About

Andrew Aronsohn, MD, is a specialist in the diagnosis and treatment of liver disease, including medical management of liver transplantation. He is an associate professor at the University of Chicago Medicine Center for Liver Diseases, a multidisciplinary center known for its research discoveries and treatment innovations related to liver diseases and transplantation. Dr. Aronsohn is also a faculty member at the MacLean Center for Clinical Medical Ethics. His research interests involve investigating ethical issues surrounding hepatitis C therapy, such as fair resource distribution and linkage to care. He leads the hepatitis curriculum of ECHO Chicago, which aims to educate and empower primary care providers to effectively manage hepatitis C in local primary care settings. Dr. Aronsohn serves as a committee member on the National Academy of Sciences report for hepatitis B and C elimination and on the AASLD/IDSA guidance for hepatitis C treatment.

Research topics

• Immunology
• Medicine
• Gastroenterology
• Internal medicine
• Political Science
• Bioinformatics
• Microbiology
• Biology
• Environmental health
• Law
• Virology
• Endocrinology
• Biochemistry
• Family medicine
• Psychology

Selected publications

• Safety and Efficacy of Upadacitinib in Patients with Inflammatory Bowel Disease After Liver Transplantation: A Case Series

  Digestive Diseases and Sciences · 2025-11-20 · 1 citations

  articleOpen access

  PURPOSE: Approximately 2% of patients with inflammatory bowel disease (IBD) have primary sclerosing cholangitis (PSC), and some require liver transplantation (LT). Managing IBD after LT is challenging given concomitant anti-rejection immunotherapies. We report our experience using upadacitinib (UPA) to treat patients with IBD after LT. METHODS: Retrospective, single-center observational study at a tertiary center, identifying patients after LT who received UPA. We assessed efficacy and safety of UPA. RESULTS: Four patients after LT (Crohn's disease n = 3; ulcerative colitis n = 1) received UPA for IBD control (n = 3) or as a steroid-sparing adjunct for anti-rejection (n = 1), alongside anti-rejection immunosuppression. Median follow-up from UPA initiation was 10.5 months (IQR 8.9-14.6); age 41.5 years (IQR 40-44); interval from LT 3.2 years (IQR 2.3-5.6). Two receiving prednisone for Crohn's control at baseline achieved steroid-free remission (Harvey-Bradshaw Index < 5). Three developed liver enzyme elevation: one stopped UPA at one month with subsequent normalization of alanine and aspartate aminotransferase; one underwent liver biopsy showing no rejection and continued UPA with 9-month follow-up; and one receiving UPA for potential anti-organ rejection plus vedolizumab ultimately discontinued UPA for suspected rejection after tapering steroids. One patient experienced mild COVID-19 that resolved without treatment change. No life-threatening adverse events were observed. CONCLUSION: In this small series, UPA controlled IBD activity in 2 of 4 patients after LT but was associated with liver-enzyme elevations in 3, prompting discontinuation in 2. These findings support cautious, closely monitored use and highlight the need for a larger multi-center study of UPA in patients with IBD after LT.

  PublisherOA PDFDOI

• Fecal Butyrate and Deoxycholic Acid Concentrations Correlate With Mortality in Patients With Liver Disease

  Gastro Hep Advances · 2025-01-01 · 5 citations

  articleOpen access

  Background and Aims: The intestinal microbiome produces metabolites, including short chain fatty acids (SCFAs) and secondary bile acids (BAs), that impact host physiology. Loss of intestinal microbiome diversity is associated with cirrhosis progression, but the impact of microbiome-associated metabolites on liver disease remains largely undefined. We aimed to correlate fecal metabolite concentrations with the severity and progression of liver disease. Methods: In this cross-sectional study, fecal samples from patients hospitalized with liver disease were analyzed by shotgun metagenomic sequencing to determine microbiome compositions and targeted mass spectrometry to quantify SCFAs and BAs. Random survival forest and logistic regression models identified clinical, metagenomic, and metabolomic features associated with rehospitalization and survival. Results: . Conclusion: Mass spectrometry rapidly identifies patients with low fecal butyrate and DCA concentrations who are at increased risk of 30-day mortality. These findings set the stage for clinical trials of microbiome reconstitution with butyrate and DCA-producing bacterial species.

  PublisherDOI

• Innovative strategies to enhance access to HCV therapy

  The Lancet · 2025-05-01

  letterSenior author
  PublisherDOI

• State-of-the-Art Review: Hepatitis C

  Clinical Infectious Diseases · 2025-04-23 · 3 citations

  article

  Hepatitis C virus (HCV) infection remains a major cause of chronic liver disease and premature mortality worldwide. The World Health Organization and US Department of Health and Human Services have committed to eliminating HCV infection as a major public health threat by 2030, as defined by a 90% reduction in incidence of new HCV infections and 65% reduction in mortality from a 2015 baseline. To help to achieve HCV elimination, it will be necessary to increase HCV screening and increase uptake of HCV treatment, particularly within primary care, correctional, and substance use treatment settings. In this review, we provide strategies for healthcare providers to implement in their practice to enhance patients' completion of the steps of the HCV care cascade. Improving successful completion of each step of the cascade will help alleviate the burden of HCV infection and make the 2030 HCV elimination goals a reality.

