Liver International最新文献

{"title":"Reply: Assessing Health-Related Quality of Life in Patients With Variant Syndromes of Autoimmune Liver Diseases","authors":"Natalie Uhlenbusch, Bernd Löwe, Christoph Schramm","doi":"10.1111/liv.70641","DOIUrl":"10.1111/liv.70641","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Efficacy and Outcomes of Endovascular Interventions in Budd-Chiari Syndrome—A Real World Analysis","authors":"Amar Mukund,&nbsp;Vaibhav Thakur,&nbsp;Ankur Jindal,&nbsp;Yashwant Patidar,&nbsp;Rakhi Maiwall,&nbsp;Shiv Kumar Sarin","doi":"10.1111/liv.70638","DOIUrl":"10.1111/liv.70638","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the long-term safety, efficacy, and clinical outcomes of endovascular interventions [hepatic vein/inferior vena cava recanalization and Direct Intrahepatic Portosystemic Shunt (DIPS)] in patients with Budd-Chiari Syndrome (BCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analysed electronic medical records of consecutive BCS patients who underwent endovascular interventions between 2010 and 2022 with at least 2 years of follow-up. We analysed laboratory and clinical parameters, types of interventions, patency rates, and survival outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 415 BCS patients, 161 patients underwent endovascular interventions (median age 33.06 (5–75) years, male-to-female ratio 2.2:1). 103 patients who underwent hepatic vein/inferior vena cava recanalization (angioplasty/stenting) and 58 patients who underwent DIPS. The DIPS group had higher baseline median Child-Turcotte-Pugh (CTP) score (8.27), MELD score (14.94) and Rotterdam score (0.96). The recanalization group had baseline CTP score (6.95), MELD score (13.01) and Rotterdam score (0.56). Both interventions resulted in significant improvements in clinical outcomes (ascites resolution and prevention of rebleeding) and ALBI grades (<i>p</i> &lt; 0.01). The DIPS group had persistently higher MELD and ALBI scores (<i>p</i> &lt; 0.05) and required more repeat endovascular interventions (58.6%). The recanalization group required fewer repeat interventions (7.7%). Patency rates at 1 and 5 years were 96% and 92% for recanalization, 82% and 45% for DIPS, and 100% and 60% for DIPS revisions, respectively. The 10-year survival rate was 92% for the recanalization group and 88% for the DIPS group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Endovascular interventions provide higher rates of symptom resolution and excellent long-term overall survival in BCS patients. Patients undergoing DIPS exhibited persistently higher severity scores and a higher need for repeat interventions, consistent with a more severe disease phenotype at baseline.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Hepatic Fibrosis and Steatosis via A Point-of-Care Transient Elastography System With Integrated AI","authors":"Zi-Hao Huang,&nbsp;Chen-Hui Ye,&nbsp;Chong-Lin Wu,&nbsp;Wan-Rui Li,&nbsp;Miao-Qin Deng,&nbsp;Li-You Lian,&nbsp;Chen-Xiao Huang,&nbsp;Yi-Xuan Wei,&nbsp;Ying-Ying Cao,&nbsp;Xiao-Na Shen,&nbsp;Yi-Wei Lin,&nbsp;Sui-Dan Chen,&nbsp;Wai-Kay Seto,&nbsp;Yong-Ping Zheng,&nbsp;Ming-Hua Zheng","doi":"10.1111/liv.70634","DOIUrl":"10.1111/liv.70634","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background &amp; Aims</h3>\u0000 \u0000 <p>Transient elastography (TE) is routinely undertaken for non-invasive assessment of liver fibrosis and steatosis, but is limited by its bulky design, inadequate imaging guidance and conventional algorithmic framework. Thus, we report a real-time B-mode image–guided, artificial intelligence–assisted, point-of-care TE (AI-POC-TE) system, providing simultaneous liver stiffness measurement (LSM) and a novel multi-domain attenuation parameter (MAP) for fat quantification. We aimed to determine the accuracy of LSM and MAP in diagnosing histology-confirmed fibrosis and steatosis in patients with chronic liver disease. Exploratory analyses assessed the minimum number of measurements required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective study included 138 patients who underwent liver biopsy and AI-POC-TE simultaneously, and diagnostic performance was evaluated by area under the receiver operating characteristic curve (AUROC). Another larger cohort of 1455 patients was examined to benchmark AI-POC-TE against conventional TE (Fibroscan).