Journal of Clinical and Experimental Hepatology最新文献

{"title":"Evaluation of Controlled Attenuation Parameter as a Tool for Assessment of Hepatic Steatosis in Living Liver Donors","authors":"Naimish N. Mehta ,&nbsp;Manmohan Rajput ,&nbsp;Karan Kumar ,&nbsp;Anand Nagar ,&nbsp;Vinay K. Mahala ,&nbsp;Vivek A. Saraswat ,&nbsp;Akash Mishra","doi":"10.1016/j.jceh.2025.102514","DOIUrl":"10.1016/j.jceh.2025.102514","url":null,"abstract":"<div><h3>Background</h3><div>Currently, there is an absence of a standardised protocol for the preoperative detection of hepatic steatosis (HS) in living liver donors. A steatotic liver graft jeopardises the outcome of the recipient with multiple potential complications. Vibration-controlled transient elastography (Fibroscan®) provides a controlled attenuation parameter (CAP), which we have utilised in our assessment of HS in living liver donors. This approach offers a promising avenue for the advancement of preoperative evaluation protocols.</div></div><div><h3>Methods</h3><div>In the period spanning from October 2022 to July 2024, a cohort of 67 liver donors were subjected to preoperative vibration-controlled transient elastography (Fibroscan®) and either preoperative or intraoperative liver biopsy. HS was defined as a fat content exceeding 10%. CAP readings were juxtaposed with liver biopsy results for the diagnosis of HS. Donors were categorised into three categories with HS &lt;5%, 5–10% and those with HS &gt;10% were rejected as per our institutional protocol. This facilitated a comprehensive evaluation of HS in the context of living donor liver transplantation.</div></div><div><h3>Results</h3><div>CAP was very accurate in detecting HS, with an area under the receiver operating characteristic curve of 0.99 (<em>P</em> &lt; 0.05). Statistical analysis determined that a CAP cutoff value of 266 dB/m provides a sensitivity of 100% and a specificity of 98.4% for predicting HS &gt;10%. Corresponding positive predictive value (PPV) is 85.71%, while the negative predictive value is 100%. Univariate analysis determined body mass index (BMI), age and serum triglyceride levels were associated with CAP; however, multivariate linear regression revealed an association with only BMI (<em>P</em> &lt; 0.001) and age (<em>P</em> &lt; 0.002). When a lower fat threshold of 5% was considered to define HS with the same cut off of CAP, the sensitivity reduced to 66.7% and specificity was 98.3% The recipients of donors with HS of 5%–10% did not show any negative outcomes.</div></div><div><h3>Conclusion</h3><div>CAP demonstrates significant potential as a predictive tool for hepatic steatosis (HS) in living liver donors. Notably, BMI and age have been identified as independent factors associated with CAP values.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102514"},"PeriodicalIF":3.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562581","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":"Predictors of Non-response to Atezolizumab Plus Bevacizumab in Patients With Unresectable Hepatocellular Carcinoma: A Multicentre Real World Study (HCC-AB Study)","authors":"Satender P. Singh ,&nbsp;Karan Kumar ,&nbsp;Anand Kulkarni ,&nbsp;Vinod Arora ,&nbsp;Ashok Choudhury ,&nbsp;Alisha Chaubal ,&nbsp;Sahaj Rathi ,&nbsp;Samir Shah ,&nbsp;Sunil Taneja ,&nbsp;Ashish Kumar ,&nbsp;Ajay Duseja ,&nbsp;Guresh Kumar ,&nbsp;P. Nagaraja Rao ,&nbsp;Vivek Saraswat ,&nbsp;Shiv K. Sarin","doi":"10.1016/j.jceh.2025.102513","DOIUrl":"10.1016/j.jceh.2025.102513","url":null,"abstract":"<div><h3>Background</h3><div>The approved immunotherapies for patients with advanced HCC are Atezolizumab and Bevacizumab. However, patients in India present late and healthcare is often available through self-financing. To rationalise the therapy, we conducted a large multicentre study to identify the baseline predictors of non-response to atezolizumab and bevacizumab in advanced unresectable HCC.