Annals of hepatology最新文献

{"title":"The new landscape of liver transplantation: Evolving candidates, new technologies, and personalized care.","authors":"Alberto Ferrarese, Laura Marta Vivian, Giulia Camillieri, Luigi Martino, Gianluca Starnella, Maria Pia Arcari, Anna Lisa Zampa, Patrizia Burra, Giacomo Germani","doi":"10.1016/j.aohep.2026.102471","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102471","url":null,"abstract":"<p><p>Liver transplantation (LT) is entering a new era shaped by changes in disease epidemiology, candidate complexity, donor utilization, and post-transplant management. The decline of viral hepatitis-related cirrhosis, together with the rise of metabolic dysfunction-associated steatotic liver disease, alcohol-related liver disease, and hepatocellular carcinoma, has transformed the LT waitlist into an older, frailer, and more cardiometabolically complex population. At the same time, donation after circulatory death and machine perfusion are expanding the donor pool and redefining the boundaries of graft suitability. Candidate selection is also moving beyond traditional diagnosis-based criteria, with increasing acceptance of early LT for carefully selected alcohol-related liver disease, utility-based transplantation for acute-on-chronic liver failure, and biology-driven transplant oncology, in which HCC is established whereas selected iCCA and unresectable CRLM indications remain investigational. In parallel, artificial intelligence and machine learning are being developed as decision-support tools for candidate assessment, waitlist prioritization, donor-recipient matching, and prediction of post-transplant outcomes; prospective validation and evidence of clinical impact remain limited. Immunosuppression is facing a similar transformation, shifting from standardized lifelong exposure toward individualized, monitored minimization and immunologic risk profiling, while complete withdrawal and operational tolerance remain restricted to highly selected recipients within specialized protocols. In this Perspective, we argue that the future of LT will depend on integrating biological reserve, disease behavior, graft quality, and expected survival benefit into transparent, multidisciplinary decision-making. The central challenge will be to translate innovation into durable clinical benefit while preserving equity in access to transplantation.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102471"},"PeriodicalIF":6.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223162","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":"Treatment outcomes in hepatic hydrothorax: A propensity score-matched survival analysis.","authors":"Pei-Ming Huang, Shuenn-Wen Kuo, Hsien-Chi Liao","doi":"10.1016/j.aohep.2026.102473","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102473","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>This study evaluated the prognostic impact of hepatic hydrothorax (HH) in decompensated cirrhosis and compared outcomes between conservative therapy and surgical diaphragmatic repair.</p><p><strong>Patients and methods: </strong>This single-center retrospective cohort included 48,464 adults with decompensated cirrhosis from 2004 to 2024. After exclusions, 386 patients (0.8%) were identified with HH, of whom 120 underwent surgical repair and 266 received conservative management. Clinical characteristics and laboratory data were analyzed. The primary endpoint was 365-day mortality. Propensity score matching (1:1, caliper 0.2) incorporating eight clinically relevant variables was used to balance baseline differences. Mortality risk was assessed using generalized estimating equations and Cox proportional hazards models.</p><p><strong>Results: </strong>Before matching, the conservative group had more severe liver dysfunction, with higher Child-Pugh scores (10.3 ± 3.0 vs. 8.8 ± 2.7, p < 0.001), while MELD scores were lower (16.5 ± 2.4 vs. 26.28 ± 16.17, p < 0.001). The 365-day mortality was 64.3% (171/266) in the conservative therapy group and 51.7% (62/120) in the surgical repair group, corresponding to a crude risk ratio of 1.24 (95% CI, 1.01-1.53) and an odds ratio of 1.69 (95% CI, 1.08-2.65). Survival analysis demonstrated a significant difference between groups (unadjusted log-rank test, χ² = 8.330, p = 0.004). After matching, 119 pairs showed well-balanced baseline characteristics. In the matched cohort, 1-year mortality remained lower with surgery (40.3% vs. 59.7%; Cohen's h = 0.39).