Wong yujun Profile picture
Jun 25 6 tweets 8 min read
💩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
✅Liver biopsy for #alcohol hepatitis
- Avoid misclassification (decomp vs alc hep)
- Avoid unnecessary steroid
- Precise fibrosis staging

⛔️Liver biopsy for🍺 hep
-? Reproducible biopsy (k<0.7)
- Access to biopsy
- Clinical diagnosis maybe as 👍

Whats' your take?😄#ILC2022
End-points in trials for🍺hepatitis? by @MarkThursz at #ILC2022

👉Alcohol abstinence 🗝️determinant for long-term outcome
- Sample size ⏫with short-term 💀

Other outcomes: cirrhosis complications, improvement in Lille/MELD are 👌 infection is subjective
#LiverTwitter
🔥Transplant for # hepatitis?
✅ by Dr Marina Berenguer #ILC2022
- Short-term outcomes were good
- similar relapse rate (careful selection)
- ⏫🏥adoption
DOI: 10.1016/S2468-1253(21)00430-1

@MATHURINPHILIP1 @MarkThursz @MorenoChristop8 @Dr_Vijay_Shah @EASLnews
#LiverTwitter
🔥Transplant for # hepatitis?
⛔️ by Dr Laurent Spahr
-🤔Long-term outcomes (>2 yrs)
-🤔Definition of return-alcohol-use
- ⏫Resources (LTx and beyond LTx)
- Future need for liver grafts? Equity?

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More from @wong_yujun

Jun 26
#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
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
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
Read 5 tweets
Jun 25
🔥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
🔥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 Image
🔥 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
Read 5 tweets
Jun 25
#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
#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 ImageImage
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 ImageImage
Read 5 tweets
Jun 25
🔥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
🤔Impact on #NAFLD/NASH trials?
👍Enrich-approach in patient selection

#ILC2022 @EASLedu @EASLnews #LiverTwitter @IanARowe @DrLoomba @NASH_and_coffee
🔥MEFIB vs MAST vs FAST to detect #NAFLD >F2 by @DrLoomba at #ILC2022

✅n=563 biopsy-proven NAFLD
Sig fibrosis 51.2%, DM 50%
🎯AUROC using rule-in/out criteria

🏆MEFIB > MAST or FAST to identify F2 NAFLD

#LiverTwitter @EASLnews @EASLedu
Read 4 tweets
Jun 24
🔥#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
🔥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
Read 7 tweets
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
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
⛔️When not to transplant #ACLF-3?

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

Give⏲️

#ILC2022 #Livertwitter
Read 5 tweets

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