DR. RUSSELL ROSENBLATT

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This study used a large national database to look at whether patients with cirrhosis from different income levels reported different experiences with their doctors. Patients earning under $35,000 a year were significantly more likely to feel treated with less courtesy and to receive poorer service, while women were more likely to feel they weren't listened to. These findings identify clear gaps in the patient-provider relationship that could worsen health outcomes for low-income and female patients with liver disease.

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Researchers examined whether worsening liver disease is linked to a specific type of heart dysfunction called cirrhotic cardiomyopathy in patients awaiting liver transplant. Among 208 patients, 23% had this condition, and those with more severe liver disease—measured by higher MELD-Na scores and worse ascites—were significantly more likely to have it. This matters because recognizing this cardiac problem early could improve how transplant candidates are selected and monitored.

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Using data from nearly half a million UK adults, researchers tested whether a blood-test-based score for liver scarring was linked to a higher risk of bleeding strokes. People with a high liver fibrosis score had twice the risk of hemorrhagic stroke compared to those without, even after accounting for factors like high blood pressure and alcohol use. This finding suggests that liver scarring—often undetected—may be an important and overlooked contributor to stroke risk.

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This study examined treatment and survival differences among Asian American patients with early-stage liver cancer using a national cancer database. When the Asian American group was looked at as a whole, outcomes appeared better than for white patients, but breaking the group apart revealed major disparities: Southeast Asian and Native Hawaiian/Pacific Islander patients had significantly higher mortality rates. Treating Asian Americans as a single group masks serious health inequities that require targeted attention from clinicians and policymakers.

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This paper describes a patient who suffered cardiac arrest caused by an unusual condition called arrhythmic mitral valve prolapse, a rare but potentially deadly heart valve problem. The case prompted a review of what warning signs clinicians should look for on standard tests like an EKG and echocardiogram to identify patients at risk before a life-threatening event occurs. The authors argue that targeted awareness of specific features can help justify more advanced imaging in the right patients.

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Researchers tracked who prescribed antiviral medications for chronic hepatitis B patients on Medicare between 2013 and 2021. Gastroenterologists and advanced practice providers took on an increasingly larger share of prescribing, while infectious disease specialists prescribed less over time. The growth of advanced practice providers in managing hepatitis B is a promising development given doctor shortages, though it signals the need for better care coordination models.

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Researchers followed patients with alcohol-related liver disease from the moment they first developed ascites—a sign of serious liver decline—and identified factors linked to transplantation or death. Younger age and higher sodium levels were associated with getting a transplant, while higher BMI, more health conditions, and a recent period of abstinence after heavy drinking were linked to death. These early predictors could help clinicians better counsel and risk-stratify patients at this critical disease turning point.

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This study evaluated whether the Affordable Care Act's Medicaid expansion changed who gets on the liver transplant waitlist and how they fare. Medicaid use on the waitlist increased substantially in states that expanded coverage, while waitlist mortality was unchanged and transplant rates for Medicaid patients improved slightly. The results indicate that broadening Medicaid access increases the number of people who can pursue transplantation without harming overall waitlist outcomes.

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Researchers tested how well liver severity scores predict six-week mortality in cirrhosis patients hospitalized with upper gastrointestinal bleeding, regardless of whether the bleeding was caused by portal hypertension. Both the Child-Turcotte-Pugh and MELD scores showed strong predictive accuracy, but only the Child-Turcotte-Pugh score performed well across all types of bleeding. This means clinicians can use this score before performing an endoscopy to quickly classify patients as low, moderate, or high risk.

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This study followed over 7,500 hospitalized patients with alcohol use disorder to examine whether early, mild alcohol-related liver damage—before cirrhosis develops—affects outcomes. Patients with early liver injury had nearly three times the 30-day mortality compared to those with no liver disease, and were also more likely to be readmitted within 30 days. The findings show that early alcohol-related liver disease is far from benign and needs to be actively identified and managed.

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This study used AI tools to measure the volume and type of coronary artery plaque in over 4,000 patients who had heart CT scans, then tracked which patients had heart attacks or needed procedures within a year. Higher total plaque volume and percentage of plaque relative to artery size predicted worse outcomes, even after accounting for blockage severity and blood flow measurements. Quantifying plaque volume adds meaningful risk information beyond what standard CT-based measures alone provide.

