Annals of hepatology最新文献

{"title":"#2 - LONG-TERM RIFAXIMIN USE IS ASSOCIATED WITH INCREASED ANTIMICROBIAL RESISTANCE AND ESBL-PRODUCING ORGANISMS IN DECOMPENSATED CIRRHOSIS PATIENTS WITH FIRST-EPISODE SPONTANEOUS BACTERIAL PERITONITIS","authors":"Issac Vargas,&nbsp;Graciela Castro","doi":"10.1016/j.aohep.2026.102267","DOIUrl":"10.1016/j.aohep.2026.102267","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Rifaximin is widely used for hepatic encephalopathy; however, its potential impact on antimicrobial resistance remains uncertain. We aimed to evaluate the association between long-term rifaximin use and antimicrobial resistance.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective study including cirrhotic patients with a first episode of SBP between 2016 and 2022. Inclusion criteria were diagnostic paracentesis within 24 hours of admission and no antibiotic exposure within the previous 90 days. Patients were stratified according to long-term rifaximin use (30 days). Group comparisons were performed using cross-tabulations with chi-square or Fisher’s exact tests, as appropriate.</div></div><div><h3>Results</h3><div>A total of 140 patients were included, of whom 39 (27.9%) had long-term rifaximin exposure and 101 (72.1%) did not. Escherichia coli was the most frequent isolate in both groups (51.3% vs 52.5%), followed by Streptococcus spp. (23.1% vs 21.8%), Klebsiella spp. (10.3% vs 7.9%), Enterococcus spp. (2.6% vs 2.0%). In contrast, ESBL-producing organisms were more frequent (34.2% vs 18.4%, p=0.047), as was resistance to ceftriaxone (34.2% vs 18.4%, p=0.047). Increased resistance was also observed for ciprofloxacin (46.9% vs 21.1%, p=0.007), ampicillin (68.0% vs 39.7%, p=0.016), and amoxicillin-clavulanate (31.6% vs 8.6%, p=0.040). Subgroup analysis showed that this association was most pronounced in patients with cryptogenic cirrhosis (p=0.048).</div></div><div><h3>Conclusions</h3><div>Long-term rifaximin use is associated with increased antimicrobial resistance and ESBL-producing organisms in patients with decompensated cirrhosis and first-episode SBP, without changes in pathogen distribution. These findings support a more selective use of rifaximin and highlight the importance of balancing its clinical benefits against the potential risk of promoting antimicrobial resistance.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102267"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810592","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":"#10 - RESEARCH MATURITY IN LATIN AMERICAN HEPATOLOGY: A METHODOLOGICAL ANALYSIS OF ABSTRACTS SUBMITTED TO THE ALEH 2025 CONGRESS","authors":"Ismael Yepes,&nbsp;Nelson Alvis","doi":"10.1016/j.aohep.2026.102292","DOIUrl":"10.1016/j.aohep.2026.102292","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Latin America faces a growing burden of liver disease, yet the state of hepatological research across the region remains poorly characterized. This study aimed to describe the methodological profile of scientific production in Latin American hepatology and to classify countries according to a proposed research maturity index.</div></div><div><h3>Materials and Methods</h3><div>Cross-sectional bibliometric study of 174 ALEH 2025 abstracts. Variables included country of principal author, study type, temporality, follow-up design, and international collaboration. A proposed RMSI was developed comprising five weighted dimensions: high-level evidence studies —clinical trials and SR/MA— (8 points), collaboration breadth and diversity (8 points), longitudinal follow-up (7 points), analytical methodology (4 points), and volume (3 points; maximum 30 points). Countries with &lt;5 abstracts were classified as Level V. Five maturity levels were defined based on total score.</div></div><div><h3>Results</h3><div>Fifteen countries were represented. Chile (24/30) and Argentina (22/30) reached Level I (Advanced). Brazil and Mexico (15/30) reached Level II (Developed) through contrasting profiles: Brazil through network diversity, Mexico through analytical methodology. Uruguay (14/30) and Costa Rica (10/30) reached Level III (Growing); Colombia, Peru, and Cuba Level IV (Emerging); remaining countries Level V (Incipient). Only 4 clinical trials and 4 systematic reviews were identified regionwide. International collaboration was present in 20.7% of abstracts, ranging from 55.6% (Chile) to 0% (Colombia, Peru, Cuba, Costa Rica).