Journal of Hepatology

Check our October issue! This month's cover features the article "Myosteatosis is closely associated with sarcopenia and significantly worse outcomes in patients with cirrhosis" by Di Cola et al. (https://bit.ly/3Trev1d) Full issue here: https://bit.ly/36khmDF EASL | The Home of Hepatology

Long-Term Efficacy of Bulevirtide in Chronic Hepatitis Delta: A 96-Week Study Reveals Significant Benefits and Safety   Bulevirtide (BLV) has been approved for chronic hepatitis delta (CHD) treatment. This phase III study, published in the Journal of Hepatology, colleagues assessed BLV’s long-term efficacy and safety over 96 weeks in 150 patients. The study showed that extending BLV therapy improved virologic and biochemical responses, including in initially suboptimal responders. Both 2 mg and 10 mg doses were equally effective. BLV was well tolerated with no discontinuations due to adverse events, confirming its safety and effectiveness for CHD. #OpenAccess here: https://lnkd.in/dfbsBGWu EASL | The Home of Hepatology

WHAT IS YOUR DIAGNOSIS ❓ A 41-year-old woman presented with dark urine, scleral icterus, fatigue, and shortness of breath, followed by acute right upper quadrant abdominal pain Blood tests: AST 364 U/L ALT 393 U/L ALP 155 U/L (ref < 130 U/L) Total bilirubin 9.2 mg/dl She started taking a progestin-only oral contraceptive 7 weeks before the presentation. History of photosensitivity. 🤔What is your diagnosis? 1️⃣ Primary sclerosing cholangitis 2️⃣ Infection 3️⃣ Drug-induced liver injury 4️⃣ Erythropoietic protoporphyria Full case here👉 https://bit.ly/3XvVpsg EASL | The Home of Hepatology

Immunotherapy for hepatocellular carcinoma: The next evolution in expanding access to liver transplantation Immunotherapy has revolutionised the treatment of advanced hepatocellular carcinoma (HCC). In addition, several phase III trials of immunotherapy in combination with surgical or locoregional therapies for early-to intermediate-stage HCC have recently reported positive results, and other phase III trials in the same patient population are currently in progress. As the application of immunotherapy is shifting to include patients with earlier stages of HCC, one looming question now emerges: What is the role of immunotherapy in the pre-liver transplant population? Liver transplantation is a potentially curative therapy for HCC and confers the additional advantage of restoring a normal, healthy liver. In pre-transplant patients, immunotherapy may improve downstaging success and tumour control at the cost of some immunologic risks. These include immune-related toxicities, which are particularly relevant in a uniquely vulnerable population with chronic liver disease, and the possibility of acute rejection after transplantation. Ultimately, the goal of immunotherapy in this population will be to effectively expand access to liver transplantation while preserving pre- and post-transplant outcomes. In this review, we discuss the mechanisms supporting combination immunotherapy, summarise key recent clinical data from major immunotherapy trials, and explore how immunotherapy can be applied in the neoadjuvant setting prior to liver transplantation in selected high-risk patients. Review by Michael Li, Sherrie Bhoori, Neil Mehta and Vincenzo Mazzaferro Full text here: https://lnkd.in/d6MJz6Ax EASL | The Home of Hepatology

Comparative Analysis of Agile Scores for Diagnosing Advanced Fibrosis and Cirrhosis in MASLD, ALD, and Viral Hepatitis Agile scores, including liver stiffness measurements (LSM), were developed to assess advanced fibrosis and cirrhosis in metabolic dysfunction-associated steatotic liver disease (MASLD). This study, published in the Journal of Hepatology, validated Agile 3+ and Agile 4, demonstrating they perform as well as LSM in diagnosing fibrosis and cirrhosis in MASLD and alcohol-related liver disease (ALD), but are less effective in viral hepatitis. Combining Agile scores with LSM or using them sequentially after FIB-4 improves classification accuracy and reduces indeterminate results, particularly for MASLD and ALD. Full text here: https://lnkd.in/dJjQg6Ni EASL | The Home of Hepatology

