Etiology Of Liver Disease Research Articles

Nash Up, Virus Down: How the Waiting List Is Changing for Liver Transplantation: A Single Center Experience from Italy.

Background and Objectives: Non-alcoholic steatohepatitis (NASH) has become the leading indication for liver transplantation in many countries, with a growing rate in the Western world. NASH patients are older and share a higher risk of comorbidities and cancer than patients with viral and/or alcoholic etiologies. The aims of this study were to evaluate waiting list (WL) registration and liver transplantation rates in patients with NASH-related cirrhosis at Padua University Hospital in the last fifteen years (1.2006–6.2020) and to compare clinical characteristics and indications for liver transplantation between patients with and without NASH, as well as the WL survival and post-transplant outcome. Materials and Methods: All adult patients with cirrhosis listed for liver transplantation at Padua University Hospital between 1.2006 and 6.2020 were retrospectively collected using a prospectively updated database; patients with NASH-related cirrhosis were divided by indication for liver transplantation (Dec-NASH vs. hepatocellular carcinoma (HCC)-NASH) and compared with patients with other etiologies of liver disease. The outcomes in terms of waiting list survival and post-transplant outcome were assessed. Results: One thousand four hundred and ninety-one adult cirrhotic patients were waitlisted during the study period. NASH patients accounted for 12% of all WL registrations, showing an increasing trend over time (from 2.5% in 2006 to 23% in 2020). In the last five years, NASH was the third, but most rapidly growing, indication for liver transplantation at our center. This trend was confirmed both for patients with decompensated cirrhosis (from 1.8% to 18%) and HCC as leading indication for transplantation (from 4% to 30%). NASH patients were older than non-NASH ones (mean ± SD age 59 ± 9 vs. 56 ± 9 years; p < 0.01), whereas no difference was found in gender or Child-Pugh of the model for end-stage liver disease score at WL registration. A majority (60.9%) of NASH patients underwent liver transplantation, showing 1-, 5- and 10-y post-transplant survivals of 86%, 73% and 60%, respectively. Conclusion: NASH cirrhosis has become a rapidly growing indication for liver transplantation at our center, both for HCC and decompensated disease, with good post-transplant survival.

A prospective observational study of lenvatinib as an initial treatment for patients with intermediate-stage hepatocellular carcinoma.

412 Background: The standard treatment for intermediate stage hepatocellular carcinoma (HCC) has been transarterial chemoembolization (TACE); however, it might not be suitable for patients (pts) beyond the up-to-7 criteria because of its insufficient efficacy and decline of liver function. Conversely, lenvatinib has shown a good response rate in the phase III trial REFLECT and was considered promising as an initial treatment for patients with BCLC stage B2 HCC. Methods: We conducted a multicenter prospective observational study to evaluate the efficacy of lenvatinib as an initial treatment for pts aged 20 years or older, diagnosed with BCLC stage B2 HCC, naive to TACE, and with preserved organ function. The primary endpoint was a 1-year survival rate, with a threshold of 60% and an expected survival rate of 78% based on previous reports of TACE. With a one-sided alpha error of 5% and a power of 70%, 25 pts were recruited over an enrollment period of 2 years and a follow-up period of 10 months. Results: Enrollment began in June 2018 and was closed with 31 eligible pts enrolled by June 2020. Data cut-off was done in April 2021. Patient characteristics are as follows: the median age was 77 years (range: 57–86); 94% of the pts were male; the etiology of chronic liver disease was hepatitis B virus, hepatitis C virus, alcohol abuse, and others in 3, 6, 9, and 10 pts, respectively; 20 and 11 pts had a Child-Pugh score of 5 and 6 points, respectively; the median maximum tumor diameter was 36 mm (range: 10–135); the number of pts with a tumor number of ≥10 was 8; and the median AFP level was 52.1 ng/mL (range: 2.4–49800). The 1-year survival rate was 71.0% (90% confidence interval [CI]: 68.4–73.6) and the primary endpoint was met. The median overall and progression-free survival was 17.0 months (95% CI, 15.3–19.2) and 10.4 months (95% CI, 6.6–13.8), respectively; the 2-year survival rate was 32.3%. The objective response rate according to RECIT1.1 and mRECIST was 22.6% and 70.0%, respectively. The common adverse events (AEs) were fatigue (68%), hypertension (65%), and anorexia (61%) in any grade, AST increased (23%), ALT increased (16%), and proteinuria (13%) in grade 3 or worse. Treatment interruption and dose reduction was required in 61% and 81% of the pts, respectively. The median relative dose intensity was 61.8% (range: 7.5–100). At the time of analysis, out of 24 pts, 17 (55%), nine (29%), and two (6%) discontinued lenvatinib due to disease progression, AEs, and conversion to curative treatments, respectively. One patient who showed partial response suddenly died during treatment due to unknown reasons. Systemic chemotherapy, TACE, and transarterial infusion therapy was administered in 11 (38%), six (21%) and one (3%) as a post study treatment, respectively. Conclusions: Our study indicates that initial treatment using lenvatinib prolongs the survival of pts with BCLC stage B2 HCC.