</p><p><strong>Conclusions: </strong>Surgical diaphragmatic repair was associated with lower 1-year mortality compared with conservative management after adjustment for measured baseline differences.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102473"},"PeriodicalIF":6.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219759","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":"High Tumor Burden: A Key Predictor of Poor Short-Term Prognosis after First Variceal Bleeding in Patients with Hepatocellular Carcinoma.","authors":"Jiawei Zhong, Linfeng Zhang, Yuman Ye, Yuxin Zhang, Fujun Zhou, Sihai Chen, Yu You, Jun Chen","doi":"10.1016/j.aohep.2026.102258","DOIUrl":"https://doi.org/10.1016/j.aohep.2026.102258","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The short-term outcome and prognosis of the first-onset esophagogastric variceal bleeding patients with hepatocellular carcinoma (HCC) is still unclear.</p><p><strong>Patients and methods: </strong>This study retrospectively enrolled 1042 first-time hospitalized patients with cirrhosis from January 2010 to December 2020. A total of 1032 patients had esophagogastric variceal bleeding and 137 of them had HCC. Clinical, laboratory, and tumor characteristics were analyzed. Clinical characteristics and 4-week outcomes (mortality, rebleeding and the composite endpoint (death or rebleeding)) were analyzed.</p><p><strong>Results: </strong>The overall 4-week mortality, rebleeding, and composite endpoint rates were 14.6% (20/137), 21.9% (30/137), and 29.2% (40/137), respectively. Multivariate analyses identified high tumor burden (OR: 7.97; 95% Confidence Interval: 2.84-26.17; p < 0.01) as an independent risk factor for 4-week mortality. The presence of portal vein thrombosis (OR: 3.07; 95% Confidence Interval: 1.35-7.17; p < 0.01) was an independent risk factor for rebleeding. For the composite endpoint, portal vein thrombosis (OR: 3.70; 95% Confidence Interval: 1.73-8.12; p < 0.01) was identified as an independent risk factor.</p><p><strong>Conclusions: </strong>For HCC patients experiencing their first variceal bleeding, high tumor burden is the primary driver of short-term adverse prognosis. Acute in-hospital events warrant particular vigilance in patients with high tumor burden accompanied by portal vein thrombosis.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102258"},"PeriodicalIF":6.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191058","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":"Characteristics and outcomes of lean versus non-lean metabolic dysfunction-associated steatohepatitis liver transplant recipients.","authors":"Ahmad Anouti, Pojsakorn Danpanichkul, Hamza Dahshi, Elias D Rady, Sindhu Pandurangi, Sara Hassan, Amal Aqul, Thomas A Kerr, Yong K Kwon, Madhukar S Patel, Thomas G Cotter","doi":"10.1016/j.aohep.2026.102456","DOIUrl":"10.1016/j.aohep.2026.102456","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Metabolic dysfunction-associated steatohepatitis (MASH) is a leading indication for liver transplantation (LT) in the United States, yet outcomes among lean MASH recipients remain poorly defined. Lean patients represent a biologically distinct phenotype with lower body mass index but comparable metabolic risk, making characterization of post-transplant outcomes critical for candidate selection and counseling.</p><p><strong>Patients and methods: </strong>Using United Network for Organ Sharing data from 1/1/2010-9/30/2025, we identified adult LT recipients with MASH/NASH and classified them as lean (BMI <25 kg/m² for non-Asian and <23 kg/m² for Asian patients) or non-lean. Donor, recipient, operative, and waitlist characteristics were compared. Kaplan-Meier methods assessed graft and patient survival, and multivariable Cox regression evaluated 1-year mortality.</p><p><strong>Results: </strong>Among 19,756 adult MASH/NASH recipients, 2426 (12.3%) were lean. Lean candidates on the waitlist experienced a lower cumulative incidence of transplantation (sHR 0.94, 95% CI 0.90-0.99, p = 0.018) and significantly lower patient survival in lean recipients (1-year: 90.1% vs. 92.2%, p < 0.01; 3-year: 83.6% vs. 86.8%, p < 0.01; 5-year: 78.2% vs. 82.1%, p < 0.01). On multivariable Cox regression, the lean phenotype was associated with higher 1-year mortality (HR 1.33, 95% CI 1.08-1.64, p < 0.01).</p><p><strong>Conclusions: </strong>Lean MASH represents a high-risk phenotype with lower transplant access and worse post-transplant survival, warranting tailored evaluation, optimization, and post-transplant surveillance.