Hepatology
Expert perspectives on liver disease, viral hepatitis, cirrhosis management, and liver transplantation.
Recent Discussions
What role is there for the assessment of hepatitis B virus genotype as it pertains to pharmacologic therapy and HCC screening?
We always get genotype before treatment of HBV. It supplies a lot of valuable information.A-G not so much but resistance testing is important in case they took Chinese herbs with lamivudine in them unknowingly. What is really important though for risk of HCC is the presence of the Basal Core Promote...
When would you consider quantification of hepatitis B surface antigen as part of the treatment decision making process?
It is not absolutely necessary. Treatment initiation decisions primarily hinge on expected benefit for reduction of inflammation, injury and fibrosis. qHBsAg is primarily a predictor of treatment duration, the likelihood of HBsAg loss during treatment.
What clinical evidence do you find most favorable of a positive response post-liver transplant for patients with portopulmonary hypertension?
In our Mayo Clinic experience, POPH patients who normalize the PVR with therapy (measured by right heart catheterization pre-transplant) are most likely to resolve POPH post-transplant and come off of all pulmonary artery hypertension medications. Normalization of right ventricular function by echoc...
What clinical scenario would you favor NOT using terlipressin for the management of HRS if there were no notable contraindications for its initiation?
None if all the contraindications are excluded.
What are your clinical considerations to pursue an automated-low-flow ascites (ALFA) pump for a patient with refractory ascites?
A patient whose ascites is difficult to control and has contra-indications for TIPS.
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...
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 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 ...