Imaging is essential in hepatocellular carcinoma (HCC) management, from screening to treatment assessment, but qualitative methods have limitations. Radiomics, a quantitative imaging approach, extracts high-dimensional f...Imaging is essential in hepatocellular carcinoma (HCC) management, from screening to treatment assessment, but qualitative methods have limitations. Radiomics, a quantitative imaging approach, extracts high-dimensional features to enhance diagnostic, prognostic, and therapeutic decision-making. It shows promise in predicting treatment response and guiding personalized therapies. Integrating radiomics with artificial intelligence, particularly deep learning, could further improve predictive accuracy and clinical utility. Future efforts should focus on standardization, validation, and developing accessible tools to incorporate radiomics into routine therapeutic strategies, ultimately optimizing patient outcomes in HCC.
Advances in liver transplantation continue to improve survival. For patients with advanced disease, specific selection criteria are implemented to ensure long-term decreases in morbidity and mortality. There has been an...Advances in liver transplantation continue to improve survival. For patients with advanced disease, specific selection criteria are implemented to ensure long-term decreases in morbidity and mortality. There has been an increasing role of liver transplantation in several malignancies that include hepatocellular carcinoma, cholangiocarcinoma, colorectal metastatic liver disease, and metastatic neuroendocrine liver disease. Innovative approaches to address the organ shortage include living donor liver transplantation, machine perfusion, and the use of ABO incompatible organs; recent advances in xenotransplantation offer another potential avenue. In this review, we cover some of the more recent focuses, trends, and advances in liver transplantation.
Recent advances have transformed the therapeutic landscape for advanced hepatocellular carcinoma (HCC). Immunotherapy combinations, such as atezolizumab-bevacizumab, ipilimumab-nivolumab, and STRIDE, have raised survival...Recent advances have transformed the therapeutic landscape for advanced hepatocellular carcinoma (HCC). Immunotherapy combinations, such as atezolizumab-bevacizumab, ipilimumab-nivolumab, and STRIDE, have raised survival expectations, while novel checkpoints (LAG-3, TIGIT, TIM-3) and targeted therapies addressing FGFR4 and β-catenin are entering late-phase trials. Additionally, metabolic and stress-pathway inhibitors targeting ferroptosis, GLS1, NRF2, and YAP-TAZ show promising synergy with existing treatments. Precision oncology innovations, including liquid biopsy and AI-driven imaging, further enhance patient-tailored approaches. Addressing equity and global implementation barriers will ensure these advances benefit all patients, marking a decisive shift toward personalized and equitable HCC care.
In recent years, the necessity for pharmacologic treatments to mitigate the risk of hepatic decompensation has been highlighted, with non-selective beta-blockers identified as the most effective option. However, a signif...In recent years, the necessity for pharmacologic treatments to mitigate the risk of hepatic decompensation has been highlighted, with non-selective beta-blockers identified as the most effective option. However, a significant therapeutic gap persists, and additional or alternative treatments have been proposed, including statins, rifaximin, albumin, anticoagulants, angiotensin receptor blockers, granulocyte-colony stimulating factor, and fecal microbial transplant. According to the data from limited clinical trials, these pharmacotherapies offer promising possibilities; nonetheless, additional investigations, particularly randomized controlled trials, are required, in some instances, prior to their incorporation into routine clinical practice.
Primary biliary cholangitis (PBC) is a rare autoimmune liver disease that leads to chronic cholestasis and progressive liver dysfunction. It is often accompanied by extrahepatic symptoms such as pruritus and fatigue, whi...Primary biliary cholangitis (PBC) is a rare autoimmune liver disease that leads to chronic cholestasis and progressive liver dysfunction. It is often accompanied by extrahepatic symptoms such as pruritus and fatigue, which significantly impair the quality of life. Current treatment options include ursodeoxycholic acid, the standard first-line therapy, along with second-line agents like obeticholic acid, and recently approved seladelpar, and elafibranor. These treatments aim to alleviate symptoms, improve liver function, and slow disease progression. This article focuses on recently approved therapies for PBC, discusses the nuances in their use, and explores the investigational pipeline of novel therapies under development.
This article provides a comprehensive overview of the current therapeutic approaches to managing hepatitis B virus infection. It begins with an outline of the goals of treatment, including viral suppression and preventio...This article provides a comprehensive overview of the current therapeutic approaches to managing hepatitis B virus infection. It begins with an outline of the goals of treatment, including viral suppression and prevention of liver disease progression. The article then delves into the current classes of antiviral agents used in clinical practice, such as nucleos(t)ide analogs (eg, tenofovir and entecavir) and pegylated interferon. The article then covers emerging therapies and novel agents under investigation, including capsid/core inhibitors, immune modulators, gene editing, and therapeutic vaccines. This article aims to inform health care professionals regarding the evolving landscape of hepatitis B treatment.
