Integrative hepatology: Enhancing overall health to manage liver disease.

Despite remarkable advances in diagnostics, pharmacotherapy, and transplantation, conventional hepatology often falls short in addressing the persistent symptoms, impaired quality of life, and broader health needs of people living with chronic liver disease. Integrative Hepatology-rooted in the principles of integrative medicine-offers a holistic, evidence-informed approach that combines conventional hepatology with complementary modalities to address the biological, nutritional, physical, psychosocial, behavioral, and environmental determinants of liver health. This framework emphasizes multimodal, patient-centered care aimed at improving both liver-specific and overall health outcomes.

Tumor burden and frailty: No association in liver transplant candidates with hepatocellular carcinoma.

Background: Frailty studies in liver transplant (LT) candidates have largely focused on patients with cirrhosis without hepatocellular carcinoma (HCC). However, HCC patients represent a distinct subgroup - typically older, with better compensated liver disease and more non-hepatic comorbidities. These factors, along with tumor burden, may influence frailty.

Coproducing a health advocate intervention for pediatric liver transplant recipients using a human-centered design.

Pediatric healthcare delivery systems are increasingly employing navigators, community health workers, and social workers to improve child and household access to healthcare and social services, with the goal of decreasing healthcare inequities. However, navigation strategies are understudied in pediatric liver transplantation. We used human-centered design methods, eliciting the perspectives of caregivers and transplant team members, to design a navigator role for pediatric liver transplantation.

Applying Metabolomics and Aptamer-Based Proteomics to Determine Pathophysiologic Differences in Decompensated Cirrhosis Patients Hospitalized with Acute Kidney Injury.

Introduction: Limited understanding of kidney dysfunction types and acute kidney injury (AKI) recovery exists due to biopsy risks in decompensated cirrhosis patients. To inform this, we analyzed aptamer-based proteomics and metabolomics to differentiate by AKI diagnosis and recovery.

Methods: A case-control study of 97 patients hospitalized at our institution.

Evolving trends in liver transplantation eligibility: A shift toward inclusivity for older adults at a Canadian Transplant Center.

Background: The surge of end-stage liver disease among older individuals challenges traditional age-based criteria for liver transplantation (LT), historically capped at 65 years. Our Canadian center shifted away from using chronologic age as an absolute refusal criterion since 2019, enabling those aged 65 years and older to seek LT. This study aimed to investigate temporal trends in the transplant care cascade for patients aged 65 and older at our center, pre- and post-clinical shift.

The Cirrhosis-Hospital Frailty Risk Score predicts mortality in patients with chronic liver disease: Analysis of a nationally representative database.

The prevalence of cirrhosis is increasing in the United States, coinciding with a demographic shift toward older and more medically complex patients. The Hospital Frailty Risk Score (HFRS) is widely used to measure comorbidity burden in administrative data. However, it is not specific to patients with cirrhosis.

Generative AI in hepatology: Transforming multimodal patient-generated data into actionable insights.

Cirrhosis care is inherently complex, marked by a high risk of acute decompensation and significant morbidity and mortality. Traditional episodic care models provide static snapshots of a patient's condition, limiting the ability to address dynamic changes in clinical status. Emerging at-home monitoring technologies and wearable devices present numerous opportunities to generate continuous clinical data, but the integration of this data into clinical workflows remains challenging.

Neighborhood Socioeconomic Deprivation Associates with Decreased Serologic Normalization Rates in Pediatric Celiac Disease.

Objective: To characterize how neighborhood socioeconomic deprivation affects tissue transglutaminase (tTG) IgA normalization, a marker of effective gluten elimination.

Study Design: We conducted a single-center, retrospective cohort study of 207 children ≤18 years old with serology- or biopsy-based celiac disease diagnosed between 2013 and 2023. The primary exposure was the neighborhood deprivation index, a continuous measure (0-1) derived from the 2018 5-year American Community Survey.

Salivary microbiome and serum metabolomics add to clinical biomarkers to predict 6-month hospitalizations in a multicenter cirrhosis outpatient cohort.

Background And Aims: Prognosticating outcomes such as hospitalizations in outpatients with cirrhosis is challenging, especially with changing etiologies and demographics. This study aims to determine the impact of multi-omic strategies on outcome prediction.

Approach And Results: NACSELD3 enrolls outpatients with cirrhosis with controlled/eradicated etiologies from 10 centers and follows them systematically.

Psychomotor Speed From Minimal Hepatic Encephalopathy Testing Is Associated With Physical Frailty in Patients With Advanced Chronic Liver Disease.

Introduction: Physical frailty and minimal hepatic encephalopathy (MHE) are common in advanced chronic liver disease (AdvCLD). Although the Psychometric Hepatic Encephalopathy Score is used for MHE diagnosis, its complexity limits routine use. The Stroop EncephalApp (StE) offers a simpler method for MHE diagnosis.