</div></div><div><h3>Conclusions</h3><div>Latin American hepatological research shows marked heterogeneity in methodological maturity. The proposed RMSI identified actionable, country-specific gaps beyond volume-based rankings. Strengthening international collaboration networks, longitudinal study designs, and high-evidence research infrastructure are the priority targets for regional scientific development.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102292"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810706","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":"#29 - PNPLA3 GENOTYPE MODIFIES THE HEPATIC RESPONSE TO DIETARY CARBOHYDRATES AND DEFINES RISK PROFILES FOR METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE: EVIDENCE FROM A LATIN AMERICAN POPULATION-BASED STUDY","authors":"Mariana Ramírez-Mejía,&nbsp;Samuel Canizales-Quinteros,&nbsp;Hugo Villamil-Ramiírez,&nbsp;Nahum Méndez-Sánchez","doi":"10.1016/j.aohep.2026.102307","DOIUrl":"10.1016/j.aohep.2026.102307","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The PNPLA3 rs738409 (I148M) variant is the most significant genetic determinant of metabolic dysfunction-associated steatotic liver disease (MASLD). Gene-diet interactions modulating MASLD risk remain understudied in Latin America, one of the regions with the highest global prevalence of the G risk allele. This study aims to evaluate gene-diet interactions between PNPLA3 rs738409 and dietary macronutrients on MASLD risk, and to define genotype-informed multifactorial risk profiles.</div></div><div><h3>Materials and Methods</h3><div>Cross-sectional study of 568 adults (57.4% MASLD; 59.5% male, age 46.8±9 years). PNPLA3 rs738409 genotyped and modeled additively. Steatosis defined by CAP 248 dB/m. Diet assessed by food frequency questionnaire; dietary score derived from 21 foods. Physical activity quantified in MET-min/week. Gene-diet interactions tested by multivariable logistic regression. Risk profiles generated excluding obesity (97% MASLD)</div></div><div><h3>Results</h3><div>The G allele showed a dose-response association with MASLD (p = 0.014), independent of body mass index (BMI). A significant interaction was detected between the PNPLA3 genotype and carbohydrate intake (p = 0.014): higher intake increased the likelihood of MASLD in CG heterozygotes (OR = 7.13, p = 0.011), but not in GG homozygotes. BMI (OR = 4.73, p &lt; 0.001) and dietary score (OR = 1.95, p = 0.003) were independent predictors. The predicted probability ranged from 14.6% to 78.0%, a nearly fivefold difference (AUC = 0.730) (<strong>Figure 1</strong>).</div></div><div><h3>Conclusions</h3><div>These findings highlight that, although PNPLA3 genetic susceptibility cannot be altered, its interaction with diet and lifestyle factors defines a broad spectrum of MASLD risk that can be addressed.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102307"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810022","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":"#35 - CLINICAL, ANATOMICAL, AND BIOCHEMICAL FACTORS ASSOCIATED WITH SECONDARY BILIARY CIRRHOSIS IN PATIENTS WITH POST-CHOLECYSTECTOMY BILE DUCT INJURY","authors":"Mónica Baca,&nbsp;Viridiana Lopez,&nbsp;Fátima Higuera,&nbsp;Andrea Ortega,&nbsp;Omar Vasquez","doi":"10.1016/j.aohep.2026.102313","DOIUrl":"10.1016/j.aohep.2026.102313","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Bile duct injury is a serious complication of cholecystectomy that may lead to chronic cholestasis, recurrent cholangitis, and secondary biliary cirrhosis. Identifying factors associated with progression to cirrhosis could facilitate early recognition of high-risk patients and timely referral to specialized centers.