Discover and read the best of Twitter Threads about #ILC2022
Most recents (15)
Time and again, doctors and nurses and first responders were given a choice between you and me my human friends. And they chose me. They chose me. Artists too, actors and writers, those who tell stories that in their way also save lives. (1/)
Faced with a choice between returning to “normal” or protecting their patients, their audiences, those whose lives they’ve touched, more of them than not chose normal. More of them than not chose me. (2/)
From countless medical conferences in every medical specialty imaginable (#asco2022 #saem22 #ddw2022 #cdic2022 #EFORT2022 #ILC2022 #Fens2022 #chest22 #NASPGHAN22 and so many more) … (3/)
#LiverTwitter
Look forward to the last #portalhtn session in #ILC022 - starting now
Approach to fundal varices with ⭐️@JuanAbraldes @ggarciatsao @VirginiaHdezGea
🔊8am, Hepato Arena
@EASLedu @EASLnews @Sanchit30497977 @AtoosaRabiee @BrettEFortuneMD @MattiasMandorf1
Look forward to the last #portalhtn session in #ILC022 - starting now
Approach to fundal varices with ⭐️@JuanAbraldes @ggarciatsao @VirginiaHdezGea
🔊8am, Hepato Arena
@EASLedu @EASLnews @Sanchit30497977 @AtoosaRabiee @BrettEFortuneMD @MattiasMandorf1
1⃣Primary prophylaxis of GV #ILC2022
✅Bleeding (Glue > NSBB)
✅Decompensation (NSBB > Glue)
⛔️TIPS/BRTO as prevention
Consider:
👉Proximity to care
👉Liver function (CTP-C vs A)
👉Local expertise
👉Potential transplant
#LiverTwitter @JuanAbraldes @VirginiaHdezGea @ggarciatsao
✅Bleeding (Glue > NSBB)
✅Decompensation (NSBB > Glue)
⛔️TIPS/BRTO as prevention
Consider:
👉Proximity to care
👉Liver function (CTP-C vs A)
👉Local expertise
👉Potential transplant
#LiverTwitter @JuanAbraldes @VirginiaHdezGea @ggarciatsao
2⃣GV bleeding in CTP-B9
⭐️Imaging - define anatomy of SPSS/PVT
🏅TIPS > Glue + NSBB:⏬rebleeding
✅EUS-guided therapy⏬rebleeding/recurrence
✅BRTO:
👍liver function
😦worsen varices/ascites -> try spleninc embolization
#LiverTwitter @JuanAbraldes @VirginiaHdezGea
⭐️Imaging - define anatomy of SPSS/PVT
🏅TIPS > Glue + NSBB:⏬rebleeding
✅EUS-guided therapy⏬rebleeding/recurrence
✅BRTO:
👍liver function
😦worsen varices/ascites -> try spleninc embolization
#LiverTwitter @JuanAbraldes @VirginiaHdezGea
🔥PPI in liver-related outcome in @Cirrhosis by @nadimmahmud
🏥Comp cirrhosis, VOCAL cohort, IPTW adjst
👉PPI exposure:
⏫Severe infection (SBP), decomp
💀Mortality (⏬prior BGIT ; ⏫ liver-related💀)
✅Use PPI when indicated
#LiverTwitter @EASLnews @serperm @KaplanDeLiver
🏥Comp cirrhosis, VOCAL cohort, IPTW adjst
👉PPI exposure:
⏫Severe infection (SBP), decomp
💀Mortality (⏬prior BGIT ; ⏫ liver-related💀)
✅Use PPI when indicated
#LiverTwitter @EASLnews @serperm @KaplanDeLiver
🔥NITs for CSPH in #HCV post-SRV by @GeorgSemmler #ILC2022
n=324 HCV, HVPG>6mmHg + paired LSM/Plt
CSPH resolved 25%
✅LSM>25kPa: CSPH
✅LSM<12k + Plt>150: exclude CSPH
✅3-yr decomp risk: 0% vs 9.6% (CSPH)
#LiverTwitter @SaSi_Lens @jaumebosch9 @MattiasMandorf1
n=324 HCV, HVPG>6mmHg + paired LSM/Plt
CSPH resolved 25%
✅LSM>25kPa: CSPH
✅LSM<12k + Plt>150: exclude CSPH
✅3-yr decomp risk: 0% vs 9.6% (CSPH)
#LiverTwitter @SaSi_Lens @jaumebosch9 @MattiasMandorf1
🔥 Important study!
