Annals of hepatology最新文献

{"title":"#34 - ARTIFICIAL INTELLIGENCE ASSISTANCE THROUGH LARGE LANGUAGE MODELS AND DIAGNOSTIC PERFORMANCE IN HEPATOLOGY: A MULTICENTER COMPARATIVE STUDY BASED ON CLINICAL SIMULATION AND DELPHI CONSENSUS","authors":"Jesus Mazadiego,&nbsp;María Herrero,&nbsp;Paloma Diego,&nbsp;Fatima Higuera,&nbsp;Scherezada Mejia,&nbsp;Juanita Perez,&nbsp;Gerardo Kato,&nbsp;Rogelio Zapata,&nbsp;Rodrigo Vazquez,&nbsp;Adriana López,&nbsp;Raquel López,&nbsp;Elias San Vicente,&nbsp;Yoali Velasco,&nbsp;Felipe Zamarripa,&nbsp;Rogelio Zapata","doi":"10.1016/j.aohep.2026.102312","DOIUrl":"10.1016/j.aohep.2026.102312","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Large language models (LLMs) may support diagnostic reasoning in hepatology. This study evaluated the association between LLM assistance and diagnostic performance in simulated hepatology clinical cases using a Delphi-validated instrument.</div></div><div><h3>Materials and Methods</h3><div>A multicenter, comparative, cross-sectional study with prospective data collection was conducted across 11 teaching hospitals in Mexico. A six-case hepatology questionnaire (30 multiple-choice items) was validated through a modified Delphi process involving eight expert gastroenterologists.</div><div>Multiple LLMs were compared against expert consensus, and the two models with the highest concordance were selected. Physicians in training and board-certified specialists in Internal Medicine and Gastroenterology were randomly assigned to groups with or without LLM assistance. The primary outcome was hepatology diagnostic accuracy.</div></div><div><h3>Results</h3><div>The study aimed to evaluate the association between LLM assistance and diagnostic performance in simulated hepatology clinical cases. A total of 197 participants were included, of whom 131 were assigned to groups assisted by artificial intelligence and 66 to the group without technological assistance. The validation process demonstrated excellent concordance in the hepatology domain (= 0.901; p &lt; 0.001), while ChatGPT® 4.0/4.0 Turbo achieved the highest agreement with expert consensus, followed by DeepSeek® R1. Among 197 participants, LLM-assisted groups achieved significantly higher hepatology accuracy scores compared with non-assisted groups (74.2 ± 14.5 vs 62.8 ± 16.3; p &lt; 0.001). The benefit was particularly evident among Gastroenterology and Internal Medicine residents, especially junior trainees, including first-year residents. Board-certified specialists also showed favorable trends toward improved performance with LLM assistance, although without statistical significance.</div></div><div><h3>Conclusions</h3><div>LLM assistance was associated with improved diagnostic performance in hepatology, particularly among physicians in training, suggesting a potential role as complementary cognitive and educational support tools.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102312"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#44 - DIAGNOSTIC PERFORMANCE OF THE FATTY LIVER INDEX AND FIB-4 IN WOMEN WITH POLYCYSTIC OVARY SYNDROME","authors":"Isabela Bodaczny,&nbsp;Isabel Pereira,&nbsp;Giovana Alvoreda,&nbsp;Amanda Recuero,&nbsp;Mário Pessoa,&nbsp;Claudia Oliveira","doi":"10.1016/j.aohep.2026.102319","DOIUrl":"10.1016/j.aohep.2026.102319","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Women with polycystic ovary syndrome (PCOS) have a considerably higher risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) compared with the general population largely driven by shared pathophysiological mechanisms, such as insulin resistance and obesity. We aimed to evaluate the performance of the Fatty Liver Index (FLI) and FIB-4 for identifying MASLD and significant fibrosis in women with PCOS.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective cross-sectional study, 165 women with PCOS were evaluated. Hepatic steatosis and fibrosis were assessed by transient elastography, and the diagnostic performance of FLI and FIB-4 was analyzed.