Paradigm Shift in Utilization of Livers from Hepatitis C –Viremic Donors into Hepatitis C Virus–Negative Patients
Despite record-breaking numbers of liver transplants (LTs) performed in the United States in each of the last 7 years, many patients remain on the wait list as the demand for LT continues to exceed the supply of available donors. The emergence of highly effective and well-tolerated direct-acting antiviral therapy has transformed the clinical course and management of hepatitis C virus (HCV) in both the pretr ansplant and posttransplant setting. Historically, donor livers infected with HCV were either transplanted into patients already infected with HCV or discarded. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 4, 2020 Category: Gastroenterology Authors: Eric F. Martin Source Type: research
Advances in Rejection Management
This article discusses T-cell –mediated rejection, antibody-mediated rejection, and chronic rejection. We focus on the prevention and then discuss treatment options. Future directions of rejection management include biomarkers of rejection, which may allow for monitoring of patients who are considered high risk for rejection a nd detection of rejection before there is any clinical evidence to improve graft and patient survival. With improved graft life and survival of liver transplant recipients, the new frontier of rejection management focuses on immunosuppression minimization, withdrawal, and personalization. (Sour...
Source: Clinics in Liver Disease - October 26, 2020 Category: Gastroenterology Authors: Claire R. Harrington, Guang-Yu Yang, Josh Levitsky Source Type: research
Cardiac and Pulmonary Vascular Risk Stratification in Liver Transplantation
Cardiovascular disease complications are the leading cause of early (short-term) mortality among liver transplant recipients. The increasingly older candidate pool has multiple comorbidities necessitating cardiac and pulmonary vascular disease risk stratification of patients for optimal allocation of scarce donor livers. Arrhythmias, heart failure, stroke, and coronary artery disease are common pretransplant cardiovascular comorbidities and contribute to cardiovascular complications after liver transplant. Valvular heart disease and portopulmonary hypertension present intraoperative challenges during liver transplant surge...
Source: Clinics in Liver Disease - October 26, 2020 Category: Gastroenterology Authors: Blessing Aghaulor, Lisa B. VanWagner Source Type: research
Transplant of Elderly Patients
This article reviews the data and discusses the pros and cons of transplants in the elderly. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 21, 2020 Category: Gastroenterology Authors: Claudia Cottone, Nathalie A. Pena Polanco, Kalyan Ram Bhamidimarri Source Type: research
Despite advances in the care of patients with chronic liver disease, notably the revolution of direct-acting antivirals to treat hepatitis C, the need for lifesaving liver transplants remains. The number of liver transplants performed increases every year, yet the demand continues to outstrip the supply. Despite this, the landscape of liver transplantation has been rapidly changing, with respect to expansions of the donor pool, aging of the recipient population, and changing diagnoses leading to liver transplantation. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 21, 2020 Category: Gastroenterology Authors: David Goldberg Source Type: research
Expanding Role of Donation After Circulatory Death Donors in Liver Transplantation
Better understanding of how to utilize donation after circulatory death (DCD) liver grafts has resulted in improved national outcomes and expansion in the number of DCD liver transplants (LTs). This improvement has been driven by better donor and recipient matching, careful evaluation of hemodynamics during withdrawal of life support, and refinement of the procurement operation. Changes to liver allocation likely will result in increased utilization of DCD liver grafts. Ischemic cholangiopathy remains the Achilles heel of DCD LTs and, although rates have fallen with improved protocols, a certain rate likely is unavoidable....
Source: Clinics in Liver Disease - October 20, 2020 Category: Gastroenterology Authors: Kristopher P. Croome, C. Burcin Taner Source Type: research
Expanding the Limits of Liver Transplantation for Hepatocellular Carcinoma
Liver transplantation is a treatment option for hepatocellular carcinoma within Milan criteria. With careful selection practices, patients with larger tumors can do well with successful downstaging followed by liver transplantation and should not be excluded based on tumor size or number alone. When considering expanded criteria for hepatocellular carcinoma, however, survival outcomes after liver transplantation should be comparable with patients without hepatocellular carcinoma. Surrogate measures of tumor biology, such as α-fetoprotein, other biomarkers, and dynamic tumor behavior including response to locoregional...