  PublisherDOI

• Executive Summary: State-of-the-Art Review: Hepatitis C

  Clinical Infectious Diseases · 2025-08-15 · 1 citations

  article
  PublisherDOI

• S3660 An Elusive Arteriobiliary Fistula Presenting as Abdominal Pain and Syncope

  The American Journal of Gastroenterology · 2024-10-01

  articleSenior author
  PublisherDOI

• International Travel for Organ Transplantation: Provider and Patient Perspectives

  Transplantation Direct · 2024-07-18

  articleOpen accessSenior author

  Background. Organ allocation in the United States to non-US citizen, non-US residents who travel for transplant (NC/NRTx) is controversial. Current policies may not be informed by stakeholder opinions, as limited data exist assessing the knowledge or opinions of providers or patients on this issue. Methods. A cross-sectional, hospital-based pilot survey was distributed to providers and patients from December 2019 to June 2020 at a single large urban transplant institute. Providers were members of the departments of surgery and medicine and included both transplant and nontransplant providers. Surveys included 10 questions on eligibility, prioritization, and limitations for deceased donor transplantation and 12 demographic questions. Results. A total of 209 providers responded (61% women, median age 40) and 119 patients responded (62% women, median age 54). Awareness of eligibility for transplantation of US citizens, non-US citizens residing in the United States (NC/R), and NC/NRTx was high in both groups, though providers and patients lacked awareness of the eligibility of nonlegal NC/R (those who live in the United States who are not citizens and are not legal residents) to donate and receive organs. Overall, 79.3% of patients stated that NC/NRTx should be eligible for transplant in the United States compared with only 60.7% of providers ( P = 0.001). Providers were more likely than patients to prioritize transplant to legal NC/NR over NC/NRTx (58.2% versus 35.1%, P &lt; 000.1) and reported that families should be able to limit donations to NC/NRTx (34.9% versus 23.2%, P = 0.03). Conclusions. Surveyed patients and providers generally support transplant in non-US citizens; however, the strength of support varied considerably based on the legal status of the patient and the occupation of those surveyed. Larger studies are necessary to develop data-informed policy.