</div></div><div><h3>Materials and Methods</h3><div>An observational, retrospective, and analytical study was conducted in patients older than 18 years with post-cholecystectomy bile duct injury. Patients were classified according to the presence or absence of cirrhosis, defined by clinical, biochemical, imaging, and/or portal hypertension findings documented in medical records. Demographic, clinical, anatomical, and biochemical variables were analyzed. Recurrent cholangitis was defined as two or more hospitalizations due to cholangitis. Quantitative variables were compared using the Mann-Whitney U test, while categorical variables were analyzed using chi-square or Fisher’s exact tests. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated.</div></div><div><h3>Results</h3><div>A total of 60 patients were included, of whom 19 (31.7%) had cirrhosis. Median age was 44 years (IQR 33.2–51.2), and open cholecystectomy was the most common surgical antecedent (70%). Strasberg E4-E5 injuries were significantly associated with cirrhosis (OR 4.26; 95% CI 1.34–13.55; p=0.019). Recurrent cholangitis showed the strongest association with cirrhosis (OR 20.04; 95% CI 4.87–82.43; p&lt;0.001). Patients with cirrhosis also had significantly higher alkaline phosphatase levels. No association was found between the type of cholecystectomy or time since injury and cirrhosis development.</div></div><div><h3>Conclusions</h3><div>Complex bile duct injuries, recurrent cholangitis, and elevated alkaline phosphatase were associated with cirrhosis, supporting the need for close surveillance and early referral in high-risk patients.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102313"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810024","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":"#51 - IMPACT OF RAPID RESPONSE TO IMMUNOSUPPRESSIVE TREATMENT ON THE CLINICAL COURSE OF PATIENTS WITH AUTOIMMUNE HEPATITIS.","authors":"Hstlim Rodríguez,&nbsp;Danay Guerrero,&nbsp;Yusimik Román,&nbsp;Kenia Valenzuela,&nbsp;Marcia Samada,&nbsp;Ludmila Martínez,&nbsp;Mirta Infante,&nbsp;Marlén Castellanos","doi":"10.1016/j.aohep.2026.102326","DOIUrl":"10.1016/j.aohep.2026.102326","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that can progress to cirrhosis and its complications. The speed of response to immunosuppressive therapy has emerged as an important prognostic predictor. The objective was to evaluate the impact of a rapid response to immunosuppressive therapy on the clinical course of patients with AIH.</div></div><div><h3>Materials and Methods</h3><div>A retrospective, real-world longitudinal study was conducted in 85 patients diagnosed with autoimmune hepatitis (AIH) treated at the Institute of Gastroenterology between 2010 and 2025. The median follow-up was 107 months.</div><div>A rapid response was defined as a 80% decrease in AST at 8 weeks of treatment. Biochemical response at 24 and 48 weeks, progression, complications, and overall survival were evaluated. Statistical analysis included chi-square tests, Kaplan-Meier curves, and the log-rank test.</div></div><div><h3>Results</h3><div>A rapid response was observed in 46 patients (54%). Rapid responders had a higher rate of complete response at 24 weeks (78.3% vs 20.5%; p&lt;0.01) and 48 weeks (69.6% vs 17.9%; p&lt;0.01). Progression to more advanced stages was lower in this group (52.2% vs 89.7%; p&lt;0.01), as was the occurrence of multiple complications (13% vs 46.1%; p&lt;0.01). Overall survival was higher in patients with a rapid response (97.8% vs 82.1%; p=0.02).</div></div><div><h3>Conclusions</h3><div>La respuesta rápida al tratamiento inmunosupresor mostró un impacto positivo en la evolución de pacientes con HAI. Su presencia se asocia con mayor respuesta bioquímica sostenida, menor progresión de la enfermedad y mayor supervivencia global.