Responses to immunotherapy in hepatocellular carcinoma patients with nonalcoholic steatohepatitis cirrhosis.

389 Background: Hepatocellular carcinoma (HCC) is the most rapidly growing cause of cancer-related mortality in the United States. Recent preclinical studies suggest that immunotherapy agents targeted at programmed cell death protein 1 (PD-1) do not lead to tumor regression in HCC with underlying nonalcoholic steatohepatitis (NASH). However, further clinical studies are needed to clarify the impact of immunotherapy on patients with NASH-related HCC. Methods: This was a single center, retrospective study analyzing the best responses to immunotherapy in patients with HCC and underlying cirrhosis due to NASH. Patients were divided into 2 groups: those with HCC related to NASH cirrhosis and those with HCC without NASH cirrhosis. All patients received immunotherapy, either as a single agent or in combination with other cancer-directed therapy, with response assessments conducted during their treatment courses. Results: A total of 79 patients were included in this study. There were 15 patients in the NASH cirrhosis-related HCC group and 64 patients in the HCC group without NASH cirrhosis. When analyzing the best disease responses to immunotherapy, 7 patients (46.7%) with HCC and NASH cirrhosis were found to have disease progression as their best responses compared to 7 patients (10.9%) who had HCC without NASH cirrhosis (risk ratio 4.27, p = 0.004). In addition, for the group without NASH cirrhosis, 57 patients (89.1%) experienced disease control (stable disease, partial response, or complete response) from immunotherapy versus 8 patients (53.3%) in the NASH cirrhosis-related HCC group (risk ratio 1.67, p = 0.004). There were no notable differences in patient age, gender, or immunotherapy agents received between the two groups, but there was a significantly greater proportion of patients of Hispanic ethnicity in the HCC group with NASH cirrhosis (p = 0.006, full patient characteristics listed in the table). However, when looking at all individuals in the study, patients of Hispanic ethnicity were not found to have a significantly higher risk of disease progression compared to non-Hispanic patients (p = 0.07). Conclusions: There were significantly higher rates of disease progression as the best response to immunotherapy in patients with HCC and NASH cirrhosis compared to those without NASH cirrhosis. With the expanded use of immunotherapy in HCC patients, further prospective studies are needed to clarify the impact of underlying liver disease etiology on immunotherapy response.[Table: see text]

Identifying the patient with acute-on-chronic liver failure: navigating through multiple definitions.

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Relationship Between Etiology of Cirrhosis and Survival Among Patients Hospitalized in Intensive Care Units

ObjectiveTo determine short-term outcomes of patients with alcohol-associated cirrhosis (ALC) admitted to the intensive care unit (ICU) compared with other etiologies of liver disease. In addition, we investigate whether quick sequential organ failure assessment accurately predicts presence of sepsis and in-hospital mortality in critically ill patients with various etiologies of cirrhosis. MethodsA retrospective cohort of 1174 consecutive patients with cirrhosis admitted to the ICU between January of 2006 and December of 2015 was analyzed. Outcomes of interest included survival rates within the ICU, post-ICU in-hospital, or at 30 days post-ICU discharge. ResultsFive hundred seventy-eight patients were found to have ALC with 596 in the non-ALC group. There was no significant difference in ICU mortality rates in ALC versus non-ALC cohorts (10.2% vs 11.7%, P=.40). However, patients with ALC had significantly higher post-ICU in-hospital death (10.0% vs 6.5%, P=.04) as well as higher mortality at 30-day post-ICU discharge (18.7% vs 11.2%, P<.001). Sustained alcohol abstinence did not offer survival advantage over nonabstinence. The predictive power for quick sequential organ failure assessment for sepsis and in-hospital mortality for patients with cirrhosis was limited. ConclusionCritically ill patients with ALC have decreased survival after ICU discharge compared with patients with other etiologies of cirrhosis, independent of alcohol abstinence.

