Hepatologist @michiganliver @vaannarbor; #cirrhosis; encephalopathy; frailty; quality improvement; father; husband. #livertwitter Co-EIC of @HepCommJournal
Ann Arbor, MI
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What are the controversies we need to solve that face US patients with cirrhosis? Join us in Miami in January
ACES-Summit.org
Organized by O’Leary, @serperm, @JasmohanBajaj, and myself, we hope you join us to build better evidence and better strategies for our patients
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Cost-effective to screen for hcc was 0.4%. Recently a vastly superior group of modelers found the exact same threshold
Made my day
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The best game in hepatology is back: HepMadness
Fill out your bracket: tourneytopia.com/aasld/hepma…
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This is the month I learned how to superimpose myself on a shared screen
piped.video/QniIrUn-Sfo
Co-Editors @ebtapper and Carmen Chak-Lui Wong highlight October's @HepCommJournal, featuring liver decompensation, acute kidney injury in alcohol-associated hepatitis, pediatric PSC, ferroptosis, and more!
Watch below and explore the issue: journals.lww.com/hepcomm/toc…
piped.video/QniIrUn-Sfo
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What counts as evidence? Hepatologists have learned to thrive in data deserts. So how can we square the standards of Cochrane and GRADE with the data that we have? And should we?
Ian and I in @FrontGastro_BMJ : fg.bmj.com/content/flgastro/…
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Everyone in hepatology and liver transplant is aware of Jennifer C. Lai, MD/MBA’s impact. This week we were privileged to have her as the Sheila Sherlock visiting professor at Michigan Hepatology
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The use of “defined daily doses” or DDD to measure “dose effect” is a big problem and should be avoided when attempting to make claims regarding the effect on or association with an outcome. It may just be measuring event-free survival!
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Everything you need to know about liver biopsy!
The first @AASLDtweets EXPO is on biopsy and it is online now without paywall: ovid.com/jnls/hep/fulltext/1…
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Together with my coauthors (Jennifer C. Lai, MD/MBA), we lay out the evidence based strategies that prevent decompensation, hospitalization, and death for the more than 2 million Americans living with cirrhosis. We also walk through how to implement these concepts in practice
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Fantastic time in Cleveland with @pgholam at NEOLA
Great event. fellows from 5 programs debated the “things we do”. their takes we so well researched & reasonable. made you feel great about the future of hepatology
🚫Abx ppx
?Urso for itch
?Steroids!
🚫Albumin challenge
🚫ffp
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Grateful to have visited Ohio State University
✅Grand Rounds
✅buckeyes at dessert
✅saw a dinosaur with @AvrahamCooperMD
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Dreams can come true.
>10 years of research, friendship, and team building with patients and caregivers brought us to these beautiful results.
Together we (@serperm) prevented falls in patients with cirrhosis.
journals.lww.com/hep/abstrac…
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An RCT of ROTEM before procedures in cirrhosis
Key points
1. Congratulations to Dr Janko!
2. Less FFP, more cryo - as expected
I will add:
1. Tired: ROTEM as a stewardship tool
2. Wired: just say no to HARMFUL transfusions
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The most important blood test in hepatology is PETH
Here is a great framework for its use, interpretation and limitations from Marina Serper @serperm in @AGA_Gastro
doi.org/10.1053/j.gastro.202…
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Great review on blood based liver cancer biomarkers by all stars Neehar, @JesusMBanales, @docamitgs, and @SaborowskiAnna in Jhep
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Research idea for Anyone with access to large federated EHR dataset
Please study the comparative prognostic value of patients receiving liver stiffness measurements from SWE & VCTE
A recent study examined this in a controlled setting but we need to know real world performance
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Micronutrient deficiency in cirrhosis
1. Super common!
2. Vitamin A and zinc among most common
3. Selenium deficiency➡️frailty
Excellent study from Melinda Wang and @AASLDtweets Impact Awardee. @JenLaiLiverDoc
journals.lww.com/hepcomm/ful…
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Mortality due to alcohol-related liver disease is rising
And if is especially driven by out of hospital deaths where the patient hadn’t been admitted to the hospital in the prior year
This is an important finding in ALD epi jech.bmj.com/content/jech/ea…
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Very important question!
Also a very important lesson about immortal time bias. Time zero was dx of stone. But the ercp group had their tx within 60 days so they were *guaranteed* to be free of complications/competing risks for … up to 60 days. The km curve says it all
#CGH4ALL @AGA_CGH 📣
What is your practice in elderly patients presenting with uncomplicated choledocholithiasis❓
🔗cghjournal.org/article/S1542…
@MedicalCollege , @wakeforestmed ,@CUGastroHep @DouglasAdlerMD,@DennisYangMD, @BilalMohammadMD, @VinayChandraMD, @shailsingh, @ShyamTMD, @MN_GIMD
📢 @DrRutwikSharma
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What is the incidence of hepatic AVMs in people with hereditary hemorrhagic telangectasia?