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102326"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810484","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":"#54 - DISTINCT EXPRESSION PROFILES OF MIR-122-5P AND MIR-92A-3P IN PLASMA, PLASMA EXTRACELLULAR VESICLES, AND LIVER TISSUE IN CHRONIC HEPATITIS C PATIENTS","authors":"Victoria Cairoli,&nbsp;Sergio Grande-García,&nbsp;María Preciado,&nbsp;Amanda Fernandez,&nbsp;Pamela Valva","doi":"10.1016/j.aohep.2026.102329","DOIUrl":"10.1016/j.aohep.2026.102329","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>miRNAs regulate gene expression and play a central role in liver pathophysiology, particularly in chronic hepatitis C (CHC) progression and fibrosis development. Circulating miRNAs, especially those contained in extracellular vesicles (EVs), have emerged as promising non-invasive biomarkers. However, the relationship between hepatic and peripheral miRNA expression and their diagnostic value remains unclear. Aim: to evaluate miR-122-5p and miR-92a-3p expression across liver, plasma, and EVs, and to assess their association with fibrosis.</div></div><div><h3>Materials and Methods</h3><div>Plasma, plasma-EVs, and liver tissue from 59 CHC individuals (21 HCV; 38 HCV/HIV) were analyzed. EV-miRNAs were assessed by NGS, and liver and plasma by RTqPCR. Analyses were performed according to infection status, fibrosis stage, and compartment. Diagnostic performance was evaluated using AUROC.</div></div><div><h3>Results</h3><div>miR-122-5p and miR-92a-3p displayed compartment- and infection-specific expression patterns. In EVs, miR-122-5p was reduced (p0.001) and miR-92a-3p was increased (p0.0001) in HCV/HIV compared with HCV, whereas both miRNAs were decreased in liver tissue from coinfected individuals (p=0.0001). EV-miR-122-5p was higher and miR-92a-3p was lower in subjects with F2 (p0.002, p0.001, resp.), while plasma levels were not associated with fibrosis stage. EV-miR-122-5p [GPT r0.653, p0.0001; GOT r0.734, p0.0001] and EV-miR-92a-3p were oppositely correlated with transaminase levels [GPT r-0.366, p0.017; GOT r-0.381, p0.014], consistent with their association with liver injury, although their diagnostic performance was moderate (0.746 y 0.767).</div></div><div><h3>Conclusions</h3><div>These findings highlight compartment-specific miRNA expression in CHC and support EV-derived miRNAs as promising non-invasive biomarkers for liver fibrosis assessment</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102329"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810488","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":"#153 - EARLY AND SUSTAINED BIOCHEMICAL RESPONSE IN LATIN AMERICAN PATIENTS WITH AUTOIMMUNE HEPATITIS PATIENTS","authors":"Ludmila Resende,&nbsp;Esteban Dominguez,&nbsp;Elze Carvalho,&nbsp;Orlando Ganem,&nbsp;Margarita Anders,&nbsp;Carlos Benitez,&nbsp;Alvaro Urzua,&nbsp;Mario Pessoa,&nbsp;Guilherme Cançado,&nbsp;Débora Terrabio,&nbsp;Viridiana Lopez,&nbsp;Alejandra Villamil,&nbsp;Andreina Fragenas,&nbsp;Pablo Coste,&nbsp;Fernando Bessone,&nbsp;Emilia Vera,&nbsp;Maria Chindamo,&nbsp;Rodrigo Zapata,&nbsp;Alexandra Ginesta,&nbsp;Ezequiel Ridruejo,&nbsp;Cláudia Couto","doi":"10.1016/j.aohep.2026.102278","DOIUrl":"10.1016/j.aohep.2026.102278","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Autoimmune hepatitis is generally associated with a favorable response to immunosuppressive therapy. In 2022, treatment targets were standardized. Biochemical response at 4–6 weeks is defined as a &gt;50% decrease in AST and ALT levels, whereas complete response is defined as normalization of AST, ALT, and IgG within 6 months. We aim to apply those criteria and determine prognostic factors related to biochemical response in 6 months.</div></div><div><h3>Materials and Methods</h3><div>We analyzed data from 1,806 patients enrolled in the ALLATIN cohort, including demographic, clinical, laboratory, and histological characteristics. Multivariable logistic regression analysis was performed to identify predictors of biochemical response at 6 months.</div></div><div><h3>Results</h3><div>Biochemical response at 4–6 weeks, 6 and 12 months were available for 1,283 patients, with response rates of 46.4%, 55%, and 43%, respectively. 