Diagnostic performance of elastography on liver fibrosis in antiviral treatment-naive chronic hepatitis B patients: a meta-analysis.

BackgroundThis study aimed to assess the performance of transient elastography (TE), two-dimensional shear wave elastography (2D-SWE), and magnetic resonance elastography (MRE) for staging significant fibrosis and cirrhosis in untreated chronic hepatitis B (CHB) patients.MethodsPubmed, Embase, Web of Science, and Cochrane Library were searched for terms involving CHB, TE, 2D-SWE, and MRE. Other etiologies of chronic liver disease, previous treatment in patients, or articles not published in SCI journals were excluded. Hierarchical non-linear models were used to evaluate the diagnostic accuracy of TE, 2D-SWE, and MRE. Heterogeneity was explored via analysis of threshold effect and meta-regression.ResultsTwenty-eight articles with a total of 4,540 untreated CHB patients were included. The summary areas under the receiver-operating characteristic curves (AUROCs) using TE, 2D-SWE, and MRE for predicting significant fibrosis (SF) were 0.84, 0.89, and 0.99, respectively. The AUROC values of TE, 2D-SWE, and MRE for staging cirrhosis were 0.9, 0.94, and 0.99, respectively. Based on the meta-analysis of studies with head-to-head comparison, 2D-SWE is superior to TE (0.92 vs 0.85, P < 0.01) in staging significant fibrosis.ConclusionTE, 2D-SWE, and MRE express acceptable diagnostic accuracies in staging significant fibrosis and cirrhosis in untreated CHB patients. 2D-SWE outperforms TE in detecting significant fibrosis in treatment-naive people with hepatitis B virus.

Type IVA choledochal cyst: a rare cause of cirrhosis in adults

BackgroundCholedochal cysts (CDCs) are characterized by congenital cystic dilations of the intrahepatic or extrahepatic bile ducts or both. CDCs are very rarely reported in sub-Saharan Africa. This congenital anomaly of the bile ducts is rarely discovered at the stage of advanced chronic liver disease with portal hypertension. We report the first Malagasy case of a type IVA choledochal cyst discovered during an etiological work-up of cirrhosis.Case presentationA 23-year-old woman was hospitalized for jaundice and ascites. Biological and radiological investigations have led to the diagnosis of secondary biliary cirrhosis due to type IVA choledochal cyst. In view of the severity of the liver damage (Child-Pugh C score), a collegial decision (hepato-gastroenterologists and visceral surgeons) had rejected surgical intervention and opted only for the management of cirrhotic decompensation.ConclusionA type IVA choledochal cyst is a possible etiology of advanced chronic liver disease.

Association of Dietary Patterns with MRI Markers of Hepatic Inflammation and Fibrosis in the MAST4HEALTH Study.

Whereas the etiology of non-alcoholic fatty liver disease (NAFLD) is complex, the role of nutrition as a causing and preventive factor is not fully explored. The aim of this study is to associate dietary patterns with magnetic resonance imaging (MRI) parameters in a European population (Greece, Italy, and Serbia) affected by NAFLD. For the first time, iron-corrected T1 (cT1), proton density fat fraction (PDFF), and the liver inflammation fibrosis score (LIF) were examined in relation to diet. A total of 97 obese patients with NAFLD from the MAST4HEALTH study were included in the analysis. A validated semi-quantitative food frequency questionnaire (FFQ) was used to assess the quality of diet and food combinations. Other variables investigated include anthropometric measurements, total type 2 diabetes risk, physical activity level (PAL), and smoking status. Principal component analysis (PCA) was performed to identify dietary patterns. Six dietary patterns were identified, namely “High-Sugar”, “Prudent”, “Western”, “High-Fat and Salt”, “Plant-Based”, and “Low-Fat Dairy and Poultry”. The “Western” pattern was positively associated with cT1 in the unadjusted model (beta: 0.020, p-value: 0.025) and even after adjusting for age, sex, body mass index (BMI), PAL, smoking, the center of the study, and the other five dietary patterns (beta: 0.024, p-value: 0.020). On the contrary, compared with low-intake patients, those with medium intake of the “Low-Fat Dairy and Poultry” pattern were associated with lower values of cT1, PDFF, and LIF. However, patients with a “Low-Fat Dairy and Poultry” dietary pattern were negatively associated with MRI parameters (cT1: beta: −0.052, p-value: 0.046, PDFF: beta: −0.448, p-value: 0.030, LIF: beta: −0.408, p-value: 0.025). Our findings indicate several associations between MRI parameters and dietary patterns in NAFLD patients, highlighting the importance of diet in NAFLD.

