prevalent in the West, there has been an increasing incidence in Asian countries in the last two decades. 2,3 The treatment of IBD primarily involves immunosuppressive and immunomodulatory drugs. This not only increases the chance of prevalence of various chronic infective diseases like chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) but also may lead to reactivation of the latter disease. [4][5][6] This will have more impact on Asian countries due to the moderately high prevalence of HBV infection. 7 Therefore, screening for chronic HBV and HCV is crucial before starting the immunosuppressive treatment in IBD. Nonalcoholic fatty liver disease is becoming more com-

Background. Paired exchange liver transplantation is an evolving strategy to overcome ABO blood group incompatibility and other barriers such as inadequate graft-to-recipient weight ratio and low remnant liver volume in donors. However, for the transplant team to carry 4 major operations simultaneously is a Herculean effort. We analyzed our experience with liver paired exchange (LPE) program over the past 9 y. Methods. This prospective study included 34 of 2340 (1.45%) living donor liver transplantations performed between May 2012 and April 2021. The reason for LPE was ABO incompatibility in all (n = 34) patients included in the study. After donor reassignment through 2-by-2 paired exchange with directed donors, the ABO matching status changed from A to A (n = 17) and B to B (n = 17), which made all matches ABO-identical. Recipients (R) and donors (D) of each swap pair were prospectively divided into R1/D1 and R2/D2 groups for comparative and survival analyses. Results. The recipients (n = 34) had a median age of 45.5 y (11–59 y), and 31 were men. LPEs were performed in 4 operating rooms running simultaneously by 2 independent surgical teams. Donor survival was 100%. Baseline clinical and perioperative parameters, postoperative complications, median intensive care unit/hospital stay, and early deaths were comparable (P > 0.1) between the R1 and R2 groups. The median follow-up period was 27 mo (1–108 mo). The 30-d and 1-y survivals were 88.2% (n = 30) and 85.3% (n = 29), respectively. Conclusions. Our experience suggests that with careful attention to ethical and logistical issues, the LPE program can expand the living donor liver pool and facilitate a greater number of living donor liver transplantations.

No abstract

Editors,We read with great interest the recent article by Brandman et al. 1 comparing the clinical prediction rules for excluding biopsy-proven cirrhosis in nonalcoholic fatty liver disease (NAFLD) and defining new cut-offs. For all prediction rules, the authors reported comparable high negative predictive values (NPV) (0.95-0.97). FIB-4 and NAFLD fibrosis scores were the most accurate in characterising patients as having cirrhosis in both the derivation as well as validation cohort, particularly those who are white, female and aged <65 years.However, there are a few issues that need to be addressed.

Chronic hepatitis B virus (HBV) infection is a global public health problem leading to liver failure, cirrhosis and hepatocellular carcinoma. [1][2][3] Chronic HBV infection and its complications contribute to approximately 780,000 deaths annually. 4,5 One of the most common causes of cancer-related deaths worldwide is hepatocellular carcinoma (HCC), with a high incidence in Asia compared to the rest of the world, mainly due to chronic HBV infection. 6,7 The development of these complications and mortality can be reduced by nucleos(t) ide analogues (NAs). Tenofovir disoproxil fumarate [TDF], Tenofovir alafenamide [TAF] and Entecavir (ETV) are the recommended firstline drugs for the management of chronic HBV infection due to their high barrier to resistance along with high antiviral potency. 8,9 The prevention of HCC in chronic HBV patients is essential to managing these patients. A meta-analysis by Cheung et al 10 reported a lower