</div></div><div><h3>Methods</h3><div>A dose of atezolizumab 1200 mg and bevacizumab 15 mg/kg was used every 3 weeks from 6 centres across India. A total of 278 patients were screened, and 160 were included in the study. The study included patients with locally advanced metastatic or inoperable hepatocellular carcinoma who were at least 18 years of age and those who received &lt;3 injections were excluded. Fifty-four percent of the included patients were BCLC-B and 46% were BCLC-C. The primary objective was to study overall survival and progression-free survival. While identifying radiological response, objective response rate and adverse effects were secondary objectives.</div></div><div><h3>Results</h3><div>The mean age was 61.9 ± 11.7 years, 88% were male, 55% had NASH, 16.3% had hepatitis C, 18.8% had hepatitis B and the rest were alcohol. The mean Model for End-Stage Liver Disease (MELD) is 12.05 ± 4.46, Albumin-Bilirubin Score (ALBI) is -2.04 ± 0.57. Fifty-five percent received first-line and 45% as second/other line therapy. The median overall survival was 10 (95% confidence interval [CI]: 6.1–15.6) months. Progression-free survival was found to be 8 (95%CI: 5.1–14.7) months overall. Eleven (6.9%) achieved complete response, 28 (17.5%) partial response, 33 (20.6%) had stable disease and 88 (55%) had progressive disease. On multivariate analysis, CRP&gt;1 mg/dl (<em>P</em>-0.007), PIVKA-II&gt;400 mAU/mL (<em>P</em>-0.019), AFP&gt;100 ng/ml (<em>P</em>-0.009), presence of diabetes (<em>P</em>-0.042) were associated with non-response to atezolizumab and bevacizumab injection. Fifty-three percent of patients developed any grade of adverse effect, and 20% developed grade 3/4 adverse events amounting to the stoppage of therapy.</div></div><div><h3>Conclusion</h3><div>Non-response to atezolizumab and bevacizumab immunotherapy was predicted by CRP&gt;1 mg/dl, PIVKA-II&gt;400mAU/ml, AFP&gt;100 ng/ml and the presence of diabetes.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102513"},"PeriodicalIF":3.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562582","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":"Diagnostic Accuracy of the LiverRisk Score to Detect Increased Liver Stiffness Among a United States General Population and Subgroups","authors":"Laurens A. van Kleef ,&nbsp;Jesse Pustjens ,&nbsp;Harry L.A. Janssen ,&nbsp;Willem P. Brouwer","doi":"10.1016/j.jceh.2025.102512","DOIUrl":"10.1016/j.jceh.2025.102512","url":null,"abstract":"<div><h3>Background</h3><div>The LiverRisk score (LRS) has recently been proposed to predict liver fibrosis and future development of liver-related outcomes in the general population. Here, we performed an external validation of this score.</div></div><div><h3>Methods</h3><div>We used data from National Health and Nutrition Examination Survey 2017-2020, a United States population-based cohort to assess the diagnostic accuracy of the LRS to detect a liver stiffness measurement (LSM) ≥8 and ≥12 kPa. Performance was tested among the entire general population and clinically relevant subgroups.</div></div><div><h3>Results</h3><div>The cohort comprised 7,025 participants (aged 49 [33-63], 49% male), and 9.7% had an LSM ≥8 and 3.2% had an LSM ≥12 kPa. The area under the receiver characteristic operator curve (AUC) in the overall population was 0.73 (95% confidence interval [CI] :0.71-0.75) and 0.78 (95% CI: 0.74-0.81) to detect an LSM ≥8 and ≥ 12 kPa, respectively, significantly outperforming the fibrosis 4 index (FIB-4) but not the nonalcoholic fatty liver disease fibrosis score, steatosis-associated fibrosis estimator (SAFE), or metabolic dysfunction–associated fibrosis 5 (MAF-5). Performance was consistent among most subgroups, but AUC levels to detect an LSM ≥8 kPa decreased to &lt;0.70 among participants aged 18-40 or 60-80 years, blacks, and individuals with diabetes or liver steatosis. The LRS categorized 80.5% as very low risk, 17.7% as low risk, and 1.8% as at risk, prevalence of an LSM ≥8 in these groups was 6.3%, 20.8%, and 50.5%, respectively. The sensitivity to detect an LSM ≥8 kPa was 47.3% in the overall population (but dropped to 21.3% for individuals aged 18-40 years) despite applying the lowest cut-off, which should yield the highest sensitivity.</div></div><div><h3>Conclusion</h3><div>The LRS score is a promising new tool to predict liver fibrosis; however, its diagnostic accuracy attenuates especially among patients aged 18-40 or 60-80 years. The overall sensitivity was only 47.3% at the lowest LRS cut-off. Further studies assessing cost-benefit ratios according to the LRS compared to FIB-4 and other risk scores such as MAF-5 and SAFE are required to determine its usefulness in referral strategies.