AASLD’s SIGs develop programming focused on highly specialized areas of hepatology.
Patients with acute-on-chronic liver failure frequently present to the ICU for care. The mortality rate for cirrhotic patients requiring ICU approaches 50%. Unique physiologic characteristics in the patient population warrant specialized, multidisciplinary, approaches to care. The goal of this meeting is to further develop dialog between surgeons, hepatologists and intensive care unit teams to better deliver care to this complex patient population by focusing on the complex physiology of chronic liver failure. In addition, we will devote special attention to areas of controversy in this patient group including initiation of renal replacement therapy, management of alcoholic hepatitis and defining futility as well as establishing appropriate goals of care.
Alcoholic hepatitis is the most severe form of Alcoholic Liver Disease (ALD). Currently the most effective form of treatment is Prednisolone, to which many patients do not respond. In the last years, there has been great interest in the development of new targeted therapies for alcoholic hepatitis. In the US, there are 4 NIAAA-funded consortia to develop such therapies. In this symposium, we seek to address this issue through the review of current pharmacological therapies, ongoing NIAAA-funded studies, and evaluate the management of alcohol use disorders in advanced ALD patients.
Learn more and view the program agenda.
Recently there is an increased interest and effort in targeting novel pathways to treat Cholestatic Liver Diseases. Up to date science is needed on the new therapeutic targets and the early experiences (successes and failures) of clinical trials to foster discussion of these various approaches and identify priorities for future clinical trials. Presentations will be arranged in pairs with the first explaining the science behind why a specific pathway has good targets for treating Cholestatic Liver Disease, followed by a summary of recent clinical trial and other descriptive experiences targeting these pathways. Further discussion after the paired talks will address why drugs did or did not perform as expected in humans, along with planning priorities for future trials.
The goal of this program is to review areas of more difficult management of the patient with liver disease in the community outpatient setting, including the approach to the patient with non-alcoholic liver disease that is not a candidate for research studies, the management of portal hypertension and portal vein thrombosis and outpatient intervention and monitoring of patients with cirrhosis and renal insufficiency. The emphasis of this program will be to provide tools for community practitioners to develop management strategies for the better outcome of their patients. We intend to also review a multidisciplinary approach to these problems and to show the benefit of working in a team that according to the problem in question, may include surgeons, oncologists, hematologists, nephrologists, interventional radiologists and nutrition experts.
This program will address the need for curative therapy for HBV by systematically reviewing the various approaches to achieving this goal. Attendees will gain a greater appreciation for the challenges in developing new HBV therapies and also discover where new therapies will fit into the future treatment landscape for HBV.
This program will include discussions of recently approved regimens and challenging patient populations. The emphasis in these lectures will be on clinical knowledge and application to individual patient management decisions, the AASLD-IDSA Guidance Panel treatment recommendations and global perspectives on disease eradication strategies.
As HCV therapies now achieve high rates of SVR across a broad spectrum of individuals in patient care, there is a need to consider those HCV-infected persons who are not or may have difficulty accessing care or engaging in HCV therapy. Additionally, aspects related to prevention of reinfection are relevant in these difficult to reach populations. This program is targeting HCV SIG clinicians, public and global health experts as well as patient advocates with the goal of sharing expertise on how to improve the cascade of care in the “difficult to reach” populations.
This program will provide a timely review of the mechanistic and clinical information relevant to HCC occurring in HCV by addressing the relevance of the problem and treatment effects. The program will also discuss key basic concepts with relevance to HCC in HCV.
Both traditional and new chemotherapeutic agents associated with liver injury will be covered to help the attendees gain a working knowledge of agents that can cause liver injury, how the injury presents and how to make the diagnosis. Attendees will also gain new insight on the challenges for chemotherapeutic drug development, approval and post-marketing surveillance in the US.
This SIG program will provide detailed, high quality, in-depth presentation of the different yet related basic molecular mechanisms that underlie various types of hepatic damage. Presenters will be highly talented, world class, liver cell biologists, including both established and junior AASLD members and non-members, to provide a solid background on the mechanisms that activate and potentiate hepatic injury, inflammation and fibrosis.
Advances in Hepatocellular Carcinoma Therapy is an overview of the current diagnostic and therapeutic modalities available for patients with liver cancer. The epidemiology and future disease burden will be presented. There will also be a discussion of the emerging role of genomics in the management of liver cancer. The role of surgical resection as well as the current indications for liver transplantation will be reviewed. Post-transplant management and recurrence will be addressed.
The goal of this program is to review the rapidly evolving landscape of non-invasive diagnostic tools for the diagnosis and staging of NAFLD. The program will review the current role and available alternatives to liver biopsy in the assessment of NASH and discuss the controversial issue of utilizing liver biopsy as “gold-standard” endpoint in clinical trials. The program will review the application of biomarkers in assessing dynamic changes in NAFLD as it pertains to response to therapies and the potential that such biomarkers (serum or imaging) could predict clinical outcomes in NAFLD.
Drug-induced liver injury (DILI) is an infrequent, but likely under-recognized cause of acute and chronic liver disease in children. This program will focus on challenges and opportunities associated with the diagnosis and management of DILI that are unique to the pediatric population. Clinical presentations include surreptitious elevation of serum aminotransferase levels, acute liver injury with or without acute liver failure, and chronic liver disease. The most common drug classes associated with DILI in children include antibiotics and anti-convulsants, as well as immunomodulatory and chemotherapeutic agents. As the number and type of drugs used to treat pediatric illnesses proliferate, and the push to make new drugs available for children gains speed, understanding how to recognize DILI is increasingly important for pediatric liver providers. Establishing causality between the liver injury and suspected agent is imperfect, but a structured approach to the child suspected of DILI will improve diagnostic skills for clinicians.
The program of the current proposal will provide a critical view to several invasive interventions that are performed in patients with portal hypertension. In detail, they will review the technique of measuring hepatic venous pressure gradient and portal pressure gradient in the course of TIPS. Specifically the potential situations that may interfere the accuracy and reproducibility of measurements and how to avoid them. Finally, some recommendations for the standardization of the procedure will be given. Additionally, the invasive procedures used to diagnose and treat cardiofundal and ectopic varices will be reviewed as well as new therapeutic strategies to solve portal hypertension in patients with portal cavernoma either in children or adults. The potential role of splenectomy or spleen embolization in the treatment of hypersplenism and of the closing or reduction of TIPS or large porto-collateral shunts in patients with severe refractory Hepatic encephalopathy will be discussed. Although these interventions are widely used, a critical review of evidence of its clinical utility is scarce. The present program will allow putting together a group of international experts in the field, promoting an analysis of the experience on the different procedures.
Given recent attention to health care reform efforts in the USA, a greater emphasis is being placed on generating and synthesizing evidence to inform policies affecting the clinical practice of hepatology. In turn, this program will review and teach learners about the most common research designs and analytic methods associated with the conduct of health care delivery research. Specifically, the topics of Quality Improvement Methods, Behavioral and Health Economics Research, Qualitative Mixed-Methods Approaches and Health Disparities Research will be reviewed and discussed in-depth through a series of interactive lectures and panel-based discussions. Examples based on the field of clinical hepatology and liver transplantation, including relevant peer-reviewed publications, will be highlighted.