Livers

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 mechanisms, including direct viral effects on liver cells, immune-mediated injury, cytokine-driven inflammation, ischemic hepatitis, microvascular thrombosis, and sepsis-related multiorgan dysfunction. Acute liver failure (ALF) is the acute form of liver damage, which has a high mortality, and recovery is dependent on various factors. We studied the effect of COVID-19 on clinical outcomes such as mortality, length of stay, and need for non-invasive and invasive ventilation in patients with acute liver failure. Methods: We performed a retrospective cohort analysis using the Nationwide Inpatient Sample (NIS) database from 2020 to 2022. Adult patients admitted to the hospital with acute liver failure were divided into 2 groups based on their COVID-19 infection status. We analyzed differences in mortality, length of stay, need for non-invasive and invasive ventilation, acute kidney injury, need for renal replacement therapy, and total charges to evaluate the effects on outcomes, and the results were then adjusted for demographic and hospital factors. Results: Of 633,155 patients with acute liver failure, 66,785 had concurrent COVID-19 infection, while 566,370 did not. Patients with concurrent COVID-19 infection had significantly higher in-hospital mortality (63.9% vs. 36.0%) and greater utilization of noninvasive ventilation (14.9% vs. 6.4%), invasive mechanical ventilation (68.9% vs. 41.7%), higher incidence of acute kidney injury (81.4% vs. 70.3%) and higher need for renal replacement therapy (26.8% vs. 16.9%). They also experienced longer hospital stays (17.1 vs. 10.7 days) and higher total charges ($345,072 vs. $221,268). The findings were statistically significant after adjusting for demographics and clinical factors. Conclusions: Patients hospitalized with acute liver failure and concurrent COVID-19 infection experienced worse clinical outcomes, including higher in-hospital mortality, greater need for ventilatory support and renal replacement therapy, and higher hospital resource utilization. Notably, COVID-19 was independently associated with worse outcomes even among patients with fewer baseline comorbidities. These findings underscore the importance of early recognition of COVID-19 in patients presenting with acute liver failure, as well as prompt, multidisciplinary management to optimize clinical outcomes. Full article

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 affects a significant proportion of patients with MASLD, yet remains under-treated in the primary care setting. The objective of this narrative review is to synthesize the available evidence regarding nutritional screening, diet, and supplements in patients with MASLD. This review is aimed at primary care physicians to improve the recognition of malnutrition in MASLD patients and provide appropriate nutritional guidance. Methods: Between November 2025 and June 2026, the authors conducted a literature review using the PubMed database. Search terms included combinations of the following: MASLD, non-alcoholic fatty liver disease (NAFLD), malnutrition, sarcopenia, nutritional screening, Mediterranean diet, micronutrients, and physical activity. Randomized controlled trials (RCTs), systematic reviews, and meta-analyses addressing nutritional outcomes in liver disease were prioritized, and consensus guidelines were incorporated where primary trial evidence was limited. Evidence was appraised by study design, risk of bias, and endpoint; recommendations resting on expert opinion or extrapolation from cirrhosis populations are identified as such. Results: Author review of the studies yielded the following conclusions. Nutritional assessment should be risk-stratified by fibrosis stage using liver disease-specific tools, as BMI and body weight are unreliable in MASLD. Weight loss has been shown to improve histological and clinical progression in MASLD. The Mediterranean diet has the strongest support for steatosis reduction among the dietary interventions discussed. Coffee consumption is consistently associated with reduced fibrosis risk in observational data, but no randomized evidence exists. GLP-1 receptor agonists achieve histological MASH resolution in up to 63% of patients but require concurrent nutritional monitoring to mitigate lean mass loss. Systemic barriers, including time constraints and limited dietitian access, remain the primary impediment to primary care implementation. Conclusions: Primary care physicians are central in managing many aspects of care for patients with MASLD. This review highlights the established evidence behind diet, exercise and malnutrition prevention in the primary care setting. Full article

