Annals of hepatology最新文献

{"title":"Evolution and impact of sarcopenia and myosteatosis in the context of liver transplantation.","authors":"François Villeret, Victor Herreros, Bénédicte Cayot, Gérald Raverot, Olivier Boillot, Laurent Milot, Pascal Rousset, Olivier Guillaud, Jérôme Dumortier, Domitille Erard","doi":"10.1016/j.aohep.2026.102481","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102481","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Sarcopenia and myosteatosis have a well-documented adverse impact on survival in liver cirrhosis patients. This study aimed to assess the prevalence and risk factors associated with muscle impairment before liver transplantation (LT), their evolution after LT, and to determine their prognostic value.</p><p><strong>Patients and methods: </strong>All cirrhotic patients listed for LT at our center between 2006 and 2010 were included. Sarcopenia and myosteatosis were assessed on transverse L3 CT images at LT listing and at 12 (M12), 60, 120, and 180 months after LT.</p><p><strong>Results: </strong>The study population consisted of 198 patients, 75.3% of whom were men, and 149 underwent LT. At LT listing, sarcopenia was diagnosed in 45.5% of patients and myosteatosis in 36.5% and 20.1% had both sarcopenia and myosteatosis. One year after LT, 56.1% of patients had persistent sarcopenia and 15.3% had de novo sarcopenia. Sarcopenia significantly improved at M12 post-LT (p=0.034). Post-LT patient survival was 89.2%, 76.3%, and 59.3% at 1, 5, and 10 years respectively. In multivariate analysis, at LT listing, MELD score ≥ 25 (HR: 2.549; p=0.001), sarcopenia (HR: 1.749; p=0.004) and myosteatosis (HR: 1.630; p=0.012) were found to be independent risk factors for overall mortality. The effects of sarcopenia and myosteatosis were additive: overall survival was significantly reduced in patients with both sarcopenia and myosteatosis compared to patients with isolated sarcopenia/myosteatosis (p=0.001).</p><p><strong>Conclusions: </strong>Sarcopenia and myosteatosis are common in cirrhotic patients listed for LT, persist after LT, and have a major and independent impact on overall mortality.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102481"},"PeriodicalIF":6.2,"publicationDate":"2026-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149369845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing in Acute Variceal Bleeding: Have We Really Figured It Out?","authors":"Beatriz A Sánchez-Jiménez, Felix Tellez-Avila","doi":"10.1016/j.aohep.2026.102483","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102483","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102483"},"PeriodicalIF":6.2,"publicationDate":"2026-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149357064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From concentrated output to regional capacity: the next step for Latin American hepatology research.","authors":"Pablo Coste, Ezequiel Ridruejo, María Fernanda Lynch-Mejía, Wagner Ramírez-Quesada, Francisco Vargas-Navarro, Fiorella Ajún-Ulate, Cristiane Villela-Nogueira, Josefina Pagés, Ismael Yepes, Victoria Mainardi, Fátima Higuera, Javier Mora, Marco Arrese","doi":"10.1016/j.aohep.2026.102484","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102484","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102484"},"PeriodicalIF":6.2,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149340391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinically significant portal hypertension rather than ALBI grade predicts prognosis in advanced hepatocellular carcinoma.","authors":"Leonardo Gomes da Fonseca, Manuel Mendizabal, Margarita Anders, Carla Bermudez, Diego Arufe, Adriana Varón, Ana Palazzo, Jorge Rodriguez, Ezequiel Ridruejo, Norberto Tamagnone, Hugo Cheinquer, Alonso Vera Torres, Juan Ignacio Marín, Federico Orozco, Jaime Poniachik, Sebastián Marciano, Daniela Simian, Oscar Beltran, Fernando Bessone, Marcelo Silva, Federico Piñero","doi":"10.1016/j.aohep.2026.102480","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102480","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Clinical trials in advanced hepatocellular carcinoma (HCC) typically include patients with preserved liver function (Child-Pugh A), without adequately considering cirrhosis or clinically significant portal hypertension (CSPH). We aimed to compare prognostic models in Child-Pugh A patients.</p><p><strong>Patients and methods: </strong>This prospective multicenter cohort study included patients with advanced HCC treated with systemic therapy (2018-2024) in Latin America. Survival was analyzed using Kaplan-Meier and Cox proportional multivariate hazards models and competing risk analysis for cause-specific mortality and hepatic decompensation.