Yang Li

Background: Alcohol‐associated liver disease (ALD) is a leading indication for liver transplantation (LT) in the United States. While post‐transplant outcomes are well established, the relative survival benefit of LT compared to non‐LT remains underdefined. Methods: Using Optum's de‐identified Clinformatics Data Mart Database, we identified adults with ALD between 2017 and 2024. We used logistic regression to evaluate factors associated with LT, and Cox regression to compare survival between LT recipients and non‐recipients. Results: Among 373,025 patients with ALD, 3453 underwent LT. Female sex (adjusted OR = 0.805; 95% Confidence Interval (CI): 0.750–0.866), African‐American race (adjusted OR = 0.542; 95% CI: 0.462–0.636), older age, and non‐liver comorbidities, and all types of metastatic cancer were associated with lower odds of LT; non‐metastatic liver cancer, however, was associated with increased odds of LT (adjusted OR = 4.147; 95% CI: 3.659–4.699). The 8‐year restricted mean survival time was 2600 days (~7.12 years) for LT recipients and 1799 days (~4.93 years) for nonrecipients. The median survival among deceased patients was 1000 days with LT vs. 355 days without LT. LT was associated with a lower adjusted mortality risk (HR, 0.365; 95% CI: 0.333–0.401). Conclusion: LT confers a substantial survival advantage for patients with ALD, beyond what is achieved without transplantation. However, significant sex and race‐based disparities persist, underscoring the need for policy interventions to promote equitable access and optimized candidate selection.

Background: Breast cancer survivors are at elevated risk for psychological distress, including depression, anxiety, and post‐traumatic stress (PTS), compared to healthy controls. Fear of cancer recurrence (FCR) is particularly prevalent, with approximately 50% of breast cancer survivors reporting clinically significant FCR. Aims: This mixed methods study examined associations among psychological distress, mental health service (MHS) use, and barriers to MHS use among breast cancer survivors. Methods: Using a sequential explanatory mixed methods design, we analyzed baseline data from 384 early‐stage, post‐treatment breast cancer survivors with clinically significant FCR enrolled in a randomized controlled trial. Associations between distress symptoms and MHS use were examined. Subsequently, qualitative interviews were conducted with 24 distressed breast cancer survivors to explore barriers to MHS use. Results: Of 298 (77.81%) breast cancer survivors with at least one clinically significant distress measure, only 61 (20.47%) reported MHS use within the prior 3 months. Anxiety ( p = 0.0030), depression ( p = 0.0015), and PTS ( p = 0.0387) symptoms were significantly associated with MHS use, whereas FCR was associated with fewer MHS visits. Interviews revealed barriers including avoidant coping, financial and logistical challenges, and limited access to timely, integrated care, as well as suggestions for improved support. Conclusions: Few clinically distressed breast cancer survivors utilize MHS. Anxiety, depression, and PTS symptoms may better predict MHS use than FCR, potentially due to avoidant coping among fearful survivors. Interventions targeting avoidance, alongside survivor‐informed improvements in mental health care delivery, may enhance MHS access and outcomes. Trial Registration: NCT05364450

Background and Purpose: Fear of cancer recurrence (FCR) is a disruptive concern among young breast cancer survivors (YBCS). Although coping strategies may help mitigate FCR, coping in YBCS remains understudied. This study examined associations between FCR and coping among YBCS and explored whether coping patterns varied across sociodemographic characteristics. Methods: This cross‐sectional secondary analysis used baseline data from a phase III randomized controlled trial. A purposive sample of 89 post‐treatment YBCS was recruited from the Midwestern US between 2021 and 2023 to complete a self‐reported survey to assess FCR, coping, mental health, and sociodemographic characteristics. Multiple linear regression and partial correlation analyses were performed to examine the associations between coping and FCR. Results: Greater FCR was associated with avoidant coping ( p = 0.0003). Emotion‐focused coping was more common among Black than White YBCS ( p = 0.0011) and among those experiencing financial strain ( p = 0.0024). Better mental health was associated with less avoidant coping ( p = < 0.0001). Conclusions: Greater FCR was associated with avoidant coping and poorer mental health. Longitudinal assessment of FCR and coping may help identify YBCS who could benefit from supportive interventions during survivorship. Trial Registration: Clinical Trial Registration Number: NCT05364450

