Journal of Clinical and Experimental Hepatology最新文献

{"title":"Prevalence of Binge Eating Disorder in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Meta-analysis","authors":"Lubna Al-Sharif, Samira M. Khalil, Matheus Souza","doi":"10.1016/j.jceh.2025.102603","DOIUrl":"10.1016/j.jceh.2025.102603","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102603"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact of Initial Laboratory-based Scores for Hepatocellular Carcinoma Patients: A Retrospective Study","authors":"Walid I. Yousif,&nbsp;Mohamed F. Bakosh","doi":"10.1016/j.jceh.2025.102604","DOIUrl":"10.1016/j.jceh.2025.102604","url":null,"abstract":"<div><h3>Background/Aim</h3><div>Hepatocellular carcinoma (HCC) is a heterogeneous tumor with variable prognosis<strong>.</strong> We aimed to evaluate different laboratory-based scores and indices to predict 1-year overall survival (OS).</div></div><div><h3>Methods</h3><div>A total of 188 patients with HCC were included. Albumin-to-alkaline phosphatase ratio (AAPR)<strong>,</strong> aspartate aminotransferase-to-lymphocyte ratio (ALR), albumin-to-bilirubin (ALBI) score, neutrophil-to-lymphocyte∗platelet ratio (N/LPR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) were evaluated in relation to 1-year OS using receiver operating characteristic (ROC) curves, Cox regression analysis, and a prediction nomogram.</div></div><div><h3>Result</h3><div>Using ROC curve analysis, area under the curve (AUC) values of AAPR, ALR, NLR, LMR, and PLR were (0.704, 0.697, 0.743, 0.677, and 0.693, respectively) for the prediction of 1-year OS. ALBI score and N/LPR failed to significantly predict 1-year OS, and the NLR has the highest AUC among all the scores. In the subgroup receiving trans-arterial chemoembolization as the initial treatment, NLR and PLR were the scores that accurately predicted 1-year OS with AUCs of 0.701 and 0.685, respectively. Baseline elevated alanine aminotransferase, a performance status ≥1, larger lesions ≥5, multiple lesions ≥2, the presence of portal vein invasion, the presence of lymph node invasion, an NLR &gt;2.27, and an LMR ≤3.40 are independent predictors of 1-year mortality in multivariate regression analysis. The C-index of the nomogram, including independent predictors in the multivariate regression analysis, predicting 1-year mortality was 0.808 (95% confidence interval: 0.771-0.845).</div></div><div><h3>Conclusion</h3><div>NLR and LMR are independent predictors of 1-year mortality, and a novel nomogram prediction model based on these scores show a higher performance. NLR is superior to other baseline non-invasive serum-based scores for the prediction of 1-year OS.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102604"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Hepatic Leiomyosarcoma: A Case Series Highlighting a Rare Malignancy","authors":"Divya Khosla ,&nbsp;Treshita Dey ,&nbsp;Rakesh Kapoor ,&nbsp;Suvradeep Mitra ,&nbsp;Divyesh Kumar ,&nbsp;Shikha Goyal ,&nbsp;Renu Madan ,&nbsp;Kimavat Hemanth Kumar ,&nbsp;Rajesh Gupta","doi":"10.1016/j.jceh.2025.102602","DOIUrl":"10.1016/j.jceh.2025.102602","url":null,"abstract":"<div><h3>Objectives</h3><div>Primary hepatic leiomyosarcoma (PHLMS) is an exceedingly rare malignant tumor originating from the liver with only a handful of cases reported in literature. Herein, we present five cases of PHLMS diagnosed and managed at our institute.</div></div><div><h3>Results</h3><div>The patients presented with non-specific symptoms, e.g., abdominal pain, lump, jaundice, etc., and imaging showed a space-occupying lesion in the liver. Hence, histopathological examination plays a pivotal role in diagnosis, revealing characteristic features of spindle-shaped cells arranged in fascicles or bundles with high mitotic rate and varying degrees of necrosis. Only 1 out of 5 patients underwent surgery. The remaining patients were planned with either palliative chemotherapy or best supportive care based on their performance status. The prognosis is however poor in such patients.</div></div><div><h3>Conclusion</h3><div>Despite aggressive management, prognosis of PHLMS remains guarded. Surgical resection is the backbone of a radical treatment. This case series presents a rare entity providing insights into the diagnosis, management, and prognosis of the patients with PHLMS.