This study provides a clear answer
Congratulate Dr. Cho on his @HepCommJournal paper And also @egnij on this very cool, super powerful LLM-NLP pipeline he built journals.lww.com/hepcomm/ful…
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What's the deal with screening for liver cancer with blood-based biomarkers?
Is it cost-effective?
journals.lww.com/hepcomm/ful…
@SeragHashem @JagChhatwal @HepCommJournal
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Over the last few years, nobody has taught us more about coagulation in liver disease than @ZanettoAlberto
Thrombin generation and prognosis, proudly published in @HepCommJournal
journals.lww.com/hepcomm/ful…
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Large study of recompensation in @HEP_Journal
1. Alcohol abstinence is key
2. High rates of achieving child A5
3. I would not recommend achieving non-ascites body weight loss targets when decompensated because that’s risky
Great study @docMPK
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Variceal bleeding on carvedilol is very rare
Some patients need banding in addition. Particularly those who are actively drinking alcohol.
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The cost of false positives - and the cost of not dealing with the diseases that lack blood tests - is super high for patients
We proposed a way forward mayoclinicproceedings.org/ar…
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Our patients @umichmedicine now have the 4th fastest time in the nation to liver transplantation from listing
It has been a joy to see these life changing stories unfold as they have
With gratitude to the team - the superb surgeons and the driving force, @AShinginaMD
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Love this: bevacizumab for AVM bleeding
onlinelibrary.wiley.com/doi/…
From @Rsk2003 and friends
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I recommend this article co-authored by my friend and colleague Vincent Chen with THE Raj Reddy on the clinical application of genetics for common liver diseases
It is a thorough and balanced review
Link and my take on next comment
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Contemporary global epidemiology of cirrhosis
journals.lww.com/hepcomm/ful…
@KarnJUVE @HepCommJournal
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Ammonia
journals.lww.com/hepcomm/ful…
A magnum opus on a true liver function test / and liver toxin
The single greatest review on this important, controversial molecule. Rajiv Jalan AASLD Publications
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Congratulations to the newest member of the Michigan Liver family
Neeya Sheth is an @AASLDFoundation 2026 Emerging Liver Advanced Practice Provider
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Lactulose is hard to beat
1. Prevents HE
2. Reduces mortality
3. Low risk of adverse events
A systematic review with Bayesian meta-analysis led by Kasmikha @UMIntMed
doi.org/10.1111/liv.70765
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Proud of Dr. Swanson
She received the Vinay Sundaram Transplant Fellowship. Vinay was a friend, collaborator, and I was his first resident on service when he was a transplant fellow. I believe he too would be proud of Linnea. Especially with how she banded varices last week
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Standard 💩 transplant by colonoscopy beats vanc taper, fidaxomycin, and newer FMT approaches for recurrent c diff in a cost-effectiveness analysis by @UMichGIHep Bill Hirsh and my former neighbors, Radha and Byron academic.oup.com/cid/advance…
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The challenge is that these are the ratings of 3 clinicians on subjective measures using dichotomized scales with ok reliability (and is the difference between 2-3 on a 4 pt scale that valid?). The models are ever changing. And mcq’s has nothing to do with my clinic
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Citescore is an alternative metric to the clarivate impact factor (coming out soon)
Here is what is happening at hep comm
With many thanks to those who submit, review, and enjoy our publication
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Drs Ezzafzafi and Lantiga show that ceftriaxone clearance is way low in cirrhosis
We are overdosing our patients
Lantiga about to change practice!
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The main driver of decreased fitness in cirrhosis is impaired oxygen extraction
Dr Alexis spent 3 years performing this important study
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Rates of hazardous drinking in patients with compensated cirrhosis
Get ready for a tidal wave of important research from the LCN!
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Income is associated with a higher rate of under-reporting of alcohol consumption
Important observation!
@Helle_schne
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A classic work of liver epidemiology by the late Hannes and Ying Shang
What outcomes will my patient with diabetes develop? 👇
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They looked at the peritoneum of patients undergoing liver transplantation, and those without cirrhosis. They find that decompensated cirrhosis has increasing inflammation and fibrosis
Without a doubt, this is true and explains why some people don’t clear ascites as efficiently
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A recent study makes use of the Uk biobank to illustrate this point nicely
But no need to check levels in chronic liver disease for prognostic purposes unless you are treating symptoms of deficiency. The associations would parallel other measures like FIB4, liver stiffness, etc
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radiation is (often) magic for hcc
Here is a nice comparison of ALBI and child scores over time, with ablation
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