Academic hepatology capacity in Latin America is highly heterogeneous, yet no standardized regional framework exists to quantify structural differences across countries. We aimed to develop and apply the Global Academic Hepatology Capacity Index (IGCAH), a composite metric integrating academic, clinical, and research dimensions, to characterize cross-country inequities in the region. National hepatology societies from 20 Latin American countries completed a 54-item structured survey. Five domain indices: human capacity, academic training, scientific productivity, clinical complexity, and collaboration/networking, were constructed using standardized z-scores and integrated into the IGCAH. Findings were triangulated with bibliometric analysis of PubMed-indexed hepatology publications (2015-2025) and thematic analysis of abstracts submitted to the ALEH 2025 Congress. Complete responses were obtained from all 20 countries. The five highest-performing countries concentrated over 80% of the hepatology workforce, formal training programs, research infrastructure, and access to advanced therapies (IGCAH >0.8). Overall, 55% of countries lacked formal specialty recognition, 45% reported absence of essential laboratory infrastructure, and only 50% met criteria for sufficient diagnostic and therapeutic complexity. Clinical services were centralized in ≤2 major cities in 70% of countries, and ten reported ≤2 national liver disease registries. Scientific productivity was highly concentrated, with four countries accounting for approximately 85% of PubMed-indexed hepatology publications, while more than half produced ≤5 papers annually. ALEH 2025 abstracts mirrored these disparities, with 75% originating from five countries; most were observational and clinical trials were scarce. Profound asymmetries characterize academic hepatology in Latin America. The IGCAH provides a robust framework to identify structural gaps and guide targeted, stage-specific capacity strengthening.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease but remains widely under-recognized in primary care. The 2023 shift from "nonalcoholic fatty liver disease" to MASLD emphasized metabolic dysfunction as a driver of disease but introduced new communication and educational challenges for primary care providers (PCPs). We aimed to assess PCPs' awareness, risk assessment, and management practices related to MASLD in the four most populous U.S. cities. A cross-sectional online survey was conducted from 5 to 13 September 2024 among 800 primary care providers (PCPs; n = 200 per city) in New York City, Los Angeles, Chicago, and Houston. Participants included physicians, physician assistants, nurse practitioners, and other primary care professionals. The survey assessed awareness of "MASLD" and "fatty liver disease", risk assessment practices for high-risk groups, patient discussions, management strategies, and the use of patient-reported outcomes (PROs). Descriptive statistics characterized sample responses, and logistic regression models identified correlates of awareness. Overall, 54.7% of PCPs reported awareness of MASLD and 86.6% were aware of fatty liver disease. Awareness of MASLD was highest among physicians (81.3%) and hospital-based practitioners (odds ratio [OR] = 2.02, 95% confidence interval [CI] 1.02-4.02) and lowest among nurse practitioners (OR = 0.21, 95% CI 0.09-0.49). Awareness of fatty liver disease increased with provider age (OR = 1.04, 95% CI 1.00-1.08). Lifestyle modification was the most recommended management approach (41.3-65.5%), while referral rates to specialists and PRO use varied substantially across cities, and 48.5% were aware of the FIB-4 Index. Only half of PCPs recognized the term MASLD, highlighting gaps in awareness and clinical practice following the mid-2023 terminology change. Targeted educational initiatives and standardized implementation of MASLD guidelines in primary care are needed to improve timely detection and management of this highly prevalent condition.