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LSM by AI-POC-TE identified patients with fibrosis with AUROCs of 0.79 for ≥F2, 0.79 for ≥F3, 0.97 for F4. Corresponding Youden's cut-offs were 8.2, 9.1 and 14.4 kPa. MAP detected steatosis of ≥ S1, ≥ S2, S3 with AUROCs of 0.92, 0.70, 0.76 and Youden's cut-offs were 244, 278 and 294 dB/m, respectively. Among 1455 patients using both TE techniques, liver stiffness was highly correlated (<i>r</i> = 0.86) and MAP also correlated well with CAP (<i>r</i> = 0.80). Fewer than 10 measurements suffice to maintain accuracy; four measurements were statistically non-inferior to the standard 10, supporting a streamlined protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found AI-POC-TE to accurately assess fibrosis and steatosis, comparable to conventional TE but with added values of portability, B-mode guidance and deep learning-based analytics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633294","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":"Radiomics-Based Assessment of Portal Hypertension Severity and Risk Stratification of Cirrhotic Patients Using Routine CT Scans","authors":"Celine Sin,&nbsp;Martin Luther Watzenboeck,&nbsp;Eugenia Iofinova,&nbsp;Lorenz Balcar,&nbsp;Georg Semmler,&nbsp;Bernhard Scheiner,&nbsp;Katharina Lampichler,&nbsp;Mattias Mandorfer,&nbsp;Lucile Moga,&nbsp;Pierre-Emmanuel Rautou,&nbsp;Maxime Ronot,&nbsp;Jörg Menche,&nbsp;Thomas Reiberger,&nbsp;Martina Scharitzer","doi":"10.1111/liv.70633","DOIUrl":"10.1111/liv.70633","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background &amp; Aims</h3>\u0000 \u0000 <p>To develop and validate a CT-based radiomics model to assess HVPG and predict a composite endpoint of liver-related events (LRE: decompensation and liver-related death) in patients with cirrhosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 357 cirrhosis patients, who received invasive HVPG measurements, 120 liver-healthy controls (training cohort) and 85 and 100 cirrhosis patients (internal and external validation cohorts, respectively), and contrast-enhanced abdominal CTs. After volumetric segmentation of the liver and spleen on CT, Bayesian parameter optimization was used for selection of extracted features and hyperparameter tuning in random forest or elastic net models. Prediction accuracy was evaluated using Pearson correlation coefficients of predicted (’radio-HVPG’) and invasive HVPG. Discrimination between relevant HVPG cut-offs was determined by receiver operating characteristic (ROC) analysis. The predictive value of radio-HVPG and invasive-HVPG for LRE was compared using Cox regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Radio-HVPG, predicted by an optimized random forest model based on 74 selected CT features, correlated with invasive-HVPG and detected clinically significant portal hypertension (CSPH: HVPG ≥ 10 mmHg) on the internal (Pearson <i>r</i> = 0.63, AUC 0.89 [95% CI: 0.81–0.96]) and external (Pearson <i>r</i> = 0.62, AUC 0.80 [95% CI: 0.64–0.91]) validation cohorts. Radio-HVPG predicted LRE when adjusting for MELD and albumin (adjusted HR: 1.14 [95% CI: 1.04–1.25], <i>p</i> = 0.005) and performed similarly to invasive-HVPG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Radiomic features accurately predict HVPG in patients with cirrhosis and allow risk stratification for LRE in a radiomics-clinical signature.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628068","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":"Baseline Alkaline Phosphatase Impacts Response Rates in Primary Biliary Cholangitis: Exploring Response to Elafibranor in ELATIVE","authors":"Cynthia Levy,&nbsp;Christopher L. Bowlus,&nbsp;Eric Lawitz,&nbsp;Nuno Antunes,&nbsp;Benjamin Miller,&nbsp;Jianfen Shu,&nbsp;Claudia O. Zein,&nbsp;Kris V. Kowdley","doi":"10.1111/liv.70630","DOIUrl":"10.1111/liv.70630","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background &amp; Aims</h3>\u0000 \u0000 <p>Baseline alkaline phosphatase (ALP) levels can influence the likelihood of achieving dichotomous biochemical response criteria in primary biliary cholangitis (PBC). This concept was explored using Week 52 data from the phase III ELATIVE trial (NCT04526665), which assessed elafibranor, a peroxisome proliferator-activated receptor α/δ agonist approved as a second-line treatment for PBC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients were grouped by baseline ALP. Outcomes assessed: biochemical response, ALP normalization, ALP change from baseline (CfB), transplant-free survival (using GLOBE score).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At Week 52, biochemical response was achieved across all subgroups receiving elafibranor (≤ 2× upper limit of normal [ULN]: 86.7%, &gt; 2–≤ 2.5× ULN: 80.0%, &gt; 2.5–≤ 3× ULN: 52.0%, &gt; 3–≤ 4× ULN: 22.2%, &gt; 4× ULN: 18.8%), and one subgroup receiving placebo (≤ 2× ULN: 13.3%). ALP normalization occurred only with elafibranor (≤ 2× ULN: 53.3%, &gt; 2–≤ 2.5× ULN: 12.0%, &gt; 2.5–≤ 3× ULN: 12.0%, &gt; 4× ULN: 12.5%). Mean ALP reductions were consistent across subgroups receiving elafibranor (overall CfB: −38.9%). Patients receiving elafibranor, regardless of biochemical response, had similar reductions in risk of liver transplant and/or liver-related mortality within 15 years (−4.0% to −4.5%); among patients receiving placebo, reduced risk was only predicted in responders (−1.