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102602"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Resistance Associated Substitutions and Predictors of Treatment Failure Following Direct-acting Antiviral Therapy in a Viral Hepatitis C Elimination Cohort","authors":"Madhumita Premkumar MD, DM ,&nbsp;Ekta Gupta MD ,&nbsp;Anchal Sandhu BSc ,&nbsp;Prerna Sharma BSc ,&nbsp;Jasvinder Nain MPH ,&nbsp;Sunil Taneja MD, DM ,&nbsp;Nipun Verma MD, DM ,&nbsp;Arka De MD, DM ,&nbsp;Ajay Duseja MD, DM, FAMS, FACG, FAASLD ,&nbsp;Gagandeep S. Grover MD ,&nbsp;Radha K. Dhiman MD, DM, FAMS, FACG, FRCP, FAASLD","doi":"10.1016/j.jceh.2025.102601","DOIUrl":"10.1016/j.jceh.2025.102601","url":null,"abstract":"<div><h3>Background</h3><div>The National Viral Hepatitis Control Program (NVHCP) has a cure rate of 91.6% when using direct-acting antivirals (DAAs)–sofosbuvir with an NS5A inhibitor (ledipasvir, daclatasvir or velpatasvir) ± ribavirin in the Punjab hub-and-spoke model of hepatitis C virus (HCV) elimination.</div></div><div><h3>Methods</h3><div>We collected the clinical and virological data for the ∼8.4% treatment failure cases. Sanger nucleotide sequencing was performed to identify the resistance-associated substitutions (RAS) following treatment failure. We ascertained the clinical and virological predictors of treatment failure under the NVHCP.</div></div><div><h3>Results</h3><div>Between April 2019 and December 2023, 50865 patients with HCV were treated; median age 41.6 years, 65% men, 85.8% without cirrhosis, 8.5% treatment experienced, median viral load (x10⁶) of 4.1 (2.9–7.8),71.3% genotype (GT)-3, with cure rate of 89.5%. On multivariable analysis, age (aOR 1.5, 95% CI: 1.3–1.9, <em>P</em> = 0.021), presence of cirrhosis (aOR1.8, 95% CI: 1.3–2.5, <em>P</em> &lt; 0.001), and poor drug compliance (aOR 0.3, 95% CI: 0.2–0.6, <em>P</em> &lt; 0.001) predicted treatment failure. We enrolled a difficult-to-treat group of 640 persons for virological testing, aged 39.2 ± 15.1 years, median HCV viral load (x10⁶) of 1.98 (1.5–2.4). Of these, 56.6% were treatment-experienced, 11.1% were prior defaulters, with predominant GT3 (73.3%) and GT1 (18.7%) with coinfection rates of 3.8% and 4.4% for hepatitis B virus (HBV) and human immunodeficiency virus (HIV), respectively. Presumed modes of transmission in this subgroup were unsafe injections (57%), and injection drug use (32.8%). A total of 243 patient samples underwent RAS testing, with 45 patients having detectable variants, and finally 31 RAS mutations were detected in the NS5A gene, with no clinically significant resistance observed in the NS5B gene. In GT-3, the RAS observed were A30K, L31 M/R, A62S, A62T, and Y93H. In GT-1, the RAS observed were M28A, H58P, G30 H/R, H58D, and Y93K. Among these Y93K, L30R, G30 H/R confer resistance to velpatasvir; such patients received retreatment with voxilaprevir-containing regimens.</div></div><div><h3>Conclusion</h3><div>Patient factors like compliance and the presence of cirrhosis predicted treatment failures. RAS do not appear to be a primary factor for treatment failure in a public health setting.</div></div><div><h3>Clinical trials gov number</h3><div>NCT03488485 available from <span><span>https://clinicaltrials.gov/study/NCT03488485</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102601"},"PeriodicalIF":3.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Splenic Artery Embolization: A Promising and Potential Tool","authors":"Amar Mukund,&nbsp;Aindrila Khatua","doi":"10.1016/j.jceh.2025.102597","DOIUrl":"10.1016/j.jceh.2025.102597","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102597"},"PeriodicalIF":3.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spleen Area Affects the Performance of the Platelet Count–Based Non-invasive Tools in Predicting First Hepatic Decompensation in Metabolic Dysfunction–Associated Steatotic Liver Disease Cirrhosis","authors":"Marcello Dallio ,&nbsp;Mario Romeo ,&nbsp;Fiammetta Di Nardo,&nbsp;Carmine Napolitano,&nbsp;Paolo Vaia,&nbsp;Simone Olivieri,&nbsp;Marco Niosi,&nbsp;Alessandro Federico","doi":"10.1016/j.jceh.2025.102596","DOIUrl":"10.1016/j.jceh.2025.102596","url":null,"abstract":"<div><h3>Background/Aims</h3><div>Various non-invasive tools (NITs) predicting first hepatic decompensation (HD) in advanced chronic liver disease (ACLD) enclose platelet (PLT) count. A relevant proportion of metabolic dysfunction–associated steatotic liver disease (MASLD)-ACLD patients do not show splenomegaly- and hypersplenism-related thrombocytopenia. We aimed to evaluate the performance of NITs in predicting HD according to ultrasound-assessed spleen size.