Cirrhosis is a major global public health concern. In South America, previous studies have identified alcohol-related liver disease (ALD) and chronic hepatitis C as the leading causes. This study describes and characterizes a contemporary South American cohort of patients with cirrhosis, focusing on the current spectrum of etiologies, demographic aspects, and the frequency of complications. This was a multicenter, retrospective cohort study conducted across 11 centers in 6 South American countries. Patients included were adults (>18 years) with confirmed cirrhosis, and a minimum of two follow-up visits. A total of 1780 patients (50.7% male, median age 61 years) were evaluated. Metabolic dysfunction-associated steatotic liver disease (MASLD) was the leading cause of cirrhosis (34.1%), followed by viral etiology (19.8%), autoimmune liver disease (18%), and ALD alone (16%). Comorbidities were highly prevalent, with self-reported alcohol intake in 37.8%, hypertension in 36.2%, and diabetes in 33.7%. Nearly two-thirds of patients (63.5%) developed at least one complication, with ascites being the most common (43.5%). Only 28.1% of the cohort underwent pre-transplant evaluation. In this contemporary South American cohort, MASLD has emerged as the leading cause of cirrhosis, and autoimmune disease affected nearly one-fifth of individuals with cirrhosis. The high burden of complications, with nearly two-thirds of patients developing at least one, and the low rate of pre-transplant evaluation suggest a significant unmet need for timely diagnosis and advanced care in the region.
The gut and the liver are the main organs in the regulation and distribution of zinc. Therefore, gut and liver disease impact zinc functions in other organs. Many of the phenomenological observations made in the past century concerning the role of zinc in growth and development and the role of zinc deficiency in many diseases are now better understood on the basis of zinc's remarkable catalytic, structural, and regulatory functions in over 3200 human proteins and its functions as an ionic messenger similar to calcium in intra- and extracellular communication, regulation of metabolism, and gene expression. Zinc has key roles in carbohydrate and lipid metabolism, nitrogen balance, pH control, and the synthesis and degradation of proteins. Its classification as a trace element distracts from its global significance in the proliferation and differentiation of all cells. Zinc is at least as important as iron, if not even more so. Its intricate cellular regulation by 24 membrane zinc transporters, a dozen metallothioneins and other zinc homeostatic proteins supports this tenet. This review will summarize the role of zinc in the integrity of the intestinal barrier, in maintaining a healthy gut, and, through the gut-liver axis, a healthy liver. Zinc is critical for a proper immune response to support and control inflammation, in fighting off insults and repairing tissues, but also in avoiding chronic inflammation. About 75% of patients with decompensated liver cirrhosis are zinc deficient. Zinc deficiency, a prooxidant and proinflammatory condition, needs clinical attention in liver disease, should include attention to gut health, and involve pharmacological treatment with supplemental zinc. Monotherapy with zinc alone, however, is not the answer. Along with zinc, additional therapeutics are required to restore intestinal and hepatic functions.
Perihilar cholangiocarcinoma (pCCA) is a rare and complex liver malignancy requiring specialized care in academic centers and multidisciplinary teams (MDTs). This study aimed to evaluate the impact of academic centers, academic MDTs, and regional collaboration on treatment outcomes. Patients with pCCA between 2017 and 2021 were identified from the Dutch Cancer Registry. The impact of center of initial diagnosis, including academic and non-academic center, and the involvement of academic MDTs were analyzed. Outcomes included tumor-directed therapy and overall survival (OS). In total, 1365 patients were included; 155 (11.4%) initially presented in an academic centers. Initial biliary drainage in academic centers was associated with lower 90-day mortality (25.0% and 40.5%, P < 0.001) compared with non-academic centers. Initial diagnosis in an academic center was associated with higher rates of tumor-directed therapy (63.5% vs 32.0%, P < 0.001) and surgery (36.1% vs 14.7%, P < 0.001). Expert MDT evaluation, regardless of center of diagnosis, showed higher rates of tumor-directed therapy (45.5% vs 9.9%, P < 0.001) and surgery (23.8% vs 2.5%, P < 0.001). Additionally, academic MDTs were independently associated with improved OS (HR 0.55 95% CI 0.48-0.63, P < 0.001) in multivariable analysis. Patients with pCCA discussed in academic MDTs had higher rates of tumor-directed therapy and improved OS. This association may partly be explained by patient selection and referral patterns. Nevertheless, these findings emphasize the importance of regional collaboration and centralization of care to ensure that all patients benefit from specialized expertise and coordinated treatment planning.
