Hepatology Communications最新文献

{"title":"National Liver Cancer Screening Trial (TRACER) study protocol.","authors":"Amit G Singal, Neehar D Parikh, Fasiha Kanwal, Jorge A Marrero, Sneha Deodhar, Stephanie Page-Lester, Camden Lopez, Ziding Feng, Nabihah Tayob","doi":"10.1097/HC9.0000000000000565","DOIUrl":"10.1097/HC9.0000000000000565","url":null,"abstract":"<p><strong>Background: </strong>Professional guidelines recommend HCC screening in at-risk patients using semi-annual ultrasound with or without alpha-fetoprotein (AFP); however, this strategy has limited effectiveness due to low adherence and sensitivity. Increasing data support the potential role of blood-based biomarker panels, which could improve both aspects. The biomarker panel GALAD, comprised of sex, age, and 3 blood biomarkers (AFP, AFP-L3, and des-carboxy prothrombin des-carboxy prothrombin), has shown high sensitivity and specificity in biomarker phase II (case-control) and phase III (retrospective cohort) validation studies. However, prospective validation in a large phase IV biomarker clinical utility trial is necessary before its adoption in practice.</p><p><strong>Methods: </strong>The National Liver Cancer Screening Trial is an adaptive pragmatic randomized phase IV trial, which began enrollment in January 2024, comparing ultrasound-based versus biomarker-based screening in 5500 patients with chronic hepatitis B infection or cirrhosis from any etiology. Eligible patients are randomly assigned in a 1:1 ratio to semi-annual screening with ultrasound ± alpha-fetoprotein (arm A) or semi-annual screening with GALAD (arm B). Randomization is stratified by enrollment site, liver disease severity (per Child-Pugh class), liver disease etiology (viral, nonviral, and noncirrhotic HBV), and sex. Patients are being recruited from 15 sites (a mix of tertiary care academic referral centers, safety-net health systems, and large community health systems) over a 3-year period, and the primary endpoint, reduction in late-stage HCC, will be assessed at the end of year 5.5.</p><p><strong>Discussion: </strong>The results of this trial will inform the best strategy for HCC screening and early-stage detection in patients with chronic liver diseases. If GALAD shows superiority, HCC screening would primarily shift from an ultrasound-based strategy to the adoption of the biomarker panel.</p><p><strong>Trial registration: </strong>NCT06084234.</p><p><strong>Trial status: </strong>The TRACER Study is actively enrolling.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atezolizumab/bevacizumab and lenvatinib for hepatocellular carcinoma: A comparative analysis in a European real-world cohort.","authors":"Tiago de Castro, Sabrina Welland, Leonie Jochheim, Cathrine Leyh, Kateryna Shmanko, Fabian Finkelmeier, Petia Jeliazkova, Andre Jefremow, Maria A Gonzalez-Carmona, Arne Kandulski, Daniel Roessler, Najib Ben Khaled, Stefan Enssle, Marino Venerito, Thorben W Fründt, Michael Schultheiß, Angela Djanani, Maria Pangerl, Andreas Maieron, Thomas C Wirth, Jens U Marquardt, Richard Greil, Christina Fricke, Rainer Günther, Andreas Schmiderer, Dominik Bettinger, Henning Wege, Bernhard Scheiner, Martina Müller, Christian P Strassburg, Jürgen Siebler, Ursula Ehmer, Oliver Waidmann, Arndt Weinmann, Matthias Pinter, Christian M Lange, Anna Saborowski, Arndt Vogel","doi":"10.1097/HC9.0000000000000562","DOIUrl":"10.1097/HC9.0000000000000562","url":null,"abstract":"<p><strong>Background: </strong>Immunotherapy-based combinations are currently the standard of care in the systemic treatment of patients with HCC. Recent studies have reported unexpectedly long survival with lenvatinib (LEN), supporting its use in first-line treatment for HCC. This study aims to compare the real-world effectiveness of LEN to atezolizumab/bevacizumab (AZ/BV).</p><p><strong>Methods: </strong>A retrospective analysis was conducted to evaluate the effectiveness and safety of frontline AZ/BV or LEN therapy in patients with advanced HCC across 18 university hospitals in Europe.