#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

🔥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

#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

💩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 #Livertwitter:

🔥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 🤔Impact on #NAFLD/NASH trials?
👍Enrich-approach in patient selection

#ILC2022 @EASLedu @EASLnews #LiverTwitter @IanARowe @DrLoomba @NASH_and_coffee

#ILC2022 @EASLedu @EASLnews @ebtapper @BloomPringle @Apichatka @markakismd @MartaBAfonso @LouisHSLau @jlouissaint89 @ajay_duseja @salvatore_piano

https://twitter.com/wong_yujun/status/1540255305270931456

🔥#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

🌎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

📢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

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

🔥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

🔥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 Plasma exchange in:
✅ HBV-ACLF
✅ ALF

#ACLF #ILC2022 @EASLedu

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