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Today’s general session opened with a sobering reminder that the prevalence of advanced liver disease, and associated mortality, continues to increase.

Today’s general session opened with a sobering reminder that the prevalence of advanced liver disease, and associated mortality, continues to increase; it is becoming ever more important to identify patients with advanced liver disease early and engage them with care. In a primary care study involving almost 18,000 patients designed to improve case-finding of significant liver disease, reflex AST testing in those with an elevated ALT and calculation of the AST:ALT ratio led to a significant increase in new diagnoses of cirrhosis.

However, in many cases, abnormal liver function tests were not followed up in primary care and, when they did, many patients failed to attend their appointments. Both adherence of GPs to referral pathways and community access to non-invasive fibrosis testing need to improve to increase rates of detection of advanced liver disease.

In other news from this session:

  • In mice lacking proinflammatory, profibrogenic monoglycerol lipase (MAGL), liver regeneration after insult was impaired as a consequence of both a direct effect on hepatocytes and an indirect effect on macrophages. This suggests that despite being profibrogenic, MAGL has pro-regenerative capacities in the liver
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  • In a subset of patients with chronic HBV infection from the AROHBV1001 phase 2a study , in whom 3 monthly doses of RNAi therapy (JNJ-3989 100−400 mg) plus a nucleos(t)ide analogue reduced serum viral parameters, a ≥1.0 log­10 reduction in HBsAg was sustained after ~9 months. Data on longer term dual and triple therapy are eagerly awaited
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  • Human transcriptomic and genetic data, transgenic mouse models and in vitro assays together pointed to a critical role for Macrophage Scavenger Receptor 1 (MSR1) as a sensor for lipid homeostasis and identified it as a potential therapeutic target in NAFLD
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  • An analysis from the prospective multicentric European Liver Transplant Registry (ELTR) between 1998 and 2017 found that risk of death within 5 years among patients who underwent liver transplant (LT) for autoimmune hepatitis (AIH) was significantly greater than after LT for other autoimmune liver diseases or for alcohol-related cirrhosis. After 5 years of follow-up, the prognosis of patients after AIH-LT improved considerably compared with the other groups
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  • In the ANRS CO12 CirVir cohort, a trajectory clustering analysis of serial serum alfa-fetoprotein and routine serum parameters identified HCV patients with persistent impaired liver function or persistent elevated biochemical parameters as being at greater risk of HCC despite SVR, suggesting that HCC surveillance could be personalised according to these parameters over time.
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