Source: Clinics in Liver Disease - October 17, 2020 Category: Gastroenterology Authors: Allison Kwong, Neil Mehta Source Type: research
Keeping Patients with End-Stage Liver Disease Alive While Awaiting Transplant
Complications of portal hypertension such as gastroesophageal variceal hemorrhage, ascites, and spontaneous bacterial peritonitis, as well as pulmonary complications, are often responsible for diminished quality of life, excess morbidity and mortality, increased health care resource use and expenditure, and dropout from the liver transplant (LT) waiting list. Therefore, the care of LT candidates on the waiting list must be centered on anticipation and prompt intervention for these complications. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 17, 2020 Category: Gastroenterology Authors: Andres F. Carrion, Paul Martin Source Type: research
Transplants for Acute Alcoholic Hepatitis
Liver transplant for severe alcohol-associated hepatitis remains a controversial practice despite evidence for a substantial survival benefit compared with medical therapy and posttransplant alcohol relapse rates comparable with previously published studies in alcohol-associated cirrhosis. The controversy stems in part from concern regarding patient selection practices, lack of long-term follow-up data, and the potential negative public perception of the practice affecting organ donation. Despite these concerns, it seems that early liver transplant for alcohol-associated hepatitis is increasingly being offered to selected ...
Source: Clinics in Liver Disease - October 17, 2020 Category: Gastroenterology Authors: Jessica Hause, John P. Rice Source Type: research
Optimizing the Selection of Patients for Simultaneous Liver-Kidney Transplant
Simultaneous liver-kidney transplantation has increased significantly in the Model for End Stage Liver Disease era. The transplantation policy has evolved significantly since the implementation of allocation based on the Model for End Stage Liver Disease. Current policy takes into account the medical eligibility criteria for simultaneous liver-kidney transplantation listing. It also provides a safety net option and prioritizes kidney transplant after liver transplant recipients who are unlikely to recover their renal function within 60 to 365 days after liver transplant alone. This review seeks to understand the unde...
Source: Clinics in Liver Disease - October 16, 2020 Category: Gastroenterology Authors: Khurram Bari, Pratima Sharma Source Type: research
Obesity Management of Liver Transplant Waitlist Candidates and Recipients
Obesity is increasing in prevalence in liver transplant candidates and recipients. The rise in liver transplantation for nonalcoholic steatohepatitis reflects this increase. Management of obesity in liver transplant candidates can be challenging due to the presence of decompensated cirrhosis and sarcopenia. Obesity may increase peritransplant morbidity but does not have an impact on long-term post-transplant survival. Bariatric surgery may be a feasible option in select patients before, during, or after liver transplantation. Use of weight loss drugs and/or endoscopic therapies for obesity management ultimately may play a ...
Source: Clinics in Liver Disease - October 12, 2020 Category: Gastroenterology Authors: Danielle Brandman Source Type: research
Beyond Ice and the Cooler
Machine perfusion (MP) has emerged as a promising preservation technique to reduce the risks associated with transplant of high risk (steatotic, elderly, and donation after circulatory death) hepatic allografts. Multiple strategies for MP are under investigation. MP facilitates assessment of organ viability and enables liver-directed therapy before transplant. Clinical trials suggest MP may improve the use of hepatic allografts, mitigate ischemia-reperfusion injury, and reduce the incidences of early allograft dysfunction, biliary complications, and ischemic cholangiopathy. As MP sees more widespread use outside of trial s...
Source: Clinics in Liver Disease - October 12, 2020 Category: Gastroenterology Authors: David D. Aufhauser, David P. Foley Source Type: research
Frailty and Sarcopenia in Patients Pre – and Post–Liver Transplant
Greater than half of patients with decompensated liver disease suffer from frailty and/or sarcopenia, which can lead to increased pre – and post–liver transplant morbidity and mortality. Although frailty and sarcopenia can impact patients with end-stage liver disease in similar ways, they are unique clinical entities with differing underlying etiologies. Early assessment and identification of frailty and sarcopenia in patients is critical to guide clinical decision-making regarding transplantation and to implement nutritional and exercise-based treatment regiments. Nonetheless, accurate diagnosis and, in partic...
