Hepatology
Expert perspectives on liver disease, viral hepatitis, cirrhosis management, and liver transplantation.
Recent Discussions
What patient features would favor the creation of a Hutson loop intra-operatively?
Our transplant surgeons have been creating Hutson loops in most patients with Roux-Y anastomosis at transplant (most are PSC with CBD involvement).It has greatly facilitated a direct approach through the loop for biliary issues, skipping the need for long ERCP approaches to reach the anastomosis. Th...
How do you incorporate other pharmacologic bariatric/appetite suppressants in the context of their clinical care plan for MASLD?
Patients with MASLD have different risk factors and drivers of disease (obesity, diabetes, eating disorders, etc). I lend personalized and individualized care when developing a care plan for patients with MASLD, including the risks, benefits, and alternatives to bariatric surgery (for those patients...
What is your approach on the pursuit of bariatric surgery in a patient with advanced fibrosis?
I ensure that patients are evaluated by a multidisciplinary team with expertise in hepatology, bariatric surgery and liver transplantation. Patients with advanced hepatic fibrosis without portal hypertension may potentially undergo bariatric surgery as significant weight loss and improvement in insu...
How does presence of clinically significant portal hypertension change patient prognosis in MASLD?
The presence of CSPH based on HVPG or the Baveno criteria (LSM on VCTE + platelet count) indicates higher chances of decompensation. Data from several clinical trials showed that higher VCTE LSM and lower platelet count are associated with higher annual decompensating event rates. Patients with MASH...
How do you approach a patient's candidacy for simultaneous liver transplant and bariatric surgery if MASLD is the etiology of their end-stage liver disease?
My approach to evaluating the candidacy for simultaneous liver transplant and bariatric surgery when MASLD is the etiology of their end-stage liver disease is no different than ensuring patient is ideal candidate for either procedure alone. Patients are evaluated both for their eligibility for baria...
Is there a role for use of GLP-1/GIP receptor agonists in the management of substance use disorders, whether or not they meet other inclusion criteria for their use?
Currently, we lack the RCTs to understand the full impact of GLP-1s on SUD outcomes. Most evidence is pre-clinical, observational, suggesting potential reductions in cravings and alcohol use. A recent RCT, lab study of semaglutide in non-treatment-seeking adults with AUD showed decreased alcohol con...
How do you utilize the Sustained Alcohol Use Post-Liver Transplant (SALT) score on surveillance for alcohol use for patients after liver transplant?
The SALT score was designed to predict the risk of sustained alcohol use after liver transplant. It was studied and is best applied when evaluating a candidate for liver transplant with alcohol use disorder. It is not used for monitoring or surveillance of alcohol use after liver transplant. Surveil...
In what clinical scenario would larsucosterol be considered as therapy in alcohol related hepatitis?
Not outside Clinical trial setting.
How do you balance infection risk versus therapeutic benefit of steroid tapers when treating patients with alcohol related hepatitis?
Patients presenting with severe alcoholic hepatitis who are initiated on corticosteroids following exclusion of an active infection and GI bleeding should have a Lille score calculated at day 7, though some centers now use a day-4 Lille score, which has similar prognostic value with regard to respon...
What role is there for use of ELF in patients with active alcohol use disorder for which Fibroscan is not able to give a reliable assessment of fibrosis due to ongoing active alcohol use?
I generally find that Fibroscans are reliable when patients are actively drinking, unless the patient has acute alcohol associated hepatitis. I currently do not order ELF tests for patients with ALD unless a fibroscan and MR elastography are unable to be completed (habitus, claustrophobia, cost/insu...