Resumo Introdução: Lesão renal aguda (LRA) é um importante fator prognóstico negativo para a sobrevida em pacientes hospitalizados com COVID-19, porém existem poucos biomarcadores confiáveis para LRA e mortalidade. Estudo teve como objetivo avaliar se níveis elevados de fator de crescimento de fibroblastos 23 (FGF23) estão associados à ocorrência de LRA e à mortalidade em pacientes com COVID-19. Métodos: Nesta coorte prospectiva de 111 pacientes com COVID-19 hospitalizados no Indiana University Academic Health Center (abril–outubro de 2020), os níveis circulantes de FGF23 e de seu correceptor Klotho foram avaliados quanto à sua associação com LRA e com a sobrevida em 28 meses. Resultados: Dos 111 pacientes, 77 não apresentaram LRA (91,0 [69,2–101,3] mL/min/1,73 m2), 17 apresentaram LRA (39,7 [28,7–57,8] mL/min/1,73 m2) e 17 apresentavam doença renal crônica terminal (DRT; 11,9 [8,6–17,5] mL/min/1,73 m2). O tempo mediano de seguimento foi de 22,6 meses. Os níveis medianos de FGF23 foram mais elevados em pacientes com LRA (305,6 [134,6–350,8] RU/mL) e em pacientes com DRT (3.607,6 [440,5–7.452,7] RU/mL), em comparação com aqueles sem LRA (120,7 [64,3–249,7] RU/mL; P < 0,001). Pacientes (excluindo aqueles com DRT) com níveis elevados de FGF23 apresentaram maior probabilidade de LRA (OR: 2,30; IC 95%: [1,31–4,03]; P = 0,004). Além disso, cada aumento de uma unidade no log(FGF23) esteve associado a um risco 45% maior de mortalidade na coorte (HR: 1,45; IC 95%: [1,02–2,07]; P = 0,04), após ajuste para idade, doença cardiovascular e IMC. Os níveis de Klotho diferiram entre os grupos (sem LRA: 576,1 [455, 730] pg/mL; com LRA: 594,6 [416,774] pg/mL; DRT: 421,5 [330, 562] pg/mL; P = 0,04), mas não estiveram associados à presença de LRA. Conclusão: Níveis elevados de FGF23 estão associados à presença de LRA e à mortalidade em pacientes com COVID-19.

Introduction: Acute kidney injury (AKI) is a key negative prognostic factor for survival in patients hospitalized with COVID-19, but few reliable biomarkers for AKI and mortality exist. This study aimed to evaluate whether elevated fibroblast growth factor 23 (FGF23) levels are associated with AKI status and mortality in COVID-19 patients. Methods: In this prospective cohort of 111 COVID-19 patients hospitalized at the Indiana University Academic Health Center (April–October 2020), circulating FGF23 and its co-receptor Klotho levels were assessed for association with AKI and 28-month survival. Results: Of the 111 patients, 77 had no AKI (91.0 [69.2, 101.3] mL/min/1.73 m2), 17 had AKI (39.7 [28.7, 57.8] mL/min/1.73 m2), and 17 had end-stage kidney disease (ESKD; 11.9 [8.6, 17.5] mL/min/1.73 m2). Median follow-up was 22.6 months. Median FGF23 levels were higher in patients with AKI (305.6 [134.6, 350.8] RU/mL) and ESKD (3,607.6 [440.5, 7,452.7] RU/mL) compared to those without AKI (120.7 [64.3, 249.7] RU/mL; P < 0.001). Patients (excluding those with ESKD) with elevated FGF23 levels had increased odds of having AKI (OR: 2.30, 95% CI: [1.31, 4.03]; P = 0.004). Moreover, each unit increase in log(FGF23) was associated with a 45% higher risk of mortality in the cohort (HR: 1.45, 95% CI: [1.02, 2.07]; P = 0.04) after controlling for age, cardiovascular disease, and BMI. Klotho levels differed by group (without AKI: 576.1 [455, 730] pg/mL; with AKI: 594.6 [416, 774] pg/mL; ESKD: 421.5 [330, 562] pg/mL; P = 0.04), but were not associated with AKI status. Conclusion: Elevated FGF23 is associated with AKI status and mortality in patients with COVID-19.