Source: Clinics in Liver Disease - October 6, 2020 Category: Gastroenterology Authors: Yedidya Saiman, Marina Serper Source Type: research
Expanding Donor Selection and Recipient Indications for Living Donor Liver Transplantation
This article reviews current living donor selection criteria, and avenues for expansion of criteria with novel surgical techniques and ongoing outcomes research. Ways in which institutions can establish and expand LDLT programs using the Living Donor Champion model are discussed. Efforts to expand recipient indications for LDLT are described. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 6, 2020 Category: Gastroenterology Authors: Akshata Moghe, Swaytha Ganesh, Abhinav Humar, Michele Molinari, Naudia Jonassaint Source Type: research
Locoregional Therapies for Hepatocellular Carcinoma
The evolution of locoregional therapies in the last decade has been refined with improved patient selection and a development of a more personalized approach. In doing so, there has been associated improved outcomes and less toxicity. With the rapidly changing landscape of systemic therapy, the role of locoregional therapies alone or in combination for downstaging and curative intent will continue to evolve. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 2, 2020 Category: Gastroenterology Authors: Anjana A. Pillai, Meera Ramanathan, Laura Kulik Source Type: research
Advances in Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) has been increasing in incidence and prevalence for more than 30 years. As hepatologists have become more adept at treating underlying liver disease and cirrhosis, patients with cirrhosis are living longer, and with longer duration of cirrhosis comes an increased risk of HCC development. Cirrhosis is the underlying disease in most patients with HCC, although around 10% of HCC occurs without cirrhosis, often in the setting of chronic hepatitis B infection. Unfortunately, even with improving treatments for viral hepatitis, cirrhosis has continued to increase worldwide, due to the epidemic of no...
Source: Clinics in Liver Disease - October 2, 2020 Category: Gastroenterology Authors: Catherine Frenette Tags: Preface Source Type: research
Hepatocellular Carcinoma: Moving into the 21st Century
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 2, 2020 Category: Gastroenterology Authors: Catherine Frenette Source Type: research
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 2, 2020 Category: Gastroenterology Source Type: research
Multidisciplinary Team Management of Hepatocellular Carcinoma Is Standard of Care
Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality, but unlike other leading causes of cancer death, HCC is increasing in mortality and burden of management. Management of HCC is unique because it usually arises in a diseased liver, which itself may be a driver of mortality. Multidisciplinary teams (MDTs) for the management of complex diseases are becoming more common, but are especially needed in the management of patients with HCC. Liver cancer MDTs are used in most centers providing comprehensive care for patients with HCC, and should be considered the standard of care for these patients. (Source: Cli...
Source: Clinics in Liver Disease - September 4, 2020 Category: Gastroenterology Authors: Dekey Lhewa, Ellen W. Green, Willscott E. Naugler Source Type: research
Tyrosine Kinase Inhibitors and Hepatocellular Carcinoma
Sorafenib was the first tyrosine kinase inhibitor (TKI) that showed success in extending survival in patients with advanced hepatocellular carcinoma (HCC). In recent years, additional TKIs have been shown to improve survival and expanded the armamentarium for treating this malignancy. The current landscape includes other classes of drugs, such as immune checkpoint inhibitors and monoclonal antibodies. The challenge is now placed on how to best select, combine, and sequence drugs with the goal of improving efficacy and minimizing toxicities to deliver better outcomes for HCC patients. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 4, 2020 Category: Gastroenterology Authors: Leonardo G. da Fonseca, Maria Reig, Jordi Bruix Source Type: research
Downstaging to Liver Transplant
Hepatocellular carcinoma is a rising indication for liver transplantation in the United States. Downstaging, defined as the reduction of tumor burden using local-regional therapy into Milan criteria, opens an avenue to access cure through transplant for patients who traditionally would not qualify. Approaching the selection of downstaging candidates through an assessment of hepatic function, staying within a modest expansion of tumor burden, and incorporation of serologic/imaging markers for tumor biology provide the best chance for successful downstaging. Following well-defined downstaging protocols with built-in failure ...
Source: Clinics in Liver Disease - September 2, 2020 Category: Gastroenterology Authors: Kali Zhou, Neil Mehta Source Type: research
Hepatocellular carcinoma (HCC) is a morphologically heterogeneous tumor with variable architectural growth patterns and several distinct histologic subtypes. Large-scale attempts have been made over the past decade to identify targetable genomic alterations in HCC; however, its translation into clinical personalized care remains a challenge to precision oncology. The role of pathology is no longer limited to confirmation of diagnosis when radiologic features are atypical. Pathology is now in a position to predict the underlying molecular alteration, prognosis, and behavior of HCC. This review outlines various aspects of hi...
