Annals of hepatology最新文献

Introduction and objectives: Nonselective β blockers (NSBBs) may be involved in reducing gut-derived inflammation and intrahepatic inflammation to prevent hepatocellular carcinoma (HCC). This study aimed to systematically investigate their association.

Materials and methods: PubMed, EMBASE, and Cochrane Library databases were searched to identify all relevant studies evaluating the association of NSBBs with HCC in liver cirrhosis patients. Sensitivity analyses were performed to explore potential sources of heterogeneity. Risk ratios (RRs) and hazard ratios (HRs) were pooled. Subgroup meta-analyses were performed according to the study design, regions, type of NSBBs, and indications of NSBBs.

Results: Twenty-four studies were finally included. Overall meta-analyses demonstrated that NSBBs were associated with a significantly reduced risk of HCC development in liver cirrhosis patients (RR=0.86; P=0.048). Sensitivity analysis did not find the source of heterogeneity. Subgroup analyses based on adjusted cohort studies with propensity-score matching (RR=0.85; P=0.01) and multivariable regression model (HR=0.66; P<0.00001), studies performed in America (RR=0.83; P=0.007) and Europe (RR=0.72; P=0.05), studies included patients receiving carvedilol (RR=0.72; P<0.00001), nadolol (RR=0.86; P<0.0001), and propranolol with dosage > 40 mg (RR=0.28; P<0.00001) or follow-up duration < 20 months (RR=0.38; P=0.04) demonstrated that NSBBs significantly decrease the risk of developing HCC in liver cirrhosis patients. However, studies included patients receiving primary or secondary prophylaxis of variceal bleeding did not reveal the protective effect of NSBBs on HCC.

Conclusions: NSBBs may play a role in preventing the occurrence of HCC in liver cirrhosis patients. Future research should focus on risk stratification and monitoring protocols to advance personalized prevention.

Introduction and objectives: Primary biliary cholangitis (PBC) frequently overlaps with metabolic dysfunction-associated steatotic liver disease (MASLD). The impact of concurrent MASLD on liver transplant (LT) in PBC remains unclear. This study compared pre- and post-LT outcomes between PBC with and without MASLD.

Materials and methods: We conducted a retrospective study using the UNOS/OPTN database to compare adult LT candidates with PBC or concomitant PBC/MASLD from 2002 to 2024. Nearest neighbor 1:1 propensity matching by multiple variables ensured cohort comparability. Outcomes included transplant probability, waitlist dropout, and post-LT patient and graft survival, analyzed with Kaplan-Meier and adjusted Cox regression.

Results: Before matching, PBC/MASLD had higher BMI (pre-transplant: 31.9 vs 26.8; post-transplant: 32.0 vs 26.6) and more diabetes (pre-transplant: 45% vs 15%; post-transplant: 42% vs 14%) compared to PBC-only. After matching (215 pre- and 151 post-transplant), PBC-only showed higher waitlist dropout (p = 0.005). Post-transplant patient and graft survival rates were similar between groups. Among PBC/MASLD, diabetes was associated with significantly lower long-term patient survival (10-year survival: 46% vs 76% in PBC/MASLD without diabetes, p = 0.01). On multivariate analysis, PBC/MASLD with diabetes remained the strongest independent predictor of post-transplant mortality (aHR 2.31, p = 0.003), followed by MELD score (aHR 1.03 per point, p = 0.02).

Conclusions: PBC is associated with increased waitlist dropout compared to PBC/MASLD. Post-LT survival is comparable between groups unless diabetes is present, which significantly impairs long-term outcomes in PBC/MASLD. Prioritized diabetes screening and metabolic management post-LT is essential in this group. Future research should investigate factors affecting waitlist dropout and optimal glycemic control strategies in PBC patients.

Introduction and objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease but remains widely under-recognized in primary care. The 2023 shift from "nonalcoholic fatty liver disease" to MASLD emphasized metabolic dysfunction as a driver of disease but introduced new communication and educational challenges for primary care providers (PCPs). We aimed to assess PCPs' awareness, risk assessment, and management practices related to MASLD in the four most populous U.S. cities.

Materials and methods: A cross-sectional online survey was conducted from 5 to 13 September 2024 among 800 primary care providers (PCPs; n = 200 per city) in New York City, Los Angeles, Chicago, and Houston. Participants included physicians, physician assistants, nurse practitioners, and other primary care professionals. The survey assessed awareness of "MASLD" and "fatty liver disease", risk assessment practices for high-risk groups, patient discussions, management strategies, and the use of patient-reported outcomes (PROs). Descriptive statistics characterized sample responses, and logistic regression models identified correlates of awareness.

Results: Overall, 54.7% of PCPs reported awareness of MASLD and 86.6% were aware of fatty liver disease. Awareness of MASLD was highest among physicians (81.3%) and hospital-based practitioners (odds ratio [OR] = 2.02, 95% confidence interval [CI] 1.02-4.02) and lowest among nurse practitioners (OR = 0.21, 95% CI 0.09-0.49). Awareness of fatty liver disease increased with provider age (OR = 1.04, 95% CI 1.00-1.08). Lifestyle modification was the most recommended management approach (41.3-65.5%), while referral rates to specialists and PRO use varied substantially across cities, and 48.5% were aware of the FIB-4 Index.

Conclusions: Only half of PCPs recognized the term MASLD, highlighting gaps in awareness and clinical practice following the mid-2023 terminology change. Targeted educational initiatives and standardized implementation of MASLD guidelines in primary care are needed to improve timely detection and management of this highly prevalent condition.

