Hepatology International最新文献

Background: Pediatric living donor liver transplantation (PLDLT) is a life-saving option for children with end-stage liver diseases. However, the growing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) raises concerns regarding the use of steatotic donor grafts, particularly in vulnerable pediatric populations.

Methods: This study retrospectively investigated the impact of steatotic liver grafts on post-transplant outcomes in PLDLT recipients. 905 PLDLT recipients at Renji Hospital, Shanghai Jiao Tong University School of Medicine, from January 2019 to December 2021 were screened using computed tomography (CT) liver/spleen ratio and classified into three groups according to the degree of steatosis. This study evaluated early liver function, post-transplant complications, and long-term graft and patient survival.

Results: Recipients in the moderate-to-severe group exhibited higher incidence of rejection. However, there were no significant differences in early liver function and the 1-year and 3-year graft and patient survival among three groups.

Conclusions: The use of steatotic livers in PLDLT can be considered a viable option, with careful donor selection and vigilant postoperative management. These findings highlight the potential of MASLD as an expansion of the donor pool owing to its rising incidence and offer new insights into optimizing pediatric transplant outcomes while addressing the scarcity of suitable donor organs.

Background and aims: Transarterial chemoembolization (TACE) combined with immunotherapy and targeted therapy provides a promising therapy for unresectable hepatocellular carcinoma (HCC). This study aimed to compare the efficacy and safety of TACE combined with atezolizumab and bevacizumab (TACE-Ate-Bev) or atezolizumab and bevacizumab alone (Ate-Bev) as first-line treatment for unresectable HCC.

Methods: This multicenter cohort study recruited patients with unresectable HCC who received TACE-Ate-Bev or Ate-Bev as first-line treatment between July 1, 2020 and December 31, 2023. Inverse probability of treatment weighting (IPTW) was employed to minimize bias. Overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were observed.

Results: 311 patients were included in this analysis, with 152 in the TACE-Ate-Bev group and 159 in the Ate-Bev group. The TACE-Ate-Bev group demonstrated significantly improved OS (26.8 [95% CI 23.1-NR] vs. 14.9 [95% CI 11.4-19.9] months, p < 0.0001) and PFS (16.0 [95% CI 12.8-17.8] vs. 6.5 [95% CI 5.4-7.6] months, p < 0.0001) compared to the Ate-Bev group, both in BCLC stage B (mOS: NR vs. 15.6 months, p < 0.0001; mPFS: 16.9 vs. 6.7 months, p < 0.0001) and BCLC stage C (mOS: 25.2 vs. 14.3 months, p = 0.00018; mPFS: 12.8 vs. 6.5 months, p < 0.0001) disease. After IPTW adjustment, the TACE-Ate-Bev group also demonstrated significantly improved OS and PFS compared to the Ate-Bev group, both in BCLC stage B and BCLC stage C disease. Grade 3-4 AEs were observed in 36 patients (24.3%) in the TACE-Ate-Bev group and 34 (21.4%) in the Ate-Bev group. There was no statistically significant difference in the proportion of gastrointestinal bleeding between the TACE-Ate-Bev and Ate-Bev groups (9.9 vs. 10.1%, p = 0.954).

Conclusion: TACE-Ate-Bev significantly improves OS and PFS with acceptable toxicity compared with Ate-Bev as first-line therapy for unresectable HCC.

Background: Several studies have shown similar efficacy between nonselective beta-blockers (NSBBs) and endoscopic variceal ligation (EVL) in preventing esophageal variceal bleeding in cirrhosis. However, the comparative effectiveness between propranolol (PPL) and EVL remains uncertain. This meta-analysis evaluated both strategies.

Methods: PubMed, Embase, and Cochrane Central were searched for randomized-controlled trials (RCTs) comparing PPL and EVL for primary prophylaxis of esophageal variceal bleeding in cirrhotic patients. Outcomes were evaluated using risk ratios (RR) with 95% confidence intervals (CI), and heterogeneity was assessed by the I² statistic. Meta-regressions were conducted based on Child-Pugh classification and presence of ascites. All statistical analyses were performed using RStudio version 4.4.2.

Results: Fourteen RCTs were included, comprising 1345 patients: 664 (49.4%) received EVL and 681 (50.6%) PPL. EVL was more effective in preventing esophageal variceal hemorrhage (RR: 1.40; 95% CI: 1.02-1.91; p = 0.035; I² = 8.5%). No differences were found in variceal bleeding-related deaths (RR: 1.28; 95% CI: 0.76-2.15; p = 0.351; I² = 0%), all-cause mortality (RR: 0.93; 95% CI: 0.76-1.14; p = 0.503; I² = 0%), or in the incidence of adverse events (RR: 1.20; 95% CI: 0.59-2.46; p = 0.612; I² = 84.7%).

Conclusion: EVL was superior in preventing esophageal variceal bleeding. Such results suggest that not all NSBBs provide equivalent efficacy in primary prophylaxis, reinforcing the need for further studies to confirm these findings.

Background and aims: Autoimmune liver diseases (AILD) have historically been considered uncommon in the Asia-Pacific region, where viral hepatitis has predominated as the leading cause of chronic liver disease. However, their recognition and clinical relevance have increased substantially in recent years, mirroring global epidemiologic trends. This proceedings report summarizes the educational course on AILD held during the 34th Annual Meeting of the Asian Pacific Association for the Study of the Liver (APASL) in 2025, highlighting contemporary insights into disease burden, diagnosis, and management across diverse populations.

Methods: International experts presented updated evidence and region-specific considerations concerning autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and IgG4-related sclerosing cholangitis. Key advances in risk stratification, imaging, serology, patient-reported outcome measures (PROMs), and emerging therapeutics were synthesized.

Results: Important updates included improved understanding of acute presentations of AIH, evolving risk stratification and second-line pharmacologic approaches in PBC, and advances in PSC diagnostics incorporating novel imaging modalities and emerging autoantibodies. The unique clinical phenotype and steroid responsiveness of IgG4-related sclerosing cholangitis were also emphasized. Increasing incorporation of PROMs into clinical practice and trials, as well as progress in targeted therapies-such as peroxisome proliferator-activated receptor agonists, farnesoid X receptor agonists, and ileal bile acid transporter inhibitors-reflects a shift toward precision medicine and improved quality of life.

Conclusions: AILD represents a growing clinical challenge in the Asia-Pacific region. Earlier recognition, individualized treatment strategies, and strengthened multinational collaboration are essential to address unmet diagnostic and therapeutic needs and to improve long-term outcomes.