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-RADS TRA) was updated in 2024, introducing refinements across contrast-enhanced ultrasound (CEUS), CT/MRI, and radiation-based therapies, including the TR-Nonprogressing category. We aimed to systematically review current evidence on the diagnostic performance, reproducibility, and clinical implications of LI-RADS TRA v2024 for post-treatment assessment of HCC across imaging modalities and locoregional therapies. Methods: A systematic search of PubMed, Embase, Scopus, Web of Science, and CENTRAL was conducted according to PRISMA 2020 guidelines. Original studies applying LI-RADS TRA v2024 (or comparisons with earlier versions or mRECIST) after locoregional therapies were included. Outcomes of interest comprised diagnostic accuracy metrics, inter-reader and inter-modality agreement, temporal behavior of TRA categories, and prognostic associations. Given substantial heterogeneity, results were synthesized narratively. Results: Six studies met inclusion criteria. After thermal ablation, CEUS applying the non-radiation TRA v2024 showed very high specificity (approximately 88–100%) and excellent negative predictive value (about 94–98%), with substantial-to-almost-perfect inter-reader agreement (κ up to 0.92) and excellent inter-modality agreement with CT/MRI (ICC ≈ 0.90). After transarterial chemoembolization, CEUS performance was time-dependent, with higher sensitivity at early follow-up (~15 days) and higher specificity at later assessment (~30 days). On MRI, non-radiation TRA v2024 combined with ancillary features improved sensitivity and, in some analyses, accuracy compared with v2017 and v2024 without ancillary features, while remaining more specific than mRECIST. In radiation-based therapies, the radiation TRA v2024 captured delayed-response patterns through the TR-Nonprogressing category, which demonstrated meaningful temporal evolution and prognostic separation from TR-Viable. Surgical validation confirmed preserved diagnostic performance against histology. Conclusions: Despite heterogeneous data, available evidence supports LI-RADS TRA v2024 as a clinically useful framework that improves clarity, reproducibility, and actionability of post-treatment HCC imaging. CEUS is particularly effective after ablation; timing is critical after TACE, ancillary features should be routinely applied on MRI, and TR-Nonprogressing appropriately reflects radiation biology while preserving prognostic value. Full article

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 lactate clearance as a viability marker lacks consensus in clinical practice. Methods: This study analyzed 213 adult liver transplants using NMP from October 2022 to January 2024. Perfusate lactate levels were measured with an Epoc^® reader and five lactate-based viability criteria were evaluated for predicting post-LT outcomes. Results: All livers cleared lactate at 6 h of NMP (median 0.51 mmol/L). However, 33 livers failed at least one lactate viability criterion. Thirteen livers (6.1%) were discarded based on traditional criteria, but discard rates would have been higher using Groningen (14.6%) or Brisbane (11.2%) criteria for lactate. Outcomes for the recipients of livers that failed the lactate criteria were comparable to those of recipients with livers meeting all criteria, including biliary complications (p = 0.63), graft survival (>0.99), and 6-month CCI (p = 0.89). ROC analysis revealed poor predictive value for graft survival for lactate clearance criteria (AUC 0.50), while lactate was outperformed by MEAF score (AUC 0.67). Conclusions: Lactate clearance alone does not predict outcomes, highlighting the need for further validation of alternative viability. Full article

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 errors and delayed treatment, particularly in resource-limited settings or when invasive procedures such as biopsies are not feasible due to risk or unavailability. This study aimed to develop a reliable and transparent machine learning approach to distinguish MLT from PLC using radiomic features derived from computed tomography (CT). Methods: We propose an explainable radiomics-based machine learning framework for the non-invasive, accurate, and interpretable discrimination of MLT and PLC, designed to assist radiologists in reducing diagnostic ambiguity and expediting patient management. This retrospective study included 30 adult patients, comprising 15 with liver metastases and 15 with pathologic hepatic cysts. Radiomic features were extracted from pre-treatment CT scans using PyRadiomics. Feature selection was performed using three complementary methods: Mutual Information, Lasso regression, and LightGBM importance ranking. HistGradientBoosting classifiers were then trained on each selected feature set. Results: Model performance was evaluated using 5-fold cross-validation and assessed with ROC AUC, accuracy, precision, recall, and F1-score. SHAP analysis was applied to interpret the models and identify key radiomic biomarkers. Statistical comparisons were performed using DeLong’s test for AUCs, McNemar’s test for classification agreement, and paired t-tests for metrics such as accuracy and F1-score. The Mutual Information-based model achieved the highest mean AUC (0.9717 ± 0.0267), significantly outperforming the other models (p < 0.035). Key features contributing to classification included texture entropy, interquartile range, and gray level non-uniformity. Conclusion: We developed a robust and interpretable machine learning framework for differentiating metastatic liver tumors from parasitic liver cysts using CT-derived radiomic features. The integration of Mutual Information feature selection, ensemble learning, and SHAP explainability ensured high diagnostic accuracy, strong calibration, and transparency. The proposed framework demonstrates substantial clinical relevance and holds promise for real-world implementation. Full article