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102512"},"PeriodicalIF":3.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic Artery Embolization in Living Donor Liver Transplant Recipients: Indications, Safety and Clinical Outcomes","authors":"Shahnawaz Bashir ,&nbsp;G.P. Venkat Choudary ,&nbsp;Ramkrishna K. Singh ,&nbsp;Subhash Gupta ,&nbsp;Bharat Aggarwal ,&nbsp;Shaleen Agarwal ,&nbsp;Sanjiv Saigal","doi":"10.1016/j.jceh.2025.102510","DOIUrl":"10.1016/j.jceh.2025.102510","url":null,"abstract":"<div><h3>Purpose</h3><div>Splenic artery embolization (SAE) is a minimally invasive interventional radiology (IR) procedure that plays an important role in the management of complications in a certain subgroup of liver transplant recipients. SAE is technically of two types – proximal (P-SAE) and distal (D-SAE). There is limited data regarding the role of SAE in liver transplant recipients. The purpose of this study was to describe the role and outcomes of SAE in LDLT recipients based on the indications and the type of procedure used.</div></div><div><h3>Material and methods</h3><div>Twenty-seven consecutive patients who underwent SAE after LDLT at our institute were retrospectively reviewed. Patients were categorized into two groups – those who underwent P-SAE (n = 7) and D-SAE (n = 20). The embolic agents used were coils or plugs in the P-SAE group; and poly vinyl alcohol (PVA) particles in the D-SAE group.</div></div><div><h3>Results</h3><div>The median follow-up of the study population was 101 days. The mean platelet and lymphocyte counts improved markedly after SAE (<em>P</em> &lt; 0.001 &amp; <em>P</em> &lt; 0.0001, respectively). Refractory ascites was significantly reduced in both the groups (100% in P-SAE &amp; 77.7% in D-SAE). Minor complications were noted in 28.5% in the P-SAE group and 65% in the D-SAE group. Major complications occurred only in the D-SAE group (15%).</div></div><div><h3>Conclusion</h3><div>Our results support the use of P-SAE for the management of splenic artery steal and small-for-size graft syndromes; and D-SAE for the management of hypersplenism and refractory ascites. Both procedures are safe and effective and the decision to perform proximal or distal SAE should be based on the indications.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102510"},"PeriodicalIF":3.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454307","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 Perioperative Serum Sodium Levels on Outcomes Following Living Donor Liver Transplantation","authors":"Akila Rajakumar ,&nbsp;Susan Paulin ,&nbsp;Amal Francis Sam ,&nbsp;Dinesh Jothimani ,&nbsp;Ashwin Rammohan ,&nbsp;Mohamed Rela","doi":"10.1016/j.jceh.2025.102511","DOIUrl":"10.1016/j.jceh.2025.102511","url":null,"abstract":"<div><h3>Background &amp; objectives</h3><div>Preoperative hyponatremia has been shown to be associated with poor outcomes post-liver transplantation. We analyzed the impact of preoperative hyponatremia and perioperative sodium (Na) changes on outcomes following adult living donor liver transplantation.</div></div><div><h3>Methods</h3><div>After obtaining clearance from Institutional ethical Committee, a retrospective review of electronic database and medical records of all adult patients who underwent LDLT between January 2019 and September 2022 was done and relevant perioperative data were collected.</div></div><div><h3>Results</h3><div>The study cohort of 520 recipients was divided into four groups based on preoperative serum Na levels in mmol/L; 12 patients (2.3%) in Group A (&lt;125); 66 patients (12.6%) in Group B (125–129); 216 patients (41.5%) in Group C (130–135) and 226 patients (43.4%) in Group D (136–145). MELD score, preoperative AKI, SBP, intraoperative ascites volume, volume of packed blood cells (PRC), other blood products and 25% albumin were significantly associated with the degree of hyponatremia. No other outcomes including mortality was associated any grade of hyponatremia. The delta sodium on postoperative day 1 was largest in Group A. The level of Na