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102456"},"PeriodicalIF":6.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179009","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":"Reflections on the TransMet trial.","authors":"Leyre Serrablo, Victor López-López, Lucia Carrion-Alvarez, Josué Israel Olivares-Del Moral, Alejandro Serrablo","doi":"10.1016/j.aohep.2026.102465","DOIUrl":"10.1016/j.aohep.2026.102465","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102465"},"PeriodicalIF":6.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165085","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":"Large esophageal varices predict hepatocellular carcinoma in newly diagnosed cirrhosis: Insights from machine learning and propensity score analysis.","authors":"Erica Villa, Davide Guido, Rosina Maria Critelli, Annalisa Berzigotti, Grazia Serino, Yuly P Mendoza, Sara Ascari, Fabiola Milosa, Filippo Scianò, Francesco Dituri, Gianluigi Giannelli","doi":"10.1016/j.aohep.2026.102460","DOIUrl":"10.1016/j.aohep.2026.102460","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Hepatocellular carcinoma (HCC) is a major complication of chronic liver disease (CLD) requiring improved risk stratification. Esophageal varices (EVs), as manifestations of severe portal hypertension, may promote HCC development through vascular remodeling and hypoxia-related pathways. We aimed to evaluate whether variceal size independently predicts HCC risk and whether specific biomarker profiles can be identified.</p><p><strong>Patients and methods: </strong>In this 12-year prospective cohort study, 545 patients with newly diagnosed compensated advanced chronic liver disease (cACLD) were enrolled at a tertiary hepatology center and followed for a median of 81 months. Baseline evaluations included endoscopy, elastography, hepatic venous pressure gradient measurement, imaging, and laboratory tests. EVs were classified as absent, small, or large according to Baveno VI nomenclature; large EVs were the primary exposure. Propensity score methods and Cox models assessed their impact on HCC risk, and random survival forests evaluated predictive value.</p><p><strong>Results: </strong>During follow-up, 92 patients (16.9%) developed HCC. Large EVs at baseline emerged as the strongest independent predictor of HCC onset, surpassing alpha-fetoprotein, hepatic venous pressure gradient, and liver stiffness. Hazard ratios ranged from 7.2 to 14.7 (all p < 0.001). After correction for multiple testing, HA, CA9, I-FABP, and TGF-β1 remained associated with large varices, suggesting extracellular matrix remodeling, hypoxia, intestinal barrier injury, and profibrogenic signaling.</p><p><strong>Conclusions: </strong>Large esophageal varices independently predict HCC in cACLD, reflecting severe portal hypertension and a pro-tumorigenic milieu, and should inform improved surveillance and preventive strategies targeting vascular and fibrotic pathways.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102460"},"PeriodicalIF":6.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164400","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":"Anticoagulation in cirrhosis: indications, drug selection, and disease-modifying potential.","authors":"Luis Téllez, Antonio Guerrero, Jesús Donate, Agustín Albillos","doi":"10.1016/j.aohep.2026.102468","DOIUrl":"10.1016/j.aohep.2026.102468","url":null,"abstract":"<p><p>Anticoagulation in cirrhosis has evolved from a perceived contraindication to an integral component of modern liver disease management. Recognition of the fragile rebalanced hemostatic state has challenged the traditional concept of cirrhosis as an exclusively hemorrhagic disorder and provided the biological rationale for anticoagulation in selected patients. Beyond preventing thrombus extension and promoting portal vein recanalization, accumulating experimental and clinical evidence suggests that anticoagulants may exert disease-modifying effects by attenuating intrahepatic coagulation, hepatic fibrogenesis, sinusoidal dysfunction, and portal hypertension. The therapeutic landscape has also changed substantially. Direct oral anticoagulants have emerged as effective and generally safe alternatives to vitamin K antagonists and low-molecular-weight heparin in carefully selected patients, although important differences in pharmacokinetics, hepatic metabolism, renal elimination, and drug interactions require individualized anticoagulant