Assessment of fatigue and its impact in chronic liver disease Patient-reported outcomes (PROs), such as health-related quality of life (HRQL), are important outcome measures for patients with chronic liver diseases (CLDs). Presence of cirrhosis and advanced liver disease have been associated with worsened HRQL and fatigue. On the other hand, some patients with earlier stages of CLD also experience fatigue, causing PRO impairment. Treatment for some CLDs may improve HRQL and, sometimes, levels of fatigue. We aimed to provide an in-depth expert review of concepts related to fatigue and HRQL in patients with primary biliary cholangitis, hepatitis C virus and MASLD (metabolic dysfunction-associated steatotic liver disease). A panel of experts in fatigue and CLD reviewed and discussed the literature and collaborated to provide this expert review of fatigue in CLD. Herein, we review and report on the complexity of fatigue, highlighting that it is comprised of peripheral (neuromuscular failure, often in conjunction with submaximal cardiorespiratory function) and central (central nervous system dysfunction) causes. Fatigue and HRQL are measured using validated self-report instruments. Additionally, fatigue can be measured through objective tests (e.g. grip strength). Fatigue has deleterious effects on HRQL and one’s ability to be physically active and socially engaged but does not always correlate with CLD severity. Treatments for hepatitis C virus and MASLD can improve levels of fatigue and HRQL, but current treatments for primary biliary cholangitis do not seem to affect levels of fatigue. We conclude that obtaining PRO data, including on HRQL and fatigue, is essential for determining the comprehensive burden of CLD and its potential treatments. Review by Zobair Younossi, Andreas Kremer, Mark G. Swain, David Jones, Christopher Bowlus, Michael Trauner, Linda Henry and Lynn Gerber Full text here: https://lnkd.in/dMU-NisU EASL | The Home of Hepatology

Rare primary liver cancers: An EASL position paper In recent years, owing to advances in our understanding of hepatocarcinogenesis, rare primary liver cancers (PLCs), including combined hepatocellular-cholangiocarcinoma, fibrolamellar carcinoma, and hepatic epithelioid hemangioendothelioma have garnered increased attention. In this position paper, an international panel of experts representing oncology, hepatology, pathology, radiology, surgery, and molecular biology has summarised the available information and evidence on the pathogenesis, diagnosis, and treatment of rare PLCs. While clinical trials of systemic treatments are underway for some rare PLCs, it is evident that more research, involving national and international collaboration, is required. Full text here: https://lnkd.in/d35N3MNE EASL | The Home of Hepatology

New Insights into Post-Translational Modifications in Cholangiocarcinoma: The Role of Protein Lactylation Cholangiocarcinoma (CCA) is an aggressive form of liver cancer with a poor prognosis. This study, published in the Journal of Hepatology, investigated the role of protein lactylation in intrahepatic iCCA, revealing that P300 catalyzes nucleolin lactylation at lysine 477 in glycolytic cells. This modification enhances MADD upregulation, activates ERK signaling, promotes tumor progression, and is associated with poor patient outcomes. #OpenAccess here: https://lnkd.in/dxm8aj-X EASL | The Home of Hepatology

Enhancing Early HCC Detection: Alternating MRI and Ultrasound Outperforms Biannual Ultrasound Ultrasound (US) is commonly used for hepatocellular carcinoma (HCC) surveillance but is less effective in detecting early-stage HCC. This study, compared biannual US with annual non-contrast abbreviated magnetic resonance imaging (NC-AMRI) for HCC detection in high-risk patients. Their study found that NC-AMRI had higher sensitivity (71.0%) and diagnostic yield (4.26%) compared to biannual US (45.2% sensitivity, 1.43% yield). Alternating US and NC-AMRI every 6 months achieved the highest sensitivity (83.9%), suggesting this combined approach is optimal for surveillance. Full text here: https://bit.ly/3yJhR8Z EASL | The Home of Hepatology

✴ Hepatology Snapshot ✴ The liver in haematologic oncologic disorders By Guilherme Cançado, Maya Deeb, David Dodington & Gideon Hirschfield EASL | The Home of Hepatology