http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/17-4-reading-leung a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/17-4-interview-leung the interview with the author

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Background. Available treatments for Wilson disease (WD) prevent longterm complications of copper accumulation. Current anti-copper agents include zinc salts, penicillamine, and trientine. Patients with WD may switch between the agents for a number of reasons. Due to the different mechanisms of action between the copper chelators and zinc salts, transitioning could require a period of overlap and increased monitoring. There are no large studies that investigate the best transition strategies between agents. In this article, we review the treatments for WD and how to monitor for treatment efficacy. Case Summary. The patient had been diagnosed with WD for over 20 years prior to establishing care in our Hepatology Clinic. During his initial course, he was transitioned from penicillamine to zinc due to evidence suggesting penicillamine had greater adverse effects in the long term. Later, he was switched to trientine. His liver enzymes and 24-hour urine copper were monitored. During these years, he intermittently had some financial hardship, requiring him to be on penicillamine rather than trientine. He also had developed acute kidney injury. Overall, his liver disease remained under control and he never had signs of decompensated cirrhosis, but had fluctuations of liver enzymes over the years. Conclusion. Anti-copper treatment for WD has to be tailored to medication side effects profile, patient’s chronic and emerging comorbidities, as well as costs. Transitioning regimens is often challenging, and it requires closer monitoring, with no predictors of response.

Rationale for hepatic artery infusion (HAI) chemotherapyThere are approximately 150,000 new cases of colorectal carcinoma diagnosed annually in the United States (1). Approximately 25% of patients present with metastatic disease at the time of diagnosis (2) and over 50% will develop metastasis to the liver at some point in their lifetime (3). Five-year overall survival (OS) in metastatic colorectal cancer (CRC) confined to the liver is approximately 20%, although complete resection can increase 5-year survival to over 50% in selected series (4-7).Liver resection provides the only chance for cure in patients with colorectal liver metastases (CRLM), however, only 15-20% of patients with CRC metastases confined to the liver are deemed resection candidates at presentation. Most patients with CRC die from metastatic disease, and two-thirds of CRC deaths are due to liver metastases (8).For patients with initially unresectable CRLM, regional treatment of metastatic disease has been a topic of considerable interest given the underwhelming response rates to systemic chemotherapy alone with median survival of roughly 20 months (9). First line systemic chemotherapy for metastatic CRC includes a fluoropyrimidine combined with other agents in various schedules (10). Despite the advances of modern combination regimens [e.g., 5-FU/ leucovorin/oxaliplatin (FOLFOX), 5-FU/leucovorin/ irinotecan (FOLFIRI) and 5-FU/leucovorin/oxaliplatin/ irinotecan (FOLFOXIRI) and targeted therapies including anti-epidermal growth factor receptor (EGFR) for RAS wild-type tumors, and anti-vascular endothelial growth

Background We provide detailed analysis and outcomes in patients post‐kidney transplant (KT) developing ascites, which has never been categorically reported. Methods Ascites was identified by ICD9/10 codes and detailed chart review in patients post‐KT from 01/2004‐06/2019. The incidence of patient death and graft loss were determined per 100‐person‐years, and the incidence rate ratio was obtained. Results Of 3329 patients receiving KT, 83 (2.5%) patients had new‐onset ascites, of whom 58% were male, 21% blacks, and 29% whites. Seventy‐five percentage were on hemodialysis. Patients were maintained primarily on tacrolimus and mycophenolate for immunosuppression. Only 14% of patients with ascites had the appropriate diagnostic workup. There was a trend toward an increased mortality in patients with ascites (incidence rate ratio, IRR [95% CI]: 1.8 [0.92, 3.19], p = .06), and a significantly higher incidence of graft loss (IRR: 5.62 [3.97, 7.76], p < .001), compared with non‐ascites patients. When classified by ascites severity, determined by imaging, moderate/severe ascites patients had the worst clinical outcomes, with a mortality of 32% and graft failure in 57%, compared with 9% and 10%, respectively, in those without ascites. Conclusion In this large cohort employing stepwise analysis of ascites post‐KT, worse outcomes were noted, dictating the need for optimized management to improve clinical outcomes.