Racial and Health Disparities among Cirrhosis-related Hospitalizations in the USA.

Background and AimsAlcohol-associated liver disease (ALD) is the most common cause of advanced liver disease worldwide, including in the USA. Alcohol use and cirrhosis mortality is higher in American Indian/Alaska Native (AI/AN) compared to Whites. Data are scanty on ALD as a liver disease etiology in AI/AN compared to other races and ethnicities.MethodsThe National Inpatient Sample on 199,748 cirrhosis-related hospitalizations, 14,241 (2,893 AI/AN, 2,893 Whites, 2,882 Blacks, 2,879 Hispanics, and 2,694 Asians or other races) matched 1:1 for race/ethnicity on demographics, insurance, and income quartile of the residence zip code analyzed.ResultsAfter controlling for geographic location and hospital type, odds ratio (OR) and 95% confidence interval (CI) for ALD as cirrhosis etiology was higher among admissions in AI/AN vs. Whites [1.55 (1.37–1.75)], vs. Blacks [1.87 (1.65–2.11)], vs. Hispanic [1.89 (1.68–2.13)] and Asians/other races [2.24 (1.98–2.53)]. OR was also higher for AI/AN vs. all other races for alcohol-associated hepatitis (AH) as one of the discharge diagnoses. The findings were similar in a subgroup of 4,649 admissions with decompensated cirrhosis and in a cohort of 350 admissions with acute-on-chronic liver failure as defined by EASL-CLIF criteria. Alcohol use disorder diagnosis was present in 38% of admissions in AI/AN vs. 24–30% in other races, p<0.001. A total of 838 (5.9%) admissions were associated with in-hospital mortality. OR (95% CI) for in-hospital mortality in AI/AN individuals was 34% reduced vs. Blacks [0.66 (0.51–0.84)], but no difference was observed on comparison with other races.ConclusionsALD, including AH, is the most common etiology among cirrhosis-related hospitalizations in the USA among AI/AN individuals. In-hospital mortality was observed in about 6% of admissions, which was higher for Blacks and similar in other races compared to admissions for AI/AN. Public health policies should be implemented to reduce the burden of advanced ALD among AI/AN individuals.

Prevention and treatment of drug-induced liver injury in patients with breast cancer and ovarian cancer

Introduction: Drug-induced liver injury is one of the most serious problems in hepatology. In most cases the abolition of the “causative” drug is a sufficient condition for the reverse development of pathological changes. However, in the case of chemotherapy for cancer patients, the abolition of hepatotoxic drug is impossible without creating an immediate or delayed threat to the patient’s life. Objective: To develop optimal schemes for the prevention and treatment of drug-induced liver injury by studying of its characteristics of with various chemotherapy regimens in patients with breast cancer and ovarian cancer. Material and methods: The screening group included 291 patients who underwent chemotherapy courses for breast cancer and ovarian cancer. The diagnosis and type of drug-induced liver injury was based on laboratory data (alanine aminotransferase and/or alkaline phosphatase increased above 2 norms) and the exclusion of other etiologies of liver diseases. Chemotherapy hepatotoxicity was assessed using the Shaposhnikov scale. The degree of hepatic encephalopathy was determined using a critical flicker frequency test. Depending on chemotherapy mode, groups of the patients were divided into subgroups: cyclophosphamide + Methotrexate+ Fluorouracil, Doxorubici + Cyclophosphamide, Epirubicin + Cyclophosphamide + 5-fluorouracil, Paclitaxel + Cisplatin, Carboplatin + Cyclophosphamide. According to the type of drug-induced liver injury, patients with cholestatic type received preparations, with cytolytic type – S-adenosylmethionine for 8 weeks. Results and its discussion: It was found that the most common side effect of chemotherapy is leukopenia, anemia and increase in level of alanine aminotransferase and alkaline phosphatase. The use of ursodeoxycholic acid and S-adenosylmethionine as an accompanying therapy significantly reduces the level of alanine aminotransferase and alkaline phosphatase degree of hepatotoxicity and hepatic encephalopathy, clinical improves the quality of life of patients and contributes to a more rapid elimination of symptoms of astheno-vegetative, dyspeptic and pain syndromes. Conclusion: It has been proven that the use of a differentiated approach to the choice of a hepatoprotector: S-adenosylmethionine in hepatocellular type, ursodeoxycholic acid - in cholestatic type of drug-induced liver injury for 8 weeks in patients with oncological profile allowed to carry out the planned therapy without deviations from the protocol.

