Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity.However,bariatric sur-gery has also been linked to increased alcohol use with up ...Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity.However,bariatric sur-gery has also been linked to increased alcohol use with up to 30%of these patients developing alcohol use disorder(AUD).The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic,metabolic,and neurohumoral changes associated with post-surgical anatomy.These patients are at increased risk of alcohol associated liver disease and,in some cases,require liver trans-plantation.In this article,we provide a scoping review of epidemiology,patho-physiology,and clinical outcomes of alcohol-related health conditions after bariatric surgery.展开更多
Sarcopenic obesity increases the risk of mortality in patients with liver disease awaiting liver transplantation and in the post-transplant period.Nutrition recommendations for individuals with sarcopenia differ from ...Sarcopenic obesity increases the risk of mortality in patients with liver disease awaiting liver transplantation and in the post-transplant period.Nutrition recommendations for individuals with sarcopenia differ from recommendations for patients with obesity or sarcopenic obesity.While these nutrition guidelines have been established in non-cirrhotic patients,established guidelines for liver transplant candidates with sarcopenic obesity are lacking.In this paper,we review existing literature on sarcopenic obesity in patients with chronic liver disease and address opportunities to improve nutritional counseling in patients awaiting liver transplantation.展开更多
Kidney disease in patients with liver disease is serious and increases mortality.Up to 50%of patients hospitalized experience an episode of acute kidney injury.In general,men with liver disease are thought to be at in...Kidney disease in patients with liver disease is serious and increases mortality.Up to 50%of patients hospitalized experience an episode of acute kidney injury.In general,men with liver disease are thought to be at increased risk of kidney disease.However,this association should be considered with caution because most studies use creatinine-based inclusion criteria,which is negatively biased against women.In this review,we synthesize data on sex differences in kidney disease in patients with chronic liver disease in the clinical setting and discuss potential physiologic underpinnings.展开更多
BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delayin...BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delaying referral beyond these criteria affects patient outcomes.AIM To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes(death,transplantation).METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE(n=159)at a large quaternary care and liver transplant center between 10/23/2017-7/31/2021.Delayed referral was defined as having prior indication(decompensation,MELD-Na≥15)for LTE without referral.Early referral was defined as referrals made within 3 mo of having an indication based on practice guidelines.Logistic regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient outcomes.RESULTS Many patients who require expedited inpatient LTE had delayed referrals.Misconceptions regarding transplant candidacy were a leading cause of delayed referral.Ultimately,delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a transplant.Delayed referral was associated with a 2.5 hazard risk of death.CONCLUSION Beyond initial access to an liver transplant(LT)center,delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver disease.There is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically indicated.It is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.展开更多
Liver injury is an increasingly recognized extra-pulmonary manifestation of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Coronavirus disease 2019(COVID-19)associated liver injury(COVALI)is a cl...Liver injury is an increasingly recognized extra-pulmonary manifestation of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Coronavirus disease 2019(COVID-19)associated liver injury(COVALI)is a clinical syndrome encompassing all patients with biochemical liver injury identified in the setting of SARS-CoV-2 infection.Despite profound clinical implications,its pathophysiology is poorly understood.Unfortunately,most information on COVALI is derived from the general population and may not be applicable to individuals under-represented in research,including pregnant individuals.This manuscript reviews:Clinical features of COVALI,leading theories of COVALI,and existing literature on COVALI during pregnancy,a topic not widely explored in the literature.Ultimately,we synthesized data from the general and perinatal populations that demonstrates COVALI to be a hepatocellular transaminitis that is likely induced by systemic inflammation and that is strongly associated with disease severity and poorer clinical outcome,and offered perspective on approaching transaminitis in the potentially COVID-19 positive patient in the obstetric setting.展开更多
文摘Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity.However,bariatric sur-gery has also been linked to increased alcohol use with up to 30%of these patients developing alcohol use disorder(AUD).The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic,metabolic,and neurohumoral changes associated with post-surgical anatomy.These patients are at increased risk of alcohol associated liver disease and,in some cases,require liver trans-plantation.In this article,we provide a scoping review of epidemiology,patho-physiology,and clinical outcomes of alcohol-related health conditions after bariatric surgery.
文摘Sarcopenic obesity increases the risk of mortality in patients with liver disease awaiting liver transplantation and in the post-transplant period.Nutrition recommendations for individuals with sarcopenia differ from recommendations for patients with obesity or sarcopenic obesity.While these nutrition guidelines have been established in non-cirrhotic patients,established guidelines for liver transplant candidates with sarcopenic obesity are lacking.In this paper,we review existing literature on sarcopenic obesity in patients with chronic liver disease and address opportunities to improve nutritional counseling in patients awaiting liver transplantation.
文摘Kidney disease in patients with liver disease is serious and increases mortality.Up to 50%of patients hospitalized experience an episode of acute kidney injury.In general,men with liver disease are thought to be at increased risk of kidney disease.However,this association should be considered with caution because most studies use creatinine-based inclusion criteria,which is negatively biased against women.In this review,we synthesize data on sex differences in kidney disease in patients with chronic liver disease in the clinical setting and discuss potential physiologic underpinnings.
文摘BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delaying referral beyond these criteria affects patient outcomes.AIM To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes(death,transplantation).METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE(n=159)at a large quaternary care and liver transplant center between 10/23/2017-7/31/2021.Delayed referral was defined as having prior indication(decompensation,MELD-Na≥15)for LTE without referral.Early referral was defined as referrals made within 3 mo of having an indication based on practice guidelines.Logistic regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient outcomes.RESULTS Many patients who require expedited inpatient LTE had delayed referrals.Misconceptions regarding transplant candidacy were a leading cause of delayed referral.Ultimately,delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a transplant.Delayed referral was associated with a 2.5 hazard risk of death.CONCLUSION Beyond initial access to an liver transplant(LT)center,delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver disease.There is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically indicated.It is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.
文摘Liver injury is an increasingly recognized extra-pulmonary manifestation of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Coronavirus disease 2019(COVID-19)associated liver injury(COVALI)is a clinical syndrome encompassing all patients with biochemical liver injury identified in the setting of SARS-CoV-2 infection.Despite profound clinical implications,its pathophysiology is poorly understood.Unfortunately,most information on COVALI is derived from the general population and may not be applicable to individuals under-represented in research,including pregnant individuals.This manuscript reviews:Clinical features of COVALI,leading theories of COVALI,and existing literature on COVALI during pregnancy,a topic not widely explored in the literature.Ultimately,we synthesized data from the general and perinatal populations that demonstrates COVALI to be a hepatocellular transaminitis that is likely induced by systemic inflammation and that is strongly associated with disease severity and poorer clinical outcome,and offered perspective on approaching transaminitis in the potentially COVID-19 positive patient in the obstetric setting.