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 investigative challenge that extends well beyond the simple administration of laxatives. This review synthesizes core recommendations from the 2022 EASL and the recent 2026 ACG guidelines to provide a structured, evidence-based framework for acute inpatient management. We emphasize that OHE diagnosis remains a clinical endeavor, where serum ammonia is valuable primarily for its high negative predictive value rather than as a confirmatory biomarker. Successful resolution hinges on a proactive ‘detective approach’ to identify and correct precipitating factors—such as infections, gastrointestinal bleeding, and iatrogenic dehydration—which drive clinical deterioration. Furthermore, we highlight the critical role of the ‘four pillars’ of management, including structured discharge planning, caregiver education, and nutritional support to ensure effective secondary prophylaxis. By bridging the gap between the latest international clinical consensus and bedside practice, this review provides essential strategies to optimize OHE management, minimize recurrence, and ultimately reduce the healthcare burden of this pleomorphic syndrome. Full article

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. GR mainly exists in two forms: the glucocorticoid-binding isoform, GRα, and the non-binding isoform, GRβ. The GRβ isoform typically exhibits minimal signaling activity beyond its role as a dominant-negative regulator of GRα, thereby decreasing glucocorticoid responsiveness and potentially causing resistance. Methods: To explore GRβ signaling independent of GRα, we developed mice with adenovirus-induced overexpression of GRβ (GRβ-Ad) and control mice with a vector (Vec-Ad). After five days on a standard diet, these mice received either vehicle or dexamethasone treatment. Liver tissues were collected, and we performed RNA sequencing and advanced PamGene kinome analysis to detect pathway changes in GRβ-Ad mice compared with controls. Results: Significant increases were observed in the expression of genes that inhibit fatty acid oxidation, inflammation, and liver cancer development. There was also a marked difference in serine/threonine kinase activity between GRβ-Ad and control mice. Conclusions: The findings suggest that elevated GRβ levels affect kinase pathways that modulate glucocorticoid signaling, disrupt liver lipid metabolism, and are associated with cancer pathways. Further research is needed to determine whether GRβ functions similarly in humans and to assess its potential contribution to hepatocellular carcinoma (HCC). Full article

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 of salvage surgery on long-term survival. Methods: We conducted a retrospective cohort study of 109 patients who underwent liver resection for CRLMs between 2013 and 2024. The primary outcome was the identification of predictors for early recurrence using Cox proportional-hazards models. The secondary outcomes focused on overall survival (OS) stratified by the timing of recurrence and subsequent treatment. Results: High tumor burden (>4 metastases) was an independent predictor of recurrence at both 6 months (HR 3.526; p = 0.008) and 12 months (HR 3.115; p = 0.004). Intraoperative blood loss >1000 mL was significantly associated with 6-month recurrence (HR 3.356; p = 0.004) and 12-month recurrence (HR 2.171; p = 0.041). For the 12-month window, independent predictors included AJCC T3/T4 stage (HR 6.513; p = 0.011) and RAS mutation (HR 2.740; p = 0.006). Notably, patients with early recurrence who underwent salvage re-hepatectomy achieved 5-year OS rates that did not statistically differ from those without recurrence (p = 0.907 for <6 months; p = 0.433 for <12 months); however, these subgroup analyses are highly underpowered. Conclusions: High tumor burden (>4 metastases), RAS mutations, significant blood loss (>1000 mL), and primary tumor T3/T4 identify patients at high risk for early recurrence. While aggressive salvage re-hepatectomy is associated with prolonged survival in select patients, the non-significant p-values in our small salvage cohorts cannot be interpreted as evidence of survival equivalence. The observed survival benefits in the salvage cohort are heavily confounded by inherent selection biases, and therefore, the true extent of this ‘rescue’ effect must be interpreted with extreme caution and validated in larger, adequately powered multicenter studies. Full article