</p><p><strong>Results: </strong>From 306 patients receiving systemic therapy, 79.1% (n=242) were Child-Pugh A (sorafenib 60.3%, atezolizumab plus bevacizumab 30.6%, and lenvatinib 8.7%). Among these, cirrhosis was observed in 78.9%, and CSPH in 51.6%. No survival differences were observed between ALBI 1 vs 2-3 grades (HR 1.08; P=0.685), or Child-Pugh A5 vs A6. In multivariable analysis, atezolizumab plus bevacizumab was independently associated with improved OS (HR 0.64, 95% CI 0.42-0.99), adjusted for AFP ≥400 ng/mL and CSPH. Other models, including the ALBI score as a continuous or categorical variable, showed no significant independent association with mortality, nor did they improve model performance. In a competing risk regression analysis accounting for death due to tumor progression as a competing event, CSPH was the only independent variable associated with hepatic decompensation, sHR 1.98 (95% CI 1.01-3.89).</p><p><strong>Conclusions: </strong>Accurate reporting of cirrhosis and CSPH is essential, even for Child-Pugh A patients, as both are independent prognostic factors that should be considered for therapeutic decision-making in advanced HCC.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102480"},"PeriodicalIF":6.2,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149340390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute-on-chronic liver failure: A global multisociety consensus on definitions.","authors":"","doi":"10.1016/j.aohep.2026.102453","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102453","url":null,"abstract":"<p><p>The acute-on-chronic liver failure (ACLF) multisociety harmonisation initiative represents a global collaborative effort to establish a unified, evidence-based framework for the definition, diagnosis, grading, and management of ACLF. Building on the strengths of existing regional definitions and integrating diverse international perspectives, this consensus provides a pragmatic, globally applicable foundation for clinical practice, research, and education. It also establishes a common framework for patient stratification, organ dysfunction and failure assessment, critical care management, liver transplantation, and the design of future phase II/III trials. Standardised, regulatory-aligned endpoints are expected to improve cross-study comparability, strengthen collaboration, and accelerate development of effective ACLF therapies.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102453"},"PeriodicalIF":6.2,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149294114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes and trends in simultaneous liver-kidney transplantation: a multicenter cohort study.","authors":"Jorge Carlos Martínez Morales, Valeria Descalzi, Elodie Bomfim Hyppolito, Adriana Varón, Alina Zerega, Pedro Marín-Castro, Graciela E Castro Narro, Josefina Pagés, Ignacio Roca, Adrián Gadano, Carlos Benítez, Bertha E Cárdenas Ramírez, Romina Rey, Álvaro Urzúa, Julia Brutti, Fernanda M Farage Osório, Paulo Lisboa Bittencourt, María L Reyes Toso, José Huygens Parente-García, Gilberto Mejía, Wellington Andraus, Manuel Mendizabal, Fernando Cairo, Renato Palma-Fernández, Melisa Dirchwolf, Mario Vilatobá, Mercedes Rodriguez Gazari, Diego Arufe, Gabriel Aballay, Rita de Cássia Martins Alves da Silva, Diego H Giunta, Angelo A Mattos, Sebastián Marciano","doi":"10.1016/j.aohep.2026.102479","DOIUrl":"10.1016/j.aohep.2026.102479","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Long-term outcomes after simultaneous liver-kidney transplantation (SLKT) are incompletely characterized. We aimed to estimate overall survival, survival with functioning grafts, kidney graft function over time, and temporal trends in SLKT practice.</p><p><strong>Patients and methods: </strong>Retrospective multicenter cohort of adults undergoing SLKT between 2003 and 2025 across 21 transplant centers in 7 Latin American countries. Overall survival and survival with functioning grafts were estimated up to 10 years after transplantation. Outcomes, recipient and donor characteristics were described across transplant eras.</p><p><strong>Results: </strong>Among 305 SLKT recipients, cirrhosis was the main liver indication (67.9%), whereas chronic kidney disease was the main renal indication (93.1%), most commonly due to polycystic kidney disease. Recipient profiles evolved over time toward greater metabolic burden, with more diabetes and MASLD, and increasing use of MELD exceptions - primarily for hepatocellular carcinoma - compared with earlier transplant eras. Overall survival was 78.5% at 1 year and 57.3% at 10 years, with 1-year survival exceeding 90% in 2022-2025; survival with functioning grafts was 77.4% and 50.9%, respectively. Early mortality predominated: 64% of deaths occurred in the first year, mainly due to bacterial infections (39%). Median eGFR among survivors remained in the mid-60 s through 10 years.