</div></div><div><h3>Results</h3><div>MASLD was identified in 120/165 (72.7%) patients. Women with MASLD were older and had greater adiposity, insulin resistance, and a worse cardiometabolic profile compared with those without MASLD (all p&lt;0.05). Patients with MASLD showed higher AST, ALT, and GGT levels, as well as a higher prevalence of metabolic syndrome (53.3% vs. 13.3%; p&lt;0.001). Significant fibrosis (F2) was observed exclusively in the MASLD group (22.5% vs. 0%; p&lt;0.001). When evaluated independently, FLI showed good discriminative ability for MASLD (AUROC=0.796; 95%CI 0.710–0.882), with an optimal cutoff of 22.7, substantially lower than the conventional threshold of 60. In contrast, FIB-4 showed poor performance for detecting significant fibrosis (AUROC=0.549). FLI strongly correlated with BMI (r=0.91), waist circumference (r=0.92), and HOMA-IR (r=0.63).</div></div><div><h3>Conclusions</h3><div>MASLD is highly prevalent in women with PCOS. The FLI may be useful for screening with adjusted cutoffs, whereas FIB-4 showed limited sensitivity for early fibrosis, underscoring the need for tailored diagnostic strategies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102319"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#62 - IMPACT OF THE MANCOZEB FUNGICIDE DRIFT PHENOMENON ON NON-TARGET POPULATIONS","authors":"Nelson Suarez,&nbsp;Raquel Da Costa,&nbsp;Vittoria Sampaio,&nbsp;Theo Telöken,&nbsp;Patrícia Riedel,&nbsp;Dvora Joveleviths,&nbsp;Ana Lazzari,&nbsp;Tiago Soares,&nbsp;Camila Baldin,&nbsp;Hidayat Kassim,&nbsp;Sheila Toniasso","doi":"10.1016/j.aohep.2026.102336","DOIUrl":"10.1016/j.aohep.2026.102336","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Mancozeb, a fungicide from the ethylenebisdithiocarbamate class, and 2,4-dichlorophenoxyacetic acid (2,4-D), a herbicide, are widely used in agriculture. Exposure may occur through inhalation, dermal contact, or ingestion during handling and application, but also through environmental routes, including spray-drift particles and contaminated water or food. These agrochemicals have been associated with hepatotoxic effects.To identify the drift phenomenon based on a biological indicator of Mancozeb exposure in occupationally exposed and non-exposed populations.</div></div><div><h3>Materials and Methods</h3><div>Fifty-four workers occupationally exposed to 2,4-D in the Middle Plateau region of southern Brazil and 31 organic farmers from the Metropolitan Region of Porto Alegre, used as controls, were evaluated. Urinary concentrations of ethylenethiourea (ETU), the main metabolite of Mancozeb, were measured as a biomarker of exposure.</div></div><div><h3>Results</h3><div>The groups were similar regarding age, body mass index, comorbidities, and alcohol and tobacco consumption. The control group had higher educational levels, without statistical significance. Urinary ETU was detected in 81% of controls and 45% of individuals exposed to 2,4-D, with a statistically significant difference between groups (p&lt;0.05) and higher levels in the control group.</div></div><div><h3>Conclusions</h3><div>The detection of ETU in both groups highlights the drift phenomenon and contamination of non-target populations. Higher levels among controls suggest indirect exposure through contaminated water or food, reinforcing the need for stricter agrochemical control and environmental and occupational monitoring.ects.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102336"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#149 - DYNAMIC CHANGES IN STEATOTIC LIVER DISEASE SUBTYPE CLASSIFICATION AND PREDICTORS OF ADVANCED FIBROSIS IN LATIN AMERICA","authors":"Luis Díaz,&nbsp;Francisco Idalsoaga,&nbsp;Mario Pessoa,&nbsp;Claudia De Oliveira,&nbsp;Patricia Zitelli,&nbsp;Scherezada Mejía-Loza,&nbsp;Ezequiel Ridruejo,&nbsp;Mirta Peralta,&nbsp;Cesar Castro,&nbsp;Jorge Garavito-Rentería,&nbsp;Rommel Zambrano-Huailla,&nbsp;Gustavo Ayares,&nbsp;Nancy Solis,&nbsp;María Orellana,&nbsp;Francisco Barrera,&nbsp;Sebastián Marciano,&nbsp;Adrian Gadano,&nbsp;Jorge Martínez,&nbsp;María Acosta,&nbsp;Martín Tagle,&nbsp;Marco Arrese","doi":"10.1016/j.aohep.2026.102264","DOIUrl":"10.1016/j.aohep.2026.102264","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Latin America is underrepresented in prospective steatotic liver disease (SLD) studies. This multinational study assessed advanced fibrosis risk across SLD subtypes in Latin America.