</p><p><strong>Results: </strong>The study included 412 patients (AZ/BV: n=207; LEN: n=205). Baseline characteristics were comparable between the 2 treatment groups. However, patients treated with AZ/BV had a significantly longer median progression-free survival compared to those receiving LEN. The risk of hepatic decompensation was significantly higher in patients with impaired baseline liver function (albumin-bilirubin [ALBI] grade 2) treated with AZ/BV compared to those with preserved liver function. Patients with alcohol-associated liver disease had poorer baseline liver function compared to other etiologies and exhibited a worse outcome under AZ/BV.</p><p><strong>Conclusions: </strong>In this real-world cohort, survival rates were similar between patients treated with LEN and those treated with AZ/BV, confirming that both are viable first-line options for HCC. The increased risk of hepatic decompensation in patients treated with AZ/BV who have impaired baseline liver function underscores the need for careful monitoring. Future trials should aim to distinguish more clearly between metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Hepatopulmonary syndrome associated with common variable immunodeficiency: Is it reasonable to investigate?","authors":"Neil Halliday, Siobhan O Burns, David M Lowe, Douglas Thorburn","doi":"10.1097/HC9.0000000000000538","DOIUrl":"10.1097/HC9.0000000000000538","url":null,"abstract":"","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-management interventions to patients with cirrhosis: A scoping review.","authors":"Samsam Aden, Mette Munk Lauridsen, Lea Ladegaard Grønkjær","doi":"10.1097/HC9.0000000000000576","DOIUrl":"10.1097/HC9.0000000000000576","url":null,"abstract":"<p><strong>Background: </strong>Self-management in chronic diseases like cirrhosis involves patients providing the necessary knowledge, skills, and confidence to enhance self-efficacy. This scoping review aims to describe the literature on self-management interventions in patients with cirrhosis to create an overview and identify key concepts and gaps in the existing literature.</p><p><strong>Methods: </strong>Four databases (CINAHL, Embase, Medline, and Scopus) were searched from November 2022 to September 2024. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Studies published from 2000 onward, including patients with cirrhosis of different etiology and severity, focusing on self-management and/or self-efficacy, and performed in a health care setting, were considered.</p><p><strong>Results: </strong>The search produced 1012 articles, of which 16 were included in the review. These represented studies from 7 countries and a sample of 1.276 patients. The studies differed in study design, sample size, delivery format, self-management interventions designed by the authors, and evaluation. However, all studies described some form of improvement in patient-related and clinical outcomes after the intervention, mainly improved patient knowledge and quality of life.</p><p><strong>Conclusions: </strong>Self-management interventions for patients with cirrhosis improved patient-related outcomes. However, more comprehensive and standardized interventions tailored to patients' needs are needed. These self-management interventions should focus on increasing confidence and self-efficacy and address the different skills required by patients to manage their disease.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical approach to diagnose and manage benign liver masses.","authors":"Reshma Reguram, Aishwarya Ghonge, Justin Tse, Renumathy Dhanasekaran","doi":"10.1097/HC9.0000000000000560","DOIUrl":"10.1097/HC9.0000000000000560","url":null,"abstract":"<p><p>Benign liver lesions are among the most commonly diagnosed abnormalities in liver imaging. They are often discovered incidentally during routine examinations or imaging conducted for unrelated reasons. These can be solid lesions, such as hemangiomas, focal nodular hyperplasia, hepatic adenomas, or cystic lesions. Recent advancements in MRI technology, particularly with hepatocyte-specific contrast agents, have enhanced the characterization of these lesions, reducing the reliance on invasive tissue sampling. Nevertheless, tissue sampling retains a crucial role in the evaluation of indeterminate lesions or those with malignant potential. While most benign liver lesions are asymptomatic, some can become symptomatic, causing discomfort, pain, or