selection. At the same time, management of portal vein thrombosis has shifted from a uniform treatment approach to a patient-centered strategy that considers thrombus characteristics, transplant candidacy, bleeding risk, and the increasing role of endovascular portal vein recanalization. This review summarizes current evidence regarding the indications for anticoagulation in cirrhosis, anticoagulant selection, management of portal vein thrombosis, and available clinical outcomes. It also examines the emerging concept of anticoagulation as a disease-modifying therapy and highlights key knowledge gaps that should guide future research. Together, these advances position anticoagulation as an increasingly important component of comprehensive cirrhosis care rather than a treatment reserved solely for thrombotic complications.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102468"},"PeriodicalIF":6.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164937","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":"Recurrence of autoimmune liver diseases after liver transplantation: exploratory analysis of a pooled Latin American cohort.","authors":"Diana Lorena Sánchez Monroy, Jose Bareño Silva, Diana Carolina Salinas, Lina Dorado Delgado, Adriana Varón Puerta","doi":"10.1016/j.aohep.2026.102454","DOIUrl":"10.1016/j.aohep.2026.102454","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Autoimmune liver diseases (AILDs) are an increasingly frequent indication for liver transplantation in Latin America. Recurrence after transplantation may affect graft function and long-term outcomes; however, recurrence patterns and associated factors remain incompletely characterized. We aimed to describe recurrence after liver transplantation in a pooled cohort of AILDs and to explore factors associated with recurrence, overall survival, and retransplantation.</p><p><strong>Patients and methods: </strong>We conducted a retrospective cohort study of adult patients with AILDs who underwent liver transplantation between 2005 and 2023. Recurrence was defined using biochemical, serological, and histological criteria. Associations were evaluated using logistic regression and Kaplan-Meier survival analyses.</p><p><strong>Results: </strong>A total of 154 patients were included, of whom 64 (41.5%) developed recurrence after a median of 49 months (IQR 21.2-91). In the primary analysis, recurrence was associated with elevated pre-transplant ALT and AST levels and a history of acute rejection. In sensitivity analyses, elevated AST levels showed the most consistent association with recurrence. Associations involving ALT were attenuated after subgroup restriction, whereas the association with acute rejection varied across analyses. No significant differences were observed in overall survival or retransplantation rates between patients with and without recurrence.</p><p><strong>Conclusions: </strong>Recurrence after liver transplantation was frequent and varied across autoimmune liver disease subtypes. Elevated pre-transplant AST levels were consistently associated with recurrence across exploratory analyses. Despite the high frequency of recurrence, no significant association was observed with impaired overall survival or increased retransplantation. These findings require confirmation in larger multicenter studies with disease-specific analyses.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102454"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164098","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":"Global sociodemographic disparities in the severity of alcohol-associated hepatitis.","authors":"Joshua Chen, Luis Antonio Díaz, Francisco Idalsoaga, Hanna Blaney, Kaanthi Rama, Vinay Jahagirdar, S Fisher Rhoads, Pojsakorn Danpanichkul, Arun Valsan, Gowripriya Nair, Hyundam Gu, Jorge Arnold, María Ayala-Valverde, Carolina Ramirez-Cadiz, Prasun K Jalal, Mohamad Ali Ibrahim, Mohamed A Elfeki, Juan Pablo Roblero, Daniela Simian, José Antonio Velarde, Jacqueline Córdova-Gallardo, Fátima Higuera-de-la-Tijera, Rita Silva, Cristina Melo Rocha, Roberta C Araujo, Gustavo Henrique Pereira, Fernando Bessone, Mario Tanno, Ayelen Kisch, Manuel Mendizabal, Sebastián Marciano, Gonzalo Gomez Perdiguero, Pedro Montes, Patricia Guerra Salazar, Geraldine Ramos, Enrique Carrera, Kristina R Chacko, Hamza Sadhra, Oluwatosin Oguntoye, Richard Sterling, Arun J Sanyal, Vijay H Shah, Douglas Simonetto, Winston Dunn, Ashwani K Singal, Patrick S Kamath, Marco Arrese, Ramon Bataller, Juan Pablo Arab","doi":"10.1016/j.aohep.2026.102464","DOIUrl":"10.1016/j.aohep.2026.102464","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Alcohol-associated hepatitis (AH) carries high short-term mortality, yet the contribution of sociodemographic factors to disease severity and outcomes is poorly defined.