Chronic liver disease (CLD) remains a major global health burden, driven by persistent hepatic injury that triggers inflammation, vascular dysfunction and progressive extracellular matrix (ECM) deposition. These processes disrupt the liver architecture, leading to advanced liver fibrosis or cirrhosis and increasing the risk of severe complications such as portal hypertension, hepatocarcinoma and even death. While fibrosis and cirrhosis were historically regarded as irreversible, accumulating experimental and clinical evidence now support the potential for fibrosis and even cirrhosis regression once the etiological insult is controlled. Nevertheless, fibrosis regression is not universally observed: about 25% of patients with advanced CLD and sustained hepatitis B virus suppression and over one-third of those with metabolic dysfunction-associated steatotic liver disease after bariatric surgery fail to experience fibrosis regression. Notably, fibrosis regression is often partial and slower in advanced CLD or cirrhosis, especially in decompensated stages, highlighting the need for a better understanding of the cellular and molecular mechanisms that either facilitate or restrict hepatic tissue repair. This review summarizes current knowledge on the dynamics of liver fibrosis regression, with a particular emphasis on the liver sinusoidal endothelial cell (LSEC) as a central regulator of the microenvironment. We discuss how LSEC phenotype determines interactions with hepatic stellate cells (HSCs), immune cells, and hepatocytes, thereby shaping the balance between fibrogenesis and resolution. Mechanisms such as endothelial capillarization, macrophage-driven inflammation, HSC activation and hepatocyte regeneration are examined in the context of both disease progression and regression. Special attention is given to vascular alterations, which represent a major limiting factor for recovery in advanced CLD. We also highlight recent experimental advances, including insights from extracellular vesicle-mediated communication, microenvironmental stiffness, transcriptomic studies of LSEC plasticity during regression, and novel biomarkers of fibrosis regression. Understanding the spatiotemporal orchestration of these processes may inform novel therapeutic strategies aimed at restoring vascular and parenchymal homeostasis, ultimately enabling fibrosis reversal, portal pressure reduction, and improved clinical outcomes in patients with advanced CLD.
Nonselective β blockers (NSBBs) may be involved in reducing gut-derived inflammation and intrahepatic inflammation to prevent hepatocellular carcinoma (HCC). This study aimed to systematically investigate their association. PubMed, EMBASE, and Cochrane Library databases were searched to identify all relevant studies evaluating the association of NSBBs with HCC in liver cirrhosis patients. Sensitivity analyses were performed to explore potential sources of heterogeneity. Risk ratios (RRs) and hazard ratios (HRs) were pooled. Subgroup meta-analyses were performed according to the study design, regions, type of NSBBs, and indications of NSBBs. Twenty-four studies were finally included. Overall meta-analyses demonstrated that NSBBs were associated with a significantly reduced risk of HCC development in liver cirrhosis patients (RR=0.86; P = 0.048). Sensitivity analysis did not find the source of heterogeneity. Subgroup analyses based on adjusted cohort studies with propensity-score matching (RR=0.85; P = 0.01) and multivariable regression model (HR=0.66; P < 0.00001), studies performed in America (RR=0.83; P = 0.007) and Europe (RR=0.72; P = 0.05), studies included patients receiving carvedilol (RR=0.72; P < 0.00001), nadolol (RR=0.86; P < 0.0001), and propranolol with dosage > 40 mg (RR=0.28; P < 0.00001) or follow-up duration < 20 months (RR=0.38; P = 0.04) demonstrated that NSBBs significantly decrease the risk of developing HCC in liver cirrhosis patients. However, studies included patients receiving primary or secondary prophylaxis of variceal bleeding did not reveal the protective effect of NSBBs on HCC. NSBBs may play a role in preventing the occurrence of HCC in liver cirrhosis patients. Future research should focus on risk stratification and monitoring protocols to advance personalized prevention.
