: Total bilirubin greater than 5 mg/dl in absence of biliary tract obstruction evidenced by ultrasound, history of chronic alcohol intake, leukocytosis, neutrophilia, elevation of transaminases with an aspartate aminotransferase / alanine aminotransferase ratio equal or greater than 2, discriminant function greater than 32.

Exclusion Criteria:

* Diabetes, chronic kidney disease, hepatitis C, hepatitis B and or human immunodeficiency virus infection, asthma or history of atopy or allergic reactions, therapy in the previous two years with steroids, pentoxifylline, metadoxine, S-adenosyl L- methionine, antioxidants or multivitamins.
D: Inclusion Criteria:

* Patient consent
* Chronic alcohol intake in the last 3 to 6 months
* Maddrey score ≥ 32
* Liver histology compatible

Exclusion Criteria:

* Hepato renal syndrome
* Hepatocarcinoma
* Recent variceal haemorrhage
* Recent bacterial infections
* Other liver diseases associated (HCV, HBV, hemochromatosis, AIH)
* Cancers or cardiac and respiratory, HIV infection
* NAC Allergy
* No patient consent
* Acetaminophen intoxication

Answer: B