⭐️Carvedilol + Simvastatin in sys inflammation by Dr Edilmar A Tapias #ILC2022 👏
n=82 cirrhosis with HRV
RCT, 1:1, CV + Sv vs CV
🎯HVPG, inflammation at 1m
⭐️Carvedilol reduce IL-6 AND HVPG
⭐️Simva enhance response
#LiverTwitter @anna_baiges @EASLnews
⭐️Carvedilol + Simvastatin in sys inflammation by Dr Edilmar A Tapias #ILC2022 👏
n=82 cirrhosis with HRV
RCT, 1:1, CV + Sv vs CV
🎯HVPG, inflammation at 1m
⭐️Carvedilol reduce IL-6 AND HVPG
⭐️Simva enhance response
#LiverTwitter @anna_baiges @EASLnews
#AIH treatment by Dr Christina Weiler-Normann #ILC2022
👉Definition of endpoints:
✅Complete response: Normal ALT & IgG (<6m)
⛔️Non-response: <50% down in ALT (<4w)
🎯Remission: HAI<4/18 (12m)
#LiverTwitter @joostphdrenth @EASLedu @EASLnews @AutoImmuneLiver @analleo
👉Definition of endpoints:
✅Complete response: Normal ALT & IgG (<6m)
⛔️Non-response: <50% down in ALT (<4w)
🎯Remission: HAI<4/18 (12m)
#LiverTwitter @joostphdrenth @EASLedu @EASLnews @AutoImmuneLiver @analleo
#AIH treatment by Dr Christina Weiler-Normann #ILC2022
Be aware of AEs:
👉Doctors underestimate AEs in patients (60% with steroid)
✅A lower dose steroid may be as good
🤔PROs as #AIH endpoints in future?
#LiverTwitter @joostphdrenth @analleo @EASLedu
Be aware of AEs:
👉Doctors underestimate AEs in patients (60% with steroid)
✅A lower dose steroid may be as good
🤔PROs as #AIH endpoints in future?
#LiverTwitter @joostphdrenth @analleo @EASLedu
AS-AIH treatment by Dr Elenora De martin #ILC2022
🔮Response predictors:
Who?
👉Labs-INR/MELD
✅Radiological (Liver volume, cirrhosis?)
⛔️Clinical (HE 3-4, ascites)
💀Identify non-responder: SURFASA score: Day 3-7
✅Bactrim prophylaxis
#LiverTwitter @joostphdrenth @EASLnews
🔮Response predictors:
Who?
👉Labs-INR/MELD
✅Radiological (Liver volume, cirrhosis?)
⛔️Clinical (HE 3-4, ascites)
💀Identify non-responder: SURFASA score: Day 3-7
✅Bactrim prophylaxis
#LiverTwitter @joostphdrenth @EASLnews
💩Gut microbiome in 🍺 by @Bernd_Schnabl
✅Untargeted:
Bugs as Drug: FMT, Probiotics:⏬ cravings @theliverdr
Drug the Bug: Rifaximin DOI: 10.1111/liv.15207
✅Targetted:
Bugs as Drug: engineered bacteria⏫IL-22
#LiverTwitter @aelsharkawy75 @jturnesv @EASLnews
✅Untargeted:
Bugs as Drug: FMT, Probiotics:⏬ cravings @theliverdr
Drug the Bug: Rifaximin DOI: 10.1111/liv.15207
✅Targetted:
Bugs as Drug: engineered bacteria⏫IL-22
#LiverTwitter @aelsharkawy75 @jturnesv @EASLnews
#Livertwitter:
🔥How often doRare you do liver biopsy for #alcoholic hepatitis?
