Publications by authors named "Ian Rowe"
Background & Aims: Hepatocellular carcinoma (HCC) risk prediction models may provide a more personalised approach to surveillance for HCC among patients with cirrhosis. This systematic review aims to summarise the performance of HCC prediction models in patients with non-viral chronic liver disease.
Method: The study was prospectively registered with PROSPERO (ID: CRD42022370078) and reported in accordance with PRISMA guidelines.
Background: Acute on Chronic Liver Failure (ACLF) complicates chronic liver disease (CLD) combining rapidly progressive hepatic with extra-hepatic multiple organ failure and high short-term mortality. Effective therapeutic options are very limited, and liver transplantation (LT) seldom utilised through concerns of high recipient mortality and resource use. Retrospective reports suggest recent outcomes may have improved, but use of LT for ACLF has not been prospectively assessed.
View Article and Find Full Text PDFBackground & Aims: Therapeutic plasma exchange (PEX) has emerged as a potential treatment option for patients with acute liver failure (ALF). The effect of PEX on survival outcomes outside of clinical trials is not yet well established. In this study we aimed to evaluate the real-world use and outcomes of PEX for the treatment of ALF.
View Article and Find Full Text PDFArticle Synopsis
- - This study assessed the cost-effectiveness of four different surveillance methods for hepatocellular carcinoma (HCC) in the UK, which included various combinations of biomarker assays and ultrasound techniques.
- - A detailed Markov model was created using Excel to simulate patient outcomes based on life-years and quality-adjusted life-years (QALYs), ultimately revealing that the GAAD method was the most cost-effective approach, while GAAD combined with ultrasound proved to be the most clinically effective.
- - The findings suggest that, given current costs and low HCC rates in the UK, either the GAAD strategy alone or in combination with ultrasound offers the best balance of cost-effectiveness, although further evaluations of the GAAD + ultrasound strategy's performance are
A roadmap for clinical trials in MASH-related compensated cirrhosis.
Nat Rev Gastroenterol Hepatol
November 2024
Article Synopsis
- Metabolic dysfunction-associated steatohepatitis (MASH) is becoming a major cause of cirrhosis globally, but there are few effective treatments and limited clinical trials for patients with MASH-related compensated cirrhosis.
- A key international workshop in April 2023 brought together experts to discuss the challenges and necessary conditions for conducting clinical trials in MASH cirrhosis, including trial design, regulatory issues, and patient recruitment.
- The workshop resulted in a "Roadmap" that outlines the current status, regulatory requirements, potential study designs, and key challenges for future clinical trials focused on MASH-related compensated cirrhosis.
Introduction And Objectives: Despite the huge clinical burden of MASLD, validated tools for early risk stratification are lacking, and heterogeneous disease expression and a highly variable rate of progression to clinical outcomes result in prognostic uncertainty. We aimed to investigate longitudinal electronic health record-based outcome prediction in MASLD using a state-of-the-art machine learning model.
Patients And Methods: n = 940 patients with histologically-defined MASLD were used to develop a deep-learning model for all-cause mortality prediction.
Background: Following the introduction of an algorithm aiming to maximise life-years gained from liver transplantation in the UK (the transplant benefit score [TBS]), donor livers were redirected from younger to older patients, mortality rate equalised across the age range and short-term waiting list mortality reduced. Understanding age-related prioritisation has been challenging, especially for younger patients and clinicians allocating non-TBS-directed livers. We aimed to assess age-related prioritisation within the TBS algorithm by modelling liver transplantation prioritisation based on data from a UK transplant unit and comparing these data with other regions.
View Article and Find Full Text PDFDeaths from the majority of cancers are falling globally, but the incidence and mortality from hepatocellular carcinoma (HCC) is increasing in the United Kingdom and in other Western countries. HCC is a highly fatal cancer, often diagnosed late, with an incidence to mortality ratio that approaches 1. Despite there being a number of treatment options, including those associated with good medium to long-term survival, 5-year survival from HCC in the UK remains below 20%.
View Article and Find Full Text PDFBackground: Hepatocellular carcinoma (HCC) incidence has increased rapidly, and prognosis remains poor. We aimed to explore predictors of routes to diagnosis (RtD), and outcomes, in HCC cases.
Methods: HCC cases diagnosed 2006-2017 were identified from the National Cancer Registration Dataset and linked to Hospital Episode Statistics and the RtD metric.
Article Synopsis
- - Liver transplantation is a complex and costly life-saving treatment for advanced liver disease, necessitating collaborative efforts and investment from healthcare systems and professionals.
- - Current metrics for monitoring liver transplantation processes and outcomes often fail to prioritize what is important to patients, lacking a patient-centered approach.
- - A Consensus Statement created by experts aims to establish new outcome measures for liver transplantation based on Value-Based Health Care (VBHC) principles, providing a framework to enhance the relevance of these metrics for patients.
Background: Following the adoption of new nomenclature for steatotic liver disease, we aimed to build consensus on the use of International Classification of Diseases codes and recommendations for future research and advocacy.
Methods: Through a two-stage Delphi process, a core group (n = 20) reviewed draft statements and recommendations (n = 6), indicating levels of agreement. Following revisions, this process was repeated with a large expert panel (n = 243) from 73 countries.
Background: A wide range of ablative and non-surgical therapies are available for treating small hepatocellular carcinoma in patients with very early or early-stage disease and preserved liver function.
Objective: To review and compare the effectiveness of all current ablative and non-surgical therapies for patients with small hepatocellular carcinoma (≤ 3 cm).
Design: Systematic review and network meta-analysis.
Background & Aims: Non-surgical therapies are frequently used for patients with early or very early hepatocellular carcinoma (HCC). The aim of this systematic review and network meta-analysis (NMA) was to evaluate and compare the effectiveness of ablative and non-surgical therapies for patients with small HCC.
Methods: Nine databases were searched (March 2021) along with clinical trial registries.
Introduction: The increasing availability of non-invasive tests (NITs) has created the opportunity to explore their use in improving risk stratification of advanced liver disease. The study aimed to determine the attitudes and practices among UK secondary care specialists, focusing primarily on attitudes to fibrosis assessment and the use of NITs.
Methods: Two web-based surveys were circulated, first between 2014 and 2015 (survey 1), and again in 2021 (survey 2).
Background: Alcohol-associated liver disease (ALD) is a common cause of morbidity and premature mortality. To date, there has been no systematic synthesis of the prevalence of ALD. This systematic review was done with the aim of reporting the prevalence of ALD across different health care settings.
View Article and Find Full Text PDFResearch developing and testing interventions that address the social determinants of liver disease are urgently needed; however, this cannot be achieved using conventional clinical research designs. A different approach is needed to conduct widely applicable, inclusive, and community-based research that addresses upstream factors driving liver morbidity. Natural experimental studies encompass a well-established field of research methodology that is less familiar to clinical hepatologists than conventional research methods such as the randomized control trial.
View Article and Find Full Text PDFBackground And Aims: Beta-blockers have been studied for the prevention of variceal bleeding and, more recently, for the prevention of all-cause decompensation. Some uncertainties regarding the benefit of beta-blockers for the prevention of decompensation remain. Bayesian analyses enhance the interpretation of trials.
View Article and Find Full Text PDFObjective: Hepatocellular carcinoma (HCC) incidence in the UK trebled between 1997 and 2017. With increasing numbers requiring treatment, understanding the likely impact on healthcare budgets can inform service planning and commissioning. The aim of this analysis was to use existing registry data to describe the direct healthcare costs of current treatments for HCC and estimate the impact on National Health Service (NHS) budgets.
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