Russell Rosenblatt

Background: Living donor liver transplantation (LDLT) remains an important alternative to deceased donor transplantation amid organ shortages. However, rising obesity may limits its growth through increased steatosis and decreased donor approval. We evaluated trends in donor and recipient BMI, liver biopsy utilization, and the association between donor obesity and recipient outcomes from 2000-2024. Methods: Adult transplant recipients and donors from 2000-2024 were identified using the UNOS STAR file. Temporal BMI trends were assessed using annual percent change (APC). Liver biopsy utilization was evaluated overall and stratified by donor obesity status (BMI ≥30 kg/m ² ), center volume, and UNOS region. Secondary outcomes included length of stay and post-operative complications. Post-transplant survival was assessed using Cox proportional hazard models, with multivariable regression adjusting for a priori selected covariates. Results: Among 7,942 donor-recipient pairs, recipient median BMI increased from 25.9 to 26.8 kg/m ² , (APC 0.1%, p =0.01), while donor BMI increased from 24.6 to 27.6 kg/m ² (APC 0.4%, p p =0.42). Conclusions: Donor and recipient BMI have both increased since 2000, yet donor obesity was not associated with inferior recipient outcomes. Liver biopsy utilization has declined substantially, with persistent regional and center-level variation. Standardization of steatosis assessment may help expand the living donor pool without compromising outcomes. Future studies should assess graft-specific outcomes and long-term steatosis recurrence.

Chronic hepatitis B (CHB) is a major cause of liver‐related morbidity and mortality in the United States. Patients with CHB require long‐term antiviral treatment and consistent follow‐up, but often face numerous barriers to accessing care and medications. In this study, we used the Medicare Part D database and the Rural–Urban Continuum code to explore specialty and geographic characteristics of healthcare providers that manage Medicare patients with CHB. Between 2013 and 2021, more than 7000 prescribers prescribed over 2.4 million 30‐day prescriptions of these CHB therapies, of which 2 million (85%) were in metropolitan counties. The number of 30‐day prescriptions increased by 5.4% annually. The number of prescriptions by GI increased by 12.5% a year and prescriptions by APPs increased by 12.2% a year, while prescriptions by ID decreased by 14.0% annually. In non‐metropolitan counties, APPs experienced −5% APC between 2013 and 2021, and PCPs experienced −12.5% APC between 2016 and 2021. In this study, we found that there has been a noticeable shift in the specialties prescribing medications for patients with hepatitis B. Gastroenterologists and APPs became significantly more involved as prescribers. The increase in APP management of patients with CHB is a welcoming development, especially in light of the physician workforce shortage. It is important to create solutions such as co‐management to ensure that patients with CHB receive consistent care without further contributing to supply–demand mismatch in gastroenterology.

Background Suboptimal patient-provider relationship is a significant contributor to healthcare disparities. Minority populations report fewer favorable interactions, which may lead to poorer outcomes and engagement in care. Patients with chronic diseases are especially at risk. Aims We aimed to study perceptions of healthcare providers and experience among those with cirrhosis. Methods The nationally representative database, All of Us, was queried. The primary outcome was “favorable healthcare experiences,” defined as whether providers asked for opinions, demonstrated respect, and were easy to understand. The secondary outcome was “unfavorable healthcare experiences,” defined as whether patients felt they were treated with less courtesy, received poorer service, or not listened to. We compared the experience between income levels and other demographic variables. Multivariable logistic regression was adjusted for a priori covariates. Results 5753 patients with cirrhosis were included with a mean age of 58. The majority were male (51%), White (52%), and US-born (84%). On multivariable analysis, compared to those earning > $150 k annually, participants with $10-35 k and < $10 k reported significantly lower odds of finding providers easy to understand (OR 0.40 [0.17–0.96] and OR 0.37 [0.15–0.94], respectively) and higher odds of feeling they were treated with less courtesy (OR 3.10 [1.06–9.03] and OR 4.13 [1.30–13.1], respectively). After further controlling for education, participants with an annual income of $10-35 k and < $10 k still reported higher odds of feeling they received poorer service than others (OR 3.87 [1.09–13.71] and OR 5.01 [1.26–19.8], respectively). Compared to men, women felt that they were not listened to (OR 1.90 [1.37–2.63]). Conclusion Patients with cirrhosis from various backgrounds report significantly different experiences with providers. Notably, those with lower income endorsed more unfavorable interactions. We identified areas for interventions to strengthen the patient-provider relationship among patients with chronic liver disease.

