Gaps in Guideline Adherence for Primary Sclerosing Cholangitis in North America—A 5‐Year Analysis

Liver International · 2026-04-10

BACKGROUND AND AIMS: Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease with a high risk of malignancy and limited therapeutic options. Both the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) recommend structured baseline evaluation, fibrosis staging and longitudinal surveillance. However, real-world adherence to these practices in North America remains unclear. METHODS: We conducted a retrospective cohort study of 1300 patients with PSC enrolled in the Consortium for Autoimmune Liver Diseases (CALiD) registry between 2018 and 2024 across 19 centres in North America. Guideline adherence was assessed for diagnostic measures at baseline (colonoscopy to establish IBD status and noninvasive fibrosis staging) and longitudinal surveillance (colonoscopy in PSC-IBD, abdominal imaging for hepatobiliary cancer surveillance and CA 19-9 testing). Prescribing patterns for ursodeoxycholic acid (UDCA) were also characterised. Multivariable logistic regression was used to evaluate demographic, clinical and socioeconomic predictors of adherence. RESULTS: At diagnosis, 78.8% of eligible patients with available data underwent colonoscopy to establish IBD status, and 45% underwent noninvasive fibrosis staging. During follow-up, only 30%-35% of patients with PSC-IBD underwent colonoscopy annually, while abdominal imaging for hepatobiliary cancer surveillance declined from 74% at Year 1 to 51% by Year 4. CA 19-9 testing was documented in 47% over 5-year period. UDCA was prescribed in 51% at baseline, with median dose of 12.5 mg/kg/day. Socioeconomic factors, including lower education and household income, were associated with reduced adherence, while cirrhosis strongly predicted completion of surveillance imaging. CONCLUSIONS: Adherence to guideline-based care in PSC remains suboptimal in North America Suboptimal adherence was observed for strongly recommended practices with longstanding guideline support (colonoscopy to establish IBD status; annual CRC surveillance in PSC-IBD) as well as practices where guideline consensus has evolved more recently or where societies differ (baseline fibrosis assessment; hepatobiliary cancer imaging). Efforts to standardise care and address socioeconomic barriers are urgently needed to improve outcomes.

Screening for Food Insecurity in Patients With Cirrhosis

Journal of Clinical Gastroenterology · 2026-04-02

INTRODUCTION: Data collection on food insecurity and barriers to a healthy diet is not routinely done in hepatology clinics, although the prevalence of food insecurity is likely high. This is a pilot study to estimate the prevalence of food insecurity and characterize food-insecure patients with cirrhosis who receive routine outpatient care. METHODS: Prospective survey of outpatients with cirrhosis to screen for food insecurity in the waiting room on the day of their appointment. Responses were linked to electronic medical record data for demographic, comorbidity, and health care utilization data. Descriptive statistics were calculated for patients who were food insecure versus food secure. Univariate and multivariable models were constructed to evaluate the relationships between patient factors and food insecurity. RESULTS: Of 150 respondents, 25% (n=38) screened positive for food insecurity. In total, 69% (n=104) reported difficulty making the best food choices for their cirrhosis, 89% (n=34) among the food insecure, and 54% (n=60) among the food secure. Compared with food-secure individuals, those with food insecurity were younger (mean age 58.1 vs. 63.5 y, P=0.02), had lower BMI (mean 27.9 vs. 30.9, P=0.03), and were more likely to be Hispanic (15.8% vs. 4.5%, P=0.05) and Medicaid-insured (28.9% vs. 10.7%, P=0.01). Both groups had similar cirrhosis etiologies, co-morbidities, decompensation events, ED visits, and hospital admissions within the past year. CONCLUSION: One in 4 patients screened during a routine outpatient hepatology visit reported food insecurity. Over 69% of patients reported difficulties with making cirrhosis-specific food choices, most of whom did not screen positive for food insecurity. Our findings underscore an urgent need for tailored screening and for interventions that address the unique barriers faced by cirrhosis patients.