bleeding, particularly if the lesion is large. A deep understanding of the molecular underpinnings of the lesions is crucial for tailoring patient management strategies, particularly in distinguishing lesions that require surgical intervention from those that can be monitored. For instance, the molecular subclassification of hepatic adenomas has provided mechanistic insights and identified certain subtypes that are at higher risk of malignancy. Most benign liver lesions can be safely monitored; however, in patients with cirrhosis or a known primary malignancy, a high index of suspicion for cancer is required. It is crucial to carefully evaluate any liver lesion identified in these patients to ensure that indeterminate lesions are not overlooked. Effective management of benign liver lesions involves a multidisciplinary team, including hepatologists, surgeons, and radiologists, ensuring a comprehensive and individualized approach to patient care. This review outlines the clinical presentation of common benign liver lesions, providing a diagnostic and management framework. Emphasis is placed on a personalized approach to minimize patient distress and optimize outcomes by leveraging imaging advancements and multidisciplinary collaboration.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracellular matrix protein 1 binds to connective tissue growth factor against liver fibrosis and ductular reaction.","authors":"Chunbao Sun, Weiguo Fan, Sreenivasulu Basha, Tian Tian, Brady Jin-Smith, Joshua Barkin, Hanhui Xie, Junmei Zhou, Xiao-Ming Yin, Chen Ling, Bing Sun, Bryon Petersen, Liya Pi","doi":"10.1097/HC9.0000000000000564","DOIUrl":"10.1097/HC9.0000000000000564","url":null,"abstract":"<p><strong>Background: </strong>Extracellular matrix protein 1 (ECM1) can inhibit TGFβ activation, but its antifibrotic action remains largely unknown. This study aims to investigate ECM1 function and its physical interaction with the profibrotic connective tissue growth factor (CTGF) in fibrosis and ductular reaction (DR).</p><p><strong>Methods: </strong>Ecm1 knockouts or animals that ectopically expressed this gene were subjected to induction of liver fibrosis and DR by feeding 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) or α-naphthyl-isothiocyanate (ANIT). ECM1 and CTGF were also examined in the livers of patients with alcohol-associated liver disease (ALD) or ethanol-exposed animals that were fed the western diet for 4 months in the WDA model with liver pathology resembing ALD in patients.</p><p><strong>Results: </strong>ECM1 bound to CTGF in yeast two-hybrid systems, cultured liver cells, and cholestatic livers damaged by DDC or α-naphthyl-isothiocyanate. This interaction blocked integrin αvβ6-mediated TGFβ activation, thereby reducing fibrotic responses in vitro. ECM1 downregulation was associated with biliary CTGF induction during human ALD progression. In experimental models, Ecm1 loss enhanced susceptibility to DDC-induced cholestasis with upregulation of Ctgf, αvβ6, alpha-smooth muscle actin, procollagen type I, serum transaminase, and total bilirubin levels in germline knockouts, whereas forced expression of this gene significantly attenuated DR and biliary fibrosis after the feeding of DDC or α-naphthyl-isothiocyanate containing diets. Moreover, ectopic Ecm1 inhibited not only alcohol-associated fibrosis but also TGFβ-mediated deregulation of hepatocyte nuclear factor 4α, preventing the production of the fetal p2 promoter-driven isoforms in the WDA model.</p><p><strong>Conclusions: </strong>We uncover a novel antifibrotic action by ECM1 that binds CTGF and inhibits integrin αvβ6-mediated TGFβ activation. Targeting its loss has therapeutic potential for the treatment of DR and liver fibrosis in chronic conditions, such as cholangiopathy and ALD.