Plasma Ammonia Levels Predict Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement.

Background: Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension. Overt hepatic encephalopathy (oHE) is a complication after TIPS associated with increased morbidity. Elevated ratio of plasma ammonia (AMM) levels compared to the local upper limit of normal (ULN) has been associated with oHE, hepatic complications and increased mortality in patients with cirrhosis without TIPS.

Impact of Frailty on the Prognosis of Patients With Liver Cirrhosis Undergoing Insertion of a TIPS.

Background And Aims: Frailty is associated with a poorer prognosis of patients awaiting liver transplantation. Data on the impact of frailty on prognosis after transjugular intrahepatic portosystemic shunt (TIPS)-insertion in patients with cirrhosis and the influence of TIPS on longitudinal changes in frailty are lacking.

Methods: We retrospectively analysed data of 123 prospectively recruited patients with cirrhosis in Mainz and Hannover prior to elective TIPS insertion and monitored them for death/liver transplantation or post-TIPS overt hepatic encephalopathy (OHE).

Transjugular diagnostic procedures in hepatology: Indications, techniques and interpretation.

Measurement of the hepatic venous pressure gradient (HVPG) and transjugular liver biopsy have emerged as important tools in clinical hepatology. Measurement of HVPG is considered the gold standard for detecting clinically significant portal hypertension, with an HVPG of ≥10 mmHg being the key prognostic threshold in patients with compensated advanced chronic liver disease (cACLD; compensated cirrhosis). A transjugular liver biopsy can be obtained within the same procedure and may be preferred over percutaneous liver biopsy in patients with coagulopathy, ascites and/or significant obesity.

Extrahepatic Replication and Genomic Signatures of the Hepatitis E Virus in the Kidney.

Introduction: The hepatitis E virus (HEV; species Paslahepevirus balayani) is a common human pathogenic and zoonotic virus that can cause both acute fulminant and chronic hepatitis. Despite its reputation as a hepatotropic virus, HEV infection is also associated with a number of extrahepatic diseases, including kidney disorders. However, the extent to which HEV replicates in kidney cells remains unclear.

Differences in the incidence of cirrhosis-associated complications between MASLD, MetALD and ALD among patients with decompensated liver cirrhosis.

Background: Recently, the new definition of steatotic liver disease (SLD) has been introduced, which not only differentiates MASLD (Metabolic Dysfunction-Associated steatotic liver disease) from alcohol-related steatotic liver disease (ALD), but also introduces the concept of metabolic and alcohol-related SLD (MetALD). However, potential differences of the new etiologies regarding the clinical phenotype of patients with advanced liver cirrhosis still remain undetermined. Therefore, we analyzed survival and the incidence of cirrhosis-related complications in SLD-patients with advanced liver cirrhosis.

Severe alpha-1 antitrypsin deficiency is associated with a higher risk of complications after first decompensation than other aetiologies of cirrhosis.

Background & Aims: Alpha-1 antitrypsin deficiency (AATD) causes/predisposes to advanced chronic liver disease. However, the role of the Pi∗ZZ genotype in patients with decompensated cirrhosis is unclear. Thus, we evaluated the impact of the Pi∗ZZ genotype on the disease course after the first hepatic decompensation event.

Minimal residual ascites 3 months after TIPS implantation implicates worse clinical outcomes in patients with cirrhosis.

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is indicated for recurrent/refractory ascites in patients with cirrhosis. The prognostic impact of residual minimal ascites after TIPS implantation has not yet been investigated.

Methods: We included patients with cirrhosis undergoing covered TIPS implantation for refractory ascites in Vienna (2000-2022) and Hannover (2009-2021) with available abdominal ultrasound 3 months after TIPS insertion (3M).

Origin of Hypofunctional CD103 NK Cells in Cirrhosis-Associated Ascites.

The occurrence of ascites is a frequent complication associated with the decompensation of liver cirrhosis. While it is known that cirrhosis leads to altered immune responses in the periphery, the immunological milieu of ascites remains poorly understood. In this study, we investigate the role and origin of natural killer (NK) cells in cirrhosis-associated ascites.

Distinct Inflammatory Imprint in Non-Cirrhotic and Cirrhotic Patients Before and After Direct-Acting Antiviral Therapy.

Background/aims: Hepatitis C virus (HCV) infection remains a global health challenge, leading to chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC). Despite the high efficacy of direct-acting antiviral (DAA) therapy in achieving sustained virologic response (SVR), concerns persist regarding long-term immune alterations and residual risks, particularly in cirrhotic patients.

Methods: This study investigates 75 soluble immune mediator (SIM) profiles in 102 chronic HCV patients, stratified by cirrhosis status, at therapy initiation, end of treatment, and long-term follow-up (median 96 weeks).