rise post-transplant on POD1 had an inverse correlation with preoperative Na levels [ r (520) −0.6, <em>P</em> &lt; 0.001]. High delta sodium was not associated with neurological complications in this cohort. Group A patients had higher incidence of postoperative AKI requiring dialysis followed by groups B, C and D. Eighty-six (16.5%) patients had large delta-Na of &gt;10 mmol/L. On univariate analysis, low pretransplant Na (&lt;130mEq/L), preoperative AKI, SBP, higher MELD and ascitic volumes, intraoperative transfusions of PRC, blood products and 25% albumin, early allograft dysfunction and need for dialysis, were associated with larger delta-Na. On multivariate analysis, preoperative Na levels ≤130 mmol/L, intraoperative ascites and PRC transfusion were found to be independent risk factors for a large delta-Na.</div></div><div><h3>Conclusion</h3><div>Hyponatremia, being a factor associated with liver disease, might not by itself contribute to poor survival when the deleterious effects of large delta changes can be avoided. The results from this study reinforces the fact that with a cautious perioperative approach, patients with hyponatremia can be transplanted safely in LDLT settings.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102511"},"PeriodicalIF":3.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480028","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":"Outcomes of Living Donor Liver Transplantation in Recipients Colonized With Carbapenem-Resistant Enterobacterales","authors":"Akila Rajakumar ,&nbsp;Prijith Ramanan ,&nbsp;Amal F. Sam ,&nbsp;Vidya Devarajan ,&nbsp;Subha Sundaramoorthy ,&nbsp;Dinesh Jothimani ,&nbsp;Ashwin Rammohan ,&nbsp;Mohamed Rela","doi":"10.1016/j.jceh.2025.102508","DOIUrl":"10.1016/j.jceh.2025.102508","url":null,"abstract":"<div><h3>Background</h3><div>Pretransplant colonization with carbapenem-resistant Enterobacterales (CRE) is associated with poorer post–liver transplantation (LT) outcomes. We aimed to analyze the incidence and risk factors for CRE colonization in adult living-donor LT recipients from January 2019 to September 2022 and its impact on post-LT outcomes.</div></div><div><h3>Methods</h3><div>Relevant perioperative parameters including bacteremia within one month post LT were recorded. Rectal swabs were used for screening living-donor liver transplantation (LDLT) recipients for CRE colonization and divided into CRE-positive (CRE-POS) and CRE-negative (CRE-NEG) groups.</div></div><div><h3>Results</h3><div>A total of 499 patients were included in study, and 163 (32.6%) were CRE colonized and received pre-emptive probiotics. Median Model for End-Stage Liver Disease score (odds ratio [OR]: 1.05 [95% confidence interval {CI}: 1.02–1.08]) and preoperative acute kidney injury (AKI) (OR: 1.95 [95% CI: 1.28–2.98]) were independently associated with preoperative CRE colonization. CRE-POS patients had higher intraoperative packed red blood cell transfusion (5 [3, 7] vs 3 [1, 6]) along with a higher incidence of post-LT bacteremia (19.6% vs 9.8%, <em>P</em> = 0.004), chest infections (25.7% vs 13.6%, <em>P</em> = 0.04), and longer intensive care unit stay (7 days [interquartile range {IQR}: 5–10] vs 6 days [IQR: 5–8] <em>P</em> = 0.006). All other perioperative parameters including survival were comparable between the two groups. Bacteremia developed in 65 of 499 patients of which 61 (93.8%) were Enterobacterales. Preoperative CRE colonization (OR: 1.9 (95% CI: 1.08–3.7]), metabolic dysfunction–associated steatotic liver disease as an etiology of liver disease (OR: 2.0 [95% CI: 1.03–3.89]), preoperative AKI (OR: 2.4 [95% CI: 1.3–4.5]), and massive transfusion (OR: 2.0 (95% CI: 1.03–3.89]) were independently associated with postoperative Enterobacterales septicemia. Patients with bacteremia due to CRE had a higher 90-day mortality (38.4% vs 14.2% <em>P</em> = 0.03). Postoperative CRE bacteremia was not associated with preoperative CRE colonization (42.8% CRE-POS vs 57.1% CRE-NEG).