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This review outlines the racial, ethnic, and socioeconomic gaps that affect patients with chronic liver disease at every stage of care, from initial screening through liver transplantation. It uses a health equity framework to identify specific barriers and offers practical, evidence-based strategies for providers and health systems to deliver more equitable care. The goal is to give clinicians concrete tools rather than simply documenting that disparities exist.

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Researchers mapped the geographic distance between zip codes and the nearest breast imaging facilities across the United States, comparing MRI, mammography, and ultrasound. On average, breast MRI facilities were nearly three times farther away than mammography sites, with the gap widest for people in rural and lower-income areas. The findings highlight a structural access problem for high-risk women who need MRI screening and suggest that contrast-enhanced mammography at existing sites could help close the gap.

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This study looked at what predicts whether kidney injury will resolve in hospitalized cirrhosis patients, and what happens to those whose kidney function doesn't improve by discharge. Higher albumin levels on admission and having a non-fatty-liver cause of cirrhosis were linked to better chances of kidney recovery, while more severe kidney injury at admission predicted worse odds. Patients whose kidney injury didn't resolve had much higher short- and long-term mortality, underscoring the urgency of aggressive treatment.

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Researchers analyzed two decades of national liver transplant data and found that while survival after transplant has steadily improved, survival from the time of waitlist listing has not. Over the same period, the rate of donated livers going unused rose significantly, as did the rate of patients dropping off the waitlist before receiving a transplant. This suggests that gains in post-transplant care are being offset by more patients dying while waiting, partly because usable organs are being declined.

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Researchers asked 70 cirrhosis patients and their liver specialists to independently estimate how long the patient would live with and without a transplant, then compared those estimates. Patients were significantly more optimistic than their doctors, and their survival estimates bore little relationship to their actual disease severity scores. Better alignment between patients and providers on prognosis is essential for patients to make informed decisions about pursuing transplantation or other care options.

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This review examines the potential of mobile technology and smartphone-based tools to assess cognitive function in patients with hepatic encephalopathy, a complication of liver disease that causes brain dysfunction. Current diagnostic tests are underused and imprecise, but digital tools could allow for real-time, continuous cognitive monitoring outside of clinic visits. The authors discuss both the promise and the significant practical, ethical, and reliability challenges that must be solved before these tools can be widely adopted.

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This review examines three decades of experience using kidneys from hepatitis C-positive donors in kidney transplantation, including the now-common practice of transplanting these organs into hepatitis-C-negative recipients. It outlines how the development of highly effective direct-acting antiviral drugs transformed this once-controversial approach into a viable strategy for expanding the organ supply. The review provides a historical and practical framework for centers considering or already using this approach.

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This study used commercial fitness trackers to monitor sleep in 25 cirrhosis patients over six months, testing whether wearable devices could detect early-stage brain dysfunction known as covert hepatic encephalopathy. Patients with this condition consistently had about one hour less restorative sleep per night, and a model combining sleep data with lab values showed good accuracy in identifying who had it. The findings open the door to passive, continuous monitoring of a complication that is currently underdiagnosed and hard to test for in practice.

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Researchers tested whether prompting hospital teams to document cirrhosis best practices—using a structured electronic medical record template—would improve patient outcomes. Patients cared for by teams using the template had significantly lower 30-day mortality (8.4% vs. 28%) and higher rates of a key diagnostic procedure for ascites. The results suggest that embedding clinical guidelines directly into the documentation workflow can translate into real survival benefits for hospitalized cirrhosis patients.

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This review addresses the management of stroke in patients who also have chronic liver disease, filling a significant gap in existing stroke guidelines. Chronic liver disease disrupts clotting, platelet counts, drug metabolism, and other factors that directly affect stroke risk and treatment decisions. The review provides vascular neurologists with practical guidance on both the unique stroke risks these patients face and the challenges of treating them with standard stroke medications.