Source: Clinics in Liver Disease - September 2, 2020 Category: Gastroenterology Authors: Monika Vyas, Xuchen Zhang Source Type: research
Surveillance for Hepatocellular Carcinoma
Patients with cirrhosis of the liver have a very high risk for developing hepatocellular carcinoma (HCC). Therefore, this group of patients should undergo surveillance to improve mortality. Better tools for stratifying the risk of HCC among patients with cirrhosis are needed. The best strategy for surveillance is the combination of alpha-fetoprotein and ultrasound of the liver every 6 months. This strategy shows a sensitivity of approximately 65% and a specificity of 90%, and importantly, has been shown to improve mortality in these patients. Balancing benefits and harms should be performed when deciding to proceed w...
Source: Clinics in Liver Disease - September 2, 2020 Category: Gastroenterology Authors: Jorge A. Marrero Source Type: research
Imaging Diagnosis of Hepatocellular Carcinoma
This article focuses on similarities and differences between the CT/MRI diagnostic algorithm (CT/MRI LI-RADS) and the CEUS diagnostic algorithm (CEUS LI-RADS) to inform health care professionals for efficient and appropriate clinical decisions through the management of patients at risk. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 1, 2020 Category: Gastroenterology Authors: Guilherme Moura Cunha, Kathryn J. Fowler, Farid Abushamat, Claude B. Sirlin, Yuko Kono Source Type: research
The Impact of Allocation Changes on Patients with Hepatocellular Carcinoma
Since the establishment of the Milan criteria, liver transplantation (LT) has been identified as an optimal therapy for selected patients with early stage, unresectable hepatocellular carcinoma (HCC) complicating cirrhosis, although a major limitation is the critical shortage of available deceased donor liver allografts. This review focuses on the evolution of liver allocation for HCC in the United States and what the most recent revisions to the allocation system mean for patients with HCC. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 1, 2020 Category: Gastroenterology Authors: Lavanya Yohanathan, Julie K. Heimbach Source Type: research
Patients with hepatocellular carcinoma (HCC) have many treatment options. For patients with surgical indication, consideration of future liver remnant and the surgical complexity of the procedure is essential. A new 3-level complexity classification categorizing 11 liver resection procedures predicts surgical complexity and postoperative morbidity better than reported classifications. Preoperative portal vein embolization can mitigate the risk of hepatic insufficiency. For small HCCs, both liver resection and ablation are effective. New medical treatment options are promising and perioperative use of these drugs may furthe...
Source: Clinics in Liver Disease - September 1, 2020 Category: Gastroenterology Authors: Yoshikuni Kawaguchi, Heather A. Lillemoe, Jean-Nicolas Vauthey Source Type: research
Role of External Beam Radiotherapy in Hepatocellular Carcinoma
External beam radiotherapy (EBRT) has improved efficacy and safety with advancements in technology and techniques. EBRT plays an important role in management of hepatocellular carcinoma (HCC). In resectable cases, EBRT serves as a bridge to transplantation or improves local control through adjuvant radiotherapy. In unresectable patients, EBRT offers high local control rates. In metastatic settings, EBRT provides effective palliation. This review presents an overview of radiotherapy treatment modalities used for HCC, current treatment guidelines for the role of EBRT in HCC, clinical outcomes between various EBRT approaches ...
Source: Clinics in Liver Disease - September 1, 2020 Category: Gastroenterology Authors: Chien Peter Chen Source Type: research
Immuno-oncology for Hepatocellular Carcinoma
Hepatocellular carcinoma is a highly prevalent and lethal cancer that many therapeutics are being tested for this disease. It has the potential to be a highly immune-responsive tumor given its inflammatory origins. The first immunotherapies were anti-programmed death-1 monotherapies, which improved response rates and survival. Novel immunotherapy combinations and immunotherapy show promise in frontline treatment. The novel antibody therapy combination of atezolizumab and bevacizumab may be practice changing. Although these landmark studies seem to offer new treatment options, the role of immunotherapy in the liver transpla...
Source: Clinics in Liver Disease - September 1, 2020 Category: Gastroenterology Authors: Samantha A. Armstrong, Aiwu Ruth He Source Type: research
Management of Side Effects of Systemic Therapies for Hepatocellular Carcinoma
Historically, systemic treatment of advanced hepatocellular carcinoma was limited to the tyrosine kinase inhibitor sorafenib. With the recent approval of several new agents the armamentarium of treatment options available to providers and patients has expanded. Although these promising advances offer hope for patients with advanced hepatocellular carcinoma, they also present new and challenging adverse effects that threaten to limit their efficacy. Immunotherapy with checkpoint inhibitors introduce immune-related adverse events, which may affect a wide array of organ systems. With prompt recognition, however, common side e...