</div></div><div><h3>Conclusion</h3><div>One-third of patients presenting for LDLT are already colonized with CRE. Preoperative CRE colonization is a risk factor for postoperative Enterobacterales septicemia but not with CRE bacteremia. Post–liver transplant CRE bacteremia has a significantly higher mortality. Active pre-LT surveillance for CRE, along with the use of targeted pre-emptive therapy as probiotics and a low threshold for discretionary use of appropriate guideline-based antibiotic therapy based on CRE colonization status, in the event of sepsis, can help improve outcomes in this cohort of LDLT recipients.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102508"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418891","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":"Naltrexone for Alcohol Use Disorder in Cirrhosis: Bridging the Gap in an Understudied Population","authors":"Romina Vergara-Quispe,&nbsp;David Marti-Aguado,&nbsp;Ramón Bataller","doi":"10.1016/j.jceh.2025.102509","DOIUrl":"10.1016/j.jceh.2025.102509","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102509"},"PeriodicalIF":3.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419433","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":"Statins in Metabolic Dysfunction–Associated Liver Disease: Hope, Hurdles, and Biostatistical Hazards","authors":"Nina Kimer,&nbsp;Elliot B. Tapper","doi":"10.1016/j.jceh.2025.102504","DOIUrl":"10.1016/j.jceh.2025.102504","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102504"},"PeriodicalIF":3.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092016","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":"Managing Complex Hepatocellular Carcinoma Subtypes: Diffuse Infiltrative, Large Tumours, and Tumour Rupture—The Challenges and Strategies","authors":"Ashok Choudhury ,&nbsp;Akash Roy ,&nbsp;Amar Mukund ,&nbsp;Deepti Sharma ,&nbsp;Subin Heo ,&nbsp;Won-Mook Choi","doi":"10.1016/j.jceh.2025.102505","DOIUrl":"10.1016/j.jceh.2025.102505","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) is the sixth most common cause of cancer globally, third most common cause of cancer-related death, and most common primary liver malignancy. Whilst nodular well-defined HCC remains the classical phenotype, presentations with infiltrative phenotype, very large HCC, and complications as tumour rupture provide immense diagnostic and therapeutic challenges. Infiltrative HCC is difficult to distinguish against the background cirrhotic liver. They are ill defined on imaging, have poor vascularity, and aggressive biological behaviour. Vascular invasion, metastasis, and poor response to loco-regional, as well as systemic therapy, leads to dismal prognosis. Very large HCCs have a relatively better prognosis than infiltrative HCC and mandate multimodal therapies to downstage for a curative response including liver transplant. Improvement in interventional radiology techniques, emerging evidence with systemic therapies including immunotherapy, and better understanding of tumour biology have opened newer avenues in the management of such complex cases. HCC rupture is a catastrophic moment in the natural history of HCC which has an exponential increase in mortality. Clinical presentation of pain abdomen, hypotension/syncope, new onset, or sudden increase in ascites mandates a strong suspicion of rupture. Presence of hemoperitoneum on diagnostic tap and contrast extravasation in a computed tomography/magnetic resonance imaging are the diagnostic hallmarks. Emergency surgical intervention, locoregional therapies in the form of bland embolisation, or chemoembolisation forms the management cornerstone. The long-term survival and liver transplant as a curative therapy still needs more data as fear of tumour spread is a possibility. This review summarises the clinical challenges with this advance HCC and provides an algorithmic approach for management.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102505"},"PeriodicalIF":3.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387396","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":"Living-Donor Liver Transplantation—The Need for Greater Transparency","authors":"Anil C. Anand,&nbsp;James Neuberger","doi":"10.1016/j.jceh.2025.102507","DOIUrl":"10.1016/j.jceh.2025.102507","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102507"},"PeriodicalIF":3.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092017","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}