  PublisherDOI

• Ethics and downstream effects of travel for transplant in the United States

  Clinical Liver Disease · 2024-01-01

  articleOpen accessSenior authorCorresponding

  BACKGROUND Travel for transplant involves the movement of people and financial assets across international borders for the express purpose of obtaining an organ transplant. In the United States, this refers to US citizens who travel abroad for transplants and the influx of non-US citizen nonresidents traveling for transplants. Given that those on the US waitlist far exceed the number of organs donated, and many patients die awaiting transplant, parity in the allotment is critical. In this context, travel to the United States for transplant becomes fraught with ethical considerations. Lack of transplant services in many countries of the world, whether due to insufficient resources and medical infrastructure or cultural or religious beliefs that do not align with deceased donor transplant, drive noncitizen nonresidents to travel to the United States for transplant. Legally, noncitizen nonresidents are eligible for transplantation in the United States. Criteria for organ allocation rely on medical necessity and proximity of available organs and do not take into account political designations such as citizenship and residency1; therefore, citizens and noncitizens alike face the same criteria for allotment. Ultimately, the decision to list is made by individual transplant centers. An international summit in 2008 brought together experts to establish definitions, principles of practice, and recommendations on transplant across national borders.2 The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (DOI) emphasized “self-sufficiency in organ donation and transplantation,” meaning a country’s ability to meet its own needs using “donation and transplant services provided within the country and organs donated by its residents.”3 The 2018 update explicitly stated that travel for transplant becomes unethical if the resources diverted to nonresidents undermine the country’s ability to provide for its own residents.3 In the United States, the United Network for Organ Sharing manages the Organ Procurement and Transplantation Network, which is charged with the fair and equitable allocation of donated organs. Organ Procurement and Transplantation Network policies historically recommended limiting transplanting noncitizen nonresidents by way of the “5% rule”, which subjected transplant centers who transplanted more that 5% noncitizen nonresidents to audit and formal review. However, no program was ever brought up for formal review.4 This was replaced in 2012 with an alternative policy that made residency and citizenship data publicly available in an effort to achieve greater transparency regarding transplant practices. Data collection categories were revised based on citizenship and residency status: US citizen, non-US citizen residing in the United States, and non-US citizen not residing in the United States (noncitizen/nonresident [NC/NR]). Importantly, a field was added indicating whether NC/NR candidates had traveled to the United States for the sole purpose of transplantation (noncitizen/nonresident; traveled for transplant [NC/NRTx])5 (Table 1). TABLE 1 - OPTN citizenship designation OPTN citizenship designation US Citizen US Citizen NC/R Noncitizen/resident NC/NR Noncitizen/nonresident NC/NRTx Noncitizen/nonresident; traveled for transplant While the overall number of those who travel to the United States for transplant (henceforth referred to as NC/NRTx) is small relative to total transplants performed, representing 0.5% of all deceased donor transplants from 2013 to 20165 and 0.6% of all deceased donor liver transplants from 2012 to 20236 (Figure 1), there is significant regional variation in the practice5,7 (Figure 2). Given that allocation is dependent on region, some US residents who share the waitlist with NC/NRTx may be affected more than others. Furthermore, given persistent organ shortages, any allocation to noncitizen nonresidents may be in conflict with the DOI’s tenet of self-sufficiency.9FIGURE 1: Total NC/NRTx DDLT by year.6 Abbreviations: DDLT, deceased donor liver transplants; NC/NRTx, Noncitizen/nonresident traveled for transplant.FIGURE 2: Total NC/NRTx DDLT by region (2012–2023).8 Abbreviations: DDLT, deceased donor liver transplants; NC/NRTx, Noncitizen/nonresident traveled for transplant; UNOS, United Network for Organ Sharing.ETHICAL FRAMEWORK Core concepts in clinical medical ethics include autonomy, beneficence, non-maleficence, justice, and utility (Table 2). The following analysis will focus on the concepts of justice and utility in the context of deceased donor liver transplants, as living donor liver transplant faces different issues of resource scarcity and is much less common.6 TABLE 2 - Core principles in medical ethics Core principles in medical ethics Autonomy Individuals right to make own decisions Beneficence Acting out of a desire to help others in need, acting in their best interest Non-maleficence Avoiding harm to the individual Justice Treating all individuals fairly and equitably Utility Acting in the interest of the greatest good for all JUSTICE Justice represents the principle of fairness to the individual and lies at the heart of ethical concerns regarding this practice. Is it fair to allow NC/NRTx when there are more US citizens and residents on the waitlist than organs available? This question will be addressed through the lens of 3 concepts: reciprocity, inequity in health care access, and inequity in wealth. Reciprocity Many have argued that it is not fair to allow NC/NRTx, citing the concept of reciprocity. NC/NRTx do not participate in the donor pool, nor do they participate in the tax system that supports transplant infrastructure. A commonly used counterargument to this focuses on the monetary contribution to the system made by these patients, many of whom are self-paying. All of this rests on the premise that organs belong to the nation-state10 as opposed to humankind overall, and this premise in itself is not without internal conflict: Does the organ belong to the state where the donor died? Where did they hold citizenship? Where do they reside? Reciprocity maintains its importance in the context of organs as a limited resource. An increase in the donor pool could be achieved by considering the reciprocity of organ donations across international borders, such as is done in Europe, though this may have limited practicality in the United States, given the geographic distances. Inequity in access to care Allowing NC/NRTx may exacerbate existing inequities, as those with more means already experience shorter waitlist times, lower rates of death on the waitlist, and higher transplant rates in part due to the ability to region shop.11 NC/NRTx may benefit from these disparities as they are often self-pay and are not bound by the regulations of insurance companies. Also, while they undergo the same process for listing as their US counterparts, they appear to have relatively lower waitlist-to-transplant times, lower waitlist mortality,12 and lower Model for End-Stage Liver Disease score5 at listing. This inequity is exacerbated by regional variation in the practice of transplanting noncitizen nonresidents where residents of certain regions are competing with NC/NRTx for organs more than others. Inequity in wealth Finally, travel to the United States for a transplant requires significant funding, whether personal wealth or sponsored by the country of origin, and therefore NC/NRTx often arrives from a small number of countries who happen to find themselves with available capital but without transplant infrastructure. In data collected from 2013 to 2016 after the intention to travel for transplant was recorded, 49% of total NC/NRTx liver and kidney listings and transplants were from Saudi Arabia and Kuwait alone.5 This presents a further inequity as many people in need of transplant worldwide do not have access to funds to pay the sticker price for the procedure. The higher reimbursement rate of those who are self-pay may also incentivize transplant centers to list NC/NRTx. UTILITY Utility represents acting for the greatest good for all. This usually pertains to allocation policies that aim to optimize benefits to all. Defining the greatest good for all If “all” represents humankind (citizens of the world) then any transplant offered provides the same amount of good. However, if “all” refers to US residents, then providing an organ to a noncitizen nonresident may not respect this principle, harkening back to the concept of reciprocity. Additionally, there is a lack of data regarding posttransplant outcomes of noncitizen nonresidents who return to their country of origin, and if their outcomes are not similar, one could argue that this was not the best use of the organ. There are no systematic approaches in place for long-term follow-up of these patients, but perhaps it is our responsibility to establish them. This might take the form of standardized requirements for communication between the United States and foreign providers, both before and following transplant, such as posttransplant video visits between the US hepatologist, the patient, and their local physician at set intervals. Ultimately, the most cost-effective and sustainable route to provide the greatest good for all may be to invest in establishing transplant infrastructure outside of the United States in keeping with DOI's emphasis on self-sufficiency. Financial equality As many NC/NRTx are self-pay, transplanting NC/NRTx does bring more money into the transplant system; however, there is no transparency regarding how these funds are spent. If, as some centers state, funds were used to provide transplants for patients otherwise unable to afford transplant care, this would support the utility of transplanting of NC/NRTx. DOWNSTREAM EFFECTS Taking all of this into account, there are several possible downstream effects of continuing to allow this practice. Of great concern has been the question of increased waitlist times for US residents if US organs are going to noncitizen nonresidents. Somewhat reassuringly, data collected by the 2017 Ad Hoc International Relations Committee for their report to United Network for Organ Sharing/Organ Procurement and Transplantation Network reviewed centers with the most transplants to NC/NR and concluded that there was no noticeable difference in time to transplant.12 More data will need to be collected to ensure that US residents’ access to transplant is not jeopardized and to account for regional variation in the practice. As organ donation depends on public engagement with the system, it is also important to consider public perceptions of transplanting NC/NRTx. The only survey to evaluate public opinion showed that 30% of respondents felt that NC/NRTx should not be allowed, and furthermore, 38% stated they might be discouraged from donating organs if they knew that NC/NRTx could be listed for transplantation in their area.13 If the practice of NC/NRTx continues to grow, there is reason to be concerned that donor deterrence will grow as well, potentially widening an already significant discrepancy in supply and demand. Finally, physicians and other health care workers may experience moral distress as they watch their own patients die on the waitlist knowing that an organ that could have saved them went to someone who traveled to obtain it, particularly given potentially financial motivations. CONCLUSION—WHERE DO WE GO FROM HERE? There are many ethical issues inherent in the practice of transplanting NC/NRTx, and more data will need to be collected to ascertain the overall impact of these transplants on US residents. Moving forward, policymakers will need to decide whether the status quo is maintained and whether centers continue to make their own determinations of who is transplanted. If so, it will be the responsibility of each center to ensure the needs of their local community are met. No matter what policies are decided upon, it is incumbent upon us to take into account the concepts of justice and utility when considering their design. Given that there is not likely to be a straightforward or easy way to address these ethical considerations while organ shortages persist, the answer may lie in investing in other countries’ transplant infrastructure and supporting regional organ-sharing programs, which would lead to more efficient utilization of resources and a self-sufficient system more in line with the tenets of the DOI.