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This study investigated whether race and neighborhood characteristics—such as poverty levels, education, and language barriers—affect the likelihood of being diagnosed with advanced liver cancer among patients with viral hepatitis and cirrhosis in New York City. Asian race and low household income were independently associated with a higher chance of being diagnosed at an advanced, harder-to-treat stage. The findings point to failures in cancer screening programs for vulnerable populations and the need for targeted outreach.

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This review covers invasive fungal infections in patients with serious liver disease, including cirrhosis, alcoholic hepatitis, and liver transplant recipients. It explains why these patients are particularly vulnerable—due to immune dysfunction, malnutrition, and disrupted gut bacteria—and covers how to diagnose and treat infections caused by organisms like Candida, Aspergillus, and Cryptococcus. The review serves as a practical clinical guide given the high mortality these infections carry in this population.

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This case report describes a patient with advanced liver cancer whose routine liquid biopsy unexpectedly found an extreme amplification of the HER2 gene, a target normally associated with breast and gastric cancers. The team confirmed the finding with tissue testing and successfully used a dual HER2-blocking drug combination, tracking the response through blood tests and circulating tumor cells. The case illustrates that liquid biopsy can uncover actionable targets in liver cancer patients who might otherwise have no targeted treatment options.

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Using national mortality and transplant listing data from 2014 to 2018, researchers found that patients with alcohol-related liver disease have far lower rates of liver transplant listing relative to deaths than patients with other liver diseases—and within that group, Black patients and women face the greatest disadvantage. Black patients with alcohol-related liver disease were listed at half the rate of White patients. These findings call for targeted interventions to address compounded disparities in transplant access.

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A national survey of 60 U.S. liver transplant programs examined how often and under what circumstances centers refer declined patients for a second opinion at another center. While all centers receive second-opinion referrals, only 25% frequently facilitate them for their own declined patients, and practices vary widely with no standardized process. Standardizing second-opinion pathways could improve equity for patients denied transplant listing.

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Researchers used data from two large randomized trials—one in diabetic patients, one in hypertensive patients—to test whether chronic liver disease is linked to worse cognitive function or smaller brain volumes. After adjusting for relevant factors, no consistent association was found between liver disease markers and cognitive test scores or brain imaging results in either group. This suggests that in people with diabetes or hypertension, liver disease does not independently drive cognitive decline, though the question remains open in other populations.

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This practical review guides clinicians through managing the range of symptoms that affect patients with cirrhosis, from ascites and brain dysfunction to pain, fatigue, and depression. It addresses the added complexity of prescribing medications in cirrhosis patients, whose altered liver function changes how drugs are processed and can cause harm at standard doses. The review is designed to give hepatologists concrete, evidence-based tools for improving quality of life in this challenging patient population.

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Using data from over 455,000 UK adults, researchers found that people with signs of advanced liver scarring were 52% more likely to develop dementia over time compared to those without liver disease, even after adjusting for many other risk factors. The association held across different types of dementia and was not explained by shared risk factors like diabetes or alcohol use. Liver fibrosis may be a meaningful and underappreciated contributor to brain health that warrants attention in dementia prevention.

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This review covers the types of infections that occur in patients with severe alcoholic hepatitis, who face a double vulnerability: their liver disease weakens the immune system, and the standard treatment—corticosteroids—can further impair infection-fighting ability. It examines the evidence on whether corticosteroids actually increase infection risk (more nuanced than once thought) and provides guidance on diagnosis, antibiotic selection, and preventive strategies. Prompt infection recognition and treatment are critical because infections dramatically worsen survival in this group.

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A national survey of 99 liver transplant programs explored current use of nondirected living liver donation (where a stranger donates to an unknown recipient) and liver paired exchange (where incompatible donor-recipient pairs swap). Most programs accepting living donors allowed nondirected donation, but only 12% performed paired exchange, though 78% said they would participate if logistical barriers were resolved. Understanding these gaps can guide policy efforts to make more flexible forms of living donation routine.

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Researchers analyzed 20 years of national data on living liver donors and found that the demographic profile has changed very little: donors remain predominantly young, White, employed, and college-educated, with a recent rise in female donors. The narrow socioeconomic and racial profile of donors likely reflects structural barriers to donation rather than medical exclusions. Addressing financial and social obstacles to donation is essential to diversify the donor pool.