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 evaluate the association between NMP and short-term outcomes following liver transplantation using a large, multivariable-adjusted national dataset. Methods: A retrospective analysis of the de-identified United Network for Organ Sharing (UNOS) database was conducted for adult liver transplant recipients between January 2020 and July 2024. Standard and deceased donor data were merged according to donor identification number. Multivariable logistic and Cox regression models were used to evaluate patient mortality, graft failure, and hospital length of stay (LOS). Results: Among 34,115 patients, adjusted regression demonstrated lower one-year patient mortality (OR 0.68, CI 0.54–0.86, p = 0.001) and graft failure (OR 0.72, CI 0.60–0.87, p = 0.001) with NMP compared to static cold storage. NMP was also associated with reduced 30-day (OR 0.67, CI 0.47–0.95, p = 0.03) and 90-day mortality (OR 0.72, CI 0.54–0.94, p = 0.02) and shorter LOS (HR 1.06, CI 1.01–1.12, p = 0.02). Kaplan–Meier and Cox analyses showed no significant differences in overall patient mortality or graft failure. Conclusions: NMP was associated with improved short-term survival in time-independent analysis; however, it failed to reach significance in time-dependent Cox regression. These findings suggest that NMP could play a role in improving short-term outcomes and expanding the donor pool for liver transplant candidates. Additional studies are needed to fully elucidate the impact of NMP on short-term survival outcomes. Full article

Wilson’s disease (WD) is traditionally known as a monogenic disorder of copper transport, but immune activation is now being increasingly recognized in a subset of patients. In a single-center retrospective cohort study of 86 treatment-naïve WD patients who were rigorously diagnosed using the Leipzig score, Jiang et al. systematically evaluated the prevalence, clinical impact, and prognostic significance of autoimmune phenomena (AP), defined by autoantibody positivity and/or elevated immunoglobulin G (IgG). They found that 55.8% of patients met the criteria for AP, with about half showing at least one autoantibody, primarily low-titer antinuclear antibodies (ANAs), indicating that immune activation is common in newly diagnosed WD. Notably, patients with WD and AP (AP-WD) had more advanced hepatic dysfunction at baseline, including higher bilirubin levels, worse synthetic function, greater cirrhosis and ascites burden, and higher composite liver scores, as well as increased urinary copper excretion. Histological analysis in a subset of patients who underwent biopsy showed more intense portal inflammation and plasma cell infiltration in AP-WD, suggesting a distinct immunopathological phenotype. Over a 60-month period, AP-WD patients had a higher incidence of liver-related adverse events (death or liver transplantation), with a nearly fourfold increased hazard compared to patients without AP. Collectively, these findings support AP as a clinically significant modifier of disease expression and outcome in WD, emphasizing the importance of routine assessment of autoantibodies and IgG at diagnosis to improve risk stratification and guide follow-up care. Full article

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 simple and safe method for calibrating MR scanner to accurately measure LIC. Methods: Five certified test objects with increasing aqueous Fe³⁺ solutions were used for R2* relaxometry to create a calibration curve with equation for converting R2* value to iron content (mg/g), using two different MR scanners. Additionally, two sets of test objects (aqueous and gelled solutions to mimic liver tissue) were developed to evaluate the feasibility of using homemade test objects. Our method was compared with two existing methods (Wood et al.’s equation and the Iron Calculator App) in 59 hematological patients, using the certified test object method as reference. We also compared our method with biopsy-based iron quantification (inductively coupled plasma optical emission spectroscopy) in four patients. Results: The equations derived from our homemade test objects were comparable to those from certified test objects across both MRI scanners. The literature methods consistently overestimated LIC compared to our method. For biopsy validation, our method was more accurate in two out of four cases. Conclusions: Our homemade calibration method offers a simple, reliable alternative for LIC quantification. The type of test object (aqueous or gelled) showed no significant difference. While biopsy-based methods remain useful, our MRI-based approach is quicker and avoids the limitations of biopsy sampling. This method, relying on the relationship between iron concentrations and relaxation times, could provide a more comprehensive and accurate assessment of liver iron levels. Full article