  PublisherOA PDFDOI

• Hepatitis C Guidance 2023 Update: American Association for the Study of Liver Diseases– Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

  Clinical Infectious Diseases · 2023 · 258 citations

  • Medicine
  • Virology
  • Environmental health

  The Infectious Diseases Society of America and the American Association for the Study of Liver Diseases have collaboratively developed evidence-based guidance regarding the diagnosis, management, and treatment of hepatitis C virus (HCV) infection since 2013. A panel of clinicians and investigators with extensive infectious diseases or hepatology expertise specific to HCV infection periodically review evidence from the field and update existing recommendations or introduce new recommendations as evidence warrants. This update focuses on changes to the guidance since the previous 2020 published update, including ongoing emphasis on recommended universal screening; management recommendations for incomplete treatment adherence; expanded eligibility for simplified chronic HCV infection treatment in adults with minimal monitoring; updated treatment and retreatment recommendations for children as young as 3 years old; management and treatment recommendations in the transplantation setting; and screening, treatment, and management recommendations for unique and key populations.

  PublisherOA PDFDOI

• Direct intrahepatic portocaval shunt compressing the bile duct: a rare case of jaundice

  Gastrointestinal Endoscopy · 2023-11-22

  article
  PublisherDOI

Frequent coauthors

• Donald M. Jensen

  Rush University Medical Center

  23 shared

• Nancy Reau

  18 shared

• Helen S. Te

  17 shared

• Michael Charlton

  University of Chicago

  7 shared

• Thomas G. Cotter

  The University of Texas Southwestern Medical Center

  7 shared

• K. Gautham Reddy

  University of Chicago

  6 shared

• Deanna Lee

  University of California, San Francisco

  6 shared

• John J. Fung

  University of Chicago

  6 shared

Labs

• University of Chicago Medicine Center for Liver DiseasesPI