Mo1229: GAPS IN GUIDELINE ADHERENCE FOR PRIMARY SCLEROSING CHOLANGITIS IN THE US: A 5-YEAR ANALYSIS OF CALID DATABASE

Gastroenterology · 2025-05-01

Safe and effective acne treatment across skin types with a 1726 nm sebum-selective laser: One year data from a prospective multicenter study

Journal of the American Academy of Dermatology · 2025-10-05 · 5 citations

BACKGROUND: Patients treated with a 1726-nm laser showed significant improvement in moderate-to-severe acne for ≥6 months in a prospective study. OBJECTIVE: One-year follow-up data are presented. METHODS: In this prospective institutional review board-approved study, patients underwent 3 treatments with a 1726-nm laser, 2-5 weeks apart. Inflammatory lesion counts and Investigator's Global Assessment scores were assessed at baseline, 3 months, and 1 year after treatment. Adverse events, treatment satisfaction, and self-confidence were assessed. RESULTS: Of 104 patients with Fitzpatrick skin types II-VI and moderate-to-severe acne, 89 and 71 patients, respectively, attended 12- and 52-week visits. At 12 weeks, 79.8% demonstrated ≥50% improvement in inflammatory lesion counts, which increased to 91.5% at 52 weeks. The proportion of patients with clear or almost clear Investigator's Global Assessment scores increased from 36.0% at 3 months to 66.2% at 52 weeks. Treatment was well tolerated: Mild erythema and edema occurred in 100% and 98.1% of patients, respectively. No blistering, crusting, or hypo- or hyperpigmentation were observed. Patient satisfaction and self-confidence improved at both follow-up timepoints. LIMITATIONS: No control group; reliance on image assessment; open-label design. CONCLUSION: The seboselective 1726-nm laser is an effective and well-tolerated therapy for reducing moderate-to-severe facial acne for at least 1 year.

Center‐Level Variability in Use of Normothermic Machine Perfusion and the Association With Recipient Insurance

Clinical Transplantation · 2025-04-01

BACKGROUND: The rapid implementation of normothermic machine perfusion (NMP), since the FDA-approved NMP devices, has resulted in a paradigm shift in the ability to use marginal livers and allow for daytime operations. A major rate-limiting factor is costs which could lead to disparities among recipients. We aim to evaluate center-level variability in utilization of NMP, and to determine whether recipient insurance type was associated with NMP. METHODS: We evaluated deceased donor liver transplants in high-volume NMP centers between January 2022 and December 2023, using the national registry. The primary outcome was whether the DDLT was performed using NMP. To explore center-level and factors associated with NMP, we evaluated variables related to donor quality and insurance. We fit multivariable logistic regression models to evaluate these factors. RESULTS: Out of 142 liver transplant centers, 72 had ≥1 DDLT using NMP, and 28 were high-volume NMP centers. There was marked center-level variability in the proportion of donation after brain death (DCD) versus donation after brain death (DBD) allografts that underwent NMP. In logistic regression, liver allografts procured using NMP were more likely to occur during the nighttime (OR 1.26, p < 0.001), more likely to be used for DCD allografts (OR 13.2, p < 0.001), and less likely to occur in recipients insured by Medicaid, Medicare, or the Veterans Health Administration. CONCLUSIONS: Our study demonstrates center-level variability in the use of NMP, and factors associated with these differences. Although the change in practice may help to increase DCD utilization, and shift the timing of transplants, the disparity based on insurance is alarming.

PRO: A multi-vendor organ procurement and transplantation network (OPTN) will improve liver procurement and use

Liver Transplantation · 2025-07-08 · 1 citations

Investigating Disparities Related to Insurance Status and Access to Locoregional Therapies for Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation

