Hepatology
Expert perspectives on liver disease, viral hepatitis, cirrhosis management, and liver transplantation.
Recent Discussions
What is your approach to the management of post-TIPS hepatic encephalopathy?
In general, this will depend on if HE is provoked or unprovoked. Provoking factors such as infection, dehydration, medications (sedatives) or GI bleeding are reversible and often do not require aggressive HE treatment when the underlying trigger is removed. It may be reasonable to consider lactulose...
What patient clinical factors do you find most impact a patient's "beta-blocker window" and their ability to maintain and tolerate beta-blocker therapy?
Hypotension (SPB<90), bradycardia (HR <50) and refractory (grade 3) ascites are typically considered triggers to at least hold but likely stop NSBB. On the other end of the window, evidence of clinically significant portal hypertension (CSPH) is the typical trigger to consider starting NSBB treatmen...
How do you foresee the integration of artificial intelligence in the management and evaluation of patients with liver lesions/tumors?
I believe it will have a major impact on the diagnosis, prognosis and response to therapy in the future for liver lesions.
When would you plan to biopsy a hepatic adenoma to see if it has high risk features/mutations?
Washout, male, imaging features to suggest beta-catenin-mutated adenoma, such as heterogeneous Eovist uptake.
What pre-transplant patient factors impact surveillance intervals and methods after liver transplant for HCC?
Both pre-transplant and explant characteristics help to predict the risk of recurrence of HCC post liver transplant. The AFP at the time of liver transplant is a well-known risk factor for tumor recurrence. So much so that an AFP > 1000 ng/ml is a disqualification for a HCC MELD upgrade in UNOS at t...
What patient factors impact your selection of initial therapies in patients with localized cholangiocarcinoma?
Tumor factors (size, location), presence of cirrhosis, liver function, other co-morbidities, and functional status.
How do you approach the evaluation of a living donor liver transplant candidate?
In principle, anyone who is an appropriate recipient for deceased donor liver transplantation (DDLT) is also eligible for living donor liver transplantation (LDLT). Recipients in need of two organs would be an exception, as well as those needing cava interposition or in whom a complex surgical histo...
How do you approach risk of development of PTLD in liver transplant recipients with positive EBV antibodies and/or viral loads?
The highest risk of developing EBV-associated PTLD in liver transplant recipients is in those who were not exposed before transplant, such as a recipient who is EBV IgG negative who receives a liver from a positive donor or who acquires EBV in another fashion post-liver transplant, most commonly in ...
How do you counsel patients on the use of marginal organs and/or high risk donors who are on the liver transplant wait list?
We have patients sign consents to accept HCV (+) donors or DCD after consultation with a transplant surgeon. However, we will probably be changing this practice with the advent and use of machine perfusion. More and more patients will be receiving such donor organs now and in the future, frankly, no...
With an increase in the prevalence of MASLD in the United States population, what recipient and donor characteristics do you find favorable for acceptance of a highly steatotic graft?
There are many different clinical and biochemical features that our surgical colleagues assess when considering potential donor liver grafts, the degree of histological steatosis being one of them. Concurrent presence of fibrosis on biopsy is important to consider, as well as the degree of micro- an...