</div></div><div><h3>Materials and Methods</h3><div>Cross-sectional analysis of prospectively enrolled adults with SLD (2023 criteria) at 16 tertiary centers in seven countries (2024–2026). We performed standardized interviews and assessed fibrosis using liver biopsy or vibration-controlled transient elastography (VCTE) when biopsy was unavailable (advanced fibrosis: biopsy F3 or VCTE 12 kPa). We used logistic regression adjusted for age, sex, ethnicity, BMI, type 2 diabetes mellitus (T2DM), physical activity, and SLD subtype.</div></div><div><h3>Results</h3><div>We included 914 participants; median age was 62 years, 56.6% were women, median BMI was 30.3 kg/m2, and 46.4% had T2DM. Based on historical diagnoses, 86.2% had MASLD, 5.4% MetALD, and 8.4% ALD (<strong>Figure A</strong>). At enrollment, 87.8% with prior MetALD reported alcohol intake within the MASLD alcohol range, while 50.7% and 46.5% with prior ALD were within the MASLD and MetALD alcohol ranges, respectively. Advanced fibrosis prevalence was 35,5%. Age (aOR:1.05, 95%CI:1.03–1.07; p&lt;0.0001), T2DM (aOR:3.65, 95%CI:2.32–5.74; p&lt;0.0001), MetALD (aOR:2.72, 95%CI:1.32–5.58; p=0.007) and ALD (aOR:21.33, 95%CI:9.02–50.44; p&lt;0.0001) were independently associated with higher odds of advanced fibrosis, whereas those who walked &gt;10,000 daily steps had lower odds (aOR:0.06, 95%CI:0.01–0.35; p=0.002)(<strong>Figure B</strong>).</div></div><div><h3>Conclusions</h3><div>In this multicenter Latin American SLD cohort, advanced fibrosis was common and mainly associated with alcohol-related SLD subtypes, T2DM, and older age, while physical activity was protective (FONDECYT 1241450).</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102264"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#69 - CORRELATION BETWEEN FIB-4 INDEX AND ADVANCED LIVER FIBROSIS DETERMINED BY TWO-DIMENSIONAL SHEAR WAVE ELASTOGRAPHY IN PATIENTS WITH METHOTREXATE-ASSOCIATED LIVER FIBROSIS","authors":"Diana Espinosa,&nbsp;Froylan Martinez,&nbsp;Samantha Armendariz,&nbsp;German Barrientos,&nbsp;Elisa Venegas,&nbsp;Andres Vargas,&nbsp;Maria Vega,&nbsp;Alejandro García,&nbsp;Rodolfo Rivera,&nbsp;Luis Frias,&nbsp;Pedro Rodríguez,&nbsp;Jacqueline Cordova","doi":"10.1016/j.aohep.2026.102343","DOIUrl":"10.1016/j.aohep.2026.102343","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Methotrexate (MTX) is widely used to treat autoimmune diseases, but it has been associated with steatohepatitis and liver fibrosis (LF). The FIB-4 index is a noninvasive test for LF, although its utility in MTX-asocciated LF remains unclear. Likewise, shear-wave elastography (SWE) effectively stages LF; however, studies exploring its correlation with FIB-4 in MTX patients are scarce.</div></div><div><h3>Objective</h3><div>To correlate the FIB-4 index with advanced LF determined by SWE in patients with MTX-associated LF.</div></div><div><h3>Materials and Methods</h3><div>An observational, retrospective study was conducted among patients receiving MTX for various indications. Patients were stratified according to FIB4 risk categories as low risk (LR) (&lt;1.3, or &lt;2.0 in patients &gt;65 years), intermediate risk (IR) (1.3/2.0–2.67), and (HR) (&gt;2.67). Advanced LF was defined as liver stiffness values &gt;9 kPa measured using SWE.</div></div><div><h3>Results</h3><div>A total of 274 patients were included; mean age was 53±14 years and 91.25% were women. Median FIB4 index was 1.21 (0.84-1.80), while mean liver stiffness was 8.52 ± 3.11 kPa. Median liver stiffness values were 7.51 (6.00–8.96) kPa in the LR group, 9.72 (7.20–10.70) kPa in the IR group, and 9.80 (7.68–12.25) kPa in the HR group. Advanced LF was present in 24.1% of LR patients, 58.4% of IR patients, and 70.4% of HR patients.</div><div>FIB4 showed a significant positive correlation with LF measured by SWE (Spearman’s rho = 0.408, p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Despite a significant correlation between FIB4 and SWE-measured liver stiffness, conventional FIB-4 risk categories failed to adequately identify advanced LF in MTX-treated patients.