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Jun 23 • 4 tweets • 9 min read
📢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
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
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
Personalized #NASH approach by @DrLoomba

✅ Metabolic risk (+fibrosis assessment)
✅ Genetic risk
🤔What is driving #HCC/cirrhosis risk?
> Genetically vs metabolically #NASH tx

#ILC2022 #Livertwitter @EASLedu @RodriguesSu24 @drkeithsiau

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More from @wong_yujun

Wong yujun Profile picture
Jun 24
#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 Image
🔥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 Image
Read 7 tweets
Wong yujun Profile picture
Jun 23
🌎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 Image
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 Image
⛔️When not to transplant #ACLF-3?

Combination of:
💡Age, Lactate, MDR infection, Respiratory

Give⏲️

#ILC2022 #Livertwitter
Read 5 tweets
Wong yujun Profile picture
Jun 22
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
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
🔥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
Read 4 tweets
Wong yujun Profile picture
Jun 22
🔥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 ImageImage
ImageImageImage
Novel biomarkers:
2) Extracellular vesicles
- released when stress
- predict decompensation (60% at 2-yr )

#LiverTwitter @RautouE #ILC2022

2/5 Image
Read 7 tweets
Wong yujun Profile picture
Jun 22
🔥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 Image
Plasma exchange in:
✅ HBV-ACLF
✅ ALF

#ACLF #ILC2022 @EASLedu ImageImage
🔥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 Image
Read 5 tweets
Wong yujun Profile picture
Jun 22
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
@EASLnews @AASLDtweets @APASLnews Benefits of EUS-guided liver biopsy & EUS guided GV treatment

#ILC2022 ImageImage
🔥🔥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 Image
Read 4 tweets

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