Transient elastography with controlled attenuation parameter (CAP) for diagnosis of moderate or severe steatosis in people with suspected non-alcoholic fatty liver disease

© 2020 The Cochrane Collaboration. This article [Turankova T, Blyuss O, Brazhnikov A, Svistunov A, Gurusamy KS, Pavlov CS. Transient elastography with controlled attenuation parameter (CAP) for diagnosis of moderate or severe steatosis in people with suspected non-alcoholic fatty liver disease (Protocol). Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD013670. DOI: 10.1002/14651858.CD013670.], has been published in final form at https://doi.org/10.1002/14651858.CD013670.Objectives: This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:. To determine the diagnostic accuracy of transient elastography with CAP for diagnosis of moderate and severe hepatic steatosis in people with suspected NAFLD when compared with liver biopsy as reference standard. To achieve this, we will compare none/mild hepatic steatosis (S0 to S1) versus moderate/severe hepatic steatosis (S2 to S3); and none/mild/moderate hepatic steatosis (S0 to S2) versus severe hepatic steatosis (S3). Secondary objectives We aim to also identify the pooled sensitivity and specificity for the most common cut-off values of CAP for diagnosis of none/mild hepatic steatosis (S0 to S1) and moderate/severe hepatic steatosis (S2 to S3); or none/mild/moderate hepatic steatosis (S0 to S2) and severe hepatic steatosis (S3) in people with suspected NAFLD, and to explore potential sources of heterogeneity influencing the diagnostic test accuracy of CAP (see: Investigations of heterogeneity).Peer reviewe

AISF position paper on liver transplantation and pregnancy: Women in Hepatology Group, Italian Association for the Study of the Liver (AISF).

After the first successful pregnancy in a liver transplant recipient in 1978, much evidence has accumulated on the course, outcomes and management strategies of pregnancy following liver transplantation. Generally, liver transplantation restores sexual function and fertility as early as a few months after transplant. Considering that one third of all liver transplant recipients are women, that approximately one-third of them are of reproductive age (18-49 years), and that 15% of female liver transplant recipients are paediatric patients who have a >70% probability of reaching reproductive age, the issue of pregnancy after liver transplantation is rather relevant, and obstetricians, paediatricians, and transplant hepatologists ever more frequently encounter such patients. Pregnancy outcomes for both the mother and infant in liver transplant recipients are generally good, but there is an increased incidence of preterm delivery, hypertension/preeclampsia, foetal growth restriction, and gestational diabetes, which, by definition, render pregnancy in liver transplant recipients a high-risk one. In contrast, the risk of congenital anomalies and the live birth rate are comparable to those of the general population. Currently there are still no robust guidelines on the management of pregnancies after liver transplantation. The aim of this position paper is to review the available evidence on pregnancy in liver transplant recipients and to provide national Italian recommendations for clinicians caring for these patients

Bleeding after paracentesis in patients with decompensated cirrhosis and acute kidney injury: the perfect storm

We read with great interest the recently published study by Hung and Garcia-Tsao that identified the presence of acute kidney injury (AKI) as the most important predictor of bleeding following paracentesis in patients with decompensated cirrhosis.1 Indeed, although the yield of this study results may be limited by its setting (retrospective, chart review), we feel that the authors should be complimented for their effort in trying to provide a clinical evidence for a pathophysiological hypothesis that was mainly suggested by experts' panel opinions.2 As a fact, this study confirms the hypothesis that the acute perturbance of renal function - but not as a chronic condition since the prevalence of renal failure was similar in patients with bleeding events and controls - may induce a derangement in the coagulation balance of cirrhotic patients when this feeble balance is challenged by an invasive procedure such as paracentesis. This article is protected by copyright. All rights reserved