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 utility and inter-reader reproducibility are not widely validated, their utility in clinical practice is currently limited. This study aimed to assess the reproducibility and prognostic performance of the ANALI without gadolinium (ANALI_NG) and DiStrict scores in predicting liver-related outcomes in patients with PSC. Methods: We conducted a multicentre retrospective cohort study enrolling adult patients with large-duct PSC and at least one MRCP from the time of diagnosis. MRCPs were scored by five blinded senior abdominal radiologists with inter- and intra-reader agreement assessed via intraclass correlation coefficients. Multivariate Cox proportional models were used to evaluate the prognostic value of the ANALI_NG and DiStrict scores, with a composite endpoint of liver transplantation, hepatic decompensation, or liver-related death. Results: Eighty-nine patients with a median of 5.5 years (IQR 3.4–9.2) of follow-up were included. The ANALI_NG score showed higher intra-reader agreement (ICC 0.87, 95% CI 0.82–0.92 vs. ICC 0.64, 95% CI 0.36–0.79) and similar inter-reader agreement (ICC 0.71, 95% CI 0.63–0.78 vs. ICC 0.67, 95% CI 0.59–0.75) compared to the DiStrict score. Only the ANALI_NG score was associated with liver-related events, which remained significant when adjusted for age and sex (aHR 1.28, 95% CI 1.01–1.63) and MELD (aHR 1.69, 95% CI 1.22–2.34). Conclusions: The ANALI_NG score is a reproducible, MRI-derived scoring system that is independently associated with liver outcomes and has higher intra-reader agreement compared to the DiStrict score. Full article

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 fibrosis, yet it remains available only in specialized centers and requires specialized equipment. We aimed to develop and internally validate a novel, simple, blood-based scoring system—the pediatric-adapted liver score (PAL score)—to predict advanced fibrosis as defined by liver stiffness, measured using TE across diverse etiologies. Methods: A retrospective study was conducted on 107 pediatric patients with CLD who underwent liver stiffness measurement through TE. Advanced fibrosis was defined as a liver stiffness measurement corresponding to the F3 METAVIR stage or above. Independent predictors of advanced fibrosis were identified using multivariable logistic regression with manual backward elimination. To facilitate bedside utility, the regression model was simplified into a ratio-based index. Performance was assessed via the area under the receiver operating characteristic curve (AUROC) and validated using bootstrap resampling (10,000 iterations). Results: Gamma-glutamyl transferase (GGT), platelets, and albumin were identified as independent predictors of fibrosis. The simplified PAL score demonstrated good discrimination with an AUROC of 0.901 (95% CI: 0.84–0.95). While statistically equivalent to the adult-derived GGT-to-platelet ratio (GPR) and S-Index, the PAL score incorporates parameters of hepatic synthesis and portal hypertension that are absent from other ratios and is easier to calculate at the patient’s bedside. At a clinically practical integer cut-off of 5.0, the score achieved a sensitivity of 95.5% and a negative likelihood ratio of 0.06, effectively ruling out advanced fibrosis. Bootstrap validation confirmed the stability of the model (bootstrap-corrected AUC 0.901). Conclusions: The PAL score is the first simple fibrosis index derived for a diverse pediatric population. Highlighting its primary strength as a highly effective screening tool, the score achieves a sensitivity of 95.5% and a negative likelihood ratio of 0.06 at a user-friendly cut-off of 5. These robust metrics allow clinicians to confidently rule out advanced fibrosis, offering an accessible triage alternative in primary care settings where transient elastography is unavailable. Full article

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 condition, is closely linked to menopause; however, its independent contribution to QoL impairment remains unclear. This study aimed to investigate the interplay between menopausal status, metabolic dysfunction, MASLD, and QoL in midlife women. Methods: A cross-sectional observational study was conducted including 80 women aged 45–55 years, comprising both premenopausal and menopausal participants. Clinical, anthropometric, biochemical, and imaging data were collected. MASLD was diagnosed using magnetic resonance imaging in the presence of metabolic dysfunction. Metabolic assessment included glucose, insulin, liver enzymes, C-reactive protein, and indices of insulin resistance (HOMA-IR) and sensitivity (QUICKI). QoL was evaluated using the Utian Quality of Life (UQOL) scale. Associations were examined using univariate and multivariable linear regression models. Results: MASLD prevalence was significantly higher in menopausal women compared with non-menopausal women (61.9% vs. 15.8%, p < 0.001). Metabolic parameters, particularly insulin resistance and body mass index, were strongly associated with MASLD. The mean total UQOL score indicated moderate QoL. In multivariable analysis, menopausal status was the only independent predictor of reduced total QoL (b = −4.93, p = 0.01) and occupational health domain (b = −4.60, p = 0.001). MASLD and metabolic parameters were not independently associated with overall QoL. Correlation analyses revealed modest associations between metabolic markers and specific QoL domains, particularly occupational and physical health. Conclusions: Menopause is the primary determinant of reduced QoL in midlife women, particularly affecting functional domains, while MASLD does not independently impact QoL despite its strong association with metabolic dysfunction. These findings suggest that menopausal status may play a more prominent role in quality-of-life outcomes than MASLD in women undergoing the menopausal transition. However, the cross-sectional design does not allow conclusions regarding causal or mechanistic relationships. Full article