Impact of NAFLD on clinical outcomes in hepatocellular carcinoma treated with sorafenib: an international cohort study.

Background:The impact of nonalcoholic fatty liver disease (NAFLD) on overall survival (OS), treatment response and toxicity in patients with hepatocellular carcinoma (HCC) treated with sorafenib is unknown. We examined the impact of NAFLD on survival and toxicity in an international cohort of patients receiving sorafenib.Methods:Clinical and demographic data were collected from patients consecutively treated at specialist centres in Europe and North America. The impact of NAFLD on OS, sorafenib-specific survival and toxicity compared with other aetiologies of liver disease using multivariable Cox-proportional hazards and logistic regression modelling was assessed.Results:A total of 5201 patients received sorafenib; 183 (3.6%) had NAFLD-associated HCC. NAFLD-associated HCC patients were more likely to be older women (median age 65.8 versus 63.0 years, p < 0.01 and 10.4% versus 2.3%, < 0.01), with a median body mass index (BMI) of 29.4. After controlling for known prognostic factors, no difference in OS in patients with or without NAFLD was observed [hazard ratio (HR): 0.99, 95% confidence interval (CI): 0.84–1.18, p = 0.98]. NAFLD-associated patients had more advanced stage HCC when they commenced sorafenib [Barcelona Clinic Liver Class (BCLC) C/D 70.9% versus 58.9%, p < 0.01] and were more likely to be commenced on a lower starting dose of sorafenib (51.4 versus 36.4%, p < 0.01). There was no difference in sorafenib-specific survival between NAFLD and other aetiologies (HR: 0.96, 95% CI: 0.79–1.17, p = 0.96). Adverse events were similar between NAFLD and non-NAFLD HCC groups, including rates of greater than grade 2 hypertension (6.3% versus 5.8%, p = 1.00).Conclusion:Survival in HCC does not appear to be influenced by the presence of NAFLD. NAFLD-associated HCC derive similar clinical benefit from sorafenib compared with other aetiologies.

Portal vein thrombosis risk factors in liver transplant candidates.

Background and AimPortal vein thrombosis (PVT) is particularly detected in advanced liver cirrhosis patients. We aimed to analyze the risk factors for PVT in liver transplant candidates.Materials and MethodsDataset for consecutive 165 cirrhotic patients who were evaluated for liver transplantation (LT) were retrospectively analyzed. We sorted patients into two groups: patients with PVT and patients without PVT. Included variables were age, sex, etiology of liver disease, body mass index, MELD-Na score, Child-Pugh score, clinical variables reflecting portal hypertension, and hepatocellular carcinoma. Univariate and multivariate logistic regression analyses were used to identify risk factors of PVT.ResultsOf 165 LT candidates, 46 had PVT (27.9%). Ascites, thrombocytopenia, history of variceal bleeding, and band ligation were risk factors for PVT in univariate analysis. In multivariate analysis, only a history of variceal bleeding (OR 3.45, 95% CI 1.02–11.6, p=0.046) significantly increased the risk of PVT.ConclusionThe previous history of variceal bleeding predicts PVT development in cirrhosis, suggesting that the severity of portal hypertension is a major predictive factor for PVT in patients with cirrhosis. Future prospective studies are needed to risk stratifying cirrhosis patients prior to LT for future PVT development and to define the prophylactic role of anticoagulation in these patients.

Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience.