Background: Acute kidney injury (AKI) is one of the common complications of liver cirrhosis. It occurs in nearly 20% of patients with cirrhosis who are hospitalized. Prior literature demonstrated that the AKI occurrence in patients with cirrhosis is independently associated with higher mortality. However, there are data assessing predictors and outcomes of AKI resolution in hospitalized patients with cirrhosis. Therefore, the aim of the current study was to identify clinical predictors of AKI resolution among inpatients with cirrhosis that are easily obtained and to evaluate the clinical outcomes of those patients. Methods: The current study is a retrospective cohort of patients with cirrhosis who were hospitalized and had AKI between 2012 and 2020 at a tertiary referral center. Patients included in this study were identified using the International Classification of Diseases 9 codes and then they were manually verified by two independent chart reviewers. AKI was classified according to the AKI Network (AKIN) serum creatinine (Cr) criteria, with AKIN resolution defined as AKIN stage 1 or lower at the time of discharge, while unresolved AKIN was defined as AKIN stage 2 or 3 at the time of discharge. For univariate analysis, Fisher’s exact and the two-sample T-test were utilized. For multivariable analysis, stepwise logistic regression was performed to evaluate variables associated with AKIN resolution. Survival curves were estimated and compared using the Kaplan–Meier method and Log-Rank Test. A p-value cutoff of 0.05 was used for statistical significance. Results: Between 2012 and 2020, there were 140 patients who were included (59% males). The majority of patients had viral hepatitis (54%) as the cirrhosis etiology with 80% of them having hepatitis C virus. Most patients had fluid-responsive AKI (49%), and stage 1 AKIN (69%). In terms of outcomes, the majority of patients (117 patients; 84%) had AKIN resolution at the time of discharge. In the multivariable analysis, after adjusting for clinical meaningful variables, our study shows that higher albumin value at the time of admission (adjusted Odds Ratio “aOR” = 3.28; p = 0.01) and non-metabolic dysfunction-associated steatotic liver disease (non-MASLD) cirrhosis (aOR = 9.43; p < 0.01) were variables associated with higher odds of AKIN resolution at the time of discharge. Conversely, we show that a higher Cr value at the time of admission was associated with lower odds of AKIN resolution at the time of discharge (aOR = 0.31; p < 0.01). When evaluating mortality, patients with unresolved AKIN at the time of discharge had higher rates of in-hospital mortality (p < 0.01) compared to those with resolved AKIN. Survival curve analyses using the Kaplan–Meier method indicated that patients with resolved AKIN experienced higher 90-day survival rates (p < 0.01). Additionally, those with resolved AKIN demonstrated greater transplant-free survival compared to patients with unresolved AKIN at both the 1-year (p = 0.04) and 3-year (p < 0.01) follow-ups. Conclusions: When evaluating clinical predictors of AKIN resolution in admitted patients with cirrhosis, our study showed that a higher admission albumin value and non-MASLD etiology of cirrhosis were associated with higher odds of AKIN resolution at the time of discharge. Conversely, a higher admission Cr value was associated with lower odds of AKIN resolution at the time of discharge. We also demonstrate that AKIN resolution during index admission was associated with improved short- and long-term transplant-free survival (up to 3 years). Our findings warrant external validation in larger cohorts to further evaluate the impact of inpatient AKI resolution on cirrhosis outcomes. Our findings can help clinicians predict AKIN outcomes and encourage more aggressive management of AKI, especially in high-risk patients, which can improve mortality.

An abstract is unavailable. This article is available as a PDF only.

An abstract is unavailable. This article is available as a PDF only.

Racial, ethnic, and socioeconomic disparities exist in the prevalence and natural history of chronic liver disease, access to care, and clinical outcomes. Solutions to improve health equity range widely, from digital health tools to policy changes. The current review outlines the disparities along the chronic liver disease health care continuum from screening and diagnosis to the management of cirrhosis and considerations of pre-liver and post-liver transplantation. Using a health equity research and implementation science framework, we offer pragmatic strategies to address barriers to implementing high-quality equitable care for patients with chronic liver disease.