Hepatic encephalopathy (HE) is a major complication after transjugular intrahepatic portal shunt (TIPS), affecting patients' quality of life. This study evaluated the efficacy of Clostridium butyricum combined with lactulose in preventing HE after TIPS. Patients were randomly divided into two groups: Clostridium butyricum plus lactulose group (trial group) and lactulose group (control group). Prophylaxis started within 24 hours post-TIPS and lasted 3 months. The primary endpoint was the occurrence of HE at 1 and 3 months after TIPS. The study also analyzed the impact on gut microbiota. No significant difference in minimal hepatic encephalopathy (MHE) incidence between the two groups. However, the trial group had a significantly lower overt hepatic encephalopathy (OHE) incidence than the control group at both one month (8.2% vs. 26.5%, P = 0.016) and three months (10.2% vs. 34.7%, P = 0.004) (HR=3.867, P = 0.008; aHR=4.819, P = 0.004). The trial group showed a higher skeletal muscle index at the third lumbar vertebra at 3 months after TIPS (42.85 ± 10.66 vs. 38.38 ± 8.61 cm²/m², P = 0.024). Combining treatment can reduce the occurrence of OHE in patients with sarcopenia (48.3% vs. 15%, P = 0.016). The abundance of butyrate-producing bacteria and the level of butyric acid in the trial group at 3 months after TIPS was significantly increased compared to the baseline. The levels of TNF-α and D-LDH in the trial group were significantly lower than those in the control group at 3 months after TIPS. Clostridium butyricum plus lactulose can significantly reduce the incidence of OHE after TIPS and improve nutritional status. In addition, combined therapy can also increase the abundance of beneficial bacteria in stool, increase the level of butyric acid in stool, and improve the inflammatory state in patients undergoing TIPS.
Chronic hepatitis C virus (HCV) infection remains a major global public health challenge. Despite the availability of highly effective therapies capable of curing the vast majority of patients, millions remain undiagnosed and often present for medical care at advanced stages of disease. This delay not only increases mortality and the burden of cirrhosis and hepatocellular carcinoma but also affects quality of life, productivity, and healthcare system costs. In this context, screening emerges as a cornerstone for achieving HCV elimination. It enables the identification of hidden cases, early treatment initiation, prevention of complications, and reduction of community transmission. At the population level, prioritizing individuals with the highest likelihood of transmitting infection produces a multiplier effect, while both universal and risk-based strategies have consistently proven cost-effective, generating medium-term savings. In Latin America, the epidemiological landscape is heterogeneous. While overall prevalence in the general population is relatively low, high endemicity persists in vulnerable groups such as people who inject drugs, incarcerated individuals, and patients undergoing hemodialysis. Major barriers include fragmented health systems, lack of clinical registries, stigma, and restricted access to diagnosis and therapy. Yet, the region also holds clear opportunities: simplified diagnostic pathways using rapid testing and reflex algorithms, micro-elimination in key populations, pooled procurement of antivirals through the Pan American Health Organization, and the integration of digital health and telemedicine. In conclusion, HCV screening constitutes both a public health necessity and an ethical obligation. Its organized and sustainable implementation is essential to translate therapeutic efficacy into collective benefit and to accelerate progress toward the elimination of hepatitis C.
Over the past few decades, the profile of liver diseases in Africa and the Middle East has undergone significant changes. The incidence of metabolic dysfunction-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the seriousness of the situation, there is a scarcity of local or regional guidelines established to address it. This document presents the clinical practice guidelines from the African Middle East Association of Gastroenterology (AMAGE) related to the screening, diagnosis, and management of MAFLD. It addresses multiple aspects of managing this condition while taking into account local circumstances and the healthcare system's management requirements. These guidelines are intended for routine clinical use, with a specific focus on particular groups when needed.