Background:Fully covered intraductal self-expanding metal stents (IDSEMS) have been well described in the management of post-liver transplant (LT) anastomotic strictures (ASs). Their antimigration waists and intraductal nature make them suited for deployment across the biliary anastomosis.Objectives:We conducted a multicentre study to analyse their use and efficacy in the management of AS.Design:This was a retrospective, multicentre observational study across nine tertiary centres in the United Kingdom.Methods:Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with IDSEMS insertion were analysed retrospectively. Recorded variables included patient demographics, procedural characteristics, response to therapy and follow-up data.Results:In all, 162 patients (100 males, 62%) underwent 176 episodes of IDSEMS insertion for AS. Aetiology of liver disease in this cohort included hepatocellular carcinoma (n = 35, 22%), followed by alcohol-related liver disease (n = 29, 18%), non-alcoholic steatohepatitis (n = 20, 12%), primary biliary cholangitis (n = 15, 9%), acute liver failure (n = 13, 8%), viral hepatitis (n = 13, 8%) and autoimmune hepatitis (n = 12, 7%). Early AS occurred in 25 (15%) cases, delayed in 32 (20%) cases and late in 95 (59%) cases. Age at transplant was 54 years (range, 12–74), and stent duration was 15 weeks (range, 3 days–78 weeks). In total, 131 (81%) had complete resolution of stricture at endoscopic re-evaluation. Stricture recurrence was observed in 13 (10%) cases, with a median of 19 weeks (range, 4–88 weeks) after stent removal. At removal, there were 21 (12%) adverse events, 5 (3%) episodes of cholangitis and 2 (1%) of pancreatitis. In 11 (6%) cases, the removal wires unravelled, and 3 (2%) stents migrated. All were removed endoscopically.Conclusion:IDSEMS appears to be safe and highly efficacious in the management of post-LT AS, with low rates of AS recurrence.

Prevalence and Correlation of Sarcopenia with Etiology and Severity of Cirrhosis of Liver

Background: Sarcopenia is an adverse prognostic factor in cirrhosis. Since sarcopenia is dependent on muscle mass and strength, its assessment varies with ethnicity. CT skeletal muscle index (CT-SMI) is taken as gold standard for diagnosing sarcopenia. Recently, parameters to define sarcopenia applicable to Indian patients have been proposed. There are limited studies on sarcopenia in Indian patients using the proposed criteria. Aims: To study the prevalence of sarcopenia in patients with cirrhosis and its correlation with severity and etiology of liver disease. Methods: An observational cross-sectional study that included consecutive patients with cirrhosis admitted to a tertiary care hospital. Patients over 70 years, malignancy and non-ambulant for over six months were excluded. Sarcopenia was measured by CT-SMI at L3 level (SMA /height in m2) and hand grip dynamometer (HGD). CT SMI value of less than 36.54 cm2/m2 in males and 30.21 cm2/m2 in females was defined as sarcopenia. HGD less than 20 kg was taken as sarcopenia in both males and females. Results: 53 patients with cirrhosis were studied for sarcopenia. Mean age was 51.89±10.31 years, males 40/53 (75%), severity of liver disease was Child C- 37.7%, B- 41.5% and A- 20.8%. Prevalence of sarcopenia was 41.2% (males- 81%, females-19%). Mean value of CT-SMI was 40.39 ±7.9 cm2/m2. Sarcopenia had significant association with CTP score (CTP C- 57%, B- 43%, A- 0%) (P- 0.005) and age (P- 0.007). Sarcopenia was most common in Alcoholic liver disease (49.1%). HGD (< 20kg) diagnosed sarcopenia in 76.2% patients. There was a significant positive correlation of HGD and CT-SMI in diagnosis of sarcopenia though HGD overdiagnosed sarcopenia when CT-SMI was taken as the gold standard for diagnosis. Conclusion: Sarcopenia is common in cirrhosis of liver. There is significant association of sarcopenia with age and severity of cirrhosis. HGD can serve as a screening test for sarcopenia.