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 challenges due to chronic immunosuppression, impaired wound healing, and the anatomic disruption caused by subcostal and “Mercedes-Benz” incisions. As survival after OLT continues to improve, the need for durable, infection-resistant abdominal wall reconstruction has become increasingly important. Methods: We performed a single-institution retrospective review of all OLT patients undergoing abdominal wall reconstruction by the senior author between June 2014 and April 2026. Our approach emphasizes component separation to reestablish myofascial continuity, biologic onlay reinforcement with human acellular dermal matrix (HADM), and multipoint fixation in a progressive tension pattern. Results: Forty patients (43 encounters) were included. Mean age was 55.7 ± 10.2 years, mean BMI was 31.2 ± 4.9 kg/m², and 60.0% were obese. The majority presented with recurrent hernias (67.4%), and 41.9% had prior mesh in situ. Component separation was performed in all cases, and intraoperative Botox in 18.6%. HADM was used in 83.7% of encounters. At a mean follow-up of 34.0 months, there was 1 hernia recurrence (2.3%). The surgical site occurrence rate was 14.0%, with seroma as the most common complication (9.3%). There were no 30-day mortalities. Conclusions: By integrating biologic and mechanical principles, this reconstructive strategy provides a durable solution for abdominal wall repair in liver transplant recipients. A 2.3% recurrence rate and 14.0% surgical site occurrence rate compare favorably to published benchmarks in the transplant population. Full article

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 interventions. Originally developed to optimize donor grafts for transplantation, EVLP has evolved into a powerful translational research platform bridging preclinical discovery and early clinical translation. This review discusses EVLP as a platform for gene therapy, immunotherapy, pharmacology, and personalized medicine, with particular emphasis on gene- and immune-based interventions as mechanistically mature exemplars. We consolidate advances in pharmacological testing and toxicity modeling, viral and non-viral gene delivery, genome engineering, and immunomodulation using perfused livers. We further describe emerging applications, including autologous EVLP pathways for organ-confined therapy, ex vivo liver surgery, and bioengineering strategies such as biliary organoid repair, RNA interference, and mitochondrial transfer. We highlight how these applications align with a paradigm shift in biomedical research, including the NIH’s recent initiative to prioritize human-based experimental models over animal-only studies. By leveraging transplant-declined or surgically resected organs that would otherwise be unused, ex vivo perfusion bridges the gap between pre-clinical testing and clinical practice, enabling real-time evaluation of interventions in functional human tissue. We discuss both the scientific opportunities afforded by EVLP and the technical, biosafety, and ethical challenges that must be addressed to enable responsible clinical translation. Full article