#ILC2022
@EASLedu @EASLnews @theliverdr @Sanchit30497977 @nipun29j @markakismd @aelsharkawy75 @jturnesv @rabataller @MATHURINPHILIP1 @MarkThursz @MorenoChristop8
🔥How often doRare you do liver biopsy for #alcoholic hepatitis?
#ILC2022
@EASLedu @EASLnews @theliverdr @Sanchit30497977 @nipun29j @markakismd @aelsharkawy75 @jturnesv @rabataller @MATHURINPHILIP1 @MarkThursz @MorenoChristop8
🔥NIT among #NAFLD in T2DM by @JeromeBoursier #ILC2022
n=1,051 biopsy-proven NAFLD
6 NITs - NFS, FIB4, VCTE, Fibrotest, Fibrometer & blood+VCTE
✅Performance⏬in T2DM
✅Approach:
- non-T2DM: FIB4 -> VCTE
- T2DM: VCTE / Fibrometer > Fibrometer
#LiverTwitter
n=1,051 biopsy-proven NAFLD
6 NITs - NFS, FIB4, VCTE, Fibrotest, Fibrometer & blood+VCTE
✅Performance⏬in T2DM
✅Approach:
- non-T2DM: FIB4 -> VCTE
- T2DM: VCTE / Fibrometer > Fibrometer
#LiverTwitter
🤔Impact on #NAFLD/NASH trials?
👍Enrich-approach in patient selection
#ILC2022 @EASLedu @EASLnews #LiverTwitter @IanARowe @DrLoomba @NASH_and_coffee
👍Enrich-approach in patient selection
#ILC2022 @EASLedu @EASLnews #LiverTwitter @IanARowe @DrLoomba @NASH_and_coffee
🔥Highlight from @BavenoVII #cirrhosis session
CSPH Cut-off:
✅Rule in: LSM>25kPa
✅Rule out: LSM<12kPa, Plt>150
👀co-factors:
⛔️Obesity
⛔️Diabetes
⛔️Alcohol
#ILC2022 #Livertwitter @ReibergerThomas @RodriguesSu24 @crisripol @jaumebosch9 @EASLnews
CSPH Cut-off:
✅Rule in: LSM>25kPa
✅Rule out: LSM<12kPa, Plt>150
👀co-factors:
⛔️Obesity
⛔️Diabetes
⛔️Alcohol
#ILC2022 #Livertwitter @ReibergerThomas @RodriguesSu24 @crisripol @jaumebosch9 @EASLnews
Defining Recompensation @BavenoVII
✅Regression (struc/func)
⛔️Primary etiology
⛔️Decompensation (<12m)
✅Stable Liver func
#ILC2022 #LiverTwitter @ReibergerThomas @RodriguesSu24 @crisripol @MattiasMandorf1 @jaumebosch9 @ggarciatsao
✅Regression (struc/func)
⛔️Primary etiology
⛔️Decompensation (<12m)
✅Stable Liver func
#ILC2022 #LiverTwitter @ReibergerThomas @RodriguesSu24 @crisripol @MattiasMandorf1 @jaumebosch9 @ggarciatsao
🔥PSVD by Dr Aurelie Plessier @ValdigGroup
Based on #clinical/#histo
✅Specific signs
✅Non-specific signs
🗝️Histology essential for diagnosis (nor now)
👉emerging role: NOT in PSVD
#ILC2022 #LiverTwitter @BavenoVII @ggarciatsao @ReibergerThomas @VirginiaHdezGea @jaumebosch9
Based on #clinical/#histo
✅Specific signs
✅Non-specific signs
🗝️Histology essential for diagnosis (nor now)
👉emerging role: NOT in PSVD
#ILC2022 #LiverTwitter @BavenoVII @ggarciatsao @ReibergerThomas @VirginiaHdezGea @jaumebosch9
#ILC2022 @EASLedu @EASLnews @ebtapper @BloomPringle @Apichatka @markakismd @MartaBAfonso @LouisHSLau @jlouissaint89 @ajay_duseja @salvatore_piano
🔥#ACLF-3: early vs late transplant @JosephAlukal
👉UNOS database: n=3,498
✅Better 90-day and 1-year survival for early LTx (<7 days)
🤔 Selection bias who goes for early vs late LTx?