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In ELATIVE, lower baseline ALP correlated with higher biochemical response and ALP normalization rates with elafibranor. However, among patients receiving elafibranor, relative reductions in risk scores and ALP were consistent regardless of biochemical response and pre-treatment ALP, indicating treatment benefit. Similar biochemical benefits were not observed among patients receiving placebo. These results support evaluating continuous measures and prognostic scores alongside dichotomous criteria to comprehensively assess efficacy.</p>\u0000 \u0000 <p><b>Trial Registration</b>: NCT04526665</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623242","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":"Physician Perspectives on Hepatitis C Treatment During Pregnancy: A Multinational Multispecialty Survey","authors":"Tatyana Kushner,&nbsp;Maria Buti,&nbsp;Mohamed El-Kassas,&nbsp;Yusuf Yilmaz,&nbsp;Hirokazu Takahashi,&nbsp;Yuichiro Eguchi,&nbsp;Stuart K. Roberts,&nbsp;Wah-Kheong Chan,&nbsp;Ming-Lung Yu,&nbsp;Ponsiano Ocama,&nbsp;Saira Khaderi,&nbsp;Manida Wungjiranirun,&nbsp;Ira M. Jacobson,&nbsp;Stuart C. Gordon,&nbsp;Aina Nicolas,&nbsp;John Ward,&nbsp;Neil Gupta,&nbsp;Lindsey Hiebert-Suwondo,&nbsp;Sheila Reynoso,&nbsp;Linda Henry,&nbsp;Maria Stepanova,&nbsp;George Papatheodoridis,&nbsp;Zobair M. Younossi,&nbsp;the Global Liver Council","doi":"10.1111/liv.70619","DOIUrl":"10.1111/liv.70619","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Although pregnant people are a WHO priority population for hepatitis C (HCV) elimination, there is limited guidance on HCV treatment in pregnancy. Emerging data suggests direct acting antiviral (DAA) therapy is safe and effective. We performed a multinational survey among gastro-hepatologists (GI-Hep), infectious disease (ID) specialists, obstetricians-gynaecologists (ob-gyns), and general practitioners (GP) to evaluate current perspectives on HCV treatment in pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 39-item survey was designed by experts at The Global Liver Council, the American College of Obstetricians and Gynaecologists, and the Coalition for Global Hepatitis Elimination and distributed electronically. Survey responses were compared across medical specialties and regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 651 participants from all WHO regions representing 58 countries completed the survey: GI-Hep: 46%, GP-ID: 36%, ob-gyns: 18%. Only 25% would consider treating HCV during pregnancy, with significant differences by specialty. Main reasons for not considering DAAs in pregnancy were insufficient safety data (27%) and no clear guidelines for HCV treatment (32%). The highest acceptance of DAA use in pregnancy was in North America (45% vs. &lt; 20% in other regions (<i>p</i> &lt; 0.01)). Predictors of a greater willingness to treat HCV in pregnancy were having ≥ 10% of practice population with injection drug use (aOR: 2.31; 95% CI: 1.49–3.60; <i>p</i> = 0.0002). GI-Hep specialty was associated with a lower willingness (aOR: 0.47; 95% CI: 0.28–0.78; <i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite relatively high levels of HCV knowledge, few participants have experience with HCV treatment in pregnancy or would consider such treatment. Further availability of safety evidence and the inclusion of specific recommendations in guidelines could increase uptake of DAAs for pregnant individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Tests for Predicting Decompensation in Compensated Advanced Chronic Liver Disease: A Comprehensive Review","authors":"Audrey Payancé,&nbsp;Pierre-Emmanuel Rautou,&nbsp;Jérôme Boursier,&nbsp;Laurent Castera,&nbsp;Dominique Valla,&nbsp;Laure Elkrief","doi":"10.1111/liv.70627","DOIUrl":"10.1111/liv.70627","url":null,"abstract":"<p>Strong non-invasive tests (NITs) are needed to predict decompensation in patients with compensated advanced chronic liver disease (cACLD) and improve personalized patient care. We conducted a comprehensive review of the studies evaluating the effectiveness of NITs in predicting decompensation or liver-related death in patients with cACLD. A literature search was conducted in the PubMed database up to August 2025. Prospective or retrospective studies that included patients with cACLD and evaluated NITs for predicting decompensation or death or liver transplantation were included. Studies evaluating elastography and blood-based tests were analysed separately. The majority of studies assessed liver stiffness measurement (LSM), primarily using transient