The epidemiology of non-alcoholic steatohepatitis (NASH) in the United States between 2010-2020: a population-based study.

INTRODUCTION AND OBJECTIVES: Non-alcoholic steatohepatitis (NASH) is a severe form of non-alcoholic fatty liver disease (NAFLD) that can progress to liver cirrhosis, liver failure and hepatocellular carcinoma. It is the second leading cause of liver transplant in the US. We aim to investigate the prevalence, demographics and risk factors NASH patients in the US. PATIENTS AND METHODS: We used a large database (Explorys IBM) that aggregates electronic health records from 26 nationwide healthcare systems. We identified adults with NASH between 2010-2020. Demographics including age, gender and race were collected. NASH risk factors including Diabetes Millets (DM), Hyperlipidemia (HLD), Hypertension (HTN) and Obesity were also collected. Cochran-Armitage test was used to assess the statistical significance of year-by-year trend. Univariable and multivariable logistic regression were used to estimate the odds ratio (OR) of risk factors. RESULTS: NASH annual prevalence rate increased from 1.51% in 2010 to 2.79% in 2020 (p < 0.0001). The proportion of patients with NASH by gender was 54.1% female vs 45.9% male (OR 1.04 [0.91-1.11]). Caucasian had higher odds of NASH than non-Caucasian (OR 1.42 [1.31-1.54]). NASH is strongly associated with DM and obesity (OR 18.61 [17.35-19.94]) and (OR 20.97 [17.87-23.21]), respectively. Other components of metabolic syndrome were associated with NASH to a lesser degree; HTN (OR 3.24 [3.20-3.28]) and HLD (OR 4.93 [4.85-4.01]). CONCLUSION: The prevalence of NASH has significantly increased in the US in the last decade. This is likely related to the increased prevalence of risk factors as well as increased awareness of the disease.

Long term outcomes of sporadic large fundic gland polyps: a single-center experience.

BACKGROUND AND STUDY AIMS: Sporadic fundic gland polyps (FGP) are the most common type of gastric polyp, reported in 0.8%-1.9% of patients undergoing Esophagogastroduodenoscopy (EGD). Data on long-term outcomes of large FGP is limited. We aim to study the natural history of sporadic large (≥ 10 mm) FGPs. PATIENTS AND METHODS: All adults who underwent EGD for any indication from April 2014 to December 2019 at a tertiary care center were retrospectively assessed, and patients with FGP (≥10mm) were identified. Data on baseline characteristics and long-term outcomes were recorded. Follow-up data were recorded for patients who underwent repeat endoscopy to evaluate for rates of dysplasia and cancer. RESULTS: A total of 4,000 patients with a diagnosis of FGP were screened and 132 large, biopsy-proven FGPs were included in the final analysis. The most common indication for EGD was gastroesophageal reflux disease (61%). During a follow-up period of 3.2 years, the rate of dysplasia, was 4.0%. Subgroup analysis based on size (10-19 mm and ≥ 20 mm) showed no significant difference in overall outcomes. CONCLUSION: Repeat EGDs for surveillance should not be routinely performed since large (≥10 mm) sporadic FGPs are mostly benign without significant malignant potential.

Weight loss interventions in living donor liver transplantation as a tool in expanding the donor pool: A systematic review and meta-analysis.

