Effectiveness of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) in an interdisciplinary setting at a large tertiary center.

Introduction: The use of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) effectively controls portal hypertension (PH)-related complications while reducing risks related to fully expanded stents. We evaluated the effectiveness of CX-TIPS in a large Viennese patient cohort.

Method: We assessed the number of patients evaluated for CX-TIPS placement by interdisciplinary discussion at the Medical University of Vienna and included all patients from the prospective AUTIPS registry undergoing CX-TIPS placement between June 2018 - December 2024.

Smoking Aggravates Inflammation, Fibrogenesis, Angiogenesis and Cancer Risk in Patients With Cirrhosis.

Background And Aims: Smoking induces a proinflammatory state, yet its role in advanced chronic liver disease (ACLD) remains understudied. This study evaluated its impact on disease-driving mechanisms and clinical outcomes in ACLD patients.

Methods: ACLD patients undergoing hepatic venous pressure gradient measurements from 2017 to 2021 were included.

Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH-A Prospective, Comparative Study.

Background: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) represent non-invasive surrogates of portal hypertension (PH) that both correlate with hepatic venous pressure gradient (HVPG). SSM may overcome limitations of HVPG and LSM in detecting presinusoidal PH components. We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies.

Clinical Features of Portal Hypertension and Their Prognostic Implications in Patients With Autoimmune Hepatitis.

Background And Aims: Autoimmune hepatitis (AIH) may progress to advanced chronic liver disease (ACLD) with clinically significant portal hypertension (CSPH). In this study, we evaluated the prevalence of different clinical CSPH features and their prognostic impact regarding decompensation, liver transplantation (LTX) and death in patients with AIH.

Method: Patients with confirmed AIH diagnosis (sIAIHG-Score ≥ 6) managed at the Vienna General Hospital between 2005 and 2023 were retrospectively analysed.

MRI-derived quantification of hepatic vessel-to-volume ratios in chronic liver disease using a deep learning approach.

Background: We aimed to quantify hepatic vessel volumes across chronic liver disease stages and healthy controls using deep learning-based magnetic resonance imaging (MRI) analysis, and assess correlations with biomarkers for liver (dys)function and fibrosis/portal hypertension.

Methods: We assessed retrospectively healthy controls, non-advanced and advanced chronic liver disease (ACLD) patients using a 3D U-Net model for hepatic vessel segmentation on portal venous phase gadoxetic acid-enhanced 3-T MRI. Total (TVVR), hepatic (HVVR), and intrahepatic portal vein-to-volume ratios (PVVR) were compared between groups and correlated with: albumin-bilirubin (ALBI) and "model for end-stage liver disease-sodium" (MELD-Na) score) and fibrosis/portal hypertension (Fibrosis-4 (FIB-4) Score, liver stiffness measurement (LSM), hepatic venous pressure gradient (HVPG), platelet count (PLT), and spleen volume.

Recompensation in decompensated cirrhosis.

Recompensation of decompensated cirrhosis has been defined by the Baveno consensus as control or cure of the main underlying cause; resolution of clinical manifestations, including ascites and hepatic encephalopathy, without the use of prophylactic medications, and without variceal bleeding for 12 months; and restoration of hepatic function. Cure and recompensation are usually associated with regression of liver fibrosis. Recompensation can occur when hepatitis C virus is eradicated, if hepatitis B virus infection (without hepatitis D co-infection) is suppressed, and following persistent alcohol abstinence in patients with alcohol-associated cirrhosis.

UDFF and Auto pSWE accurately assess liver steatosis and fibrosis risk in obese patients with MASLD.

Metabolic dysfunction-associated steatotic liver disease (MASLD) can progress to fibrosis and cirrhosis. Fibrosis and steatosis assessment with vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) requires a dedicated device and time to obtain ≥10 reliable measurements. Auto pSWE allows for the simultaneous collection of 15 ARFI-based liver stiffness measurements (LSM) and UDFF-based steatosis assessment in a single acquisition.

Establishing hepatic decompensation as a meaningful clinical outcome during systemic therapy for hepatocellular carcinoma.

Unlike other solid tumours, the prognosis of patients with advanced hepatocellular carcinoma (HCC) is dually influenced by tumour progression and liver dysfunction. Accumulating evidence suggests that clinically evident hepatic decompensation events exert an even stronger impact on the prognosis of patients with HCC than tumour progression. This observation is particularly relevant in the new era of highly effective immunotherapy, that can also be administered to patients with worse hepatic function (i.

Refining Prognosis in Cirrhosis Patients With Ascites: Impact of Acute vs. Non-Acute Decompensation.

Background: A more granular understanding of hepatic decompensation in cirrhosis has led to the classification of acute decompensation (AD) and non-acute decompensation (NAD). In this study, we assessed differences in the clinical course of AD versus NAD in patients with ascites as the first decompensation event.

Methods: 505 cirrhosis patients with ascites as first decompensation were included in this single-center longitudinal cohort study and followed until further decompensation, orthotopic liver transplantation (OLT), or death.

Molecular patterns of the NO-sGC-cGMP pathway in progressive and regressive liver fibrosis models.

The nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine-monophosphate (cGMP) pathway is impaired in liver fibrosis. We investigated expression patterns of NO-sGC-cGMP components via RT-qPCR in various rat models of liver fibrosis and murine models of liver fibrosis regression. Hepatic cGMP-levels were measured chromatographically.

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.

Risk of portal hypertensive complications preventable by TIPS in patients with ascites.

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of recurrent/refractory ascites in patients with cirrhosis. The aim of this study is to identify patients with ascites as index decompensation who are at risk of developing portal hypertension (PH)-related complications within 12 months that seem preventable by TIPS.

Methods: We included 451 patients from two tertiary care centres (Vienna and Padua, derivation cohort) with clinically significant ascites (grade 2/3) as a single first decompensating event and without contraindications for TIPS placement.

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).

The Vasopressin Biomarker Copeptin is Linked to Systemic Inflammation and Refines Prognostication in Decompensated Cirrhosis.

Background & Aims: Copeptin, an arginine-vasopressin biomarker, may confer prognostic information in patients with advanced chronic liver disease (ACLD).

Methods: Patients with ACLD included in the Vienna Cirrhosis Study (NCT03267615) between January 2017 and April 2023 and available copeptin levels were prospectively recruited and classified into 6 predefined clinical ACLD stages from S0 (subclinical portal hypertension) to S5 (further decompensation). A prognostic score (MELD-copeptin score) in patients with decompensated ACLD (dACLD) was developed in a derivation cohort (n = 150) and validated in an internal (n = 148) and an external validation cohort (n = 771).

Acute liver failure in patients admitted to the intensive care unit-a Viennese retrospective single-center analysis.

Background: Acute liver failure (ALF) is characterized by a rapid deterioration of liver function and a high mortality without transplantation depending on etiology and onset. Immediate transfer to a dedicated intensive care unit (ICU) and evaluation for high-urgency liver transplantation (HU-LTx) is recommended to maximize chances of survival. Data on ALF epidemiology are limited, particularly for Central Europe.

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).

Insulin-like Growth Factor-1 Reflects Liver Disease Stage and Improves Prediction of Liver-related Mortality.

Background & Aims: Liver-related mortality represents a growing public health concern, disproportionately affecting younger subjects. Because there are no established tools for early detection of individuals at risk for liver-related death (LRD), we analyzed LRD predictors in the UK Biobank (UKB) data and validated the usefulness of serum insulin-like growth factor-1 (IGF-1).

Methods: The UKB dataset encompassing 325,981 participants, a median follow-up of 13.