#ILC2022 #Livertwitter @EASLedu @EASLnews
@VinaySundaramMD @RajivJalan1 @DrLiver @ebtapper
👉UNOS database: n=3,498
✅Better 90-day and 1-year survival for early LTx (<7 days)
🤔 Selection bias who goes for early vs late LTx?
#ILC2022 #Livertwitter @EASLedu @EASLnews
@VinaySundaramMD @RajivJalan1 @DrLiver @ebtapper
🔥Urine NGAL predicts response to Terlipressin/albumin in HRS by Dr Carmine Gambino
N=162 #cirrhosis, 🇮🇹
AKI>48hrs
urine NGAL:
⏫ ATN-AKI
⬇️ in Terli responders
💡NGAL>220 predict 90-day Mortality (AUROC: 0.85)
#ILC2022 #Livertwitter @salvatore_piano @ProfPaoloAngeli
N=162 #cirrhosis, 🇮🇹
AKI>48hrs
urine NGAL:
⏫ ATN-AKI
⬇️ in Terli responders
💡NGAL>220 predict 90-day Mortality (AUROC: 0.85)
#ILC2022 #Livertwitter @salvatore_piano @ProfPaoloAngeli
🌎Global CLEARED registry by @JasmohanBajaj
n=1,383; Reason for admission: GI bleeding🩸, HE🧠
✅Infection🦠: 25%
✅AKI: 46%
✅30-D Readmission: 33%
🪦30-D Mortality: 33%
😟Transplant: 11%
#ILC2022 #LiverTwitter @EASLedu
n=1,383; Reason for admission: GI bleeding🩸, HE🧠
✅Infection🦠: 25%
✅AKI: 46%
✅30-D Readmission: 33%
🪦30-D Mortality: 33%
😟Transplant: 11%
#ILC2022 #LiverTwitter @EASLedu
Recruitment/selection policy on post-LTx in ACLF-3 by Dr Thierry 🇫🇷
🪦3-year survival: ACLF-3 ⬇️ 66% vs 82%
✅Volume ⏫, survival ⏫
✅Survival gap diminished btw #ACLF-3 vs non-AC LF 3👍
How?
💡MDT, post-ICU care, TAM score, surgery/anes
✅ICU network (list from ICU)
#ILC2022
🪦3-year survival: ACLF-3 ⬇️ 66% vs 82%
✅Volume ⏫, survival ⏫
✅Survival gap diminished btw #ACLF-3 vs non-AC LF 3👍
How?
💡MDT, post-ICU care, TAM score, surgery/anes
✅ICU network (list from ICU)
#ILC2022
⛔️When not to transplant #ACLF-3?