Background: Small intestine bacterial overgrowth (SIBO) is associated with steatohepatitis (SH) in subjects with metabolic-associated steatotic liver disease (MASLD). The impact of ileocecal valve (ICV) incontinence, a major cause of SIBO in patients with MASLD, remains unknown because of the unmet need for a non-X-ray-dependent diagnosis. Methods: Exploiting water as contrast medium and colonic irrigation via a hydro-colon machine (Clean Colon Srl, Monza, Italy), we developed a new abdominal ultrasound (US) procedure for diagnosing and grading ICV incontinence. In a pilot, observational, feasibility and safety study, we correlated a new ICV incontinence parameter with irritable bowel syndrome (IBS, ROMA IV criteria), serum transaminases (AST, ALT), platelet counts, FIB-4, US liver steatosis and stiffness (LS, measured by Shear Wave and Transient Elastography, SWE and TE). Results: We prospectively studied 32 consecutive subjects with IBS who underwent a pre-colonoscopy colon cleansing after informed consent: 19 males (59%), body mass index (BMI) 26.6 ± 2.6 kg/m², age 57 ± 19 years, 16 (50%) with US liver steatosis. The half-hour (27 min, range 20–35 min) procedure was safe and well tolerated except in two males with prostate hypertrophy. ICV incontinence was graded (after 2500–3000 mL irrigation) according to cecum/right-colon distention with/without (immediate or delayed) reflux into terminal ileum (TI): 0 = cecum distension without TI reflux; 1 = cecum distension with TI reflux; 2 = absence of cecum distension with TI reflux. Cecum/right-colon distention (grade 0 or 1) was perceived by the patients whereas the right colon irrigation with complete ICV incontinence (grade 2) was symptomless. ICV continence associated with LS (p ≤ 0.0001). A histologic diagnosis of non-alcoholic steatohepatitis was confirmed in a 35-year-old obese male with SIBO and LS > 8 kPa (8.7/8.5 kPa by SWE/TE):steatosis (grade S3) with hepatocyte ballooning, lobular inflammation (grade 6/8) without fibrosis (stage 0/4, F0). Conclusions: The new US-based approach provides a feasible, easy-to-perform, mini-invasive tool for the diagnosis and grading of ICV incontinence. Preliminary results prompt prospective studies investigating the impact of ICV incontinence as a possible co-factor of steatohepatitis in patients with MASLD. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease. Accurate staging of hepatic fibrosis is pivotal for risk stratification; however, ultrasonography (US)-based elastography techniques may yield variable results across various technologies and manufacturers. The present study aimed to assess the concordance of liver stiffness (LS) measurements between two different US elastography technologies and manufacturers in patients with MASLD. Methods: This cross-sectional study included 68 postmenopausal women with MASLD. LS was measured using two-dimensional shear wave elastography (2D-SWE) on a LOGIQ™ E10 device and both 2D-SWE and point SWE (pSWE) on an Acuson Sequoia device. Hepatic steatosis was quantified using the ultrasound-guided attenuation parameter (UGAP). Results: The LS measurements were 5.0 ± 1.3 kPa with 2D-SWE on LOGIQ™ E10, 4.3 ± 1.5 kPa with 2D-SWE on Acuson Sequoia, and 3.8 ± 0.8 kPa with pSWE on Acuson Sequoia. A significant, but low correlation was found between LOGIQ™ E10 2D-SWE and Acuson Sequoia pSWE (rs = 0.25, p = 0.045), and a moderate correlation between Acuson Sequoia 2D-SWE and pSWE (rs = 0.37, p = 0.002). No correlation was shown for 2D-SWE between the two different manufacturers. Bland–Altman analysis showed moderate-to-poor agreement of LS values between the three different US elastography techniques. Conclusions: LS measurements differed across US elastography technologies and manufacturers in postmenopausal women with early-stage MASLD. These findings highlight the need to standardize existing US elastography devices before elastography-derived LS can be applied interchangeably in MASLD diagnostic algorithms. Full article

Background: Liver diseases are an increasing public health concern in Morocco; reliable national population-based estimates of liver fibrosis and cirrhosis in Morocco are currently unavailable. Existing evidence is largely limited to selected high-risk groups and hospital-based cohorts. Generating reliable prevalence data is crucial for designing evidence-based screening pathways, targeting high-risk groups and informing prevention and treatment policies. Objectives: Our aim was to comprehensively review studies on the prevalence of liver fibrosis and cirrhosis in Morocco, focusing on characterizing study populations, specifically high-risk populations and hospital-based cohorts, diagnostic methods and thresholds used. The review also summarizes hospital-based cirrhosis cohorts without merging them with prevalence estimates, and identifies gaps in the literature, particularly the absence of population-based prevalence studies and national epidemiological data in Morocco. Methods: The study systematically reviewed literature up to 26 October 2025, including studies conducted in Morocco among high-risk populations or hospital-based cirrhosis cohorts, using multiple databases. Two reviewers independently screened and extracted data, assessing bias with the Joanna Briggs Institute (JBI) checklist. Due to heterogeneity in study populations and diagnostic approaches, a narrative synthesis was performed. Hospital-based cohorts were analyzed separately to provide contextual information and were not included in prevalence estimates. Results: From 1198 records, four Moroccan studies providing prevalence data on liver fibrosis and cirrhosis were included, primarily involving patients with hepatitis C, HIV, or rheumatoid arthritis. Additionally, three hospital-based cirrhosis cohorts were incorporated for a contextual analysis of disease severity and complications. In total, seven studies were included, with prevalence and hospital-based data analyzed separately to ensure clarity. Conclusions: Current evidence on liver disease in Morocco is limited but suggests a significant burden among high-risk groups. The findings highlight major gaps in national epidemiological data and underscore the urgent need for comprehensive nationwide data and improved diagnostic tools to guide effective screening, prevention, and resource allocation. Full article