A prospective multicenter validation of RETREAT for post-transplantation hepatocellular carcinoma recurrence prediction.

Background: The RETREAT score is a simple risk stratification tool for post-liver transplantation (LT) hepatocellular carcinoma (HCC) recurrence that has been validated in retrospective cohort studies. A prospective, multicenter study is needed to further demonstrate accuracy especially given evolving clinical demographics and HCC transplant practice.

Aim: To validate and compare the RETREAT score to other post-LT HCC recurrence risk scores in a contemporary, prospective cohort of patients.

Longer travel and traffic are associated with adult liver transplant waitlist mortality in the United States.

Transportation to transplant centers is a barrier to liver transplantation (LT). We analyzed the impact of travel metrics on LT waitlist outcomes in the United States. A total of 83 640 adult LT candidates in the Scientific Registry of Transplant Recipients database (2013-2021) were included.

Experiences of gender-affirming practices in healthcare settings and HIV testing among transgender and nonbinary young adults in the United States.

Transgender and nonbinary young adults in the United States (U.S.) experience disproportionately high rates of HIV and face unique barriers to accessing HIV testing, a key component of HIV prevention.

Role of Cardiovascular Deaths on Changes in the Longevity Gap Between U.S. and Other Countries.

Introduction: Between 2008 and 2019 the gap in life expectancy between the U.S. and other high-income countries grew significantly, with the reasons for the growth remaining unknown.

Neoadjuvant atezolizumab plus bevacizumab prior liver transplantation for hepatocellular carcinoma.

Background & Aims: The combination of atezolizumab and bevacizumab offers a novel approach to immunomodulation, showing efficacy as a primary treatment in advanced hepatocellular carcinoma (HCC). Concerns about graft safety and rejection have limited its exploration in the neoadjuvant setting of liver transplantation (LT). In this study, we investigate the clinical efficacy and the safety profile of pre-transplant administration of atezolizumab and bevacizumab for HCC.

Association Between Health Care Discrimination and Medical Mistrust Among Black Assigned Female at Birth Adults with Minoritized Sexual and Gender Identities in the United States.

Black sexually and gender minoritized (SGM) people who were assigned female at birth (AFAB) experience compounding health care inequities, barriers to equitable care, and disproportionately adverse health outcomes. Given prior literature indicating that both experienced and/or anticipated reported health care discrimination and medical mistrust may shape these health care experiences of Black SGM AFAB people, we sought to investigate the specific interplay between these two factors to bolster understanding of their relationship. In January and February 2023, we conducted a cross-sectional online survey of 156 Black SGM AFAB adults in the United States (U.

DAA-PASS: A Prospective Evaluation of HCC Recurrence After Direct Acting Antiviral Therapy.

Direct-acting antiviral (DAA) therapy is associated with a significant reduction in hepatocellular carcinoma (HCC) incidence among patients with cirrhosis, but data are conflicting about the risk of recurrence following DAA therapy. DAA-PASS was a prospective, pragmatic, observational study designed to estimate the risk of HCC recurrence associated with DAA therapy exposure during routine clinical care. Eligible patients were DAA treatment naive with Barcelona Clinic Liver Cancer (BCLC) stage A.

Differential aging trends among candidates for liver transplant with and without HCC.

HCC has become a leading indication for liver transplant (LT), with HCC registrants increasing more than 6-fold in the past 2 decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older patients with HCC are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger patients with HCC, and patients without HCC.

Downstaging of hepatocellular carcinoma before liver transplantation: Results from a national multicenter prospective cohort study.

Background And Aims: Patients with HCC meeting United Network for Organ Sharing (UNOS)-downstaging (DS) criteria have excellent post-liver transplantation (LT) outcomes. Studies on HCC beyond UNOS-DS criteria ("All-Comers" [AC]) have been limited by small sample size and short follow-up time, prompting this analysis.

Approach And Results: Three hundred twenty-six patients meeting UNOS-DS and 190 meeting AC criteria from 9 LT centers across 5 UNOS regions were enrolled from 2015 to 2023 and prospectively followed.

Twelve tips on applying AI tools in HPE scholarship using Boyer's model.