Background: Men are at higher risk for metabolic dysfunction-associated steatotic liver disease (MASLD) with clinically significant fibrosis (CSF) than premenopausal women, but data are lacking in persons with HIV (PWH). The aim of this study was to discover prevalence and severity of MASLD in PWH by sex assigned at birth and menopausal status. Methods: We examined participants from the prospective, cross-sectional HIV NASH CRN who had suppressed HIV-1 RNA, self-reported sex assigned at birth and menopause status, and underwent transient elastography (TE). The primary outcome was MASLD (controlled attenuation parameter [CAP] ≥ 263 dB/m, ≥1 cardiometabolic risk factor, Alcohol Use Disorders Identification Test score <8) with CSF (MASLD-CSF, TE Liver Stiffness Measurement ≥ 8 kPa). Results: Nine hundred and sixty-four PWH were included: 709 men (73.5%) and 255 women (26.5%) with similar median ages (55.1 and 56.6 years, P-value = .08). The most common race was Black (52%). Women had lower prevalence of MASLD-CSF than men (5.5% vs 10.6%, P = .02). In a multivariable logistic regression model for MASLD-CSF, diabetes (OR 3.26 [95% confidence interval 2.01–5.30], P < .0001), hyperlipidemia (1.97 [1.14–3.39], P = .02), and waist circumference (WC) above sex-specific cutoff (women: 80 cm, men: 94 cm) (4.59 [2.12–9.93], P < .0001) were associated with higher odds of MASLD-CSF, while female sex was associated with lower odds (0.43 [0.23–0.81], P = .01). Variables and effect sizes associated with MASLD-CSF differed among sex/menopause subgroups. Conclusions: Female sex was protective against MASLD-CSF in PWH. Men with diabetes, hyperlipidemia, and high WC would be candidates for MASLD screening. Further studies of PWH with women, especially more young women, are needed.

Key Points: In individuals undergoing bariatric surgery, the magnitude of decline in GFR postbariatric surgery is directly associated with presurgery GFR. Reductions in GFR postsurgery were only weakly correlated with weight loss. In obese individuals, GFR-estimating equations performed best when deindexed and when applied in people with reduced kidney function. Background: Important questions remain about how bariatric ( i.e ., weight loss) surgery affects measured GFR (mGFR) and eGFR as well as what factors influence change in mGFR postsurgery. Methods: Data were pooled from all seven available studies (dates: 2004–2018) measuring GFR prebariatric and postbariatric surgery using gold standard methods. Change in postsurgery mGFR, factors that could influence change in mGFR, and effects on five GFR-estimating equations were analyzed using standard statistical methods. Results: The cohort included 105 individuals from the United States and Europe. Sixty-eight percent were female, 97% were White, the mean age was 50 years (range, 24–70), and the mean body mass index was 46±8 kg/m ² . The mean presurgery mGFR of 107 ml/min (range, 31–215) fell to 92 ml/min (−14%; 95% confidence interval, −21 to −10) postsurgery, with a strong linear relationship existing between presurgery mGFR and % change in GFR ( r =−0.51; −0.64 to −0.35). Individuals with presurgery mGFR ≥90, 60 to r =0.22; 0.03 to 0.40). After adjusting for sex, changes in mGFR postsurgery were associated with higher presurgical age (−0.6 ml/min per year; −1.1 to −0.2), mGFR (−0.5 ml/min per 1 ml/min; −0.6 to −0.4), and change in systolic BP (−0.3 ml/min per 1 mm Hg; −0.6 to 0.0). All GFR-estimating equations significantly underestimated postsurgical GFR reductions in people with preserved kidney function and had improved bias, precision, and accuracy when deindexed and applied to individuals with mGFR <90 ml/min. Conclusions: In individuals with obesity undergoing bariatric surgery, the magnitude of postsurgical decline in mGFR was directly associated with presurgery GFR and weakly correlated with weight loss. In addition, GFR-estimating equations' performance improved when deindexed and used in people with reduced kidney function, with the combined creatinine/cystatin C equations having the best overall performance.

Background Socioeconomic factors significantly influence access to kidney transplantation, with socially vulnerable populations experiencing delays in receiving transplants, resulting in prolonged dialysis duration and poorer post-transplant outcomes. This study evaluates the relationship between social vulnerability and disparities in preemptive kidney transplantation using the Social Vulnerability Index (SVI), a composite measure developed by the Centers for Disease Control and Prevention (CDC). Methods Utilizing data from the Scientific Registry of Transplant Recipients (SRTR) from 2012 to 2020, we analyzed 155,424 adult kidney transplant recipients. The primary exposure was SVI, categorized into quartiles, while primary outcomes included preemptive transplant status and dialysis vintage. Multivariable regression models were adjusted for clinical covariates such as age, gender, BMI, diabetes, and peripheral vascular disease. Result Findings indicate that higher social vulnerability is significantly associated with a reduced likelihood of preemptive kidney transplantation (p < 0.0001) and an increased duration of dialysis prior to transplantation. Patients in the highest SVI quartile (0.75–1.00) were more than twice as likely to undergo dialysis before transplantation compared to those in the lowest quartile (OR = 2.21, 95% CI: 1.89–2.57). Similarly, increased SVI was strongly correlated with prolonged dialysis duration (OR = 3.43, 95% CI: 3.31–3.55, p < 0.0001). Conclusions These results highlight the impact of socioeconomic disparities on access to timely kidney transplantation. Addressing social vulnerability factors—such as poverty, education, and healthcare access—may help reduce inequities and improve transplantation outcomes. Future interventions should target high-SVI communities to facilitate earlier transplant access and reduce reliance on prolonged dialysis.

