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Livers, Volume 6, Issue 4

2026 August - 27 articles

Cover Story: Hepatic crown-like structures (hCLS), sometimes called lipogranulomas, are shell-like aggregates of macrophages surrounding large lipid-laden, dying hepatocytes. They play a role in removal of excess lipid and are critical sites of inflammation regulation, fibrosis modulation and macrophage imprinting and development. Recent advances in single-cell sequencing and lineage tracing have shown considerable heterogeneity of the cells that make up the CLS. The cover image demonstrates this heterogeneity in mouse liver with alcohol-associated steatohepatitis. It shows lipid-associated macrophages in red, Kupffer cells in green and, and newly formed Kupffer cells in yellow. The paper describes recent advances in hCLS biology providing a current picture of their role in progression and resolution of steatotic liver diseases. View this paper
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Articles (27)

  • Article
  • Open Access
300 Views
13 Pages

National-Level Prevalence of Overweight and Obesity Among Liver Transplant Recipients in the USA, 1988–2022, and Projections to 2050

  • Sarpong Boateng,
  • Frhaan Zahrawi,
  • Prince Ameyaw,
  • Mansoor Jalal Zai,
  • Mohammad-Javad Khosousi,
  • Vandana Khungar and
  • Bubu A. Banini

21 August 2026

Background/Objectives: As indications of liver transplantation evolve and the burden of obesity rises in the general population, a clear understanding of weight trends among liver transplant (LT) recipients is needed to inform evidence-based guidance...

(This article belongs to the Special Issue Transforming Liver Transplantation: Breakthroughs and Boundaries)
  • Review
  • Open Access
633 Views
32 Pages

Digital and Biological Twins in Cholangiocarcinoma: From Translational Research to Precision Medicine—A Narrative Review

  • Lorenzo Manganaro,
  • Giuseppe De Sario,
  • Guido Carpino,
  • Lewis J. Frey,
  • Eugenio Gaudio,
  • Wing-Kin Syn,
  • Domenico Alvaro and
  • Vincenzo Cardinale

13 August 2026

Background: Cholangiocarcinoma (CCA) is a highly heterogeneous malignancy with limited therapeutic options and poor prognosis. The increasing complexity of molecular stratification and treatment selection has stimulated interest in computational and...

(This article belongs to the Special Issue Liver Cancer Heterogeneity in the Era of Single-Cell and Spatial Multiomics)
  • Article
  • Open Access
294 Views
15 Pages

Hepatic Vein–Inferior Vena Cava Confluence Angle as a Key Anatomical Predictor of Technical Success in Transjugular Liver Biopsy

  • Naohiro Wada,
  • Takashi Kobayashi,
  • Asako Nogami,
  • Michihiro Iwaki,
  • Satoru Saito,
  • Atsushi Nakajima and
  • Masato Yoneda

13 August 2026

Background/Objectives: Transjugular liver biopsy (TJLB) occasionally fails, most commonly because of difficulty in hepatic vein (HV) catheterization. We investigated whether the HV–inferior vena cava (IVC) confluence angle measured on CT or MRI...

  • Article
  • Open Access
398 Views
12 Pages

Longitudinal Changes in Utility Scores and Health-Related Quality of Life During Interferon-Free Direct-Acting Antiviral Therapy for Chronic Hepatitis C in Japan: Implications for Cost–Utility Analysis

  • Maki Hirao,
  • Hiroki Sugimori,
  • Ataru Igarashi,
  • Hiroshi Yatsuhashi,
  • Toshihiko Satoh,
  • Shunya Ikeda,
  • Naohiko Masaki,
  • Hiroshi Yotsuyanagi,
  • Tomoyuki Takura and
  • Tomohiro Hirao
  • + 5 authors

12 August 2026

Background/Objectives: Interferon-free direct-acting antiviral (DAA) therapy cures chronic hepatitis C virus (HCV) infection, but its short-term effects on health-related quality of life (HRQoL) are captured differently by generic and disease-specifi...

  • Review
  • Open Access
533 Views
14 Pages

10 August 2026

Peroxisome proliferator-activated receptors (PPARs) are ligand-activated nuclear transcription factors comprising three isoforms—PPARα, PPARγ, and PPARβ/δ—that regulate hepatic lipid metabolism, glucose homeostasis,...