AI has changed the landscape of health professions education. With the hype now behind us, we find ourselves in the phase of reckoning, considering what's next; where do we start and how can educators use these powerful tools for daily teaching and learning. We recognize the great need for training to use AI meaningfully for education.

Creating custom GPTs for faculty development: An example using the Johari Window and Crucial Conversation frameworks for providing feedback to struggling students.

Feedback plays a crucial role in the growth and development of trainees, particularly when addressing areas needing improvement. However, faculty members often struggle to deliver constructive feedback, particularly when discussing underperformance. A key obstacle is the lack of comfort many faculty experience in providing feedback that fosters growth.

Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment.

Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.

Value of HCC surveillance in a landscape of emerging surveillance options: Perspectives of a multi-stakeholder modified Delphi panel.

HCC surveillance is recommended by liver professional societies but lacks broad acceptance by several primary care and cancer societies due to limitations in the existing data. We convened a diverse multidisciplinary group of cancer screening experts to evaluate current and future paradigms of HCC prevention and early detection using a rigorous Delphi panel approach. The experts had high agreement on 21 statements about primary prevention, HCC surveillance benefits, HCC surveillance harms, and the evaluation of emerging surveillance modalities.

Enhancing the prognostic accuracy of the RETREAT score with AFP-L3 and DCP tumor markers.

The RETREAT (Risk Estimation of Tumor Recurrence After Transplant) Score is a validated tool to predict post-transplant HCC recurrence risk. Alpha-fetoprotein (AFP) bound to Lens culinaris agglutinin (AFP-L3) and des-gamma-carboxyprothrombin (DCP) measured at transplant predict worse post-LT survival and may improve the RETREAT score. Our cohort comprised 284 patients transplanted for HCC who were within or downstaged to Milan, with 23 (8.

Reflections From the Pandemic: Is Connectivism the Panacea for Clinicians?

The COVID-19 pandemic and the recent increased interest in generative artificial intelligence (GenAI) highlight the need for interprofessional communities' collaboration to find solutions to complex problems. A personal narrative experience of one of the authors compels us to reflect on current approaches to learning and knowledge acquisition and use solutions to the challenges posed by GenAI through social learning contexts using connectivism. We recognize the need for constructivism and experiential learning for knowledge acquisition to establish foundational understanding.

Model of Urgency for Liver Transplantation in Hepatocellular Carcinoma: A Practical Model to Prioritize Patients With Hepatocellular Carcinoma on the Liver Transplant Waitlist.

Background & Aims: Currently, patients with hepatocellular carcinoma (HCC) in the United States are assigned a uniform score relative to the median Model for End-Stage Liver Disease (MELD) at transplant after a minimum 6-month waiting period. The authors developed a risk stratification model for patients with HCC using the available and objective variables at time of listing.

Methods: Adult liver transplant candidates with approved HCC exception in the Organ Procurement and Transplantation Network database from 2015-2022 were identified.

Economic Disadvantage During Childhood, Obesity, and Diabetes Across Three Birth Cohorts of Older Mexicans.

Objectives: Diabetes prevalence has increased markedly in Mexico. We examined the individual and joint contributions of economic disadvantage during childhood (EDDC) and elevated body weight on diabetes prevalence in 3 cohorts of Mexican adults.

Methods: Data on those 60-69 years old from the 1930-1939, 1940-1949, and 1950-1959 birth cohorts in Waves 1 (2001), 3 (2012), and 5 (2018) of the Mexican Health and Aging Study were used.

Pervasive Stagnation: Flat and Rising Cardiovascular Disease Mortality Post-2010 Across US States and Counties.

Since 2010, the U.S. has experienced adverse trends in cardiovascular disease (CVD) mortality, which dramatically slowed long-standing life expectancy improvements.

Analysis of treatment benefits and prognostic factors for posttransplant HCC recurrence in a large Euro-American-Asian cohort.

Posttransplant HCC recurrence significantly impacts survival, yet its management is challenging due to limited evidence. With recent advancements in HCC treatment, updated data on managing recurrent diseases are needed. In this retrospective study across 6 centers (2000-2022), we employed Cox proportional-hazards regression and log-rank tests to assess survival differences.