</p><p><strong>Conclusions: </strong>SLKT achieved acceptable long-term patient, graft, and kidney function outcomes, with improved 1-year survival in recent eras. Early mortality remained concentrated in the first year and was often infection-related, highlighting an important target for post-transplant care as recipient metabolic complexity increases. These multicenter data provide long-term benchmarks to inform counseling and program planning amid an evolving metabolic burden.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102479"},"PeriodicalIF":6.2,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149294129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From availability to governance: a continuum model for the adoption of artificial intelligence in clinical medicine.","authors":"Javier Crespo","doi":"10.1016/j.aohep.2026.102478","DOIUrl":"10.1016/j.aohep.2026.102478","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102478"},"PeriodicalIF":6.2,"publicationDate":"2026-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149294093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-glucose cotransporter-2 inhibitors and mortality and liver-related outcomes in patients with alcoholic cirrhosis, type 2 diabetes, and obesity.","authors":"Mohamad Mahdi Osman, Omar T Sims, Dian J Chiang","doi":"10.1016/j.aohep.2026.102470","DOIUrl":"10.1016/j.aohep.2026.102470","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Sodium-glucose co-transporter 2 inhibitors (SGLT2-i¹) improve cardiovascular and renal outcomes in type 2 diabetes mellitus, but their safety and clinical impact in advanced liver disease remain uncertain because patients with cirrhosis were underrepresented in major trials.</p><p><strong>Materials and methods: </strong>Using the TriNetX research network, we identified adults with alcoholic cirrhosis, type 2 diabetes, and obesity and compared outcomes according to SGLT2-i exposure. After 1:1 propensity score matching, 5,128 matched pairs were analyzed. The primary outcome was all-cause mortality; secondary outcomes included all-cause hospitalization, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and variceal bleeding.</p><p><strong>Results: </strong>In the matched cohort, SGLT2-i use was associated with lower all-cause mortality (HR, 0.71; 95% CI, 0.66 to 0.78), hospitalization (HR, 0.84; 95% CI, 0.80 to 0.89), ascites (HR, 0.72; 95% CI, 0.67 to 0.77), spontaneous bacterial peritonitis (HR, 0.74; 95% CI, 0.62 to 0.87), and variceal bleeding (HR, 0.82; 95% CI, 0.67 to 0.99), with no difference in hepatic encephalopathy.</p><p><strong>Conclusions: </strong>Among patients with alcoholic cirrhosis, type 2 diabetes, and obesity, SGLT2-i use was associated with improved survival and fewer liver-related complications.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102470"},"PeriodicalIF":6.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149242763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacotherapy for MASLD: current evidence and challenges in clinical practice.","authors":"Laura Pages, Diego Rojo, Alba Jimenez-Masip, Elena Tricarico, Eduard Mas, Anna Aguilar, Nerea Gomez, Lucia Molinero, Juan M Pericas","doi":"10.1016/j.aohep.2026.102477","DOIUrl":"10.1016/j.aohep.2026.102477","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by a complex pathophysiology driven by intertwined metabolic and hepatic pathways, enabling the identification of multiple therapeutic targets and a rapidly expanding drug development pipeline. This review summarizes the current and emerging therapeutic landscape for MASLD and discusses key challenges for clinical implementation. The imminent availability of several new therapies is expected to pose important clinical challenges, particularly in accurately identifying patients most likely to benefit. Currently, resmetirom and semaglutide are the only two drugs conditionally approved for patients with fibrosis stages 2-3, pending final phase 3 outcomes, and represent the main liver-directed and metabolic-focused therapeutic strategies, respectively. Treatment selection should follow a phenotype-based approach integrating metabolic profile and liver disease stage. Non-invasive tests are central for assessing treatment eligibility; however, strategies incorporating metabolic risk profiling and longitudinal monitoring will be essential to optimize real-world management of MASH.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102477"},"PeriodicalIF":6.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149242810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the liver: Social vulnerability, addiction care, and survival in alcohol-associated hepatitis.","authors":"Felix Henrique Paim Kessler, Lísia von Diemen, Mario Reis Álvares-da-Silva","doi":"10.1016/j.aohep.2026.102475","DOIUrl":"10.1016/j.aohep.2026.102475","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102475"},"PeriodicalIF":6.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149242702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}