</div></div><div><h3>Methods</h3><div>In this observational study, 148 splenic and 27 asplenic (ASP) MASLD-compensated advanced chronic liver disease (cACLD) patients were enrolled. Ultrasound artificial intelligence–based tools distinguished splenomegaly-affected patients (SAPs) and normal-spleen patients (NSPs). Albumin-Bilirubin score (ALBI) and PLT count–based NITs (PLNs) (Fbrosis-4 [FIB-4], ALBI-FIB-4, red cell distribution width-to-PLT ratio [RPR], liver stiffness measurement [LSM]-to-platelet ratio [LSM/PLTr], and ANTICIPATE ± non-alcoholic steatohepatitis [NASH]) were determined. Over 3 years, the first HD was recorded.</div></div><div><h3>Results</h3><div>Limitedly to SAP, spleen area inversely correlated with PLT (relationship [R]: −0.981; <em>P</em> &lt; 0.0001), confirming the role of splenomegaly-related hypersplenism in conditioning thrombocytopenia. HD occurred similarly in SAPs (20.48%), NSPs (21.15%), and ASP patients (25%) (<em>P</em>: 0.198). In NSP, PLNs showed a reduced influence on HD (FIB-4 [<em>P</em>: 0.03], ALBI-FIB-4 [<em>P</em>: 0.001], RPR [<em>P</em>: 0.002], LSM/PLTr [<em>P</em>: 0.01], and ANTICIPATE ± NASH [<em>P</em>: 0.001]) compared to SAP. In NSP, the spleen area was inversely associated (adjusted sub-distribution hazard ratio: 0.870) and more significantly (<em>P</em> &lt; 0.0001) impacted HD. Consistently, unlike SAPs, in NSPs and ASP patients, PLNs showed poor performance, and exclusively ALBI maintained a good accuracy (NSP: area under the curve [AUC]: 0.651, <em>P</em>: 0.04; ASP patients: AUC: 0.625, <em>P</em>: 0.03) in predicting 3-year HD.</div></div><div><h3>Conclusion</h3><div>Ultrasound-assessed spleen size affects the predictive performance of the PLNs in MASLD-cACLD patients.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102596"},"PeriodicalIF":3.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent Carriers, Severe Consequences: The Hidden Threat of Carbapenem-Resistant Enterobacteriaceae Colonization in Liver Transplantation","authors":"Simone Incicco,&nbsp;Salvatore Piano","doi":"10.1016/j.jceh.2025.102600","DOIUrl":"10.1016/j.jceh.2025.102600","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102600"},"PeriodicalIF":3.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Search for Prognostic Biomarkers in Patients with Surgically Treated Hepatocellular Carcinoma","authors":"Ece J. Dinc,&nbsp;Madhukar S. Patel,&nbsp;Yujin Hoshida ,&nbsp;Amit G. Singal","doi":"10.1016/j.jceh.2025.102599","DOIUrl":"10.1016/j.jceh.2025.102599","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102599"},"PeriodicalIF":3.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifestyle Intervention is Effective in Reversal of Fibrosis in NAFLD Patients: Results from a Retrospective Real-World Study","authors":"Shivaram P. Singh ,&nbsp;Prajna Anirvan ,&nbsp;Swati Chouhan ,&nbsp;Manas K. Panigrahi ,&nbsp;Chitta R. Khatua ,&nbsp;Samir Hota ,&nbsp;Mitali M. Rath ,&nbsp;Sanjib K. Kar ,&nbsp;Bijay Misra ,&nbsp;Preetam Nath ,&nbsp;Saroj K. Sahu ,&nbsp;Jimmy Narayan ,&nbsp;Ayaskanta Singh","doi":"10.1016/j.jceh.2025.102598","DOIUrl":"10.1016/j.jceh.2025.102598","url":null,"abstract":"<div><h3>Background</h3><div>Nonalcoholic fatty liver disease (NAFLD) is a lifestyle disorder, and lifestyle intervention (LI) remains the cornerstone of NAFLD management. Despite this, in recent years, the focus has been primarily on developing newer drugs and not on LIs, presumably due to a lack of medication adherence. We aimed to investigate the ability of LI to reverse fibrosis in NAFLD patients.</div></div><div><h3>Methods</h3><div>Seven hundred seventy-six patients were retrospectively included, of which 565 patients were analysed. Anthropometric and biochemical parameters and 2D-SWE measurements of all patients were recorded before and after LI.