  • Article
  • Open Access
677 Views
19 Pages

Comparative Analysis of Acute Liver Injury in Mice Following Two Routes of Acetaminophen Administration

  • Liana Monteiro da Fonseca Cardoso,
  • Ayla Josma Teixeira,
  • Miriam Salles Pereira,
  • Tatiane Barreto da Silva,
  • Andrea Henriques-Pons and
  • Luiz Anastacio Alves

6 August 2026

Background: Acute liver failure (ALF) is a rare, yet potentially fatal clinical syndrome characterized by the rapid deterioration of hepatic function in individuals without pre-existing liver disease, typically occurring over a period of days to week...

(This article belongs to the Special Issue Recent Advances in the Detection and Pathophysiology of Steatotic, Alcoholic and Drug-Induced Liver Diseases)
  • Review
  • Open Access
831 Views
51 Pages

Unmet Needs in Primary Sclerosing Cholangitis Associated with Inflammatory Bowel Disease: A Comprehensive Review

  • Anthony Vignone,
  • Simone Di Cola,
  • Flaminia Ferri,
  • Francesco Covotta,
  • Lewis J. Frey,
  • Wing-Kin Syn,
  • Domenico Alvaro and
  • Vincenzo Cardinale

5 August 2026

Primary sclerosing cholangitis (PSC) is a rare cholangiopathy strongly associated with inflammatory bowel disease (IBD), particularly ulcerative colitis. PSC-IBD defines a clinically quiescent but biologically aggressive colitis phenotype, characteri...

(This article belongs to the Topic Liver Diseases: From Pathogenesis to Modern Management)
  • Review
  • Open Access
902 Views
37 Pages

5 August 2026

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide and remains a major therapeutic challenge due to its marked inter- and intratumoral heterogeneity, diverse etiologies, and high propensity for therape...

  • Article
  • Open Access
634 Views
28 Pages

4 August 2026

Background/Objectives: Metabolically dysregulated-associated steatotic liver disease (MASLD) is a complex, multifactorial disorder characterised by hepatic lipid accumulation, insulin resistance, oxidative stress, and dysfunction of the gut–liv...

  • Review
  • Open Access
783 Views
16 Pages

1 August 2026

The hepatic crown-like structure (hCLS) is a shell-like aggregate of macrophages surrounding a large lipid-laden dying hepatocyte. This feature was initially assumed to simply be a response to increased inflammatory stress during steatotic liver dise...

  • Review
  • Open Access
1,130 Views
49 Pages

From FIB-4 to the Artificial Intelligence Era: The Evolution of Non-Invasive Tools (NITs) for Tailored Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

  • Mario Romeo,
  • Fiammetta Di Nardo,
  • Claudio Basile,
  • Carmine Napolitano,
  • Paolo Vaia,
  • Luigi Di Puorto,
  • Mattia Indipendente,
  • Alessia De Gregorio,
  • Marcello Dallio and
  • Alessandro Federico

16 July 2026

Metabolic dysfunction–associated steatotic liver disease (MASLD) has become the leading global cause of chronic liver disease, driving cirrhosis, hepatic decompensation, hepatocellular carcinoma (HCC), and a disproportionate burden of major adv...

  • Article
  • Open Access
609 Views
12 Pages

Trends and Outcomes of Acute Liver Failure in Patients with COVID-19 Infection: Insights from United States National Inpatient Sample Analysis 2020–2022

  • Antony Arumairaj,
  • Dili Dhanani,
  • Anuradha Shunmugam Veluswamy,
  • Abhishek Kumar Mariswamy Arun Kumar,
  • Jose Andres Perez Moscoso,
  • Jayesh Mittal,
  • Vipulkumar Prajapati,
  • Divya Korpu and
  • Poojaben Dhorajiya

15 July 2026

Introduction: COVID-19, in addition to its direct detrimental respiratory infection, is associated with multiple systemic complications involving different organs, including the liver. COVID-19 has been associated with liver injury through multiple m...

  • Review
  • Open Access
1,026 Views
18 Pages

14 July 2026

Background: Nutrition and nutrition-related interventions are a salient yet under-recognized component of preventing the development of and complications of metabolic dysfunction-associated steatotic liver disease (MASLD). Additionally, malnutrition...

