Electronic health records to test multimorbidity influences to plasma biomarker interpretation for Alzheimer's disease.

Objective: Plasma biomarkers of Alzheimer's disease (AD) pathology are frequently tested in specialized research settings, limiting generalizability of findings. Using electronic health records and banked plasma, we evaluated plasma biomarkers - phosphorylated tau 217 (p-tau), β-amyloid 1-42/1-40 (Aβ/Aβ) and p-tau/Aβ - in a real-world, diverse clinical population with multimorbidities.

Methods: Participants (n=617; 44% Black/African American; 41% female) were selected from the University of Pennsylvania Medicine BioBank with plasma assayed using Fujirebio Lumipulse.

Process Variation in Liver, Kidney, and Pancreas Transplantation: A Multicenter Evaluation From the Consortium for the Holistic Assessment of Risk in Transplant.

Background: Transplant center processes for determining candidacy are complex, poorly documented, ambiguous, and variable across centers. Opaque and nonstandardized transplant processes can compromise data collection and lead to inconsistent outcomes.

Methods: To understand process variation and data quality in transplantation, we surveyed 8 abdominal transplant centers in an existing research consortium about their processes of care for liver, kidney, and pancreas transplants.

Survivorship interventions after liver transplantation (LT): A systematic review of interventions targeting physical and psychosocial well-being after LT.

Despite improved survival, liver transplantation (LT) recipients need interventions that promote survivorship including better quality of life. This systematic review describes the goals and quality of existing post-LT interventions to identify gaps in post-LT care. Published manuscripts and registered clinical trials were identified using MEDLINE, PsycINFO, Cochrane, and Scopus from inception to January 1, 2024.

Policy innovations to advance equity in solid organ transplantation.

Advances in solid organ transplantation, such as improved organ preservation technologies and novel approaches to immunosuppression management, have the potential to improve outcomes in transplant recipients. However, despite these developments, there are persistent disparities in access to transplantation across, and within, certain countries. Low-income and middle-income countries have particularly low rates of transplantation, as well as less access to new technologies, mainly due to limited infrastructure and resources.

Adverse Liver Outcomes, Cardiovascular Events, and Mortality in Steatotic Liver Disease.

Importance: Steatotic liver disease is a major cause of advanced liver disease and is associated with increased risks of long-term adverse outcomes. However, estimates in steatotic liver disease subtypes according to the revised nomenclature are limited in population-based cohorts.

Objective: To compare the risks of adverse liver outcomes, major adverse cardiovascular events (MACE), and all-cause mortality across steatotic liver disease subtypes.

Balancing abstinence and harm reduction across the continuum of care for liver transplantation in alcohol-associated liver disease.

Alcohol use following liver transplantation (LT) is associated with worse outcomes. Strategies for predicting, preventing, and managing alcohol consumption among candidates and recipients of LT with alcohol-associated liver disease (ALD) have historically emphasized complete abstinence. We propose a harm reduction approach as a possible complementary and realistic strategy for managing alcohol use in the context of LT for ALD.

Cause-specific mortality in patients with steatotic liver disease in the United States.

Background & Aims: Causes of death across steatotic liver disease (SLD) subtypes remain incompletely characterized in routine clinical practice. We aimed to quantify and compare cause-specific mortality in patients with SLD.

Methods: We conducted a retrospective cohort study of adults with imaging-confirmed hepatic steatosis receiving outpatient care in the national Veterans Health Administration (2010-2021).

The Role of Patient-Reported Outcomes in Cirrhosis.

Critical to achieving the aim of person-centered care is a patient's direct report on the impact of illness and healthcare interventions on their global well-being. These reports are termed patient-reported outcomes (PROs) and defined as any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else. The aim of this review was to provide an overview of what are PROs, types of validated instruments to measure PROs in cirrhosis, and benefits of using PROs in the care of patients with cirrhosis.

From embedded interprofessional clinics to expanded alcohol-associated liver disease programs.

Hazardous alcohol use remains a major contributor to acute and chronic liver disease, while alcohol-associated liver disease (ALD) is a leading indication for liver transplantation. In recent years, embedded, interprofessional ALD clinics have improved access to alcohol use disorder care within hepatology and liver transplantation, but more work is needed to meet this challenge. The literature is lacking regarding scaling procedures to provide services for increasingly large ill patient populations.

Carbohydrate consumption drives adaptive mutations in associated with increased risk for systemic infection.

Dissemination of organisms from the gut microbiota is a major contributor to sepsis and critical illness. Patients with cirrhosis are prone to systemic infections and are commonly prescribed the carbohydrate lactulose to manage hepatic encephalopathy (HE) . Commensal metabolism of lactulose is believed to reduce pathobiont colonization through short-chain fatty acid production, but its direct effects on gut pathobionts remain unexplored .