elastography (TE-LSM). There is a strong association between higher LSM values and an increased risk of decompensation, allowing classification of patients at low risk of decompensation from those with a higher risk. However, none of the studies reported data calibration, thereby limiting the ability to accurately predict the individual risk of decompensation. Higher FIB-4, ELF, and MELD values have been associated with an increased occurrence of decompensation. However, their performance was modest, with an area under the curve (AUC) below 0.75. Innovative approaches to improving the non-invasive prediction of decompensation may include levels of extracellular vesicles, genetic polymorphisms, or imaging-derived variables. Furthermore, since decompensation is the result of numerous interacting factors, artificial intelligence has the potential to improve the clinical relevance of predictive models by incorporating and processing a high-dimensional set of variables that reflect the underlying pathophysiological complexity.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13049463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616047","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":"Impact of Disease-Specific Treatment and Non-Selective Beta Blockers on Risk of PVT in Cirrhotic Patients With HCV or PBC","authors":"Humberto C. Gonzalez,&nbsp;Stuart C. Gordon,&nbsp;Sheri Trudeau,&nbsp;Trueman Wu,&nbsp;Lora Rupp,&nbsp;Christina Melkonian,&nbsp;Mark A. Schmidt,&nbsp;Yihe G. Daida,&nbsp;Amandeep K. Sahota,&nbsp;Christopher L. Bowlus,&nbsp;Mei Lu","doi":"10.1111/liv.70628","DOIUrl":"10.1111/liv.70628","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Portal vein thrombosis (PVT) is a common sequela of cirrhosis. Despite regression of fibrosis/cirrhosis observed among some patients after disease-specific treatment, few studies have considered the role of treatment and response on risk of PVT among patients with cirrhosis across different liver disease states. We considered aetiological treatment and response as well as whether non-selective beta-blockers (NSBBs), statins, and anticoagulants were associated with risk of PVT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data for patients with cirrhosis (compensated or decompensated) from two large, US-based multisite cohort studies. Patients with hepatitis C (HCV) were drawn from the Chronic Hepatitis Cohort Study. Patients with primary biliary cholangitis (PBC) were drawn from the Fibrotic Liver Disease Consortium. Risk for PVT was assessed using a discrete survival model that includes both fixed covariates and time-dependent variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 6659 HCV patients, 274 developed PVT across ~13 years of follow-up. Significant risk factors included time-varying decompensated cirrhosis (adjusted hazard ratio [aHR] 27.41, 95% confidence interval [CI] 15.89–47.30), male sex (aHR 1.48, 95% CI 1.12–1.94), and use of NSBBs (aHR 2.07, 95% CI 1.61–2.67). Among 786 PBC patients, 67 developed PVT across ~8 years of follow-up. Use of NSBBs was the only significant PVT risk factor in these patients (aHR 2.56, 95% CI 1.52–4.31). Neither sustained virological response [SVR] after antiviral treatment (HCV patients) nor response to ursodeoxycholic acid [UDCA] treatment (PBC patients) was associated with risk of PVT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In two large well-characterized samples of cirrhotic patients with HCV or PBC, disease-specific treatments were not associated with PVT risk. NSBB treatment was independently associated with &gt; 2 times the risk of PVT in both samples, regardless of compensated or decompensated status.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13049362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615786","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":"Care Pathways for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-The-Art Review.","authors":"Kirsi M A van Eekhout, Leonard D Broekman, Vivian D de Jong, Maurice Michel, Rick Grobbee, Douglas Maya-Miles, Manuel Romero-Gómez, Jean Muris, Juan M Mendive, Yasaman Vali, Oscar H Franco, Jörn M Schattenberg, Céline Fournier-Poizat, Manuel Castro Cabezas, Maarten E Tushuizen, Adriaan G Holleboom","doi":"10.1111/liv.70603","DOIUrl":"10.1111/liv.70603","url":null,"abstract":"<p><p>Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) is a growing clinical challenge, necessitating effective diagnostic strategies to identify advanced liver fibrosis while minimising unnecessary referrals of mild cases. Current clinical guidelines recommend care pathways utilising non-invasive tests (NITs) to stratify patients, but the optimal diagnostic algorithm across care settings remains unclear. This state-of-the-art review systematically