Critical care outcomes in decompensated cirrhosis: a United States national inpatient sample cross-sectional study.

Background: Prior assessments of critical care outcomes in patients with cirrhosis have shown conflicting results. We aimed to provide nationwide generalizable results of critical care outcomes in patients with decompensated cirrhosis.

Methods: This is a retrospective study using the National Inpatient Sample from 2016 to 2019.

High rifaximin out-of-pocket costs are associated with decreased treatment retention among patients with hepatic encephalopathy.

Background And Aims: Hepatic encephalopathy (HE) is associated with significant morbidity and mortality for those with cirrhosis. Despite the known benefits of rifaximin use for HE, treatment retention remains low. This study aimed to evaluate the impact of out-of-pocket (OOP) rifaximin cost on treatment retention among commercially insured patients in the United States.

Factors Associated With Adherence to First-line Antiviral Therapy Among Commercially Insured Patients With Chronic Hepatitis B.

Background: Nonadherence to antiviral therapy can lead to poor clinical outcomes among patients with chronic hepatitis B (CHB). We used a claims database to evaluate risk factors for nonadherence to antiviral therapy among commercially insured patients with CHB in the United States.

Methods: We obtained data for commercially insured adult patients with CHB prescribed entecavir or tenofovir disoproxil fumarate (TDF) in 2019.

Outcomes of patients with acute liver failure listed for liver transplantation: A multicenter prospective cohort analysis.

Liver transplantation (LT) is a life-saving treatment for patients with acute liver failure (ALF). Currently, there are few detailed data regarding long-term outcomes after LT for ALF. We combined prospective data from the Acute Liver Failure Study Group (ALFSG) Registry with those of the Scientific Registry of Transplant Recipients (SRTR) to assess outcomes among consecutive patients with ALF listed for LT.

Understanding immune perspectives and options for the use of checkpoint immunotherapy in HCC post liver transplant.

Treatment modalities for hepatocellular carcinoma (HCC) vary from surgical techniques and interventional radiologic strategies to systemic therapy. For the latter, the use of immune checkpoint inhibitors (ICIs) has gained popularity due to successful trials showing increased survival. In patients who have undergone liver transplantation, recurrence of HCC poses a significant challenge.

Trends in Pricing and Out-of-Pocket Spending on Entecavir Among Commercially Insured Patients, 2014-2018.

This cross-sectional study of health claims from patients with private insurance examines trends in the cost of entecavir prescribed for chronic hepatitis B treatment.

L-Asparaginase-Induced Hepatotoxicity Treated Successfully With L-Carnitine and Vitamin B Infusion.

Asparaginase plays an integral role in chemotherapy for acute lymphoblastic leukemia (ALL). We present a 69-year old woman with refractory ALL, who developed asparaginase-induced hepatotoxicity and cholangiopathy after starting intravenous PEG-L-asparaginase-based chemotherapy. The patient was ultimately treated with the combination of L-carnitine and vitamin B complex, resulting in normalization of liver enzymes levels.

Thyroid Disease-Induced Hepatic Dysfunction: A Clinical Puzzle.

The diagnostic evaluation of an individual with clinical and laboratory evidence of thyroid dysfunction in the setting of acute liver injury is crucial. There is a complex relationship between the thyroid and the liver, and so, it requires a careful elucidation of the inciting disease process before instituting a treatment plan. We discuss a patient who had presented with coagulopathy, encephalopathy, and laboratory evidence of acute liver injury, hence adjudged to have developed drug-induced acute liver failure and transferred for liver transplant evaluation.

Improving Hepatitis B Care in the US: A Case for a New "Ryan White" Program.

Chronic hepatitis B infection is common in the United States, yet only a minority of eligible people are screened, vaccinated, and receive treatment. The Ryan White HIV/AIDS program has been a key tool for ensuring that socioeconomically disadvantaged HIV-infected patients have access to care. Many of the same disease and patient attributes that make the Ryan White program necessary and effective for HIV exist in chronic hepatitis B.

Predictors of Survival After Liver Transplantation in Patients With the Highest Acuity (MELD ≥40).

Objective: To identify factors that accurately predict 1-year survival for liver transplant recipients with a MELD score ≥40.

Background: Although transplant is beneficial for patients with the highest acuity (MELD ≥40), mortality in this group is high. Predicting which patients are likely to survive for >1 year would be medically and economically helpful.

Comparison of Clinical Outcomes of Induction Regimens in Patients Undergoing Liver Transplantation for Acute Liver Failure.

Spontaneous survival rates in acute liver failure (ALF) are vastly improved by liver transplantation (LT). However, the value of induction agents beyond steroids continues to be debated. To understand the potential benefit of different induction regimens in the ALF population, we compared overall survival of recipients undergoing LT in the United States for ALF.

Changes in liver allocation in United States.

Purpose Of Review: United States has seen several significant changes in liver allocation. The aim of this review is to focus on those changes.

Recent Findings: The success of liver transplantation led to its wider applicability for patients with end-stage liver disease.

Acetaminophen is Undetectable in Plasma From More Than Half of Patients Believed to Have Acute Liver Failure Due to Overdose.

Background & Aims: Evaluation of patients with acute liver injury (ALI) or acute liver failure (ALF) often includes measurement of plasma levels of acetaminophen, to determine exposure and/or toxicity. However, once liver injury has developed, acetaminophen might be undetectable in plasma. We investigated the association between level of acetaminophen measured and outcomes of patients designated as having ALF or ALI due to acetaminophen toxicity.

What a Nephrologist Needs to Know About Acute Liver Failure.

Although relatively rare in the United States, acute liver failure (ALF) is associated with very high rates of morbidity and mortality. A leading cause of morbidity and mortality is cerebral edema and intracranial hypertension. Hypothermia, osmotic diuretics, and hyperosmolar therapy are commonly used to manage these complications; however, when these are ineffective, renal replacement therapy may be needed for volume management.