  • Systematic Review
  • Open Access
859 Views
12 Pages

14 July 2026

Background: Accurate post-treatment imaging assessment of hepatocellular carcinoma (HCC) is essential for guiding retreatment, transplantation eligibility, and prognosis. The Liver Imaging Reporting and Data System Treatment Response Algorithm (LI-RA...

(This article belongs to the Special Issue The Transformative Role of Contrast-Enhanced Ultrasound (CEUS) in Chronic Liver Disease)
  • Article
  • Open Access
768 Views
23 Pages

Assessing Lactate’s Role as a Predictor of Post-Transplant Outcomes During Normothermic Machine Perfusion

  • Rebecca Panconesi,
  • Sangeeta Satish,
  • Chase J. Wehrle,
  • Mingyi Zhang,
  • Keyue Sun,
  • Chunbao Jiao,
  • Omer F. Karakaya,
  • Geofia Crasta,
  • F. Selin Yildirim and
  • Andrea Schlegel
  • + 19 authors

10 July 2026

Background/Objectives: The use of extended-criteria donors (ECDs) is rapidly increasing, with higher risks for impaired outcomes after liver transplantation (LT). Normothermic machine perfusion (NMP) can enhance graft viability assessment, though lac...

(This article belongs to the Special Issue Transforming Liver Transplantation: Breakthroughs and Boundaries)
  • Article
  • Open Access
729 Views
25 Pages

An Interpretable Machine Learning Model for the Differentiation of Liver Cysts and Liver Tumors Based on Computed Tomography (CT) Imaging

  • Mamoun Qjidaa,
  • Anass Benfares,
  • Mohammed Amine El Azami El Hassani,
  • Amine Benkabbou,
  • Amine Souadka,
  • Anass Majbar,
  • Zakaria El Moatassim,
  • Maroua Oumlaz,
  • Oumayma Lahnaoui and
  • Abdeljabbar Cherkaoui
  • + 7 authors

9 July 2026

Background: Metastatic liver tumors (MLT) and parasitic liver cysts (PLC) are common liver conditions that often exhibit similar imaging characteristics, making accurate diagnosis challenging using imaging alone. This overlap can result in diagnostic...

  • Review
  • Open Access
1,458 Views
14 Pages

Evidence-Based Bedside Management of Overt Hepatic Encephalopathy: From Guidelines to Clinical Practice

  • Eugenio Franceschini,
  • Andrea De Sinno,
  • Matteo Cappelli Aimone Chiorat and
  • Dante Pio Pallotta

9 July 2026

Overt hepatic encephalopathy (OHE) is a defining decompensation event in liver cirrhosis, associated with substantial morbidity, mortality, and high readmission rates. For the bedside clinician, managing OHE presents a complex diagnostic and investig...

  • Article
  • Open Access
782 Views
19 Pages

Glucocorticoid Receptor β (GRβ)-Induced Pathways Modify Liver Glucocorticoid Responsiveness Through Transcriptional and Kinase Signaling Mechanisms

  • Genesee J. Martinez,
  • Zachary A. Kipp,
  • Evelyn A. Bates,
  • Sally N. Pauss,
  • Joseph S. Marino and
  • Terry D. Hinds

7 July 2026

Background/Objectives: The glucocorticoid receptor (GR) is essential for regulating liver energy balance, metabolism, and inflammation. Stress and other factors can impair its function, resulting in glucocorticoid-resistant metabolic liver disease. G...

(This article belongs to the Topic Signaling Pathways in Liver Disease 2nd Edition)
  • Article
  • Open Access
522 Views
15 Pages

3 July 2026

Background: Early recurrence following curative-intent hepatectomy for colorectal liver metastases (CRLMs) remains a significant clinical challenge. This study investigates risk factors for recurrence within 6 and 12 months and evaluates the impact o...

  • Article
  • Open Access
709 Views
12 Pages

Early Survival Signal for Normothermic Machine Perfusion in Liver Transplantation Amidst Limited Registry Data

  • Carter Burns,
  • Gwendolyn Henry,
  • Ron Varghese,
  • Zhi Mei Sonia He,
  • John Goss and
  • Abbas Rana

2 July 2026

Background/Objectives: There is a critical disparity between donor organs and recipients awaiting liver transplantation. Normothermic machine perfusion (NMP) has emerged as a promising strategy with which to address this shortage. This study aimed to...

