Hepatology
Expert perspectives on liver disease, viral hepatitis, cirrhosis management, and liver transplantation.
Recent Discussions
What patient clinical factors do you find most impact a patient's "beta-blocker window" and their ability to maintain and tolerate beta-blocker therapy?
Hypotension (SPB<90), bradycardia (HR <50) and refractory (grade 3) ascites are typically considered triggers to at least hold but likely stop NSBB. On the other end of the window, evidence of clinically significant portal hypertension (CSPH) is the typical trigger to consider starting NSBB treatmen...
How do you foresee the integration of artificial intelligence in the management and evaluation of patients with liver lesions/tumors?
I believe it will have a major impact on the diagnosis, prognosis and response to therapy in the future for liver lesions.
When would you plan to biopsy a hepatic adenoma to see if it has high risk features/mutations?
Washout, male, imaging features to suggest beta-catenin-mutated adenoma, such as heterogeneous Eovist uptake.
What pre-transplant patient factors impact surveillance intervals and methods after liver transplant for HCC?
Both pre-transplant and explant characteristics help to predict the risk of recurrence of HCC post liver transplant. The AFP at the time of liver transplant is a well-known risk factor for tumor recurrence. So much so that an AFP > 1000 ng/ml is a disqualification for a HCC MELD upgrade in UNOS at t...
What patient factors impact your selection of initial therapies in patients with localized cholangiocarcinoma?
Tumor factors (size, location), presence of cirrhosis, liver function, other co-morbidities, and functional status.
How do you approach risk of development of PTLD in liver transplant recipients with positive EBV antibodies and/or viral loads?
The highest risk of developing EBV-associated PTLD in liver transplant recipients is in those who were not exposed before transplant, such as a recipient who is EBV IgG negative who receives a liver from a positive donor or who acquires EBV in another fashion post-liver transplant, most commonly in ...
How do you counsel patients on the use of marginal organs and/or high risk donors who are on the liver transplant wait list?
We have patients sign consents to accept HCV (+) donors or DCD after consultation with a transplant surgeon. However, we will probably be changing this practice with the advent and use of machine perfusion. More and more patients will be receiving such donor organs now and in the future, frankly, no...
With an increase in the prevalence of MASLD in the United States population, what recipient and donor characteristics do you find favorable for acceptance of a highly steatotic graft?
There are many different clinical and biochemical features that our surgical colleagues assess when considering potential donor liver grafts, the degree of histological steatosis being one of them. Concurrent presence of fibrosis on biopsy is important to consider, as well as the degree of micro- an...
What patient features would favor the creation of a Hutson loop intra-operatively?
Our transplant surgeons have been creating Hutson loops in most patients with Roux-Y anastomosis at transplant (most are PSC with CBD involvement).It has greatly facilitated a direct approach through the loop for biliary issues, skipping the need for long ERCP approaches to reach the anastomosis. Th...
How do you incorporate other pharmacologic bariatric/appetite suppressants in the context of their clinical care plan for MASLD?
Patients with MASLD have different risk factors and drivers of disease (obesity, diabetes, eating disorders, etc). I lend personalized and individualized care when developing a care plan for patients with MASLD, including the risks, benefits, and alternatives to bariatric surgery (for those patients...