Combination of:
💡Age, Lactate, MDR infection, Respiratory
Give⏲️
#ILC2022 #Livertwitter
Combination of:
💡Age, Lactate, MDR infection, Respiratory
Give⏲️
#ILC2022 #Livertwitter
📢Personalized medicine in #NAFLD by @DrLoomba
✅Current gaps in #NAFLD:
- Rapid progressors
- non-cirrhotic HCC
😧At risk NASH (F2 beyond)? Try these👇
✅FAST (low PPV) - exclude biopsy
✅MAST (PPV 91-97) - rule-in & treat
✅MEFIB (AUROC 0.9)
#ILC2022 #Livertwitter @EASLedu
✅Current gaps in #NAFLD:
- Rapid progressors
- non-cirrhotic HCC
😧At risk NASH (F2 beyond)? Try these👇
✅FAST (low PPV) - exclude biopsy
✅MAST (PPV 91-97) - rule-in & treat
✅MEFIB (AUROC 0.9)
#ILC2022 #Livertwitter @EASLedu
Personalized medicine in #NAFLD by @DrLoomba
🔥Gut microbiome (AUROC 0.936)
- Detect advanced #fibrosis
- Identify 1st-degree relative with #cirrhosis (ethnically universal)
👉DOI: 10.1016/j.cmet.2020.06.005
- FGF19 treatment response in #NASH
#ILC2022 #LiverTwitter @EASLedu
🔥Gut microbiome (AUROC 0.936)
- Detect advanced #fibrosis
- Identify 1st-degree relative with #cirrhosis (ethnically universal)
👉DOI: 10.1016/j.cmet.2020.06.005
- FGF19 treatment response in #NASH
#ILC2022 #LiverTwitter @EASLedu
Personalized #NASH treatment by @DrLoomba
Choose yr drugs based on🎯
⏩#Fibrosis reversal vs #NASH resolution?
✅Combination = way forward. Why?
⏫Efficacy
⏬Dose ( ?potentially ⏬AE)
#ILC2022 #LiverTwitter @jturnesv @aelsharkawy75 @IanARowe @DharJahnvi @drshafikuchay
Choose yr drugs based on🎯
⏩#Fibrosis reversal vs #NASH resolution?
✅Combination = way forward. Why?
⏫Efficacy
⏬Dose ( ?potentially ⏬AE)
#ILC2022 #LiverTwitter @jturnesv @aelsharkawy75 @IanARowe @DharJahnvi @drshafikuchay
Improving MELD by @elizebeth_verna
🤔Why changes are needed MELD allocation? 👇
1) Changing epidemiology of cirrhosis (⏬HCV, ⏫Alcohol/NASH)
2) Creatinine - under-estimate kidney injury esp female
3) 🔼Female wait-list mortality
#ILC2022 #Livertwitter @EASLedu
🤔Why changes are needed MELD allocation? 👇
1) Changing epidemiology of cirrhosis (⏬HCV, ⏫Alcohol/NASH)
2) Creatinine - under-estimate kidney injury esp female
3) 🔼Female wait-list mortality
#ILC2022 #Livertwitter @EASLedu
Evolution of MELD
🤔What's new in MELD 3.0?
- Gender, albumin, bilirubin
✅Advantages:
- ⏬Gender-based disparity (sex & height)
- ⏬Creatinine cap
- 👍Adjust for Interaction bil-NA & creatinine-albumin
#ILC2022 #Livertwitter @elizabeth_verna @EASLedu
🤔What's new in MELD 3.0?
- Gender, albumin, bilirubin
✅Advantages:
- ⏬Gender-based disparity (sex & height)
- ⏬Creatinine cap
- 👍Adjust for Interaction bil-NA & creatinine-albumin
#ILC2022 #Livertwitter @elizabeth_verna @EASLedu
🔥Beyond MELD:
✅ Better predict kidney injury (nGAL) & reversibility
✅ Clinical predictor: ACLF, frailty (LFI) ?sarcopenia
✅ AI (data source? biological plausibility?)
✅ Focus on transplant benefit score > wait-list mortality
#ILC2022 #Livertwitter @elizebeth_verna
✅ Better predict kidney injury (nGAL) & reversibility
✅ Clinical predictor: ACLF, frailty (LFI) ?sarcopenia
✅ AI (data source? biological plausibility?)
