Electronic decision aids enhance management of primary care patients with steatotic liver disease: Proof of concept pilot study.

Background: The approach to appropriate risk stratification for metabolic dysfunction-associated steatotic liver disease (MASLD) is variable, and the adoption of non-invasive liver disease assessments in clinical practice is suboptimal. In this study, we implemented an electronic decision support tool for primary care patients with MASLD to assess its influence on linkage to care.

Methods: We performed a prospective, before-and-after pilot study in which post-implementation providers were presented with an electronic decision aid automating non-invasive liver disease assessments with the Fibrosis-4 score and providing individualized, guideline-directed recommendations.

Post-liver transplantation outcomes in acute-on-chronic liver failure: Impact of alcohol as a precipitant and etiology of chronic liver disease.

Background: Acute-on-chronic liver failure (ACLF) has been associated with excellent post- liver transplant (LT) outcomes at one year, however the impact of alcohol as ACLF precipitant, specifically alcohol-associated hepatitis (AH), and as etiology of chronic liver disease (CLD) remains uncertain. This study aimed to assess the effect of alcohol as ACLF precipitant and CLD etiology (alcohol-associated liver disease (ALD) vs. non-ALD) on post-transplant outcomes.

Cultural Influences, Considerations, and Challenges for Organ Donation and Liver Transplantation Around the World.

Introduction: Although liver transplantation (LT) rates have increased globally, the demand for organs still exceeds the supply. This review highlights cultures with significant influences on organ donation and LT.

Methods: We performed a literature search for articles related to cultures, ethnologies, philosophies, policies, religions, socio-economic factors, and other influences affecting organ donation in LT around the world.

Noninvasive assessment of liver inflammation in metabolic dysfunction associated steatohepatitis using MR cytometry.

The current diagnostic gold standard for metabolic dysfunction-associated steatohepatitis (MASH) requires invasive biopsy to assess steatosis, inflammation, and ballooning. While MRI-based proton density fat fraction (PDFF) and MR elastography address steatosis and fibrosis, non-invasive methods for evaluating hepatic inflammation remain lacking. This study developed a diffusion MRI (dMRI)-based MR cytometry technique to map liver cellular properties, including MRI-derived cell size (excluding fat content) and cell density.

Medications for Weight Loss and MASLD: A National Survey of Hepatology and Gastroenterology Provider Practices, Attitudes, and Knowledge Before Resmetirom.

Goals: Our aim was to perform a national survey of provider attitudes, practices, and knowledge regarding weight loss and MASLD medications in patients with MASLD.

Background: While weight loss is a cornerstone in the management of metabolic dysfunction-associated steatotic liver disease (MASLD), FDA-approved medications for weight loss remain underutilized.

Results: We conducted a survey before resmetirom approval of hepatology and gastroenterology providers practicing in 44 states.

Distinguishing Hepatocellular Carcinoma from Cirrhotic Regenerative Nodules Using MR Cytometry.

Background And Objectives: Current guidelines recommend contrast-enhanced CT/MRI as confirmatory imaging tests for diagnosing hepatocellular carcinoma (HCC). However, these modalities are not always able to differentiate HCC from benign/dysplastic nodules that are commonly observed in cirrhotic livers. Consequently, many lesions require either pathological confirmation via invasive biopsy or surveillance imaging after 3-6 months, which results in delayed diagnosis and treatment.

Magnesium Depletion Score and Mortality in Individuals with Metabolic Dysfunction Associated Steatotic Liver Disease over a Median Follow-Up of 26 Years.

Unlabelled: Metabolic dysfunction associated steatotic liver disease (MASLD) has been associated with increased risks of all-cause and cardiovascular disease (CVD) mortality. Identification of modifiable risk factors that may contribute to higher risks of mortality could facilitate targeted and intensive intervention strategies in this population. This study aims to examine whether the magnesium depletion score (MDS) is associated with all-cause and CVD mortality among individuals with MASLD or metabolic and alcohol associated liver disease (MetALD).

The clinical relevance of the new criteria for cirrhotic cardiomyopathy and future directions.