Introduction and objectives: Early detection of metabolic dysfunction-associated steatotic liver disease (MASLD) with fibrosis may facilitate interventions that can prevent disease progression and may justify screening. However, the optimal combination and threshold of cardiometabolic risk factors (CMRFs) for identifying MASLD with fibrosis remains unclear. We aimed to evaluate the diagnostic performance of various CMRFs-based screening criteria.

Patients and methods: We analyzed data from 75,124 individuals who underwent comprehensive health screening, including liver ultrasonography and CMRFs assessment. Liver fibrosis risk was assessed using the fibrosis-4 (FIB-4) index, with age-specific thresholds (≥2.0 for age >65 years, ≥1.3 for age ≤65 years). We evaluated multiple screening approaches based on different combinations and thresholds of CMRFs.

Results: MASLD with fibrosis was present in 5.8% of participants. The ≥2 CMRFs criterion achieved the highest sensitivity (86.0%) but moderate specificity (50.2%), while ≥3 CMRFs provided balanced performance (62.9% sensitivity, 72.3% specificity). Diabetes mellitus (DM)-based criteria showed high specificity but limited sensitivity. The comprehensive DM OR obesity OR ≥2 CMRFs criterion achieved high sensitivity (81.7%) and moderate specificity (55.8%).

Conclusions: CMRFs-based screening criteria showed varying performance for identifying MASLD with fibrosis. The ≥2 CMRFs criterion maximizes case detection, while ≥3 CMRFs provides balanced performance. The comprehensive DM OR obesity OR ≥2 CMRFs approach achieves high sensitivity while maintaining reasonable specificity, offering practical utility for routine clinical screening.

Introduction and objectives: Autoimmune hepatitis (AIH) is diagnosed based on clinical, biochemical, immunological, and histological parameters, and on the exclusion of other liver diseases. Multiple scoring systems are available for AIH diagnosis, all of which require liver biopsy (LB). With the aim of reducing invasive procedures to minimize patient's risks, this study evaluated whether LB may be spared for AIH diagnosis in some children, similar to primary biliary cholangitis.

Materials and methods: Children with histologically confirmed autoimmune liver disease (AILD) were evaluated from 5 Pediatric Units. We retrospectively collected clinical, laboratory, imaging and histological data to assess AIH diagnostic scores (International Autoimmune Hepatitis Group [IAIHG] criteria, juvenile AIH score [JAIH], and simplified criteria [s-IAIHG]) in each patient pre- and post-LB. The diagnosis of autoimmune sclerosing cholangitis (ASC) was based on magnetic resonance cholangiopancreatography and liver histology.

Results: Ninety-one patients (55 females) were evaluated (36 with AIH type I, 24 with AIH type II, 8 with seronegative AIH, and 23 with ASC). The mean age at diagnosis and duration of follow-up were 8.9 ± 4.8 and 9.6 ± 7.8 years, respectively. Based on IAIHG, JAIH and s-IAIHG scores, pre-LB scores were "definite" for 15.3%, 49.5%, and 0% of patients, respectively. Post-LB, the diagnosis was confirmed in all these patients. We found no associations between liver histological findings or diagnostic scores and relapses or treatment withdrawal.

Conclusions: In patients with a "definite" AIH score pre-LB, LB is not necessary for diagnosis. Histological findings and scoring systems do not predict relapses or treatment withdrawal.

Metabolic dysfunction associated steatotic liver disease (MASLD), previously referred to as nonalcoholic fatty liver disease (NAFLD) and metabolic associated fatty liver disease (MAFLD), is increasingly prevalent among obese children and adolescents. It is associated with significant long-term health risks, including type 2 diabetes, cardiovascular disease, advanced liver conditions, and liver-related mortality. This systematic review analyzed 26 longitudinal studies with follow-up durations ranging from 4.5 to 39 years to investigate the persistence and progression of liver steatosis from childhood into adulthood and its associated complications. Prevalence data were derived from studies using varying diagnostic criteria, including NAFLD, MAFLD, and MASLD, which may reflect differences in patient populations due to distinct inclusion criteria. Diagnostic methods included imaging, liver biopsy, and biomarkers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and genetic variants like patatin-like phospholipase domain-containing protein 3 (PNPLA3) and transmembrane 6 superfamily member 2 (TM6SF2). Despite its systemic impact, MASLD often progresses silently in pediatric populations with limited awareness among parents, affected children, and healthcare providers. Fragmented medical records and low follow-up rates further hinder effective management during the transition from pediatric to adult care. This review highlights the need for more comprehensive longitudinal research to better understand the progression of liver steatosis and its systemic effects. By synthesizing current evidence, it emphasizes the importance of early identification, timely intervention, and sustained care to mitigate long-term health consequences and improve outcomes.

Chronic hepatitis B virus (HBV) infection remains a major cause of cirrhosis and hepatocellular carcinoma worldwide, with substantial public health implications in Latin America. Despite the availability of an effective vaccine, HBV continues to be underdiagnosed and undertreated across the region, where healthcare access is often limited and heterogeneous. In alignment with the World Health Organization's 2024 strategy for HBV elimination, the Latin American Association for the Study of the Liver (ALEH) presents updated regional guidelines to simplify diagnosis, expand treatment eligibility, and improve vaccination coverage. The recommendations emphasize the use of rapid diagnostic tests and reflex HBV DNA testing to overcome barriers to laboratory access, while promoting non-invasive methods to assess liver disease severity. Expanded treatment criteria include patients with significant fibrosis, elevated HBV DNA levels, co-infections, and other risk factors, ensuring broader access to antiviral therapy with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), or entecavir (ETV). Preventing mother-to-child transmission through universal screening, maternal prophylaxis, and timely neonatal vaccination is prioritized. Additionally, universal HDV testing in HBV-infected patients is recommended. These guidelines highlight the urgent need for decentralization, simplification, and equity in HBV management to achieve elimination goals in Latin America by 2030.