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102343"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#78 - VENTRICULO-ARTERIAL COUPLING AND REGIONAL ARTERIAL FLOW REDISTRIBUTION IN PREVIOUSLY DECOMPENSATED CIRRHOSIS: A DOPPLER-BASED PROOF-OF-CONCEPT STUDY","authors":"Diego Arufe,&nbsp;Edgar Suarez,&nbsp;Omar Perez,&nbsp;Laura Mindiola","doi":"10.1016/j.aohep.2026.102350","DOIUrl":"10.1016/j.aohep.2026.102350","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Decompensated cirrhosis is characterized by systemic/splanchnic vasodilation and reduced effective arterial volume. Ventriculo-arterial coupling (VAC), integrating ventricular performance and arterial load, may better reflect this circulatory derangement than cardiac output alone.</div><div>To explore the association between VAC and regional arterial Doppler parameters in patients with previously decompensated cirrhosis, as a proof-of-concept approach to mesenteric-renal flow redistribution.</div></div><div><h3>Materials and Methods</h3><div>We conducted an exploratory observational study including patients with previously decompensated cirrhosis who underwent echocardiographic and vascular Doppler assessment. VAC was calculated as the ratio between arterial elastance and ventricular elastance. Regional Doppler assessment included velocity-time integral (VTI) and resistance index measurements in the renal artery, superior mesenteric artery (SMA), splenic artery, hepatic artery, and intrarenal arteries when available. Associations between VAC and Doppler-derived parameters were evaluated using Spearman’s rank correlation. The SMA VTI/renal VTI ratio was calculated as a redistribution index.</div></div><div><h3>Results</h3><div>Lower VAC was significantly associated with lower renal artery VTI (rho=0.51; p=0.025). SMA VTI showed an inverse correlation with VAC, with a trend toward statistical significance (rho=-0.53; p=0.053). The SMA VTI/renal VTI ratio was significantly and inversely correlated with VAC (rho=-0.65; p=0.012). Cardiac output and cardiac index were not significantly associated with regional VTI measurements.</div></div><div><h3>Conclusions</h3><div>Lower VAC was associated with reduced renal VTI and a higher SMA-to-renal VTI ratio, suggesting Doppler-derived regional arterial flow redistribution related to arterial load and ventriculo-arterial uncoupling rather than cardiac output alone.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102350"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#80 - TRENDS IN MORTALITY RELATED TO CIRRHOSIS IN COLOMBIA 2000 – 2024: YEARS OF LIFE LOST, AND GEOGRAPHIC DISPARITIES","authors":"Betty Morales,&nbsp;Ismael Yepes,&nbsp;Nelson Alvis-Guzman,&nbsp;Nelson Alvis-Zakzuk","doi":"10.1016/j.aohep.2026.102351","DOIUrl":"10.1016/j.aohep.2026.102351","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Cirrhosis remains a leading cause of morbidity and mortality worldwide, with marked geographic heterogeneity driven by hepatitis B and C, alcohol-related liver disease, and the rising burden of NAFLD/MALD. In low and middle-income countries like Colombia, the regional disease burden remains poorly characterised, limiting effective policy responses. This study analyses trends in cirrhosis-related mortality across Colombian departments, stratified by age and sex, to inform public health priorities and guide equitable resource allocation.</div></div><div><h3>Materials and Methods</h3><div>Descriptive study using ICD-10 cirrhosis-related codes. Crude (CiMR) and age-standardised mortality rates (ASMR) per 100,000 person-years were estimated. Temporal trends were analysed using Joinpoint regression to identify inflection points, annual percent change (APC), and average annual percent change (AAPC). Years of life lost (YLLs) and regional distribution were calculated using DANE vital statistics microdata (2000–2024).