AASLD’s The Liver Meeting 2023 is Nov 10-14 in Boston, and Baylor Scott & White researchers will present the latest insights from one of the largest multi-specialty transplant centers in the nation: Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute.
Baylor Scott & White Research Institute maintains a comprehensive research portfolio designed to study and expand options for management of all aspects of liver disease and explore innovations in abdominal transplant surgery, patient recovery and outcomes. This work includes studies focused on improving quality of life before and after a liver transplant, expanding the organ donor pool and investigational research for early diagnosis and treatment of a myriad of liver conditions, including liver cancer, fatty liver disease and alcohol use disorder.
Researchers and clinicians from Baylor University Medical Center in Dallas and Baylor Scott & White All Saints Medical Center – Fort Worth will share the following research at the meeting.
For a list of all presentations and talks that feature work by clinicians and researchers at Baylor Scott & White Health, click here.
Additional details about the annual meeting are on the event website.
Sumeet Asrani, MD, MSc, chief of hepatology and liver transplantation at Baylor University Medical Center provides an overview of Baylor Scott & White’s participation at AASLD’s The Liver Meeting 2023.
FEATURED PRESENTATIONS AND SESSIONS HIGHLIGHTING RESEARCH IN HEPATOLOGY
FRIDAY, NOVEMBER 10, 2023
POSTER PRESENTATION – Clearing the path: Improving Rifaximin Access for Liver Patients and Evaluating Impact on Hospital Readmission
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Author: Daniel Cain, DO
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Time: 12 p.m.-1 p.m. EST
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Abstract/Study Purpose: Hepatic Encephalopathy (HE) is a debilitating complication of chronic liver disease and accounts for roughly 55,000 hospitalizations each year. Rifaximin is known to decrease hospitalizations for patients with HE. Access to rifaximin has been a barrier to many due to the high cost associated with the medication. We describe a quality improvement project conducted in a real-world cohort which led to successful and timely access to rifaximin to patients with access barriers.
POSTER PRESENTATION – Effect of Aortic Stenosis on Intra-Operative Hemodynamics and Outcomes in Liver Transplantation
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Author: Stevan Gonzalez, MD, MS
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Time: 12 p.m.-1 p.m. EST
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Abstract/Study Purpose: Factors associated with development of nephrogenic ascites among patients with end-stage renal disease (ESRD) remain poorly characterized. Patients with ESRD are at increased risk of heart failure (HF). Comprehensive assessment of nephrogenic ascites vs cardiogenic ascites by transjugular (TJ) liver biopsy, echocardiography, and peritoneal fluid analysis could more accurately discriminate etiology, guide management, and ascertain clinical outcomes.
SATURDAY, NOVEMBER 11, 2023
SESSION – Innovations in Transplantation: Now and Beyond
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Speaker: Anji Wall, MD, PhD
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Time: 8:30-10:00 a.m. EST
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Description: The goal of this session is to review current innovations in transplantation and what is being developed for use in the near future. The session will focus on the innovations in artificial organs and xenotransplantation, future policy changes in organ allocation and a debate on the best ways to achieve near-term growth in liver transplantation.
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For More Information: Click here
WORKSHOP – Surgery & Liver Transplantation Workshop
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Speaker: Anji Wall, MD, PhD
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Time: 11:00-12:30 p.m. EST
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Description: This is a two-part workshop for attendees with an interest in the current state of liver transplantation in two specific domains:
1) The current state, and possible interventions, to address inequities in access to liver transplantation
2) The current and future expanding indications and shrinking contraindications to liver transplantation, as well as some technical advances. -
For More Information: Click here
POSTER PRESENTATION – Efficacy of Continuous Terlipressin Infusion in HRS-AKI in a Transplant-Enriched Population: A Comparative Prospective and Retrospective Cohort Study
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Co-Author: Stevan Gonzalez, MD, MS
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Time: 12 p.m.-1 p.m. EST
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Abstract/Study Purpose: Hepatorenal syndrome-acute kidney injury (HRS-AKI), a serious complication of decompensated cirrhosis with limited therapeutic options, is associated with significant morbidity and mortality. Liver transplant (LT) is the definitive treatment but access is limited. Continuous terlipressin infusion may provide HRS reversal and renal outcome benefits and as such was assessed in a population enriched with LT candidates.
POSTER PRESENTATION – Prevention of Bleeding Events After Endoscopic Variceal Ligation with Proton Pump Inhibitors: Benefit or Risk.
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Author: Ricardo Albarran-Anguiano, DO
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Time: 12 p.m.-1 p.m. EST
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Abstract/Study Purpose: Proton pump inhibitors (PPI) are frequently used following endoscopic variceal ligation (EVL) in both acute hemorrhage or elective procedures; although PPI therapy may decrease postbanding ulcer size, its impact on bleeding risk is not well defined.
ORAL PRESENTATION – Current Trends in Liver Transplants: Estimating GFR in patients with decompensated cirrhosis awaiting transplant: Updated GRAIL without race performs better than CKD EPI 2021
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Speaker: Sumeet Asrani, MD, MSc
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Time: 4:00-5:00 p.m. EST
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Abstract/Study Purpose: Accurate estimation of glomerular filtration rate (GFR) is important for decisions regarding dual organ transplantation and patient management on the waitlist. Currently, a novel race free equation (CKD-EPI AS, Inker et al. NEJM 2021) is the reference standard for estimating GFR across the US. However, its performance in patients with cirrhosis was never validated. Further, performance of CKD EPI AS 2021 may be suboptimal in cirrhosis patients with low GFR, ascites and frail patients (AASLD 2022). We have shown that liver specific equations (GFR assessment in liver disease, GRAIL, Asrani et al. Hepatology 2019) have better performance as compared to other GFR equations. We sought to develop and validate an updated GRAIL without race (GRAIL_NR).