73% of patients who achieved an early response maintained at one year, whereas 95% of those who responded at 6 months achieved sustained response at one year. Male sex, younger age at diagnosis, clinically significant portal hypertension, lower ALT levels, and lower albumin levels at diagnosis remained independently associated with insufficient biochemical response at 6 months of treatment. Clinically significant portal hypertension increased the likelihood (OR = 1.82; p &lt; 0.001), whereas higher albumin levels demonstrated a protective effect (OR = 0.83; p = 0.036).</div></div><div><h3>Conclusions</h3><div>In this expanded cohort, the rate of biochemical response was lower than previously reported both in our group and in the literature. Male sex, younger age at diagnosis, and greater disease severity at presentation were independently associated with poorer treatment response.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102278"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810646","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":"#175 - ANTITUBERCULOSIS DRUG-INDUCED LIVER INJURY: CLINICAL PROFILE AND SEVERITY IN A CASE SERIES FROM A PERUVIAN REFERRAL HOSPITAL","authors":"Sonia Damian-Pizarro,&nbsp;Diego Huanay-Martínez,&nbsp;Carlos García-Encinas,&nbsp;Juan Burgos,&nbsp;María Bustamante","doi":"10.1016/j.aohep.2026.102283","DOIUrl":"10.1016/j.aohep.2026.102283","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Antituberculosis drug-induced liver injury (AT-DILI) is a potentially serious complication that can disrupt tuberculosis treatment and lead to significant mortality, posing a major public health challenge in high-burden countries like Peru.</div></div><div><h3>Objectives</h3><div>To describe the clinical and biochemical features and the severity of hospitalized patients with AT-DILI at a Peruvian referral center.</div></div><div><h3>Materials and Methods</h3><div>We reviewed cases of adults diagnosed with AT-DILI who were hospitalized between 2019 and 2026. Diagnosis, severity and causality were defined using international criteria (International DILI Expert Group) and the Roussel Uclaf Causality Assessment Method (RUCAM). Clinical variables, drugs received at the time of the event, latency period, biochemical profile and mortality were analyzed. Categorical variables were expressed as percentages; continuous variables as mean, standard deviation, median or range, depending on their distribution.</div></div><div><h3>Results</h3><div>Thirteen cases were included (7 females), 2 of whom had multidrug-resistant tuberculosis (MDR-TB). Mean age was 39.3 years. All patients received pyrazinamide and ethambutol. Three patients (23.1%) were coinfected with human immunodeficiency virus (HIV). Median latency was 52 days (range: 7–365). Hepatocellular pattern was observed in 53.8% of cases. RUCAM causality was possible in 53.8% and probable in 46.2%. DILI severity was mild in 2 cases (15.4%), moderate in 5 (38.5%), severe in 3 (23.1%; 1 MDR-TB) and fatal in 3 (23.1%; 1 MDR-TB). DILI-related mortality was 23.1%.</div></div><div><h3>Conclusions</h3><div>Patients hospitalized with AT-DILI present high severity and elevated mortality rates. Therefore, regular biochemical monitoring, timely discontinuation and gradual reintroduction of anti-TB drugs are essential.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102283"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810649","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":"#60 - HEPATOCELLULAR CARCINOMA SURVEILLANCE AND SURVIVAL BENEFIT IN REAL WORLD PRACTICE: A PROSPECTIVE BRAZILIAN COHORT STUDY","authors":"Diego Vieira,&nbsp;Rodrigo Cambraia,&nbsp;Geraldo Pereira,&nbsp;Lucy Fonseca,&nbsp;Marcelo França,&nbsp;Rosangela Teixeira","doi":"10.1016/j.aohep.2026.102334","DOIUrl":"10.1016/j.aohep.2026.102334","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Surveillance for hepatocellular carcinoma (HCC) is essential for early tumor detection and improved outcomes. However, the real-world impact of structured surveillance on tumor burden and survival remains incompletely defined. This study evaluated the effect of structured HCC surveillance on tumor stage and overall survival.