</div></div><div><h3>Results</h3><div>Weight reduction was observed in 85.2% of the patients. The mean body mass index (BMI) decreased from 26.08 ± 3.53 kg/m² to 25.06 ± 3.19 kg/m² (<em>P</em> &lt; 0.001) in the cohort. The mean waist and hip circumferences decreased significantly from 98.87 ± 8.72 cm to 94.40 ± 7.67 cm and from 103.63 ± 7.91 cm to 101.98 ± 7.17 cm, respectively (<em>P</em> &lt; 0.001). Significant reductions in serum low-density lipoprotein (112.93 ± 33.23 mg/dL to 104.12 ± 31.10 mg/dL, <em>P</em> &lt; 0.001) and very low-density lipoprotein (34.05 ± 19.43 mg/dL to 30.26 ± 12.58 mg/dL, <em>P</em> &lt; 0.001) levels were also observed post-intervention. Decrease in liver stiffness was observed in 67.9% of the patients, and a one-stage reduction in fibrosis was observed in 40.5% of the patients, while a 2-point reduction in liver stiffness was observed in 52% of the patients; reversal of hepatic steatosis occurred in 16.4% of the patients. A significant reduction in liver stiffness was seen post-intervention (7.21 ± 1.84 kPa to 6.61 ± 1.59 kPa, <em>P</em> &lt; 0.001). BMI reduction correlated positively with a decrease in liver stiffness (r = 0.43, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>LI when sustained over a year can improve liver stiffness in NAFLD, even in a real-world setting. However, prospective case–control studies are required to robustly assess the effectiveness, safety with regard to micronutrient deficiency, and long-term outcomes of LI in NAFLD.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102598"},"PeriodicalIF":3.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Exchange With Corticosteroids as a Rescue Therapy for Severe Prolonged Cholestasis in Acute Viral Hepatitis","authors":"Sunil Taneja ,&nbsp;Rohit Mehtani ,&nbsp;Chandragiri P. Ganesh ,&nbsp;Sweta Rose ,&nbsp;Sathyanarayanappa Balaraja ,&nbsp;Kannupriya ,&nbsp;Sahaj Rathi ,&nbsp;Arka De ,&nbsp;Divjot Lamba ,&nbsp;Nipun Verma ,&nbsp;Madhumita Premkumar ,&nbsp;Rekha Hans ,&nbsp;Rati R. Sharma ,&nbsp;Ajay Duseja","doi":"10.1016/j.jceh.2025.102594","DOIUrl":"10.1016/j.jceh.2025.102594","url":null,"abstract":"<div><h3>Background and aims</h3><div>Prolonged cholestasis after acute viral hepatitis (AVH) complicates &lt;1% of patients. The treatment includes the use of anti-pruritic medications in a stepwise manner. This study assessed the role of Plasma exchange (PLEX) with corticosteroids on severe prolonged cholestasis.</div></div><div><h3>Methods</h3><div>Retrospective analysis of patients with AVH and prolonged cholestasis was conducted. Prolonged cholestasis was defined as jaundice for &gt;6 weeks with peak serum bilirubin &gt;10 mg/dL, in the absence of haemolysis and renal failure with alanine transferase level below 500U/L. A combination of centrifugal PLEX with corticosteroids was offered if there was no response to anti-pruritic medications. A control group, which received only anti-pruritic medications, was included for comparison.</div></div><div><h3>Results</h3><div>Fifty-nine patients, predominantly males (90%; n = 53) were included. Most common etiology was HAV (n = 56; 94.9%) followed by HEV (n = 3; 5.1%). Despite more severe disease, (higher Visual Analogue Scale (VAS) - 9 [9-9] vs 8 [7–8], <em>P</em> &lt; 0.001 and higher bilirubin - 30.6 ± 4.1 vs 27.3 ± 7.1 mg/dL, <em>P</em> = 0.03), bilirubin reduction was faster in combination group. Percentage reduction in bilirubin at week 1 and week 4 was 43.6% ± 7.9% and 93.8% ± 1.6% in the combination group vs 37.9% ± 12.9% and 89.4% ± 4.4% in the conservative group (<em>P</em> = 0.04 and &lt; 0.001, respectively). Median time to symptom improvement was less in the combination group (25 [22–27] days vs 42 [38–48] days; <em>P</em> &lt; 0.001 in conservative group).</div></div><div><h3>Conclusion</h3><div>PLEX combined with low-dose oral steroids results in significant improvement in prolonged cholestasis and can be considered as an effective rescue therapy in patients who do not respond to standard anti-pruritic medications.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102594"},"PeriodicalIF":3.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}