examines studies describing clinical care pathways for detecting advanced fibrotic MASLD and stratifying patients at risk. A comprehensive literature search of MEDLINE, Embase, Cochrane Library, and Scopus, finalised in January 2026, identified nine relevant studies that met predefined criteria including structured care plans and applicability beyond diagnosis alone. Pathway populations included patients at risk for MASLD (type 2 diabetes (n = 4) or broad range cardiometabolic risk factors (n = 1)) or confirmed MASLD (n = 4). The most frequently employed NITs were FIB-4 and vibration-controlled transient elastography (VCTE). Numbers needed to screen (NNS) for hepatology referral and advanced fibrosis detection varied considerably across pathways and populations, reflecting heterogeneity in design and fibrosis assessment methods. All studies reported improved patient risk stratification; attendance rates declined at each pathway step. Findings suggest that NIT-based clinical care pathways can effectively align patient management and optimise transmural care for MASLD. Nonetheless, heterogeneity in pathway design and fibrosis determination highlights the need for standardised protocols and validation in larger, at-risk cohorts to strengthen evidence supporting widespread adoption. This review contributes to advancing MASLD management within evolving clinical frameworks.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 4","pages":"e70603"},"PeriodicalIF":5.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13000678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481027","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":"RRM2 Promotes the Progression of Intrahepatic Cholangiocarcinoma by Inhibiting Ferroptosis Through the HIF-1α Pathway","authors":"Yinghui Song,&nbsp;Yufeng Li,&nbsp;Jia Zhou,&nbsp;Yuhuai Peng,&nbsp;Guoyi Xia,&nbsp;Xu Chen,&nbsp;Yu Jiang,&nbsp;Yizhi Wang,&nbsp;Yueren Wang,&nbsp;Feicheng Yang,&nbsp;Sulai Liu","doi":"10.1111/liv.70623","DOIUrl":"10.1111/liv.70623","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Intrahepatic cholangiocarcinoma (ICC) is a malignant tumour associated with a poor prognosis. Recent studies have suggested that ribonucleotide reductase subunit M2 (RRM2) could promote tumour progression. This study aims to explore the expression, function and mechanism of RRM2 in ICC by regulating ferroptosis through the HIF-1α signalling pathway.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The expression of RRM2 and HIF-1α was detected in ICC patients, and the relationship between RRM2 and prognosis was analysed. CCK-8, clone formation assay, wound healing assay, transwell invasion experiment, cell apoptosis detection and tumorsphere formation assay were conducted to evaluate the effect of RRM2 on the progression of ICC. Transcriptomics was used to explore the mechanism of RRM2 promotion of ICC. Ferroptosis inducer (Ferrostatin-1) and inducer (RSL3), HIF-1α inhibitor (LW6) and inducer (CoCl&lt;sub&gt;2&lt;/sub&gt;) were applied to investigate the effects of RRM2 on reactive oxygen species (ROS), ferroptosis-related indicators and HIF-1α expression. The effects of RRM2 on tumour growth were validated using subcutaneous tumours in nude mice.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;RRM2 was significantly upregulated in ICC tissues and was associated with a poor prognosis in patients. Overexpression of RRM2 promoted the proliferation, colony formation, invasion, metastasis, stemness, and inhibited apoptosis of ICC cells. Transcriptomics clarified that the HIF-1α signalling pathway was a key downstream pathway. The expression of HIF-1α was significantly positively correlated with the expression of RRM2 and was associated with poor prognosis in patients. Overexpression of RRM2 upregulated HIF-1α and reduced ROS levels. RRM2 upregulated SLC7A11 and GPX4 and downregulated ACSL4 by regulating the HIF-1α signalling pathway, inhibiting intracellular iron ion accumulation and lipid peroxidation, thus suppressing ferroptosis. Under hypoxic conditions, the anti-tumour effect of knocking down RRM2 was weakened. HIF-1α inhibitor could reverse the ferroptosis inhibition caused by RRM2 overexpression, and the HIF-1α inducer could alleviate the enhanced ferroptosis caused by knocking down RRM2. In vivo experiments also confirmed that overexpression of RRM2 promoted tumour growth, upregulated Ki-67, GPX4, HIF-1α, and N-cadherin, and downregulated E-cadherin.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;RRM2 inhibited ferroptosis by regulating the HIF-1α signalling pathway, thereby promoting the progression of ICC. The RRM2/HIF-1α/ferroptosis axis may become a potential target for ICC therapy.&lt;/p&gt;\u0000 ","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}