Early allograft dysfunction (EAD) substantially compromises graft and recipient outcomes; the clinical consequences of EAD vary according to severity. Research focusing on EAD in pediatric liver transplantation (pLT) remains notably limited. This study sought to validate the EAD severity grading models in pLT and assess the impact of varying severity grades of EAD on both graft and recipient outcomes. This retrospective study enrolled 360 patients who performed pLT (living-donor liver transplantation (LDLT)=299, deceased-donor liver transplantation (DDLT)=61) between April 2017 and September 2024. The severity of EAD was graded using the Liver Graft Assessment Following Transplantation (L-GrAFT7) risk score. The incidence of binary EAD in pLT was 34.2%. The area under the receiver operating characteristic curve of EAD, Model for Early Allograft Function (MEAF) score, and L-GrAFT7 risk score for predicting graft loss within 90-day post-transplant were 0.84, 0.97, and 0.96 in the LDLT cohort; and 0.79, 0.78, and 0.95 in the DDLT cohort. Significant differences were observed among the low-, moderate-, and high-risk groups in the LDLT cohort regarding ventilator support time, ICU stay time, length of hospitalization, death in hospital, early complications (including hepatic artery thrombosis, portal vein thrombosis, hepatic vein/inferior vena cava stenosis/thrombosis, and biliary complications), and late complications (including hepatic artery thrombosis, portal vein stenosis/thrombosis and hepatic vein/inferior vena cava stenosis). In the DDLT cohort, significant differences were found among the three groups in terms of ICU stay time, death in hospital, early complications (including intra-abdominal bleeding and biliary complications), and late complications (hepatic vein/inferior vena cava stenosis) (p<0.05). The log-rank test revealed statistically significant differences in graft and recipient survival among the three groups within 90-day, 180-day, and 1-year in both the LDLT and DDLT cohorts (p<0.05), with this significant difference also observed throughout follow-up period in the DDLT cohort (p<0.05). The MEAF score and L-GrAFT7 risk score effectively predict early graft loss following pLT, with high-risk EAD markedly compromising both short- and long-term graft and recipient outcomes.
Chronic hepatitis B virus (HBV) infection remains a major cause of cirrhosis and hepatocellular carcinoma worldwide, with substantial public health implications in Latin America. Despite the availability of an effective vaccine, HBV continues to be underdiagnosed and undertreated across the region, where healthcare access is often limited and heterogeneous. In alignment with the World Health Organization's 2024 strategy for HBV elimination, the Latin American Association for the Study of the Liver (ALEH) presents updated regional guidelines to simplify diagnosis, expand treatment eligibility, and improve vaccination coverage. The recommendations emphasize the use of rapid diagnostic tests and reflex HBV DNA testing to overcome barriers to laboratory access, while promoting non-invasive methods to assess liver disease severity. Expanded treatment criteria include patients with significant fibrosis, elevated HBV DNA levels, co-infections, and other risk factors, ensuring broader access to antiviral therapy with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), or entecavir (ETV). Preventing mother-to-child transmission through universal screening, maternal prophylaxis, and timely neonatal vaccination is prioritized. Additionally, universal HDV testing in HBV-infected patients is recommended. These guidelines highlight the urgent need for decentralization, simplification, and equity in HBV management to achieve elimination goals in Latin America by 2030.
To assess the utility of telemedicine in the provision of hepatitis C care, we compared characteristics and outcomes of HCV-infected patients engaging in standard in-clinic care, telemedicine only (TM), and hybrid (HB) models of care across pre-, peri‑ and post-COVID-19 pandemic periods. HCV RNA-positive patients assessed between October 2017 and March 2025 at The Ottawa Hospital Viral Hepatitis Program (Ottawa, Canada) were retrospectively analyzed. Of 1118 patients, 626 (56.0%) engaged in standard care, 139 (12.4%) in TM care, and 353 (31.6%) in HB care. TM group patients were less likely to have immigrated, experienced substance abuse, housing instability, incarceration, or psychiatric conditions, or be based in Ottawa. Utilization of HB and TM care was highest during the pandemic. Across all time periods, HB care demonstrated higher DAA treatment initiation and completion compared to standard or TM care (standard: 81.5 %; TM: 79.1 %; HB: 92.1 %, p < 0.01) and (standard: 91.3%; TM: 93.6%; HB: 96.3%, p = 0.02), respectively, with no difference in SVR. During the pandemic, a greater proportion of patients experiencing barriers to cure engaged in HB or TM care and achieved DAA completion (pre: 91.1%; pandemic: 98.1%; post: 95.8%, p < 0.01). HB care was associated with increased odds of DAA initiation (OR = 2.87; 95% CI 1.82 to 4.53), including patient populations experiencing barriers to cure (OR = 2.35; 95% CI 1.35 to 4.07). HB models demonstrate potential in addressing public health challenges and engaging marginalized populations, supporting increased integration into HCV care programs.