✅ Focus on transplant benefit score > wait-list mortality
#ILC2022 #Livertwitter @elizebeth_verna
🔥BIomarkers by Dr @RautouE
1) Novel biomarkers:
CT scan:
- Liver surface nodularity predicts decompensation & survival
- SPSS predict HE (MELD<10)
#ILC2022 #Livertwitter @EASLnews
1/5
1) Novel biomarkers:
CT scan:
- Liver surface nodularity predicts decompensation & survival
- SPSS predict HE (MELD<10)
#ILC2022 #Livertwitter @EASLnews
1/5
Novel biomarkers:
2) Extracellular vesicles
- released when stress
- predict decompensation (60% at 2-yr )
#LiverTwitter @RautouE #ILC2022
2/5
2) Extracellular vesicles
- released when stress
- predict decompensation (60% at 2-yr )
#LiverTwitter @RautouE #ILC2022
2/5
🔥Liver support system by Dr Faouzi Saliba
🌉to transplant
Plasma exchange
✅Transplant-free survival
✅Ongoing RCT (APACHE trial)
⛔️Not for those beyond #ACLF-3
#ILC2022 #Livertwitter @EASLnews @EASLedu
🌉to transplant
Plasma exchange
✅Transplant-free survival
✅Ongoing RCT (APACHE trial)
⛔️Not for those beyond #ACLF-3
#ILC2022 #Livertwitter @EASLnews @EASLedu
🔥Hepatocyte transplant by Dr Anil Dhawan
✅Human hepatocytes
✅Children with ALF (n=8)
👉Alginate microencapsulated, peritoneal transplantation
Read more:👉doi.org/10.1016/j.jhep…
#ILC2022 #Livertwitter @EASLnews @EASLedu @Apichatka @jturnesv @aelsharkawy75 @LiverNotFighter
✅Human hepatocytes
✅Children with ALF (n=8)
👉Alginate microencapsulated, peritoneal transplantation
Read more:👉doi.org/10.1016/j.jhep…
#ILC2022 #Livertwitter @EASLnews @EASLedu @Apichatka @jturnesv @aelsharkawy75 @LiverNotFighter
Endohepatology by Dr Wim Laleman
Potential roles of EUS:
✅Liver biopsy - potential advantages
✅GV treatment - coil +/- glue
✅Intrahepatic portosystemic shunt
✅Portal-pressure measurement
#LiverTwitter #ILC2022 @EASLnews @AASLDtweets @APASLnews
Potential roles of EUS:
✅Liver biopsy - potential advantages
✅GV treatment - coil +/- glue
✅Intrahepatic portosystemic shunt
✅Portal-pressure measurement
#LiverTwitter #ILC2022 @EASLnews @AASLDtweets @APASLnews
@EASLnews @AASLDtweets @APASLnews Benefits of EUS-guided liver biopsy & EUS guided GV treatment
#ILC2022
#ILC2022
🔥🔥HVPG vs EUS-PPG? Which camp are you in?
🤔Sedation effect on PPG measurement?
👉Correlation btw HVPG vs PPG? Long-term data?
-> await Encounter trial
#ILC2022 @ASGEendoscopy @helpatologist @ggarciatsao @LizzieAbyMD @jaumebosch9
🤔Sedation effect on PPG measurement?
👉Correlation btw HVPG vs PPG? Long-term data?
-> await Encounter trial
#ILC2022 @ASGEendoscopy @helpatologist @ggarciatsao @LizzieAbyMD @jaumebosch9
Biotech has been depressing lately, but some positive things have recently shown signs of life:
1. ARGX APLS raising $$ on data.
2. Hated IGMS gets a nice deal.
3. SRRA and ATRS M&A.
1. ARGX APLS raising $$ on data.
2. Hated IGMS gets a nice deal.
3. SRRA and ATRS M&A.
4. REGN is a buyer and scoops up neglected CMPI
5. Promising early allo CAR-NK data