Incidence and Clinical Significance of Recompensation After HCV Cure.

Background And Aims: Baveno VII has proposed criteria for cirrhosis recompensation, but their prognostic significance in decompensated patients cured of hepatitis C virus (HCV) deserves further investigation. Thus, we studied the incidence and impact of recompensation after HCV cure as well as its predictors.

Methods: A total of 2570 patients with advanced chronic liver disease (ACLD) from 10 European centers were retrospectively included, including 2209 and 361 patients with compensated ACLD and decompensated cirrhosis who achieved sustained virologic response to direct-acting antivirals (DAAs).

Bacterial Infections in Patients With Severe Alcohol-Associated Hepatitis: Drivers of Organ Failure and Mortality.

Background: Severe alcohol-associated hepatitis (sAH) is a life-threatening condition with limited treatment options. Although corticosteroids offer some benefit in short-term survival, their use remains controversial due to concerns about increased infection risk. Infections are a major cause of mortality in sAH; however, the reasons for this remain unclear.

Distinct clusters of bacterial and fungal microbiota in end-stage liver cirrhosis correlate with antibiotic treatment, intestinal barrier impairment, and systemic inflammation.

Decompensated liver cirrhosis (dLC) is associated with intestinal dysbiosis, however, underlying reasons and clinical consequences remain largely unexplored. We investigated bacterial and fungal microbiota, their relation with gut barrier integrity, inflammation, and cirrhosis-specific complications in dLC-patients. Competing-risk analyses were performed to investigate clinical outcomes within 90 days.

QuickStroop for screening for minimal hepatic encephalopathy in patients with cirrhosis.

Background & Aims: QuickStroop, a shortened version of the Stroop EncephalApp, has recently been proposed for screening for minimal hepatic encephalopathy (MHE) in patients with cirrhosis in the USA. At present, there are no data on its clinical utility for MHE screening in patients in Europe, and only limited data are available regarding its comparison to the Animal Naming Test (ANT).

Methods: In total, 242 patients with cirrhosis without signs of hepatic encephalopathy (HE) ≥ grade 1 and no history of overt HE were included as the development cohort.

Decreasing interleukin-6 levels after TIPS predict outcomes in decompensated cirrhosis.

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) effectively treats complications of cirrhosis. Systemic inflammation (SI) is linked to acute-on-chronic liver failure (ACLF) and liver-related death. We aimed to assess the trajectory and clinical impact of SI parameters after TIPS implantation.

Early Occurrence of Hepatic Encephalopathy Following Transjugular Intrahepatic Portosystemic Shunt Insertion is Linked to Impaired Survival: A Multicenter Cohort Study.

Background & Aims: Hepatic encephalopathy (HE) is a common complication following transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, the prognostic significance of overt HE post-TIPS remains controversial.

Methods: We screened 2137 patients who underwent TIPS insertion at 8 German tertiary care centers between 2004 and 2021.

Freiburg index of post-TIPS survival (FIPS) identifies patients at risk of further decompensation and ACLF after TIPS.

Background & Aims: The Freiburg index of post-TIPS survival (FIPS) defines a high-risk group of patients with significantly reduced survival following transjugular intrahepatic portosystemic shunt (TIPS) implantation. However, the clinical hallmarks responsible for these patients' unfavorable outcome remain to be identified. Therefore, the present study aimed to characterize the clinical course after TIPS implantation according to the FIPS.

Value and Kinetics of Virological Markers in the Natural Course of Chronic Hepatitis D Virus Infection.

Background And Aims: Chronic hepatitis D virus (HDV) infection can cause severe liver disease. With new treatment options available, it is important to identify patients at risk for liver-related complications. We aimed to investigate kinetics and predictive values of novel virological and immunological markers in the natural course of chronic HDV infection.

Long-term outcome and risk stratification in compensated advanced chronic liver disease after HCV-cure.

Background And Aims: Around 750,000 patients per year will be cured of HCV infection until 2030. Those with compensated advanced chronic liver disease remain at risk for hepatic decompensation and de novo HCC. Algorithms have been developed to stratify risk early after cure; however, data on long-term outcomes and the prognostic utility of these risk stratification algorithms at later time points are lacking.

Comparison of clinical outcomes in patients with refractory ascites treated with either TIPS, tunneled peritoneal catheter, or ascites pump.

Background: Refractory ascites (RA) remains a serious complication in patients with cirrhosis. Currently, the insertion of a TIPS is considered the standard of care in these patients. To achieve symptom control in those with TIPS contraindications, tunneled peritoneal catheters (PeCa) or ascites pumps were introduced.