Cardiac dysfunction in patients with liver disease has been recognized since the 1950s. Initially attributed to shared risk factors, it is now evident that cardiac dysfunction in patients with cirrhosis can occur in the absence of known cardiac, that is, coronary artery and valvular heart disease, and across all etiologies for cirrhosis. In 1996, this myocardial dysfunction was termed cirrhotic cardiomyopathy (CCM).

Informatics-driven solutions for optimal care delivery in liver transplantation.

Clinical informatics, which combines health information technology and clinical expertise, aims to improve health care delivery and outcomes. For candidates and recipients of liver transplants, the complexities of their management are vast. Care often involves significant volumes of data from various sources and multiple health care settings and health care systems.

Worldwide variations in COVID-19 vaccination policies and practices in liver transplant settings: results of a multi-society global survey.

Background: Despite the WHO's report of 24 available SARS-CoV-2 vaccines, limited data exist regarding vaccination policies for liver transplant (LT) patients. To address this, we conducted a global multi-society survey (EASL-ESOT-ELITA-ILTS) in LT centers.

Methods: A digital questionnaire assessing vaccine policies, safety, efficacy, and center data was administered online to LT centers.

Safety and efficacy of continuous terlipressin infusion in HRS-AKI in a transplant population.

Hepatorenal syndrome-acute kidney injury (HRS-AKI) is associated with significant morbidity and mortality. While liver transplantation is the definitive treatment, continuous terlipressin infusion for HRS-AKI may provide benefit and, as such, was assessed in a population composed of candidates for liver transplant (LT). Fifty hospitalized LT-eligible patients with HRS-AKI received a single bolus followed by continuous terlipressin infusion.

Perioperative Characteristics and Outcomes of Fontan Versus Non-Fontan Patients Undergoing Combined Heart-Liver Transplantation: A Retrospective Cohort Study.

Objectives: Combined heart-liver transplantation (CHLT) is becoming increasingly frequent as a maturing population of patients with Fontan-palliated congenital heart disease develop advanced liver fibrosis or cirrhosis. The authors present their experience with CHLT for congenital and noncongenital indications, and identify characteristics associated with poor outcomes that may guide intervention in high-risk patients.

Design: This was a single-center retrospective cohort study.

Evaluation of terlipressin-related patient outcomes in hepatorenal syndrome-acute kidney injury using point-of-care echocardiography.

Background And Aims: Treatment of hepatorenal syndrome-acute kidney injury (HRS-AKI), with terlipressin and albumin, provides survival benefits, but may be associated with cardiopulmonary complications. We analyzed the predictors of terlipressin response and mortality using point-of-care echocardiography (POC-Echo) and cardiac and renal biomarkers.

Approach: Between December 2021 and January 2023, patients with HRS-AKI were assessed with POC-Echo and lung ultrasound within 6 hours of admission, at the time of starting terlipressin (48 h), and at 72 hours.

INFUSE: Rationale and design of a multi-center, open label, collaborative study to treat HRS-AKI with continuous terlipressin infusion.

Background: Hepatorenal syndrome-acute kidney injury (HRS-AKI) carries significant morbidity and mortality among those with end-stage liver disease. Bolus terlipressin for treatment of HRS-AKI received FDA approval in September 2022. US implementation of terlipressin, however, is hindered by the paucity of local data on the optimal patient population and administration mode, as well as the effect on transplant priority.

Cirrhosis-related sarcopenia may not resolve after liver transplantation.

Background & Aims: Sarcopenia has significant burden in cirrhosis and has been shown to worsen short-term post-liver transplantation (LT). This study aims to evaluate the long-term change in sarcopenia post-LT along with its associations and predictors.

Methods: A retrospective study of adult patients who underwent LT at a tertiary centre between 1/1/2009 and 12/31/2018.

Cirrhotic cardiomyopathy influences clinical outcomes and enhances performance of conventional risk prediction models in acute-on-chronic liver failure with severe sepsis.

Background: Point-of-care echocardiography (POC-Echo) is an essential intensive care hemodynamic monitoring tool.

Aims: To assess POC-Echo parameters [i.e.