Key Points: Body fluid volumes are significantly higher at the end of the 3-day interdialytic interval compared with the 2-day interdialytic interval. V_E/VCO₂ slope, a noninvasive index of exercise pulmonary vascular resistance, is elevated after the 3-day interdialytic interval. VO₂Peak is similar across interdialytic intervals but was limited following dialysis by postdialysis fatigue. Background: The long interdialytic interval in thrice-weekly hemodialysis is associated with volume accumulation and excess cardiovascular risk. Few studies have evaluated cardiovascular functional changes after interdialytic intervals. This study sought to evaluate cardiovascular functional response patterns, as assessed by cardiopulmonary exercise testing, after the short and long interdialytic intervals. Methods: We conducted an exploratory single-center, quasi-experimental 2-arm study involving crossover of treatment sequences in patients on conventional thrice-weekly maintenance hemodialysis. All patients underwent cardiopulmonary exercise testing, bioelectrical impedance spectroscopy, and physical function testing on three study visits: posthemodialysis and prehemodialysis at the end of a 2-day and the 3-day interdialytic intervals. Results: Thirty-one patients (n=19 men, mean [SD] age 55 [12] years, median [interquartile range] dialysis vintage 56 [24–96] months) completed all study visits. Interdialytic weight gain and total body fluid were greater after the 3-day compared with the 2-day interval (P < 0.001). Ventilation/carbon dioxide production (V_E/VCO₂) slope, a noninvasive index of exercise pulmonary vascular resistance and right ventricular (RV) dysfunction, was significantly elevated at the 3-day (31.2 [4.8] L V_E/L VCO₂; P = 0.002) compared with the 2-day interval (29.5 [3.9] L V_E/L VCO₂). No significant differences between interdialytic intervals were observed for peak oxygen uptake (VO₂Peak) or VO₂ at the anaerobic threshold. Change (Δ) in V_E/VCO₂ slope (ΔV_E/VCO₂) the 2-day to the 3-day interval was correlated with Δbody weight (r=0.36, P = 0.04) and left ventricular mass index (r=0.44, P = 0.02). Conclusions: The long interdialytic interval is associated with abnormal exercise-derived ventilatory and hemodynamic responses, including ventilation-perfusion mismatch and potentially RV dysfunction and RV-pulmonary artery uncoupling during exercise as suggested by elevated V_E/VCO₂ slope.

Background Socioeconomic factors significantly influence access to kidney transplantation, with socially vulnerable populations experiencing delays in receiving transplants, resulting in prolonged dialysis duration and poorer post-transplant outcomes. This study evaluates the relationship between social vulnerability and disparities in preemptive kidney transplantation using the Social Vulnerability Index (SVI), a composite measure developed by the Centers for Disease Control and Prevention (CDC). Methods Utilizing data from the Scientific Registry of Transplant Recipients (SRTR) from 2012 to 2020, we analyzed 155,424 adult kidney transplant recipients. The primary exposure was SVI, categorized into quartiles, while primary outcomes included preemptive transplant status and dialysis vintage. Multivariable regression models adjusted for clinical covariates such as age, gender, BMI, diabetes, and peripheral vascular disease. Result Findings indicate that higher social vulnerability is significantly associated with a reduced likelihood of preemptive kidney transplantation (p < 0.0001) and an increased duration of dialysis prior to transplantation. Patients in the highest SVI quartile (0.75–1.00) were more than twice as likely to undergo dialysis before transplantation compared to those in the lowest quartile (OR = 2.21, 95% CI: 1.89–2.57). Similarly, increased SVI was strongly correlated with prolonged dialysis duration (OR = 3.43, 95% CI: 3.31–3.55, p < 0.0001). Conclusion These results highlight the impact of socioeconomic disparities on access to timely kidney transplantation. Addressing social vulnerability factors—such as poverty, education, and healthcare access—may help reduce inequities and improve transplantation outcomes. Future interventions should target high-SVI communities to facilitate earlier transplant access and reduce reliance on prolonged dialysis.