Source: Clinics in Liver Disease - September 1, 2020 Category: Gastroenterology Authors: Adam C. Winters, Fatima Bedier, Sammy Saab Source Type: research
Role of Biomarkers and Biopsy in Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is increasing in prevalence and is the third leading cause of cancer-related death worldwide. Unlike other malignancies, HCC can be diagnosed with dynamic imaging with very high accuracy, and tissue diagnosis is not needed for cancer therapy. There is a unique role of established as well as developing biomarkers in diagnosis, prognosis, and management of HCC. Sequencing HCC tumors has yielded substantial insights into HCC tumor biology and has raised the possibility of precision oncology in which therapy decisions are guided by cancer genetics. However, it is not ready for prime time yet. (So...
Source: Clinics in Liver Disease - August 27, 2020 Category: Gastroenterology Authors: Vincent L. Chen, Pratima Sharma Source Type: research
Lifestyle and Environmental Approaches for the Primary Prevention of Hepatocellular Carcinoma
Patients with chronic liver disease are at increased risk of developing hepatocellular carcinoma (HCC). Most patients diagnosed with HCC have limited treatment options and a poor overall prognosis, with a 5-year survival less than 15%. Preventing the development of HCC represents the most important strategy. However, current guidelines lack specific recommendations for primary prevention. Lifestyle factors may be central in the pathogenesis of HCC, and primary prevention strategies focused on lifestyle modification could represent an important approach to the prevention of HCC. Both experimental and epidemiologic studies h...
Source: Clinics in Liver Disease - August 24, 2020 Category: Gastroenterology Authors: Tracey G. Simon, Andrew T. Chan Source Type: research
The Changing Global Epidemiology of Hepatocellular Carcinoma
Hepatocellular carcinoma is among the leading causes of morbidity and mortality. Owing to the current epidemic of metabolic syndrome, the population affected by nonalcoholic fatty liver disease/nonalcoholic steatohepatitis continues to increase and now comprises a significant portion with those with hepatocellular carcinoma. The World Health Organization goal of obtaining universal hepatitis B virus vaccination has led to a global effort to improve vaccination, prevent mother-to-child transmission, and implement linkage to care to avoid the development of hepatocellular carcinoma. In contrast with the decreased burden of c...
Source: Clinics in Liver Disease - August 15, 2020 Category: Gastroenterology Authors: Allyce Caines, Ranya Selim, Reena Salgia Source Type: research
Consultations in Liver Disease
Community practitioners in the field of Gastroenterology are frequently consulted to evaluate inpatients and outpatients with acute and chronic liver issues. Many of the medical problems are complex, and recent advances in the field may be difficult to follow for busy providers. This issue of Clinics in Liver Disease on Consultations in Liver Disease is the fourth in a series dedicated to supporting community providers with pertinent clinical information about consultations that are commonly encountered in community practice. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 1, 2020 Category: Gastroenterology Authors: Steven L. Flamm Tags: Preface Source Type: research
Consultations in Liver Disease
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 1, 2020 Category: Gastroenterology Authors: STEVEN L. FLAMM Source Type: research
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 1, 2020 Category: Gastroenterology Source Type: research
Clinics in Liver Disease
Hepatocellular Carcinoma: Moving Into the 21st Century (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 1, 2020 Category: Gastroenterology Source Type: research
Focal Nodular Hyperplasia and Hepatic Adenoma
Focal nodular hyperplasia and hepatocellular adenoma are benign liver lesions that occur most frequently in women and may be found as incidental findings on imaging. hepatocellular adenomas may be infrequently associated with malignant progression or risk of rupture and as such, require surveillance or definitive treatments based on their size threshold. It is important clinically to differentiate these lesions, and utilizing imaging modalities such as contrast enhanced ultrasound or magnetic resonance imaging can be helpful in diagnosis. Further molecular subtyping of hepatocellular adenoma lesions may be beneficial to de...
Source: Clinics in Liver Disease - June 2, 2020 Category: Gastroenterology Authors: Lauren Myers, Joseph Ahn Source Type: research
Alpha1-antitrypsin deficiency (A1ATD) is an inherited cause of chronic liver disease. It is inherited in an autosomal codominant pattern with each inherited allele expressed in the formation of the final protein, which is primarily produced in hepatocytes. The disease usually occurs in pediatric and elderly populations. The disease occurs with the accumulation of abnormal protein polymers within hepatocytes that can induce liver injury and fibrosis. It is a commonly under-recognized and underdiagnosed condition. Patients diagnosed with the disease should be regularly monitored for the development of liver disease. Liver tr...