Frailty is highly prevalent in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD). However, the extent to which frailty influences cardiovascular disease (CVD) incidence, cardiovascular mortality, and all-cause mortality in MASLD individuals remains poorly understood. This study aimed to evaluate the impact of frailty on cardiovascular outcomes and mortality in this population. A total of 193,942 participants without prior CVD from the UK Biobank were included. Participants were categorized into three groups based on frailty phenotype: non-frailty, pre-frailty, and frailty. MASLD was defined as hepatic steatosis accompanied by at least one cardiometabolic abnormality. The primary outcome was CVD incidence, with secondary outcomes including cardiovascular and all-cause mortality. After multivariate adjustment, the risk of CVD was higher in MASLD participants with pre-frailty (HR 1.08, 95% CI 1.05-1.12) and frailty (HR 1.41, 95% CI 1.33-1.49) than in those with non-frailty. The association of frailty with CVD was strongest in participants with MASLD and advanced fibrosis (HR 2.60, 95% CI 2.04-3.30), intermediate in MASLD without fibrosis (HR 1.73, 95% CI 1.63-1.84), and weakest in non-MASLD (HR 1.58, 95% CI 1.47-1.70). Similar results were also observed for cardiovascular mortality. Furthermore, among the five components of frailty phenotype, slow gait speed demonstrated the strongest associations with the risks of CVD incidence in MASLD, cardiovascular mortality, and all-cause mortality. Frailty was associated with increased risks of CVD incidence, cardiovascular mortality, and all-cause mortality among individuals with MASLD, particularly those with a higher fibrosis burden as defined by FIB-4.
Unexplained elevated liver enzymes (ELE) are common and often linked to metabolic dysfunction-associated steatotic liver disease (MASLD). Diagnosis in primary care is difficult due to limited access to advanced imaging, highlighting the need for simple non-invasive tools. This study aimed to develop and validate a pragmatic, laboratory-based score to predict hepatic steatosis in patients with unexplained ELE. A derivation cohort of 206 patients with 40 classified as steatosis-positive with a NAFLD Activity Score (NAS) ≥4 was analyzed. Candidate predictors were tested by univariate analysis and entered into multivariate logistic regression. Regression coefficients were scaled to construct an integer-based score (HABIT). Validation was performed in a retrospective cohort of patients with unexplained ELE attending our hepatology clinic between 2019 and 2021(n = 648), all undergoing standardized diagnostic work-up including ultrasound, elastography, and laboratory testing. Multivariate analysis identified HbA1c, body mass index (BMI), and triglycerides as independent predictors of steatosis. The HABIT score was derived as: (61 × HbA1c [%]) + (3 × BMI [kg/m²]) + Triglycerides [mg/dL]. Diagnostic accuracy was high in the derivation cohort (AUROC: 0.83) and robust in validation (AUROC: 0.81), outperforming the Hepatic Steatosis Index (HSI, AUROC: 0.77). Cut-offs <490 and >630 reliably ruled out (sensitivity 93.6 %) or confirmed (specificity 92.5 %) steatosis. Score values correlated significantly with ultrasound grades and CAP. The HABIT score is a simple, robust tool for identifying hepatic steatosis in unexplained ELE. It outperforms HSI and may facilitate early detection and risk stratification in primary care with limited diagnostic resources.