Digestive Diseases and Sciences · 2025-11-01

PURPOSE: Patients with hepatocellular carcinoma (HCC) and Medicaid insurance on the liver transplantation (LT) waitlist face higher risks of waitlist dropout, though mechanisms behind this disparity remain unclear. We aimed to assess differences in the use of locoregional therapy (LRT) based on insurance status and whether these differences contribute to waitlist disparities. METHODS: We conducted a retrospective cohort study using Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) data on adult patients (≥ 18 years) waitlisted with standardized HCC Model for End-stage Liver Disease (MELD) exceptions from 1/1/2015 to 12/31/2022. Mixed effects multiple variable logistic regression models were used to evaluate the association between insurance status and LRT receipt, adjusting for key clinical and HCC-related variables. RESULTS: Patients with Medicaid had higher odds (OR: 1.09; 95% CI: 1.01, 1.18) of receiving LRT compared to patients with private insurance. Additionally, when comparing waitlist time following HCC MELD exception approval for our cohort, Medicaid patients experienced longer median waitlist time (206 days; IQR 88-371) compared to privately insured patients (182 days; IQR 69-313) (p < 0.001). CONCLUSION: Contrary to expectations, Medicaid patients were more likely to receive LRT than those with private insurance. These findings highlight the importance of further investigating contributing factors that facilitate these outcomes.

State-Level Variability in Location of Death of Patients with End-Stage Liver Disease

Digestive Diseases and Sciences · 2025-10-08

PURPOSE: Although deaths from end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) in the United States increasingly occur at home or in hospice, inpatient medical facility deaths remain high. Despite the decrease in in-hospital deaths for all causes, non-White decedents are more likely than White decedents to die in a hospital setting. This study aimed to determine state-level variability in the location of death among patients with ESLD and HCC and to assess racial/ethnic differences in these patterns, focusing on Black, White, and Hispanic/Latino patients. METHODS: A retrospective cross-sectional analysis was conducted using 2018-2022 data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research. The proportion of patients with ESLD, HCC, and both conditions who died at an inpatient medical facility, home, hospice facilities, and a combination of both home and hospice was calculated, stratified by race/ethnicity. Mapping was utilized to compare these proportions across the US. RESULTS: There was notable geographic variation in the location of death across all groups. Black and Hispanic/Latino patients with ESLD and HCC more frequently died in inpatient facilities compared to White patients. A statistically significant positive correlation was observed between the number of registered hospice agencies in a state and the proportion of deaths occurring at home among White (Spearman's ρ = 0.33, p = 0.02) and Hispanic/Latino patients (Spearman's ρ = 0.38, p = 0.01). CONCLUSIONS: Future research should investigate factors driving interstate variability and racial differences in end-of-life care for ESLD and HCC patients, which may include hospice availability and the presence of palliative care laws. Strategies to reduce these differences and enhance access to quality end-of-life care for all, particularly for racial/ethnic minorities, are needed.

Early liver transplantation in alcohol-associated liver disease—Evolution of practice, patient selection, management, and outcomes

Liver Transplantation · 2025-09-19 · 2 citations

Early liver transplantation (eLT) for alcohol-associated liver disease (ALD), defined as transplantation with less than 6 months of alcohol abstinence, has emerged as a standard intervention for carefully selected patients unresponsive to medical therapy. Rising ALD prevalence, driven by increased alcohol use, particularly among patients in early adulthood, and exacerbated by the COVID-19 pandemic, has led to an increased demand for eLT for ALD. Recent studies have demonstrated that eLT can yield survival outcomes comparable to standard liver transplantation, although patient selection remains challenging, with return to drinking (RTD) after transplant a primary concern. Various psychosocial evaluation tools can help identify candidates at lower risk for RTD, but predictive accuracy remains limited due to the complex, individualized nature of alcohol use disorder among ALD patients. Multidisciplinary approaches to managing alcohol use disorder, such as integrated care models, are increasingly being adopted to improve outcomes and achieve sustained alcohol abstinence after transplant. Despite the recent increase in eLT for ALD, international practices vary widely, with countries like the United States, France, and Belgium leading in adoption, whereas others still impose strict sobriety requirements. Notably, racial, ethnic, and geographic disparities in access to eLT for ALD have emerged, highlighting the need for more standardized and equitable practices. This review traces the development and expansion of eLT in ALD, addressing selection and management challenges, while proposing a biopsychosocial framework to optimize patient and graft outcomes across the liver transplantation continuum.

Su1665: NEIGHBORHOOD DYSFUNCTION, FOOD INSECURITY, SOCIAL ISOLATION AND STRESS ARE MODIFIABLE UPSTREAM FACTORS THAT CONTRIBUTE TO METABOLIC ASSOCIATED STEATOTIC LIVER DISEASE

Gastroenterology · 2025-05-01