No abstract

Alcohol-associated liver disease has seen a significant rise in the last 2 decades, with an associated rise in the need for accurate alcohol use assessment. Alcohol use has been associated with poor outcomes in both the pre-liver transplant and post-liver transplant patients. Patients with alcohol use disorder often under-report their alcohol consumption because of varying factors, highlighting the need for objective assessment of alcohol use. Aside from the available self-report questionnaires, multiple serologic biomarkers are currently available to assist clinicians to assess recent alcohol consumption among patients with chronic liver disease, liver transplant candidates, and recipients. In this review, we will assess some of these alcohol biomarkers, discuss their strengths and weakness, and review-available data to discuss their role in pre-liver transplant and post-liver transplant population.

Introduction: Portal vein thrombosis (PVT) results in significant morbidity and mortality in patients with cirrhosis. Data on the safety and efficacy of anticoagulation for PVT prevention is limited, and there remains no consensus in clinical guidelines on the appropriateness of prophylactic anticoagulation for PVT. We performed a systematic review and meta-analysis on outcomes following anticoagulation as PVT prophylaxis in cirrhosis. Methods: Pubmed, Embase, and Web of Science were searched from inception to February 13, 2022 for relevant studies. Full length studies comparing anticoagulation to other modalities as prophylaxis against PVT in cirrhosis with at least n510 patients were included for analysis. Pooled odds ratios (OR) were calculated using a random-effects model for PVT development, bleeding events, and all-cause mortality. Heterogeneity among included studies was assessed using I 2 statistics and Cochran Q test. Low heterogeneity was defined as I 2 , 50% and Cochran Q p value .0.10. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB2) and the Risk of Bias in Non-randomized Studies -of Interventions (ROBINS-I) tool. Results: Our literature search revealed 1,516 records of which 572 duplicates were removed, yielding 944 records for screening. Six studies (n5407) examining prophylactic anticoagulation for PVT were included for analysis, of which two were randomized controlled trials (RCTs) and four were observational studies. Four studies specifically examined prophylactic anticoagulation in patients undergoing laparoscopic splenectomy. Anticoagulation was associated with decreased PVT development (OR 0.18; 95% CI 0.10-0.30) with low heterogeneity (I 2 50%; p50.48), no significant difference in bleeding events (OR 0.91; 95% CI 0.35-2.38) with low heterogeneity (I 2 50%; p50.72), and no significant difference in all-cause mortality (OR 0.64; 95% CI 0.26-1.60) with low heterogeneity (I 2 50%; p50.59). (Figure ) Conclusion: Anticoagulation is effective as prophylaxis against the development of PVT in patients with cirrhosis. Although anticoagulation was associated with lower rates of PVT development, there was no observed difference in bleeding event occurrence or survival. Additional studies will be necessary in order to better characterize the clinical utility of anticoagulation for PVT prevention, and to identify which patients would most benefit from anticoagulation.[1374] Figure 1. Forest plots for rate of (A) portal vein thrombosis development, (B) bleeding events, and (C) all-cause mortality following the use of anticoagulation as prophylaxis against portal vein thrombosis in cirrhosis.

Introduction: Many non-invasive scores have been proposed for predicting the presence of esophageal varices (EV) in patients with compensated advanced chronic liver disease(cACLD),to avoid unnecessary esophagogastroduodenoscopy (EGD). No extensive studies have described real-world experience with non-invasive scores Methods: In cross-sectional analysis from Jan 2015 and Dec 2021,we studied Baveno VI criteria (liver stiffness .20 kPa & platelet count , 150X109cells/L), exp Baveno VI criteria (liver stiffness .25 kPa & platelet count, 110 X109cells/L), CHESS ALARM score (Model50.0333Age-0.5983Male-0.0183Platelet10.0323liver stiffness), APRI score and FIB-4 score in predicting the presence of EV,varices needing treatment (VNT) in cACLD patients, in Mid-West United States Results: Of 424 patients(42.8%males,mean age59.2612.5 years,78.3%Caucasian and 14.9%Afro American). Etiology of cACLD was NAFLD (55.3%),chronic hepatitis C (32.7%),alcohol (23.1%). EV present in 126 (29.7%), VNT in 32 (7.5%). 221 patients(52%) met Baveno VI criteria and 173(40.7%) met exp Baveno VI criteria. Among patients with EV on EGD, 87.7% met Baveno VI criteria, and 77.4% met exp Baveno VI criteria. Of all patients who had VNT (n532), 85.7 % met expanded Baveno criteria. Baveno VI criteria (p, 0.001), expanded Baveno VI criteria (p, 0.001) and CHESS-ALARM score (p, 0.001, at cut off .0.37) independently correlated with presence of EV on logistic regression analysis. Baveno VI criteria had a predictive accuracy of 93.1% to rule out EV, and exp Baveno VI criteria had a predictive accuracy of 98.3% to rule out VNT. On comparison of non-invasive scores, predictive accuracy (AUROC) for EV on EGD was highest for CHESS-ALARM score (0.82, CI50.77 to 0.86), then FIB-4 (0.80, CI50.76 to 0.85), APRI (0.76, CI50.72 to 0.81) and lowest for MELD-NA (0.66, CI50.60 to 0.72). CHESS-ALARM score at -0.36 with sensitivity 82.9% and specificity 70% to predict EV. AUROC for predicting VNT on EGD was highest for CHESS-ALARM score (0.79, CI50.72 to 0.86), followed by FIB-4 (0.78, CI50.72 to 0.85), APRI (0.73, CI50.66 to 0.81), and the lowest for MELD-NA (0.66, CI50.58 to 0.74). CHESS-ALARM score of -0.36 has sensitivity of 90.2 and specificity of 66.2% to predict VNT Conclusion: Baveno VI criteria has high predictive accuracy in ruling out EV in cACLD. Expanded Baveno VI criteria has high accuracy to rule out VNT. CHESS-ALARM score has high predictive accuracy for identifying EV and VNT. Application of these scores could reduce the burden of EGD in cACLD. (Figure ) [1169] Figure 1. Comparison of noninvasive scores for predicting esophageal varices and varices needing treatment. A: ROC for predicting esophageal varices, B: ROC for predicting varices needing treatment S1170 Anticoagulation for the Treatment of Portal Vein Thrombosis in Patients With Cirrhosis: A Systematic Review and Meta-Analysis