Physical Function as Assessed by the Liver Frailty Index Remains Stable Over Time in Patients With Hepatocellular Carcinoma Treated With Locoregional Therapies.

Introduction: It is unknown how frailty evolves over time in patients with hepatocellular carcinoma who are treated with locoregional therapies (LRTs).

Methods: We conducted a retrospective study of LRT-treated hepatocellular carcinoma patients with Liver Frailty Index (LFI) assessments. Linear mixed-effects modeling was used to assess the impact of time (modeled linearly per month) and other variables on LFI.

Central line-associated bloodstream infection rates in pediatric short bowel syndrome in the United States: A retrospective cohort study from 2016 to 2023.

Background: Central line-associated bloodstream infections (CLABSIs) are the leading cause of hospitalization in pediatric short bowel syndrome, disproportionately impacting socioeconomically disadvantaged children. We examined changes in overall CLABSI rates over time and assessed whether socioeconomic disparities persist.

Methods: Using the Pediatric Health Information System database, we studied short bowel syndrome patients aged <18 years hospitalized between 2015 and 2023.

Characterizing practice variations in the care of hospitalized patients with cirrhosis across the University of California Health.

Despite publicly available practice guidelines, in-hospital cirrhosis care remains highly variable. Prior studies of cirrhosis guideline adherence have been limited by administrative claims data. We aimed to overcome these limitations by using a novel multicenter electronic health record (EHR) database, the University of California Health Data Warehouse (UCHDW), to compare guideline adherence in the 5 medical centers of the University of California Health (UCH).

Annual Out-of-Pocket Medical Costs and Financial Toxicity Among Transplant Recipients in the United States.

Background: The significant financial costs associated with solid-organ and bone marrow transplantation incurred by the United States' (U.S.) health systems are well documented.

Patterns of dietary supplement use among United States patients with steatotic liver disease: Vitamins, minerals and botanicals.

Background: Dietary supplement (DS) usage among United States adults has significantly increased. Patients with steatotic liver disease (SLD) may have unique motivations to take DS in light of their liver condition and co-morbidities.

Aim: To characterize DS use in SLD patients and explore motivations for their use.

The Liver Transplant Comorbidity Index (LTCI): A composite index of ambulatory pre-LT factors to identify patients at increased risk of post-LT mortality.

Background And Aims: Frailty is strongly associated with mortality after liver transplantation. However, national guidelines discourage its use as a sole reason to decline a patient for liver transplantation, as some frail patients have acceptable outcomes. We aimed to develop a composite index, the Liver Transplant Comorbidity Index (LTCI), integrating frailty and other comorbidities, as a risk factor for longer-term (3-year) posttransplant mortality.

Racial differences in primary sclerosing cholangitis: A retrospective cohort study leveraging a new ICD-10 code.

Introduction And Objectives: There are limited data examining racial disparities in PSC-related clinical features and events. We aimed to leverage a new PSC ICD-10 code to characterize racial differences in a nationwide contemporary cohort of patients with PSC.

Patients And Methods: We used de-identified clinical/administrative data from the Vizient® Clinical Data Base to identify outpatient and inpatient adult patients with PSC using a PSC-specific ICD-10-CM code (K83.

Transforming liver transplant allocation with artificial intelligence and machine learning: a systematic review.

Background: The principles of urgency, utility, and benefit are fundamental concepts guiding the ethical and practical decision-making process for organ allocation; however, LT allocation still follows an urgency model.

Aim: To identify and analyze data elements used in Machine Learning (ML) and Artificial Intelligence (AI) methods, data sources, and their focus on urgency, utility, or benefit in LT.

Methods: A comprehensive search across Ovid Medline and Scopus was conducted for studies published from 2002 to June 2023.

Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia.

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012.

Sarcopenia As a Predictor of Survival and Complications of Patients With Cirrhosis After Liver Transplantation: A Systematic Review and Meta-Analysis.

Introduction: This systematic review/meta-analysis evaluated the impact of sarcopenia in patients with cirrhosis before liver transplantation (LT) on outcomes after LT.

Methods: A systematic search was conducted in six medical databases until February 2022. The primary outcome was overall mortality after LT, while several secondary outcomes including liver graft survival and rejection, the need for transfusions, the length of the intensive care unit (ICU) and hospital stay, and surgical complications were evaluated.

Differential aging trends among candidates for liver transplant with and without HCC.

HCC has become a leading indication for liver transplant (LT), with HCC registrants increasing more than 6-fold in the past 2 decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older patients with HCC are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger patients with HCC, and patients without HCC.