EXPERIENCE IN THE USE OF HUMAN ALBUMIN IN COMPLICATIONS OF LIVER CIRRHOSIS AT HOSPITAL JUÁREZ DE MÉXICO

Controlled clinical studies have demonstrated the benefits of albumin in decompensated cirrhotic patients with ascites, elevated creatinine, spontaneous bacterial peritonitis, refractory ascites, hepatorenal syndrome and encephalopathy, in whom the use of albumin improves not only patient survival but also expands intravascular volume, improves microcirculation, binding to numerous substances such as bile acids, nitric oxide and cytokines. However, the time of administration and the dose remains controversial. To present the experience of the administration of human albumin, the clinical and epidemiological factors associated with the success of the treatment in the different complications of hospitalized patients for decompensated cirrhosis in the Gastroenterology Department at Hospital Juárez de México from January 2019 to January 2021. A descriptive, retrospective, observational and cross-sectional study of a cohort of patients hospitalized for decompensated liver cirrhosis in the Gastroenterology Department at Hospital Juárez de México. The records of 63 patients who were administered albumin at a dose of 0.7 gr/kg of body weight were reviewed according to the type of complication, reason for admission, in such a way that epidemiological data, values ​​from laboratory studies, cause of prescription and administration results which were analyzed with measures of central tendency and percentages, obtaining Child Pugh and MELD scores. Of the population studied (N = 63); 42.8% were men (n = 27) with an average age of 57.7 years, 57.1% were women (n = 36) with an average age of 59.42 years. Regarding the etiology of liver disease, the following order was observed: alcohol-related liver disease in 42.8%, MAFLD (metabolic associated fatty liver disease) 42.8%, AIH (autoimmune hepatitis) 4.75%, PBC (primary biliary cirrhosis) 4.75% and HBV (hepatitis B virus) 4.75%. Indications for the use of albumin were spontaneous bacterial peritonitis 53.3%; an acute renal failure that does not respond to fluids, precipitated by: upper gastrointestinal bleeding in 14.2%, urinary tract infection 9.5%, alcoholic hepatitis 9.5%, liver failure due to hepatitis B virus 4%, hepatorenal syndrome 9.5%. 42.8% of the patients in the study cohort had at least one comorbidity. 77.7% of them had type 2 diabetes, 11.1% had type 2 diabetes and arterial hypertension, UC was observed in 11.1% of the population. 4.76% had Child-Pugh score A, 28.57% had Child-Pugh score B and Child Pugh score C 66.66% with an average MELD Na of 25 points. In 94.7% of the cases, effectiveness was observed in the resolution of the complication, 5.3% of the patients, despite the administration of albumin, died of septic shock (secondary to urinary tract infection n = 3, SBP n = 4 and pneumonia n = 1), these patients had Child Pugh C, mean MELD Na 32, and mean serum albumin of 1.8 mg / dl, in contrast to the respondents who had mean serum albumin of 2.62 mg / dl. Unlike what is reported in the literature, we observed that despite the lower doses administered than those recommended in the treatment guidelines, we obtained a 94.7% success rate in treated patients, observing that factors such as serum albumin value, comorbidities, Child Pugh score, MELD-NA and added infectious processes can be determining factors in the results of treatment, which raises the question of: whether the administration of albumin should be individualized according to the clinical characteristics of the patient and not a standardized dose according to their complication. Serum albumin values, the presence of comorbidities, acute infections, and high Child Pugh and MELD Na scores are independent factors that affect the results of human albumin treatment in decompensated cirrhotic patients. The authors declare that there is no conflict of interest

Liver cancer risk-predictive molecular biomarkers specific to clinico-epidemiological contexts.

Hepatocellular carcinoma (HCC) risk prediction is increasingly important because of the low annual HCC incidence in patients with the rapidly emerging non-alcoholic fatty liver disease or cured HCV infection. To date, numerous clinical HCC risk biomarkers and scores have been reported in literature. However, heterogeneity in clinico-epidemiological context, e.g., liver disease etiology, patient race/ethnicity, regional environmental exposure, and lifestyle-related factors, obscure their real clinical utility and applicability. Proper characterization of these factors will help refine HCC risk prediction according to certain clinical context/scenarios and contribute to improved early HCC detection. Molecular factors underlying the clinical heterogeneity encompass various features in host genetics, hepatic and systemic molecular dysregulations, and cross-organ interactions, which may serve as clinical-context-specific biomarkers and/or therapeutic targets. Toward the goal to enable individual-risk-based HCC screening by incorporating the HCC risk biomarkers/scores, their assessment in patient with well-defined clinical context/scenario is critical to gauge their real value and to maximize benefit of the tailored patient management for substantial improvement of the poor HCC prognosis.

Single centre experience with liver biopsy of 100 patients

Background and Aim: With the availability of serologic markers and other non-invasive tests for assessment of liver diseases, the need for liver biopsy has reduced. However, in certain conditions it is of paramount importance that biopsy be done for accurate and timely treatment. We aimed to identify the etiology of undiagnosed liver disease, grade the stage of liver disease, and determine safety of the procedure

Autoantibodies: are they a clue for liver diseases?