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For More Information: Click here
SUNDAY, NOVEMBER 12, 2023
INVITED TALK – Alcohol-Associated Liver Disease: Transplant Triumphs and Challenges
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Speaker: Sumeet Asrani, MD, MSc
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Time: 8:30-9:00 a.m., EST
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Description: Liver Transplantation remains important in the management of patients with alcohol associated liver disease that have liver decompensation or develop complications. This session will address some recent advances as well as challenges for this indication.
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For More Information: Click here
POSTER PRESENTATION – Prevalence of Heart Failure and Hepatic Congestion in Nephrogenic Ascites: Histopathologic and Echocardiographic Characterization
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Co-Author: Stevan Gonzalez, MD, MS
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Time: 12 p.m.-1 p.m. EST
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Abstract/Study Purpose: Factors associated with development of nephrogenic ascites among patients with end-stage renal disease (ESRD) remain poorly characterized. Patients with ESRD are at increased risk of heart failure (HF). Comprehensive assessment of nephrogenic ascites vs cardiogenic ascites by transjugular (TJ) liver biopsy, echocardiography, and peritoneal fluid analysis could more accurately discriminate etiology, guide management, and ascertain clinical outcomes.
ORAL PRESENTATION – AASLD Guidance: Acute on Chronic Liver Failure and the Management of Critically ILL Patients with Cirrhosis
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Speaker: Sumeet Asrani, MD, MSc
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Time: 2:00 – 3:30 PM EST
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Description: This session covers recently published data complemented by new guidance for clinical providers in recently finalized or published AASLD practice guidances. Attendees will learn about the diagnosis and treatment of patients with acute chronic liver failure; portal hypertension and varices in cirrhosis; and procedures for the management of variceal hemorrhage. Choosing appropriate treatments remains a challenge for clinical providers to better manage patients who have chronic liver diseases and the implementation of up-to-date guidance statements can positively affect treatment decisions and patient outcomes.
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For More Information: Click here
MONDAY, NOVEMBER 13, 2023
ORAL PRESENTATION – EARLY LACTATE-GUIDED TREATMENT STRATEGIES IN CRITICALLY ILL PATIENTS WITH CIRRHOSIS AND SEPSIS
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Speaker: Luis Garrido Treviño, MD
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Time: 8:30- 10:00 AM EST
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Abstract/Study Purpose: Inpatient mortality among cirrhosis patients requiring Intensive Care Unit (ICU) admission for sepsis is high especially in those with Acute on Chronic Liver Failure. Endpoints of early goal directed therapy within 24 hours of admission are poorly defined in cirrhosis patients. Specifically, lactate (LA) clearance is impaired in cirrhosis, but early LA-guided resuscitation strategies are part of sepsis protocols in non-liver population. Recently, Model for End-stage Liver Disease-lactate (MELD-LA) was developed and independently validated as a simple, objective marker for short term prognosis in critically ill patients with cirrhosis as compared to MELD, MELD-Sodium and ICU specific scores in multiple global populations (n=8,640). Among cirrhosis patients with sepsis, we sought to identify MELD-LA cutoffs for 30-day mortality as well as assess early LA clearance as potential surrogate of effective goal directed therapy.
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For More Information: Click here
Debate – Albumin Use in Patients with Decompensated Cirrhosis
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Speaker: Sumeet Asrani, MD, MSc
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Time: 12:30- 1:15 PM EST
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Description: Recently, there has been increased interest in judicious use of IV albumin in patients with decompensated cirrhosis. On one hand, its use has been advocated as first line therapy for several indications. On the other hand, concerns about its unregulated use has been called into question based on recent studies. This MTE will evaluate both sides of the debate and at the end, offer some guidance on specific use cases for albumin and contraindications to its use in patients with decompensated cirrhosis.
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For More Information: Click here
PRESENTATION – Mandates and best practices for liver transplant in alcohol-associated liver disease: is it time for regulation and national policy reform?
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Speaker: Sumeet Asrani, MD, MSc
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Time: 3:30-4:30 p.m. EST
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Abstract/Study Purpose: Alcohol-associated liver disease (ALD) has surged as an indication for transplant, increasing over 5-fold in the past 20 years, and is now the #1 indication for transplant in the US. Early (i.e. without mandated period of abstinence) transplant has partly contributed to this trend, and is now the fastest growing indication for transplant. Despite the growing dominance of ALD for transplant, there is no standardization of practice or policies across transplant centers, and there is lack of alcohol-specific quality metrics from regulatory organizations, which could be contributing to disparities in transplant access and outcomes. Alcohol-associated liver disease (ALD) has surged as an indication for transplant, increasing over 5-fold in the past 20 years, and is now the #1 indication for transplant in the US. Early (i.e. without mandated period of abstinence) transplant has partly contributed to this trend, and is now the fastest growing indication for transplant. Despite the growing dominance of ALD for transplant, there is no standardization of practice or policies across transplant centers, and there is lack of alcohol-specific quality metrics from regulatory organizations, which could be contributing to disparities in transplant access and outcomes.
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For More Information: Click here