</div></div><div><h3>Materials and Methods</h3><div>A prospective cohort study was conducted between 2019 and 2024. HCC was classified according to LI-RADS criteria. Patients were stratified into:</div><div>(1) HCC detected through structured surveillance with biannual abdominal ultrasound plus alpha-fetoprotein (AFP), and (2) HCC diagnosed outside surveillance. The primary outcome was overall survival (OS), estimated using the Kaplan-Meier method and groups were compared by log-rank test. The study was approved by the local Ethics Committee, all participants provided written informed consent.</div></div><div><h3>Results</h3><div>206 patients were included, with 73 (35.4%) and 133 (64.6%) diagnosed under surveillance and outside surveillance, respectivelly. Surveillance patients had lower baseline AFP levels (7.8 vs 59.0 ng/mL; p = 0.002), lower frequency of AFP &gt;20 ng/mL (41.1% vs 56.9%; p = 0.03), and higher prevalence of early-stage HCC (BCLC 0/A) (71.0% vs 35.5%; p &lt; 0.001). They also presented smaller tumors (31.5 vs 54.0 mm; p &lt; 0.001) and better liver function, with higher prevalence of ALBI Grade I (70.4% vs 32.5%; p &lt; 0.001). HCC-related mortality was lower in the surveillance group (20.5% vs 45.4%; p &lt; 0.001), with significantly longer overall survival (48.1 vs 29.7 months; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>HCC surveillance was associated with earlier detection, lower tumor burden, preserved liver function and improved survival.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102334"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810653","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":"#87 - BEYOND WEIGHT LOSS: TRIAL-LEVEL MEDIATION ANALYSIS OF METABOLIC CHANGES AND HISTOLOGICAL RESPONSE TO PHARMACOTHERAPY IN MASH","authors":"Pedro Passos,&nbsp;Valbert Costa-Filho,&nbsp;Bernardo Moraes,&nbsp;Igor Silveira,&nbsp;Leonardo Süffert,&nbsp;Guilherme Cançado","doi":"10.1016/j.aohep.2026.102357","DOIUrl":"10.1016/j.aohep.2026.102357","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Although MASH pharmacotherapies primarily target metabolic dysfunction, the degree to which metabolic changes account for histological response remains unclear. We quantified the contribution of weight, insulin resistance, and hepatic fat changes to histological outcomes across RCTs.</div></div><div><h3>Materials and Methods</h3><div>We systematically identified RCTs enrolling adults with biopsy-confirmed MASH. Arm-level data were used to derive contrasts for metabolic mediators and histological endpoints. Mediation was assessed using a Bayesian trial-level framework with within-between decomposition to minimize ecological bias. Indirect effects were expressed as absolute risk differences (ARDs) with 95% credible intervals (CrI) and Bayes factors (BF10).</div></div><div><h3>Results</h3><div>Thirty-three RCTs (105 arms) were included. We found anecdotal evidence against weight loss explaining fibrosis improvement without MASH worsening (ARD 0.012, 95%CrI –0.041 to 0.065; BF10=0.35) and toward it explaining MASH resolution without fibrosis worsening (0.050, –0.001 to 0.099; BF10=2.09), with moderate evidence of indirect effects in incretin-based therapies (BF10=5.15). Changes in insulin resistance did not consistently explain fibrosis improvement without MASH worsening (0.001, –0.004 to 0.006; BF10=0.03) or MASH resolution without fibrosis worsening (0.000, –0.004 to 0.004; BF10=0.02), arguing against a meaningful indirect effect. Likewise, liver fat reduction showed little evidence of explaining fibrosis improvement without MASH worsening (0.004, –0.019 to 0.027; BF10=0.15) or MASH resolution without fibrosis worsening (–0.002, –0.012 to 0.008; BF10=0.07). Sensitivity analyses largely supported the main findings.</div></div><div><h3>Conclusions</h3><div>Improvements in metabolic parameters did not consistently account for trial-level histological benefits, except for a moderate signal in incretin-based-therapies for MASH resolution. These findings suggest that direct hepatic or unmeasured pathways may contribute to treatment effects.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102357"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810667","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}