Autoantibody testing has contributed to both biological and clinical insights in managing patients with liver disease. These autoantibodies often have clinical value for the diagnosis, disease activity and/or prognosis. We aimed to investigate the potential application of auto-antibodies in different etiologies of non-autoimmune liver diseases. This study was conducted on 53 infants and children with chronic liver diseases. The patients were subjected to clinical history and examination, laboratory investigations and abdominal ultrasound. Serum of all infants and children was tested for measurement of antiprothrombin antibody and anti-b2-glycoprotein I (ab2GPI) and anticardiolipin (ACL) auto-antibodies using a fully-automated enzyme linked immunosorbent assay (ELISA) system. The mean age of the infants with cholestatic liver diseases was significantly lower than those with metabolic liver diseases, hepatitis C virus (HCV) and vascular liver diseases (p < 0.05). The gender distribution was proportionate in all groups (p = 0.703). Autoantibodies showed significant variations among different etiologies of chronic liver diseases. he incidence of ab2GPI and ACL was significantly increased in both HCV (94.7% and 78.9%, respectively) and vascular liver diseases patients (90.9% and 72.7%, respectively) (p < 0.05). Antiprothrombin antibodies were found in 81.8% of vascular liver disease patients. Interestingly, all types of autoantibodies were deficient in cholestatic and metabolic liver diseases. Testing for liver-related autoantibodies should be included in the workup of patients with chronic liver diseases. Further studies are needed to explain the cause-effect association of ACL, ab2GPI and antiprothrombin with chronic HCV and vascular liver diseases.

Abstract IA-43: Designing individual-level and structural interventions to reduce and eliminate racial disparities in liver cancer

Abstract Over the past two decades, the incidence of hepatocellular carcinoma (HCC) has increased dramatically, in the United States and worldwide. The tremendous racial diversity in the United States allows for evaluation of racial differences in HCC risk and outcomes. Blacks, Asians and Hispanics all have increased liver cancer risk compared to non-Hispanic Whites. The cause of this disparity is poorly understood but is thought to be multi-factorial. The prevalence and etiology of chronic liver disease differs amongst racial subgroups; nonalcoholic fatty liver disease is most prevalent in Hispanics, while Blacks and Asians are disproportionately affected by viral hepatitis. Moreover, there are substantial racial inequalities with regards to access to comprehensive health care. In addition to racial differences in HCC risk, there are significant racial disparities in cancer stage at HCC diagnosis and receipt of appropriate cancer treatment. Multiple retrospective studies have confirmed significant disparities in survival after HCC diagnosis; Blacks in the United States and worldwide have the lowest survival, compared to other races. There are many stages along the cancer continuum where clinicians and researchers can intervene to improve how individuals living with liver disease are diagnosed, which could subsequently reduce the risk of HCC and improve outcomes. Using hepatitis B as a case study, this lecture will discuss individual-level interventions as well as the necessary structural interventions targeting healthcare policy, organizations, institutions and vulnerable communities that will be required to achieve widespread reduction in HCC-related disparities. Citation Format: Patricia D. Jones. Designing individual-level and structural interventions to reduce and eliminate racial disparities in liver cancer [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-43.

EUS-guided fine-needle liver biopsy in pediatric patients using a modified technique with one-pass, one-actuation wet suction

Liver biopsy (LB) can be a valuable tool to determine the etiology of pediatric liver disease. There is limited data of the role of EUS-LB in children. This study evaluated the efficacy and the safety of a modified technique (M)LB in cases at high risk of bleeding or obese children. In addition, the tissue yield of EUS-(M)LB and percutaneous (PC) approach were compared. A retrospective analysis was performed, comparing EUS-(M)LB and PC-LB in children at a tertiary referral center. All consecutive children referred for PC-LB and EUS-LB who had an unexplained liver test abnormality after exclusion of biliary disorders from March-2017 to August-2018 were included. EUS-(M)LB consisted of a one pass wet suction technique using a 19-gauche core needle. A comparison was performed between total specimen length (TSL) and the number of complete portal triads (CPTs). The cohort included 28 EUS-(M)LB and 28 PC-LB pediatric cases. The median (IQR) age was 14.5 years (13.4-16). The median TSL was 8.6 (5.8-9.6) in EUS-(M)LB cases and 7 cm (7-9) in PC-LB cases (P =0.788). The maximum intact specimen was 2.8 cm (EUS-(M)LB) and 1.6 cm (PC-LB) (P =0.009). The mean (SD) number of CPTs per sample was 28.2 (7.3) and 11.6 (2.1), respectively (P =0.001). Adverse events included once case of self-limited abdominal pain in the PC-LB group. EUS-(M)LB has the potential to be a safe and effective alternative diagnostic modality when compared to PC-LB, to evaluate children with unexplained liver test abnormalities who undergo EUS to evaluate biliary disorders.