Hepatology Forum最新文献

Background and aim: The rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) poses a significant public health challenge, yet the future burden at a subnational level is poorly quantified. State-specific projections are crucial for guiding policy, resource allocation, and targeted public health interventions. We project the future burden of MASLD by state to 2050.

Materials and methods: We developed a state-level forecasting model using data from the Global Burden of Disease (GBD) 2021 study and state-level population projections from the Weldon Cooper Center. For each state, historical age- and sex-specific MASLD DALY rates (1990-2021) were projected to 2050 using automatic ARIMA/ETS time-series forecasting. Projected rates were then applied to annual state population projections to estimate the absolute DALY burden. Associated direct healthcare costs were calculated using a derived national-average cost per MASLD DALY, discounted at 3% annually. A probabilistic sensitivity analysis (PSA) with 1,000 iterations was performed to quantify uncertainty in baseline DALY rates and costs.

Results: Over the projection period (2022-2050), the total discounted MASLD burden in the U.S. is projected to be 5.5 million DALYs, with associated healthcare costs exceeding $2.3 trillion. The absolute burden is concentrated in the most populous states, with California (Mean DALYs: 444,363; 95% UI: 395,767-494,159), Texas (386,956; 95% UI: 337,640-435,164), and Florida (311,884; 95% UI: 275,974-347,758) projected to have the highest lifetime burdens. However, DALY rates per 100,000 population are projected to be highest in states within the South and Appalachia.

Conclusion: The future burden of MASLD in the United States is projected to be substantial, growing, and geographically unequal, with distinct hotspots of high per-capita burden and divergent future trends. These state-level projections underscore the urgent need for tailored, regional public health strategies and provide essential data to inform state-level policy and resource allocation to address the escalating MASLD epidemic.

Background and aim: Transjugular intrahepatic portosystemic shunt (TIPS) is pivotal for refractory ascites in cirrhosis, yet many patients experience poor outcomes. Sarcopenia, a common muscle-wasting syndrome in cirrhosis, is tied to portal hypertension, but its role in TIPS efficacy remains unclear. This study aimed to assess sarcopenia's impact on post-TIPS ascites resolution, complications, and mechanisms.

Materials and methods: This retrospective multicenter study included 294 cirrhotic patients undergoing TIPS (2016-2021). Sarcopenia was defined by CT-based L3-SMI. Outcomes included ascites resolution (International Club of Ascites criteria), HE, and stent dysfunction. Analyses were adjusted for ΔPPG (PPG reduction), MELD-Na, and NLR as the inflammatory marker.

Results: Sarcopenic patients had reduced odds of ascites resolution (OR 0.42, 95% CI 0.28-0.63) and a higher HE risk (HR 2.48, 95% CI 1.72-3.57) versus non-sarcopenic patients.

Conclusion: In this study, sarcopenia independently predicted poor TIPS outcomes, including reduced ascites resolution and increased risk of hepatic encephalopathy, through potential hemodynamic and metabolic pathways, supporting its value in personalized management. Screening for sarcopenia may help optimize TIPS candidacy and inform therapies targeting inflammation and ammonia.

Background and aim: Hepatotoxicity represents a significant adverse effect associated with cancer treatment. The present study was designed to evaluate the possible hepatoprotective effects of bevacizumab and nivolumab when administered concomitantly with cisplatin.

Materials and methods: A total of forty-two male Wistar Albino rats were randomly allocated into six groups: control, bevacizumab (10 mg/kg), nivolumab (3 mg/kg), cisplatin (12 mg/kg), cisplatin plus bevacizumab, and cisplatin plus nivolumab. Histological assessment of liver tissues was performed using hematoxylin and eosin (H&E) and Masson's trichrome staining. Immunohistochemical evaluation was conducted for inflammatory markers (TNF-α, IL-6), the angiogenic factor VEGF, and apoptotic markers (Bax, Bcl-2, Caspase-3).