Source: Clinics in Liver Disease - June 1, 2020 Category: Gastroenterology Authors: Vignan Manne, Kris V. Kowdley Source Type: research
Budd-Chiari syndrome (BCS), or hepatic venous outflow obstruction, is a rare cause of liver disease that should not be missed. Variable clinical presentation among patients with BCS necessitates a high index of suspicion to avoid missing this life-threatening diagnosis. BCS is characterized as primary or secondary, depending on etiology of venous obstruction. Most patients with primary BCS have several contributing risk factors leading to a prothrombotic state. A multidisciplinary stepwise approach is integral in treating BCS. Lifelong anticoagulation is recommended. Long-term monitoring of patients for development of cirr...
Source: Clinics in Liver Disease - June 1, 2020 Category: Gastroenterology Authors: Lamia Y.K. Haque, Joseph K. Lim Source Type: research
Transjugular Intrahepatic Portosystemic Shunts
Transjugular intrahepatic portosystemic shunts is an established treatment for portal hypertensive complications. Advancements in technology and technique have led to novel indications, including treatment of chronic portal vein thrombosis and use before abdominal surgery to alleviate portal hypertensive complications. Use of TIPS can facilitate the embolization of large portal-systemic shunts to alleviate refractory hepatic encephalopathy owing to excessive portal shunting. Despite these advances, transjugular intrahepatic portosystemic shunts is an invasive procedure with risk for complications and should be performed at...
Source: Clinics in Liver Disease - May 30, 2020 Category: Gastroenterology Authors: Justin R. Boike, Steven L. Flamm Source Type: research
Thrombocytopenia in Chronic Liver Disease
Thrombocytopenia is common in advanced liver disease, and such patients frequently need invasive procedures. Numerous mechanisms for thrombocytopenia exist, including splenic sequestration and reduction of levels of the platelet growth factor thrombopoietin. Traditionally, platelet transfusions have been used to increase platelet counts before elective procedures, usually to a threshold of greater than or equal to 50,000/ μL, but levels vary by provider, procedure, and specific patient. Recently, the thrombopoietin receptor agonists avatrombopag and lusutrombopag were studied and found efficacious for increasing platele...
Source: Clinics in Liver Disease - May 30, 2020 Category: Gastroenterology Authors: Kathy M. Nilles, Steven L. Flamm Source Type: research
Evaluation and Management of Esophageal and Gastric Varices in Patients with Cirrhosis
This article aims to update outpatient and inpatient strategies to include the latest recommendations on variceal screening and surveillance, primary and secondary prophylaxis of variceal bleeding, and therapy for patients with acute variceal bleeding. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 30, 2020 Category: Gastroenterology Authors: Sofia Simona Jakab, Guadalupe Garcia-Tsao Source Type: research
Cutaneous Manifestations of Chronic Liver Disease
This article covers general cutaneous signs that may correlate with various liver diseases and describes specific cutaneous signs as they relate to more specific liver diseases. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 28, 2020 Category: Gastroenterology Authors: Ashaki D. Patel, Kimberly Katz, Kenneth B. Gordon Source Type: research
is a highly lethal biliary epithelial tumor that is rare in the general population but has increased rates in patients with primary sclerosing cholangitis (PSC). It is heterogenous, and management varies by location. No effective prevention exists, and screening is likely only feasible in PSC. Patients often present in an advanced state with jaundice, weight loss, and cholestatic liver enzymes. Diagnosis requires imaging with magnetic resonance cholangiopancreatography, laboratory testing, and endoscopic retrograde cholangiopancreatography. Potentially curative options include resection and liver transplant with neoadjuva...
Source: Clinics in Liver Disease - May 28, 2020 Category: Gastroenterology Authors: Adam P. Buckholz, Robert S. Brown Source Type: research
Hepatitis B Virus Reactivation
This article defines HBV reactivation, discusses risk stratification and common medications that can induce HBV reactivation as well as guideline recommendations for prevention of HBV reactivation, and describes the prognosis and management of patients who experience HBV reactivation. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 25, 2020 Category: Gastroenterology Authors: Sirina Ekpanyapong, K. Rajender Reddy Source Type: research