A global action agenda for turning the tide on fatty liver disease

Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of “agree” responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% “agree”). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce the prevalence of fatty liver disease and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.publishedVersio

A global research priority agenda to advance public health responses to fatty liver disease

Background & aims An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of ‘agree’ responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement (‘agree’ + ‘somewhat agree’); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% ‘agree’), 13 priorities had 90% combined agreement. Conclusions Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community’s efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat

Liver transplantation for patients with acute-on-chronic liver failure in Asia

Poster Presentation: P-0213This journal suppl. entitled: Conference Abstracts: 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, JapanAIM: Acute-on-chronic liver failure (ACLF) is characterized by high mortality. Liver transplantation (LT) is effective in patients who do not improve with supportive measures. This study examines the outcome of ACLF patients who underwent LT in Asia. METHODS: Prospectively collected data from 17 Asian countries in the APASL ACLF Research Consortium was analyzed. 43 patients who underwent LT for ACLF were compared with 1657 non-transplanted ACLF patients. The variables analyzed include patient demographics, acute insult, background liver disease, severity scores (MELD and SOFA scores) and post-LT outcome. RESULTS: Mean age of LT patients was 42.1 years and non-transplanted patients was 43.7 years. 74.4 % of LT patients and 85.1 % of non-LT patients were male. The most common acute liver insult was HBV reactivation (24.4 %) in LT patients, compared with alcohol (49.5 %) in non-LT patients. Three-month survival rate was 76.7 % in LT group, and 52.6 % in non-LT group. Mean MELD scores prior to transplant was (27.7 ± 4.7) and (30.5 ± 8.3) in non-transplant group. In LT patients, baseline renal dysfunction predicted mortality (mean urea: 1.4 vs. 0.84 mg/dL, p = 0.015) (mean creatinine: 61 vs. 27 lmol/l, p = 0.042). High SOFA score was significantly associated with mortality in both LT (12.5 vs. 8, P = 0.015) and non-LT (8.3 vs. 10.9, p\0.001) patients. In non-LT patients, baseline urea (68.5 vs. 41.2 lmol/l, p\0.001), MELD (33.8 vs. 27.5, p\0.001) and Child-Pugh score (12 vs. 11, p\0.001) were independently associated with mortality. CONCLUSION: Baseline renal dysfunction and higher SOFA score predict poorer LT outcome in ACLF patients

Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy

Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers

Better survival in patients with hepatitis e virus c.f. to other acute insults causing acute-on-chronic liver failure (ACLF) – APASL-ACLF research consortium (AARC) database

Poster Presentations: Viral hepatitis: Hepatitis A, B, D, E – clinical (except therapy): no. THU-107BACKGROUND AND AIMS: The current study aims to analyse impact of acute insult on short term mortality in ACLF patients