Results: Administration of cisplatin resulted in hepatotoxic changes, including disruption of normal hepatic cord architecture, cytoplasmic vacuolization, hemorrhage, mononuclear cell infiltration, and enhanced collagen accumulation. Co-treatment with bevacizumab or nivolumab significantly alleviated these histopathological changes (p<0.001). In addition, levels of inflammatory and pro-apoptotic markers (TNF-α, Bax, Caspase-3) were markedly reduced, whereas expression of the anti-apoptotic protein Bcl-2 was increased in the combination treatment groups compared with the cisplatin-only group. In the cisplatin + nivolumab group, the TNF-α level was 1.0 (0.8-1.2), whereas in the cisplatin-only group it was 2.0 (1.8-2.0) (p=0.03). The Bcl-2 level in the cisplatin + nivolumab group was 1.0 (0.8-1.2), while it was 0.2 (0-0.6) in the cisplatin group (p=0.04).

Conclusion: Bevacizumab and nivolumab exhibited hepatoprotective properties when combined with cisplatin, as demonstrated by histological improvement and regulation of inflammatory and apoptotic signaling pathways.

Background and aim: Hepatic encephalopathy (HE) is a complication of cirrhosis and one of the most important manifestations of this disease. Intravenous albumin may have the potential to mitigate oxidative stress injury inherent to the pathogenesis of HE. Our study aims to evaluate the efficacy and safety of albumin for the treatment of HE.

Materials and methods: We performed a systematic review and meta-analysis using the PubMed, Embase, and Cochrane databases. We searched for randomized controlled trials (RCTs) comparing albumin to placebo in patients with HE and decompensated cirrhosis. The outcomes were mortality and clinical improvement of HE. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI). Heterogeneity was assessed using the Cochran Q test and I² statistics. Trial sequential analysis (TSA) was performed for all outcomes.

Results: This study included four RCTs, amounting to 306 patients. There was a significant difference favoring albumin use for mortality (OR 0.44; 95% CI 0.24 to 0.79; p=0.007; I²=0%) and for HE improvement (OR 2.41; 95% CI 1.22 to 4.75, p=0.011; I²=34.9%) compared to placebo. There was no significant difference in ammonia levels (p=0.580), liver transplantation (p=0.732), and significant adverse events (AE) rate (p=0.586). TSA revealed that the pooled effect is statistically significant for mortality reduction with albumin use; however, regarding sample size, the result is not definitive.

Conclusion: In patients with HE, intravenous albumin leads to HE improvement and reduced mortality, without an increase in AE rates. However, the TSA indicated that further studies are required to draw precise evidence regarding the use of albumin to reduce mortality in this population.

The coexistence of metabolic dysfunction-associated steatotic liver disease (MASLD) and viral hepatitis has gained greater focus due to the global increase in chronic liver diseases. This convergence of conditions creates a unique clinical entity characterized by complex molecular interactions, difficult diagnosis, and treatment issues. The frequency of MASLD alongside viral hepatitis is becoming more prevalent. Overlapping pathogenic mechanisms, such as insulin resistance, activation of pro-inflammatory cytokines, hepatic steatosis, and persistent viral infection, establish a synergistic pathophysiological relationship that exacerbates fibrosis and liver damage. Non-invasive fibrosis assessments, multimodal imaging, and, in certain cases, liver biopsies are often required to achieve diagnostic accuracy. This review intends to examine the epidemiological overlap, shared pathophysiological mechanisms, diagnostic hurdles, and management challenges associated with the concurrent manifestation of MASLD and viral hepatitis.

Background and aim: This study aimed to determine the efficacy and safety of tenofovir alafenamide fumarate (TAF) prophylaxis in hepatitis B virus (HBV)-infected or HBV-experienced individuals with benign and malignant diseases receiving chemo/immunosuppressive or biological modifier therapy.

Materials and methods: This is a multicenter, observational study in which data from 13 centers were reviewed and entered into a standardized electronic case report form.