Severe alcohol-associated hepatitis (SAH) remains a difficult-to-treat severe liver ailment with limited therapeutic options and high mortality. The article reviews new data to help identify the steroid non-responders at...Severe alcohol-associated hepatitis (SAH) remains a difficult-to-treat severe liver ailment with limited therapeutic options and high mortality. The article reviews new data to help identify the steroid non-responders at the baseline to reduce the risk of infections and increased mortality. New information on the use of growth factors, such as granulocyte-colony stimulating factor, plasma exchange, and fecal microbiota transplantation, has been provided to choose as a monotherapy or with steroids for SAH. Early selection for liver transplantation after careful ethical considerations and risks of recidivism post-transplant can help improve survival upto 70% to 80%.
Hundreds of rare monogenic metabolic liver diseases together affect 1 in 800 live births. Liver transplantation remains the only cure for many of these disorders. Liver-targeted DNA and RNA-based molecular therapies are...Hundreds of rare monogenic metabolic liver diseases together affect 1 in 800 live births. Liver transplantation remains the only cure for many of these disorders. Liver-targeted DNA and RNA-based molecular therapies are potential alternatives, for which critical advances at preclinical level have led to clinical trials.This review will provide a concise profile of viral and nonviral vectors for liver-targeted delivery of therapeutic DNA and RNA payloads, as well as novel approaches to gene editing for the treatment of monogenic liver diseases.
Patients with cirrhosis who require surgeries are at higher risk of surgical complications and mortality than patients without cirrhosis. Several tools are available to predict the risk of mortality after surgery in pati...Patients with cirrhosis who require surgeries are at higher risk of surgical complications and mortality than patients without cirrhosis. Several tools are available to predict the risk of mortality after surgery in patients with cirrhosis and should be used as a standard part of the preoperative evaluation. Improving surgical outcomes requires multidisciplinary care to ensure proper patient selection, to determine the appropriate timing of surgery, and to optimize the medical management of cirrhosis.
Vascular liver pathology represents a heterogenous group of diseases impacted by the dual blood supply to the liver at each distinct microanatomic site. Portal vein-based disease is well described in association with por...Vascular liver pathology represents a heterogenous group of diseases impacted by the dual blood supply to the liver at each distinct microanatomic site. Portal vein-based disease is well described in association with portal vein thrombosis but may also precede or occur in the absence of thrombosis. Central vein-based disease is also well described in association with right heart failure and Budd Chiari syndrome but may show similar features with sinusoidal obstruction. Sinusoidal-based vascular disease is not as well characterized, and several emerging concepts are reviewed in this article.
Liver disease is common in patients with heart failure, often resulting from hepatic congestion and decreased perfusion due to reduced cardiac output. Patients with congenital heart disease (CHD) are particularly suscept...Liver disease is common in patients with heart failure, often resulting from hepatic congestion and decreased perfusion due to reduced cardiac output. Patients with congenital heart disease (CHD) are particularly susceptible to hepatic injury due to their complex physiology, both before and following surgical interventions. Individuals with single-ventricle CHD who have undergone the Fontan procedure are especially prone to developing Fontan-associated liver disease (FALD). Screening and managing FALD remains challenging, necessitating a multidisciplinary approach to guide patient-care and to deepen the understanding of liver disease in the context of CHD.
This article reviews the pathophysiology, diagnosis, and management of portopulmonary hypertension (PoPH) and hepatopulmonary syndrome (HPS) in liver transplant candidates. PoPH is characterized by elevated pulmonary pre...This article reviews the pathophysiology, diagnosis, and management of portopulmonary hypertension (PoPH) and hepatopulmonary syndrome (HPS) in liver transplant candidates. PoPH is characterized by elevated pulmonary pressures and vascular remodeling, with implications for transplant eligibility based on hemodynamic criteria. HPS, marked by intrapulmonary vascular dilations, results in hypoxemia, often requiring liver transplantation as the only curative therapy. Screening protocols, particularly the role of echocardiography and right heart catheterization, are discussed alongside pulmonary arterial hypertension-targeted therapies. The paper emphasizes the importance of monitoring and managing pulmonary pressures pretransplant and posttransplant to improve outcomes and reduce posttransplant mortality risk.
Hepatotoxicity from oncologic drugs represents an increasing clinical burden for patients, providers, and the health care system. The complexity of clinical presentations, multi-drug regimens, and the need to control the...Hepatotoxicity from oncologic drugs represents an increasing clinical burden for patients, providers, and the health care system. The complexity of clinical presentations, multi-drug regimens, and the need to control the underlying cancer while preserving liver function, results in significant diagnostic and therapeutic challenges. These challenges are best met with a careful and systematic approach with multi-disciplinary management decisions between oncology and hepatology providers. This contemporary review discusses the known pathophysiology and patterns of hepatotoxicity for key drug classes and agents, including unique presentations such as sinusoidal obstruction syndrome, key aspects of the diagnostic approach, and principles of management.