</div></div><div><h3>Results</h3><div>A total of 55,077 cirrhosis-related deaths were recorded (mean 2,203/year); 62.1% in men and 69.3% in individuals over 59. Mean age at death was 66.1 years. K74.6 accounted for 75.7% of deaths and K70.3 for 22.2%. Cumulative YLLs reached 1,569,620 (28.51/death). CiMR increased significantly from 4.38 to 5.44, with a greater rise in women (APC: 1.91) than men (APC: 0.74). The male-to-female rate ratio declined from 2.07 to 1.54. ASMR decreased 24.8% overall, with greater reduction in men (38.3%) than women (20.1%). Regional ASMRs ranged from 2.33 (Orinoquia-Amazonia) to 6.73 (Oriental).</div></div><div><h3>Conclusions</h3><div>Crude cirrhosis-related mortality increased significantly, age-standardised rates declined over the period, with a narrowing gap between sexes, reflecting demographic ageing and differential trends by sex and region.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102351"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#110 - THERAPEUTIC ATTRITION CREATES APPARENT SURVIVAL ADVANTAGES IN DELAYED SYSTEMIC THERAPY FOR HEPATOCELLULAR CARCINOMA","authors":"Maria Lynch-Mejía,&nbsp;Francisco Vargas-Navarro,&nbsp;Wagner Ramírez-Quesada,&nbsp;Fiorella Ajún,&nbsp;Daniel Perez-Muñoz,&nbsp;Andrés Solera-Vega,&nbsp;Silvia Alfaro-Cartin,&nbsp;Karen Rodríguez-Masís,&nbsp;Dennis Brenes-Redondo,&nbsp;Pablo Coste","doi":"10.1016/j.aohep.2026.102275","DOIUrl":"10.1016/j.aohep.2026.102275","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Delayed transition from locoregional to systemic therapy (ST) is common in hepatocellular carcinoma (HCC), yet its clinical implications remain controversial due to survivor and time-zero biases. Therapeutic attrition, ST initation timing, and survival outcomes were assesed in this real-world HCC cohort from Central America. We aimed to evaluate therapeutic attrition and determine whether apparent survival differences by timing of transition to ST reflected time-zero and survivor selection biases.</div></div><div><h3>Materials and Methods</h3><div>A multicenter real-world longitudinal cohort-study was conducted including consecutive adults with confirmed HCC managed across two tertiary-referral centers between 2018-2024. Therapeutic trajectories were reconstructed longitudinally. Transition to ST (sorafenib or atezolizumab-bevacizumab) was classified as early (first or second treatment) or delayed (2 prior-treatments). Overall survival (OS) was analyzed both from HCC diagnosis and from ST initiation using Kaplan-Meier and Cox-proportional hazards models adjusted for ALBI-grade, ECOG, and BCLC-stage.</div></div><div><h3>Results</h3><div>Among 260 patients with HCC, 184 (70.8%) received active treatment, 111 (42.7%) underwent multiple therapeutic interventions, but only 50 (19.2%) ultimately reached ST, demonstrating substantial therapeutic attrition. Thirty-five patients (70%) transitioned early and 15 (30%) underwent delayed transition. When OS was measured from ST initiation, survival did not differ between groups (p=0.77). However, when OS was measured from HCC diagnosis, delayed transition was associated with longer-survival (log-rank p=0.003; adjusted HR 0.40, p=0.019), consistent with time-zero and survivor selection biases.</div></div><div><h3>Conclusions</h3><div>Therapeutic attrition substantially limits access to ST in real-world HCC care. Apparent survival advantages associated with delayed transition primarily reflect time-zero and survivor biases, cautioning against naïve interpretation of survival analyses in treatment sequencing studies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102275"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#9 - BEYOND FIRST-DEGREE RELATIVES: EXPLORATORY ASSESSMENT OF HEPATIC FIBROSIS RISK IN EXTENDED BIOLOGICAL FAMILY NETWORKS OF PATIENTS WITH MASLD-RELATED CIRRHOSIS","authors":"Ismael Yepes,&nbsp;Nicole Chamorro,&nbsp;Guillermo Donado,&nbsp;Maria Saavedra,&nbsp;Samuel Perez,&nbsp;Yohana Poveda,&nbsp;Juan Restrepo","doi":"10.1016/j.aohep.2026.102291","DOIUrl":"10.1016/j.aohep.2026.102291","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) has a well-established hereditary component, yet the risk of hepatic fibrosis in extended family networks remains unexplored. This study aimed to explore the prevalence of significant hepatic fibrosis in biological relatives of patients with MASLD-related cirrhosis and to identify associated risk factors.