Results: A total of 158 individuals who received TAF prophylaxis were included in the analysis. Before starting the prophylaxis, 51 individuals were hepatitis B surface antigen positive, while 107 were HBV-experienced. Thirty patients had detectable HBV DNA levels. Twelve of them had abnormal serum alanine aminotransferase levels. Forty patients were switched to TAF. Solid tumors (34%) were the most common primary disease types. The median follow-up period was 17.2 months. From baseline to the end of the follow-up period, none of the patients had clinical, biochemical, or serological evidence of HBV reactivation under TAF prophylaxis. The virological response rate was 87%. HBV suppression was well maintained after switching in the 40 patients who were switched to TAF treatment. All patients maintained their chemo/immunosuppressive therapy without interruption. TAF prophylaxis was well tolerated. No drug discontinuation due to adverse effects was observed. No HBV-related morbidity or mortality was observed during the TAF prophylaxis. No significant differences were found in the glomerular filtration rate change or hypophosphatemia during TAF prophylaxis, but the serum triglyceride levels were significantly increased (p=0.019).

Conclusion: TAF prophylaxis is effective, safe, and tolerable in preventing chemo/immunosuppressive or biological modifier-induced HBV reactivation in HBV-infected or HBV-experienced individuals.

Advanced liver disease, including cirrhosis and hepatocellular carcinoma (HCC), represents a major global health challenge, driven in part by the rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD). In parallel, micro-and nanoplastics (MNPs) have emerged as pervasive environmental contaminants with potential hepatotoxic effects. This review provides an in-depth analysis of current knowledge regarding the role of MNPs in the pathogenesis of cirrhosis and HCC, particularly in the context of the growing MASLD burden, and identifies key areas for future research. The literature search included original studies and review articles indexed in PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2014, to November 1, 2024. Evidence from animal models indicates that MNP exposure may induce hepatic changes resembling those seen in human MASLD and metabolic dysfunction-associated steatohepatitis (MASH) through both direct and indirect mechanisms. Importantly, MNPs may act as a "second hit" in the presence of pre-existing metabolic stress, potentially exacerbating liver injury. However, human data remain scarce, with only two small-scale studies investigating MNPs in clinical cohorts. Recent advances in analytical methods for quantifying MNPs in blood present new opportunities to explore their association with MASLD, cirrhosis, and HCC in human populations. While significant progress has been made in understanding MNP-induced hepatotoxicity in experimental models, their clinical relevance to human liver disease progression remains largely unexplored. Further multidisciplinary research integrating environmental science, molecular biology, and clinical hepatology is urgently needed.

Microwave ablation (MWA) is a widely used treatment for liver metastases, particularly for lesions smaller than 3 cm. Although generally safe, rare complications such as segmental or lobar portal vein thrombosis (PVT) can occur. We present a unique case of tumor-like focal fat deposition in the left hepatic lobe following left PVT, a rare complication of MWA, in a 59-year-old female with pancreatic adenocarcinoma liver metastasis. Post-ablation imaging revealed geographic-shaped areas of focal hepatic steatosis confined to the left lobe, accompanied by left PVT. Dual-echo MRI, a routine but highly effective imaging sequence for liver fat characterization, was instrumental in distinguishing benign fat deposition from tumor recurrence. This case highlights the importance of recognizing focal hepatic steatosis as a rare but significant complication of MWA and PVT, with implications for clinical management and follow-up strategies.

Endoscopic ultrasound (EUS) is being increasingly used for both diagnostic and therapeutic purposes in various settings in gastroenterology and hepatology. Similarly, it has also been adopted in liver transplantation (LT), and its utilization is steadily increasing. EUS strengthens LT care in both the pre-transplant and post-transplant periods. Specifically, EUS is valuable in the evaluation of liver parenchyma, portal hypertension assessment and variceal management, tissue sampling when percutaneous or transjugular approaches are contraindicated or impractical, detection and characterization of hepatic and nodal metastases-thereby refining staging and sometimes even eligibility for LT-management of postoperative collections, and enabling biliary and pancreatic interventions in altered anatomy by creating access routes. In this review, we discuss these applications of EUS, along with its current limitations and its evolving role in the setting of LT.