Autoimmune hepatitis (AIH) is diagnosed based on clinical, biochemical, immunological, and histological parameters, and on the exclusion of other liver diseases. Multiple scoring systems are available for AIH diagnosis, all of which require liver biopsy (LB). With the aim of reducing invasive procedures to minimize patient's risks, this study evaluated whether LB may be spared for AIH diagnosis in some children, similar to primary biliary cholangitis. Children with histologically confirmed autoimmune liver disease (AILD) were evaluated from 5 Pediatric Units. We retrospectively collected clinical, laboratory, imaging and histological data to assess AIH diagnostic scores (International Autoimmune Hepatitis Group [IAIHG] criteria, juvenile AIH score [JAIH], and simplified criteria [s-IAIHG]) in each patient pre- and post-LB. The diagnosis of autoimmune sclerosing cholangitis (ASC) was based on magnetic resonance cholangiopancreatography and liver histology. Ninety-one patients (55 females) were evaluated (36 with AIH type I, 24 with AIH type II, 8 with seronegative AIH, and 23 with ASC). The mean age at diagnosis and duration of follow-up were 8.9 ± 4.8 and 9.6 ± 7.8 years, respectively. Based on IAIHG, JAIH and s-IAIHG scores, pre-LB scores were "definite" for 15.3%, 49.5%, and 0% of patients, respectively. Post-LB, the diagnosis was confirmed in all these patients. We found no associations between liver histological findings or diagnostic scores and relapses or treatment withdrawal. In patients with a "definite" AIH score pre-LB, LB is not necessary for diagnosis. Histological findings and scoring systems do not predict relapses or treatment withdrawal.
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a rapidly increasing global public health challenge. The objective was to analyze MASLD trends in Mexico by sex and state (1990-2023) and assess the association between the MASLD burden and the Socio-Demographic Index (SDI). Secondary analysis of Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2023 data (NAFLD definition, interpreted under the 2023 MASLD nomenclature) conducted across Mexico's 32 states and nationally. We examined key burden indicators like mortality, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life years (DALY). We used a Joinpoint regression to identify significant trends and the Pearson correlation coefficient to estimate the relationship between DALY rates and the SDI. Between 1990 and 2023, the national MASLD deaths increased significantly by 229%. Male DALY rates were 2.2 times higher than female rates in 2023, and premature mortality accounted for almost all the burden (around 97%). YLD rates increased significantly, particularly among males, indicating a growing contribution of disability to the total impact of the disease. Sub-nationally, DALY rates rose significantly in 21 states, although declines occurred in Mexico City, Hidalgo, and Jalisco. Nationally, a significant positive correlation (0.71) was found between the DALY rates and the SDI. These results suggest that socioeconomic development in most regions is associated with the adoption of unhealthy lifestyles and dietary patterns. Future policy interventions must include targeted health campaigns, especially for adult men and women aged between 60-84 years, to mitigate the accelerating trend, alongside regulatory actions necessary to control Mexico's obesogenic environment.
Livers from donation after circulatory death (DCD) are less frequently utilized than those from donation after brain death (DBD). Normothermic machine perfusion (NMP) offers the opportunity to assess high-risk grafts before transplantation; however, the predictive value for each respective donor type remains unclear. The aim of this meta-analysis was to compare outcomes between DBD and DCD livers subjected to NMP. Studies on clinical liver NMPs published in four databases up to March 2025 were reviewed. A random-effects meta-analysis using Cohen's D and log odds ratios to calculate effect sizes (ES) was conducted. Sixteen studies were included, encompassing 568 livers (297 DBD, 271 DCD) subjected to NMP. Following the viability assessment, the utilization rate was 91% for DBD and 74% for DCD livers (ES: 0.59, p=0.10), despite exposure of DBD grafts to worse donor risk factors such as higher age (ES: 0.36, p=0.006), and longer CIT (ES: 0.33, p=0.015). Stringency in viability assessment, such as the inclusion of cholangiocyte criteria and lactate clearance within 2 hours, resulted in 20-22% lower DCD utilization rates, compared to DBD. Post-transplantation, DBD and DCD grafts had 3.6% and 12% non-anastomotic strictures (ES: -0.69, p=0.053), and 95% and 90% one-year death-censored graft survival (ES: 0.56, p=0.41). Presumed high-risk DBD and DCD grafts achieve excellent transplant results after viability assessment during NMP. Stringency of viability criteria correlated with lower DCD utilization rates. More research is needed to elucidate evidence-based assessment criteria that correlate directly to transplant outcomes.