</div></div><div><h3>Materials and Methods</h3><div>This exploratory, multicenter, cross-sectional study enrolled 165 biological relatives of 58 index cases with MASLD-related cirrhosis across three hepatology centers. Relatives were classified by coefficient of genetic relationship into first-degree -parents, children, siblings- (n=114) and second/third-degree relatives -grandparents, grandchildren, aunts, uncles, nephews, or nieces - (n=51). Significant hepatic fibrosis was defined as liver stiffness measurement 8.0 kPa by transient elastography. Univariate logistic regression identified associated variables<strong>.</strong></div></div><div><h3>Results</h3><div>Significant hepatic fibrosis was detected in 8.5% (14/165) of biological relatives, a rate exceeding general population estimates. Abdominal obesity by ATP III criteria was the only independent predictor of significant fibrosis (OR 3.3; 95% CI 1.008–11.19; p=0.049). No significant associations were observed for diabetes mellitus, dyslipidemia, or other cardiometabolic risk factors. Prevalence was comparable between first-degree and second/third-degree relatives (8.8% vs. 7.8%; p=0.84).</div></div><div><h3>Conclusions</h3><div>This exploratory study provides preliminary evidence that hepatic fibrosis affects extended family networks of MASLD-related cirrhosis patients at rates exceeding general population estimates, with central adiposity as the primary associated factor. These findings justify adequately powered confirmatory studies incorporating genetic characterization to refine family screening strategies in high-risk population</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102291"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#31 - GUT-LIVER PHENOTYPE IN PRIMARY SCLEROSING CHOLANGITIS ASSOCIATED WITH ULCERATIVE COLITIS: PANCOLITIS WITH LOW CLINICAL INTESTINAL ACTIVITY AND ADVANCED HEPATOBILIARY COURSE IN A MEXICAN COHORT","authors":"Deborah Espinoza,&nbsp;Viridiana Lopez,&nbsp;Fatima Higuera","doi":"10.1016/j.aohep.2026.102309","DOIUrl":"10.1016/j.aohep.2026.102309","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Primary sclerosing cholangitis (PSC) associated with ulcerative colitis (UC) represents a gut-liver phenotype characterized by extensive colitis, low clinical intestinal activity, and risk of hepatic progression. Its characterization in Mexico is limited.</div><div>To describe the intestinal and hepatobiliary phenotype of patients with PSC-UC and compare it exploratorily with PSC without ulcerative colitis (UC).</div></div><div><h3>Materials and Methods</h3><div>We conducted an observational, retrospective, descriptive-comparative cohort study including 16 adult patients with PSC evaluated between 2021 and 2024. PSC was defined by clinical, biochemical, and cholangiographic criteria. Patients were grouped according to UC presence; those without IBD served as an exploratory comparison group. Montreal extent, endoscopic Mayo score, Truelove-Witts severity, and hepatobiliary variables were analyzed.</div></div><div><h3>Results</h3><div>Five patients had PSC-UC and 11 had PSC without UC. In PSC-UC, 5/5 had Montreal E3, 5/5 Mayo 2-3, and 5/5 mild Truelove-Witts, showing discordance between endoscopic activity and clinical expression. Hepatobiliary involvement was advanced: 5/5 had cirrhosis, 4/5 portal hypertension, and 3/5 Child-Pugh B/C. Median MELD was 10 and MELD-Na was 8. Osteoporosis occurred in 3/5 versus 1/11 without UC (p=0.063), and dermatologic manifestations in 2/5 versus 0/11 (p=0.083).</div></div><div><h3>Conclusions</h3><div>PSC-UC showed pancolitis, moderate-to-severe endoscopic activity, low clinical intestinal activity, and advanced hepatobiliary disease. These findings support multidisciplinary hepatobiliary, endoscopic, and bone surveillance. Although no colorectal cancer was documented, PSC-associated pancolitis justifies close colonoscopic surveillance. Sample size and retrospective design limit inference.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102309"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}