(This article belongs to the Special Issue Transforming Liver Transplantation: Breakthroughs and Boundaries)
  • Article
  • Open Access
603 Views
12 Pages

Liver Iron Content and Magnetic Resonance: A “Biopsy-Free” Quantification Method and Its Validation

  • Lorenzo Cinci,
  • Cosimo Nardi,
  • Martina Legato,
  • Valentina Carrai,
  • Valeria Santini,
  • Ginevra Danti,
  • Simone Busoni,
  • Susanna Pucci,
  • Luca Messerini and
  • Linda Calistri

1 July 2026

Background/Objectives: Accurate liver iron content (LIC) quantification and monitoring are crucial for managing patients with hematological disorders. Biopsy-based LIC assessment is invasive and prone to sampling errors. This study aimed to develop a...

(This article belongs to the Topic Advances in Gastrointestinal and Liver Disease: From Physiological Mechanisms to Clinical Practice, 2nd Edition)
  • Article
  • Open Access
718 Views
11 Pages

Prognostic Value and Inter-Reader Agreement of the ANALING and DiStrict MRCP Scores in Primary Sclerosing Cholangitis

  • Thomas Goodwin,
  • Numan Kutaiba,
  • Mark Goodwin,
  • Ruth P. Lim,
  • Leon Winata,
  • Bruno Di Muzio,
  • William Kemp,
  • Stuart Roberts,
  • Natassia Tan and
  • Ammar Majeed

1 July 2026

Background/Objectives: The ANALI and DiStrict scores are novel quantitative magnetic resonance cholangio-pancreatography (MRCP)-derived scoring systems designed to predict outcomes in primary sclerosing cholangitis (PSC). However, as their prognostic...

  • Article
  • Open Access
668 Views
14 Pages

Development and Internal Validation of a Novel Pediatric-Adapted Liver (PAL) Score for Predicting Advanced Fibrosis: Comparison with Transient Elastography

  • Alexandru-Ștefan Niculae,
  • Alina Grama,
  • Gabriel Bența,
  • Alexandra Mititelu,
  • Sorina Adam and
  • Tudor Lucian Pop

26 June 2026

Background & Aims: Accurate assessment of liver fibrosis is important for the management of pediatric chronic liver disease (CLD). Transient Elastography (TE) has emerged as a validated non-invasive method for accurately assessing hepatic fibrosi...

  • Article
  • Open Access
913 Views
17 Pages

Association of Menopause with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Quality of Life in Women

  • Anastasia Ntikoudi,
  • Eleni Evangelou,
  • Petros Galanis,
  • Dimitra Anna Owens,
  • Sarantoula Ventouri,
  • Despoina Rizikou,
  • Anastasia Papachristou,
  • George Mastorakos and
  • Eugenia Vlachou

25 June 2026

Background: Menopause represents a critical physiological transition associated with hormonal changes that influence both metabolic health and quality of life (QoL). Metabolic dysfunction-associated steatotic liver disease (MASLD), a common metabolic...

  • Article
  • Open Access
722 Views
12 Pages

25 June 2026

Background: Ventral hernias are a common complication following abdominal surgery, occurring in up to 20% of patients after midline laparotomy and as many as 43% of those who undergo orthotopic liver transplantation (OLT). These hernias pose unique c...

  • Review
  • Open Access
1,293 Views
21 Pages

Ex Vivo Liver Perfusion as a Platform for Gene Therapy, Immunotherapy, Pharmacology, and Personalized Medicine

  • Paul Travers,
  • Yichen Wang,
  • Yan Yan,
  • Jiang Zou,
  • Nabanita Halder,
  • Kristin E. Clift,
  • Xiaojun Cai,
  • Robert L. Kruse,
  • Vivek Kumbhari and
  • Yuting Huang
  • + 2 authors

24 June 2026

Ex vivo liver perfusion (EVLP) sustains human or large animal livers outside the body under near-physiological conditions, enabling functional monitoring for lactate clearance, bile production, and oxygen consumption and allowing targeted therapeutic...

(This article belongs to the Special Issue Liver Cancer: Molecular Genetics, Biomarkers, and Emerging Therapeutic Frontiers)
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Livers - ISSN 2673-4389