BACKGROUND: With increasing rates of liver transplantation and a stagnant donor pool, the annual wait list removals have remained high. Living donor liver transplantation (LDLT) is an established modality in expanding the donor pool and is the primary method of liver donation in large parts of the world. Marginal living donors, including those with hepatic steatosis, have been used to expand the donor pool. However, due to negative effects of steatosis on graft and recipient outcomes, current practice excludes overweight or obese donors with more than 10% macro vesicular steatosis. This has limited a potentially important source to help expand the donor pool. Weight loss is known to improve or resolve steatosis and rapid weight loss with short-term interventions have been used to convert marginal donors to low-risk donors in a small series of studies. There is, however, a lack of a consensus driven standardized approach to such interventions. AIM: To assess the available data on using weight loss interventions in potential living liver donors with steatotic livers and investigated the feasibility, efficacy, and safety of using such donors on the donor, graft and recipient outcomes. The principal objective was to assess if using such treated donor livers, could help expand the donor pool. METHODS: We performed a comprehensive literature review and meta-analysis on studies examining the role of short-term weight loss interventions in potential living liver donors with hepatic steatosis with the aim of increasing liver donation rates and improving donor, graft, and recipient outcomes. RESULTS: A total of 6 studies with 102 potential donors were included. Most subjects were males (71). All studies showed a significant reduction in body mass index post-intervention with a mean difference of -2.08 (-3.06, 1.10, I 2 = 78%). A significant reduction or resolution of hepatic steatosis was seen in 93 of the 102 (91.2%). Comparison of pre- and post-intervention liver biopsies showed a significant reduction in steatosis with a mean difference of -21.22 (-27.02, -15.43, I 2 = 56%). The liver donation rates post-intervention was 88.5 (74.5, 95.3, I 2 = 42%). All donors who did not undergo LDLT had either recipient reasons or had fibrosis/steatohepatitis on post intervention biopsies. Post-operative biliary complications in the intervention group were not significantly different compared to controls with an odds ratio of 0.96 [(0.14, 6.69), I 2 = 0]. The overall post-operative donor, graft, and recipient outcomes in treated donors were not significantly different compared to donors with no steatosis. CONCLUSION: Use of appropriate short term weight loss interventions in living liver donors is an effective tool in turning marginal donors to low-risk donors and therefore in expanding the donor pool. It is feasible and safe, with comparable donor, graft, and recipient outcomes, to non-obese donors. Larger future prospective studies are needed.

Liver Allografts From Older Donors With or Without Recovery of Thoracic Organs and Their Impact on Hepatic Graft and Patient Survival.

OBJECTIVES: Multiorgan procurement involving thoracic organs prolongs the liver recovery cross-clamp time. This may impact the outcome of hepatic allograft, more so in older donors (age > 60 years). We compared the outcomes of liver allografts from older donors with and without recovery of thoracic organs. MATERIALS AND METHODS: Using the Scientific Registry of Transplant Recipients database, we compared survival outcomes of 258 adults who received a liver allograft from older donors with thoracic organ recovery (group A) with 6006 patients who received liver allografts from older donor without thoracic organ recovery (group B). Furthermore, we performed a subgroup analysis matched for recipient and donor risk factors including presence of hypertension, diabetes mellitus, renal function, donor age, and use of inotropes. For the final analyses, there were 159 patients in group A and 468 in group B. RESULTS: The 1-month, 1-year, 3-year, and 5-year patient survival rates in group A were 95%, 91.6%, 70.1%, and 65.5% compared with 95%, 92%, 70%, and 57.7% in group B, respectively (P = .695). Graft survival rates for group A at the same time points were 91.5%, 81.0%, 71.7%, and 57.4% compared with 91.3%, 81.1%, 61.9%, and 50.4% in group B, respectively (P = .791). In the matched population, patient survival rates at 1 month, 1 year, 3 years, and 5 years were 95%, 83.1%, 77.1%, and 68.8% compared with 94.4%, 81.6%, 72.2%, and 66.8% in group B, respectively (P = .69). Graft survival rates at the same time points were 88.7%, 76.8%, 71.5%, and 63.1% in group A and 90.0%, 77.5%, 70.4%, and 62.5% in group B, respectively (P = .956). CONCLUSIONS: Liver procurement with or without recovery of thoracic organs from donors > 60 years old does not affect liver grafts and recipient outcomes in the short-term or long-term and should be encouraged.

Rapid Resolution of Cholangitic Abscess and Biliary Sepsis in a Liver Transplant Recipient after Hepatic Artery Revascularization.

Hepatic arterial flow is paramount in preserving biliary integrity. We present an interesting clinical scenario of a liver transplant recipient with biliary anastomotic stricture who developed biliary abscess and sepsis after Endoscopic Retrograde Cholangiopancreatography. The abscess did not respond to maximal medical management, percutaneous drainage, and adequate endoscopic biliary drainage. Clinically, patient continued to deteriorate and imaging identified hepatic artery stenosis which was treated with percutaneous intra-arterial stenting. Revascularization and perfusion of infected area led to rapid resolution of abscess and sepsis. This case emphasizes the anatomic basis of biliary ductal pathology. An important educational point is to understand that interrupted hepatic arterial supply can lead to biliary complications in liver transplant recipients and early correction of perfusion deficit should be pursued in such cases. In nonresolving hepatobiliary infections after liver transplantation, hepatic arterial compromise should be looked for and if present promptly treated. Reperfusion of biliary system in our patient led to improved antibiotics penetration, resolution of abscess and sepsis, and healing of biliary stricture.