</p><p><strong>Patients and methods: </strong>We conducted a prospective cohort study across 30 centers in 14 countries (January 2015-September 2024). We included adults who met National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for AH. Outcomes included infections, access to liver transplantation (LT), and survival. Mortality was analyzed with Fine-Gray competing-risk models.</p><p><strong>Results: </strong>Among 726 participants (median age, 49 years; 90.1% male), 24.8% had less than secondary education, and 37.6% reported good social support. Severe AH was more frequent in those without secondary education than in those with at least secondary education (97.2% vs. 81.7%; P < 0.0001). The 30- and 90-day survival rates were lower among participants without secondary education (66.4% and 50.4%, respectively) than among those with at least secondary education (88.4% and 81.2%, respectively). In adjusted analyses, moderate and good social support were associated with lower mortality (each sHR 0.58, 95% CI, 0.38-0.89 and 0.38-0.94, respectively), as were secondary (sHR 0.48, 95% CI, 0.24-0.97) and tertiary education (sHR 0.44, 95% CI, 0.20-0.97) and corticosteroid use (sHR 0.63, 95% CI, 0.42-0.95).</p><p><strong>Conclusions: </strong>Lower educational attainment and poorer perceived social support were associated with greater AH severity at presentation and higher mortality, independent of clinical risk factors. These findings highlight the need to address social determinants and favor equitable access to evidence-based therapies, including early LT.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102464"},"PeriodicalIF":6.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164771","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":"Impact of metabolic dysfunction-associated steatotic liver disease on the development of hepatocellular carcinoma after HCV cure.","authors":"Eiichi Ogawa, Akira Kawano, Motoyuki Kohjima, Toshimasa Koyanagi, Kazufumi Dohmen, Aritsune Ooho, Takeaki Satoh, Kazuhiro Takahashi, Norihiro Furusyo, Eiji Kajiwara, Koichi Azuma, Yasunori Ichiki, Rie Sugimoto, Hiromasa Amagase, Masatake Tanaka, Hideyuki Nomura, Jun Hayashi","doi":"10.1016/j.aohep.2026.102455","DOIUrl":"10.1016/j.aohep.2026.102455","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on hepatocellular carcinoma (HCC) development after hepatitis C virus (HCV) elimination remains incompletely understood. This study aimed to clarify this association in a cohort of patients stratified by fibrosis severity.</p><p><strong>Patients and methods: </strong>We analyzed the data of 2596 eligible patients obtained from a multicenter database between 2014 and 2025. The FIB-4 index was used to assess fibrosis status, with patients categorized into three groups: <1.45, 1.45-3.25, and >3.25. Cox proportional hazards and Fine-Gray subdistribution hazards models were used to evaluate factors independently associated with HCC development.</p><p><strong>Results: </strong>The median follow-up duration was 6.7 years. MASLD was present in 975 patients (36.3%) and was more frequent among men and patients with diabetes. During follow-up, 156 patients (6.0%) developed de novo HCC. Patients with MASLD had a higher cumulative incidence of HCC than those without MASLD (log-rank test, P<0.001); however, no HCC occurred in patients with FIB-4<1.45. MASLD was associated with HCC development in multivariable analysis of the overall cohort and in patients with FIB-4 1.45-3.25 and >3.25. Older age, male sex, lower albumin level, and higher AFP level at post-treatment week 12 were also independently associated with HCC development, whereas individual cardiometabolic risk factors were not significant after adjustment.</p><p><strong>Conclusions: </strong>MASLD was significantly associated with an increased risk of HCC after HCV cure, even among patients with intermediate FIB-4 values of 1.45-3.25. These findings support the need for tailored surveillance and management strategies.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102455"},"PeriodicalIF":6.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147157","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}