The potential for recompensation in treatment-naïve patients with autoimmune hepatitis (AIH) and decompensated cirrhosis, per Baveno VII criteria, remains underexplored. This study aimed to identify the clinical characteristics and prognostic factors associated with recompensation. We enrolled 81 treatment-naïve patients with biopsy-proven AIH and decompensated cirrhosis (median follow-up 61.8 months). All patients were treatment-naïve at enrollment and had confirmed diagnoses based on liver biopsy. Using Baveno VII criteria, we assessed recompensation. Data on baseline characteristics, treatment response, and long-term outcomes were collected. Predictive factors were analyzed by Cox regression, and baseline cytokine levels (IL-10, IL-17A, TNF-α, IFN-γ) were compared between recompensated and non-recompensated groups. Among all 81 immunosuppressed patients, 28 (34.6%) achieved recompensation, which was associated with a reduced risk of all-cause mortality (p = 0.044). Multivariate analysis identified higher baseline BMI (kg/m², HR = 1.161, 95% CI: 1.022-1.326, p = 0.025), elevated ALT (×ULN, HR = 1.168, 95% CI: 1.216-1.365, p = 0.028), higher ALB level (g/L, HR = 1.388, 95% CI: 1.195-1.635, p < 0.001), and complete biochemical response (CBR) at 6 months (HR = 1.895, 95% CI: 1.154-2.312, p = 0.014) as independent predictors of recompensation, while diabetes was a negative predictor (HR = 0.582, 95% CI: 0.294-0.896, p = 0.004). Additionally, recompensated patients had significantly lower baseline levels of IL-17A, TNF-α, and IFN-γ. In this longitudinal cohort of biopsy-proven AIH-related decompensated cirrhosis, 34.6% of patients achieved recompensation with immunosuppressive therapy, which was linked to superior transplant-free survival. Factors favoring recompensation included higher baseline BMI, albumin, and ALT levels, 6-month CBR, and no diabetes. These patients also had significantly lower baseline inflammatory cytokines.
Coronary artery disease (CAD) is common in liver transplant (LT) recipients, but post-LT rates compared to the general population are unknown in Sweden. We identified all LT recipients in the Swedish National Patient Registry (1987-2020). Each patient was matched with up to 10 population controls for age, sex, municipality, and transplantation year. International Classification of Diseases (ICD) codes defined liver disease aetiology and cardiovascular risk factors. New CAD events were a composite of myocardial infarction, coronary revascularisation, angina, or CAD-related death. Cox regression compared CAD risk in LT recipients and controls across subgroups. We identified 2925 LT recipients and 27,589 controls. Mean age was 54 years; 63% were men. Cardiovascular risk factors were more common in LT recipients. During a median follow-up of 8.0 years, LT recipients had over twice the CAD risk compared with controls (adjusted hazard ratio [aHR]=2.02; 95% confidence interval [CI]=1.80-2.30). Among LT recipients, chronic kidney disease (CKD) (aHR=2.64; 95%CI=1.94-3.60) and previous CAD (aHR=7.85; 95%CI=6.10-10.11) predicted incident CAD. In controls, several factors-including previous CAD, hypertension, diabetes, hypercholesterolemia, CKD, and lung disease-were predictive. The CAD rate was twofold higher in LT recipients than controls. In recipients, only CKD and prior CAD predicted post-transplant CAD, whereas traditional risk factors predicted CAD in controls.