Lower Child Opportunity Index is associated with increased health care utilization following pediatric liver transplantation.

Social determinants of health are known to lead to adverse health outcomes, including high acute care utilization. The mechanisms underlying health care disparities among children who have undergone liver transplantation (LT) are poorly understood. To elucidate the relationship between social determinants of health and health care utilization among children (<18 y old at the time of LT) who have undergone LT, we performed a retrospective study merging data from the Organ Procurement and Transplantation Network (OPTN) and the Pediatric Health Information System (PHIS) database.

LIVE-SMART: A sequential, multiple assignment randomized trial to reduce falls in cirrhosis.

Introduction: Falls are a major threat to the well-being of patients with cirrhosis. We are performing a clinical trial to determine whether lactulose, TeleTai-Chi, or their combination will reduce falls in HE and improve health-related quality of life (HRQOL) among patients with cirrhosis.

Methods And Analysis: Patients with cirrhosis and portal hypertension without HE will be enrolled in 3 US states and followed participants for 24 weeks.

Identifying Metabolic Dysfunction-Associated Steatotic Liver Disease Using Natural Language Processing in a US National Cohort.

Introduction: Although metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with increased alcohol intake (MetALD) are identified as clinical entities; tools to identify patients from electronic health records (EHRs) to perform large outcome studies are lacking.

Methods: In this retrospective study of participants from the Veterans Analysis of Liver Disease cohort assembled from 1/1/2013 to 12/31/2022, a rule-based natural language processing (NLP) algorithm searched EHRs for imaging evidence of hepatic steatosis. This was combined with identification of cardiometabolic risk factors and harmful alcohol use.

Clinical outcomes and care for spontaneous bacterial peritonitis: A national cohort study.

Background And Aims: Spontaneous bacterial peritonitis (SBP) leads to high rates of acute kidney injury (AKI), hepatorenal syndrome, and mortality. Population-based studies on contemporary SBP epidemiology are needed to inform care. In a large, national cohort of patients diagnosed with SBP and confirmed by ascitic fluid criteria, we characterized ascitic fluid characteristics, in-hospital and 12-month mortality, AKI, and recurrent SBP.

Mortality, Hepatic Decompensation, and Cardiovascular Outcomes in Lean vs. Non-lean MASLD Cirrhosis: A Veterans Affairs Cohort Study.

Background And Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) has a global prevalence of 25%. Studies on incident liver and cardiovascular outcomes in lean (Body mass index: BMI < 25 kg/m, or < 23 kg/m for Asians) vs. non-lean individuals with MASLD have reported mixed results.

Rapid identification and phenotyping of nonalcoholic fatty liver disease patients using a machine-based approach in diverse healthcare systems.

Nonalcoholic fatty liver disease (NAFLD) is the most common global cause of chronic liver disease and remains under-recognized within healthcare systems. Therapeutic interventions are rapidly advancing for its inflammatory phenotype, nonalcoholic steatohepatitis (NASH) at all stages of disease. Diagnosis codes alone fail to recognize and stratify at-risk patients accurately.

Validation and Epidemiologic Definition of the Novel Steatotic Liver Disease Nomenclature in a National United States Cohort With Cirrhosis.

Background & Aims: Novel steatotic liver disease (SLD) definitions were introduced in 2023. Accurate and meaningful classifications using clinical data are needed to study interventions and outcomes.

Methods: In a national cohort of Veterans with cirrhosis and imaging-confirmed steatosis, 7 algorithms differentially emphasizing cardiometabolic risk factors (CMRFs) and alcohol exposure were developed to define alcohol-associated liver disease (ALD), metabolic dysfunction associated SLD (MASLD), and MASLD with increased alcohol intake (MetALD).

Albumin for Spontaneous Bacterial Peritonitis: Care Variation, Disparities, and Outcomes.

Introduction: Intravenous albumin reduces mortality in spontaneous bacterial peritonitis (SBP). We sought to characterize albumin use for SBP over time and investigate patient-level and hospital-level factors associated with use.

Methods: A retrospective cohort study in the Veterans Health Administration between 2008 and 2021 evaluated trends and patient-level, practice-level, and facility-level factors associated with use among patients with cirrhosis hospitalized for SBP confirmed with ascitic fluid criteria.

Structural social determinants of health as barriers to liver transplant waitlisting.

Social determinants of health, both individual and structural, impact access to liver transplantation (LT). We aimed to evaluate the association between structural social determinants of health (SSDoH) and individual-level psychosocial factors (as measured by the Stanford Integrated Psychosocial Assessment for Transplant, SIPAT score) on failure to waitlist for LT. We conducted a single-center retrospective cohort study of 2762 patients evaluated for LT.