Clin Liver Dis
· 2025 Aug · PMID 40670033
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Liver disease significantly impacts hematologic malignancies like lymphoma, leukemia, and multiple myeloma. Chronic hepatitis B and C increase risks, complicate treatment, and may lead to reactivation during chemotherapy...Liver disease significantly impacts hematologic malignancies like lymphoma, leukemia, and multiple myeloma. Chronic hepatitis B and C increase risks, complicate treatment, and may lead to reactivation during chemotherapy. Bone marrow transplantation (BMT) is associated with the risk of hepatic complications. Antiviral therapy mitigates risks, improving survival. Screening and prophylactic treatment are essential for managing liver-related complications in these patients. Cirrhosis complicates the treatment of hematologic malignancies by altering drug metabolism, increasing toxicity, and heightening risks of complications. BMT further challenges liver function, with increased risk of complications like sinusoidal obstruction syndrome, requiring specialized management.
The liver plays a key role during sepsis. These key roles include regulating metabolism, immune and inflammatory responses, and coagulation cascades, which are essential to the systemic response to sepsis. Sepsis is char...The liver plays a key role during sepsis. These key roles include regulating metabolism, immune and inflammatory responses, and coagulation cascades, which are essential to the systemic response to sepsis. Sepsis is characterized by tissue and organ damage, which results in multiple organ dysfunction syndrome, including hepatic dysfunction, which significantly contributes to the severity of the disease. This review examines the inflammatory, hemodynamic, and metabolic alterations in sepsis and their effects on the liver. We outline the clinical and laboratory findings of sepsis-induced liver dysfunction. Finally, we discuss current and emerging therapies, as well as timely listing for liver transplantation.
A wide variety of bacterial pathogens have been demonstrated to cause hepatic infection, leading to a range of clinical manifestations, including subclinical hepatitis, liver abscess, cholestatic hepatitis, and rarely fu...A wide variety of bacterial pathogens have been demonstrated to cause hepatic infection, leading to a range of clinical manifestations, including subclinical hepatitis, liver abscess, cholestatic hepatitis, and rarely fulminant hepatic failure. These organisms exhibit different epidemiology; some are transmitted through inhalation, others by an insect vector or animal exposure. A patient's exposure history, combined with the clinical findings and presence of hepatic dysfunction, may provide clues to the underlying diagnosis and have prognostic implications. This section will review the most important or characteristic bacterial infections involving the liver, focusing on the patterns and severity of liver dysfunction and treatment.
A bidirectonal relationship between insulin resistance, diabetes and metabolic dysfunction-associated steatotic liver disease exists. In those with metabolic syndrome, impairments of glucose and lipid metabolism lead to...A bidirectonal relationship between insulin resistance, diabetes and metabolic dysfunction-associated steatotic liver disease exists. In those with metabolic syndrome, impairments of glucose and lipid metabolism lead to increased liver fat, necroinflammation (steatohepatitis) and subsequent hepatic fibrosis. An integrated perspective and heightened awareness of metabolic dysfunction associated steatotic liver disease is critical to tempering the rising epidemic metabolic dysfunction associated steatohepatiitis, cirrhosis, liver cancer and need for liver transplanation patients with diabetes and metabolic syndrome. Medical and surgical treatments targeting insulin resistance, obesity and diabetes mellitus hold promise in improving lipotoxic liver injury which contributes to steatohepatitis and progressive hepatic fibrosis.
Telomeres are repetitive sequences at the ends of chromosomes that contribute to genome stability and prevent replicative senescence. Telomere biology disorders (TBDs) encompass a spectrum of genetic conditions character...Telomeres are repetitive sequences at the ends of chromosomes that contribute to genome stability and prevent replicative senescence. Telomere biology disorders (TBDs) encompass a spectrum of genetic conditions characterized by accelerated telomere shortening, which affects different organs, including the liver. TBD-related hepatic manifestations are often unrecognized and can range from asymptomatic liver test abnormalities to steatohepatitis, hepatopulmonary syndrome, or cirrhotic and noncirrhotic portal hypertension requiring liver transplantation. This review summarizes the current literature and aims to describe liver involvement in TBDs, highlighting diagnostic gaps and therapeutic challenges.
Amyloidosis is a heterogeneous group of diseases caused by the deposition of misfolded proteins and can involve many organ systems, frequently including the liver. The liver can play a unique role in several forms of amy...Amyloidosis is a heterogeneous group of diseases caused by the deposition of misfolded proteins and can involve many organ systems, frequently including the liver. The liver can play a unique role in several forms of amyloidosis, acting as both the target and source of misfolded proteins, placing the gastroenterologist and hepatologist in a critical role on the multidisciplinary care team. This article will review the most common forms of amyloidosis with an emphasis on the manifestations of hepatic involvement, the management of hepatic complications as well as liver-directed therapies, including liver transplantation and rapidly emerging targeted therapies.