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Baveno VII for HCC-Are we there yet?","authors":"Yan Wang, Yiheng Zhang, Yundong Qu, Tao Li","doi":"10.1097/HC9.0000000000000544","DOIUrl":"10.1097/HC9.0000000000000544","url":null,"abstract":"","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baveno VII for HCC: Are we there yet?","authors":"Ashraf Ullah, Umar I J Choudhary, Naeem A Khan, Syed B Shah","doi":"10.1097/HC9.0000000000000542","DOIUrl":"10.1097/HC9.0000000000000542","url":null,"abstract":"","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of patients with acute liver failure not listed for liver transplantation: A cohort analysis.","authors":"Victor Dong, Valerie Durkalski, William M Lee, Constantine J Karvellas","doi":"10.1097/HC9.0000000000000575","DOIUrl":"10.1097/HC9.0000000000000575","url":null,"abstract":"<p><strong>Background: </strong>Acute liver failure (ALF) is a rare condition leading to morbidity and mortality. Liver transplantation (LT) is often required, but patients are not always listed for LT. There is a lack of data regarding outcomes in these patients. Our aim is to describe outcomes of patients with ALF not listed for LT and to compare this with those listed for LT.</p><p><strong>Methods: </strong>Retrospective analysis of all nonlisted patients with ALF enrolled in the Acute Liver Failure Study Group (ALFSG) registry between 1998 and 2018. The primary outcome was 21-day mortality. Multivariable logistic regression was done to identify factors associated with 21-day mortality. The comparison was then made with patients with ALF listed for LT.</p><p><strong>Results: </strong>A total of 1672 patients with ALF were not listed for LT. The median age was 41 (IQR: 30-54). Three hundred seventy-one (28.9%) patients were too sick to list. The most common etiology was acetaminophen toxicity (54.8%). Five hundred fifty-eight (35.7%) patients died at 21 days. After adjusting for relevant covariates, King's College Criteria (adjusted odds ratio: 3.17, CI 2.23-4.51), mechanical ventilation (adjusted odds ratio: 1.53, CI: 1.01-2.33), and vasopressors (adjusted odds ratio: 2.10, CI: 1.43-3.08) (p < 0.05 for all) were independently associated with 21-day mortality. Compared to listed patients, nonlisted patients had higher mortality (35.7% vs. 24.3%). Patients deemed not sick enough had greater than 95% survival, while those deemed too sick still had >30% survival.</p><p><strong>Conclusions: </strong>Despite no LT, the majority of patients were alive at 21 days. Survival was lower in nonlisted patients. Clinicians are more accurate in deeming patients not sick enough to require LT as opposed to deeming patients too sick to survive.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical care guidance in patients with diabetes and metabolic dysfunction-associated steatotic liver disease: A joint consensus.","authors":"Jee-Fu Huang, Tien-Jyun Chang, Ming-Lun Yeh, Feng-Chih Shen, Chi-Ming Tai, Jung-Fu Chen, Yi-Hsiang Huang, Chih-Yao Hsu, Pin-Nan Cheng, Ching-Ling Lin, Chao-Hung Hung, Ching-Chu Chen, Mei-Hsuan Lee, Chun-Chuan Lee, Chih-Wen Lin, Sung-Chen Liu, Hwai-I Yang, Rong-Nan Chien, Chin-Sung Kuo, Cheng-Yuan Peng, Ming-Ling Chang, Chung-Feng Huang, Yi-Sun Yang, Hung-Chih Yang, Han-Chieh Lin, Horng-Yih Ou, Chun-Jen Liu, Chin-Hsiao Tseng, Jia-Horng Kao, Wan-Long Chuang, Chien-Ning Huang, Pei-Jer Chen, Chih-Yuan Wang, Ming-Lung Yu","doi":"10.1097/HC9.0000000000000571","DOIUrl":"10.1097/HC9.0000000000000571","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide, affecting >30% of the global population. Metabolic dysregulation, particularly insulin resistance and its subsequent manifestation as type 2 diabetes mellitus, serves as the fundamental pathogenesis of metabolic liver disease. Clinical evidence of the recent nomenclature evolution is accumulating. The interaction and impacts are bidirectional between MASLD and diabetes in terms of disease course, risk, and prognosis. Therefore, there is an urgent need to highlight the multifaceted links between MASLD and diabetes for both hepatologists and diabetologists. The surveillance strategy, risk stratification of management, and current therapeutic achievements of metabolic liver disease remain the major pillars in a clinical care setting. Therefore, the Taiwan Association for the Study of the Liver (TASL), Taiwanese Association of Diabetes Educators, and Diabetes Association of the Republic of China (Taiwan) collaboratively completed the first guidance in patients with diabetes and MASLD, which provides practical recommendations for patient care.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"8 11","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}