About

Paul J. Gaglio, MD, FACP, AGAF, FAASLD, is a Professor of Medicine and the Division Director of Hepatology and Transplant Hepatology at Rutgers, New Jersey Medical School. He serves as the Medical Director of Liver Transplantation at Rutgers and is responsible for overseeing the Liver Transplantation Program and the Hepatology Fellowship Program. Dr. Gaglio has previously held positions as the Director of Hepatology Outreach at NY-Presbyterian Hospital, Columbia University Irving Medical Center, and as Medical Director of Adult Liver Transplantation at The Montefiore Medical Center, Columbia Presbyterian Hospital, and The Tulane University Medical Center. His research interests include the treatment of hepatitis B and C, the natural history of hepatitis C in liver transplant recipients, and metabolic dysfunction associated with steatotic liver disease. He has published multiple manuscripts, book chapters, and abstracts, and has participated in numerous research trials related to liver disease and transplantation. Dr. Gaglio has lectured nationally and internationally on these topics and is recognized as a leading expert in his field, being listed in Castle Connolly Top Doctors, Marquis Who's Who in America, and receiving several teaching awards. In 2011, he was named Physician of the Year by the NY Chapter of the American Liver Foundation.

Research topics

• Medicine
• Intensive care medicine
• Internal medicine
• Pathology
• Cardiology
• Cartography
• Demography

Selected publications

• Development and Internal Validation of a Pretransplant Biomarker Panel for Mortality Prediction Following Liver Transplant

  JAMA Surgery · 2026-02-11 · 2 citations

  articleOpen access

  Importance: Current pretransplant clinical scoring systems fail to accurately estimate post-liver transplant (LT) survival, making recipient selection challenging. Persistent immune dysfunction contributes to early LT recipient mortality but is not captured by existing models. Objective: To identify plasma biomarkers of pretransplant immune dysfunction and to develop a biomarker-based pre-LT risk stratification tool to predict post-LT mortality. Design, Setting, and Participants: Prospective biomarker analysis of consecutively enrolled adult LT recipients was conducted. Healthy controls were included for baseline comparison. Patients undergoing LT at Houston Methodist Hospital (October 1, 2013, to December 31, 2017) and Rutgers/University Hospital (January 1, 2019, to March 31, 2021) were enrolled under an institutional review board-approved protocol, and data were censored on March 31, 2023, and analyzed. Patients with cirrhosis older than 18 years undergoing deceased donor LT were included. Exclusion criteria were age greater than 70 years, cancer other than hepatocellular carcinoma, retransplant, status 1A, intraoperative mortality, multivisceral transplant (except liver-kidney), and sample availability. Exposures: Plasma cytokine, chemokine, and immune exhaustion biomarkers were quantified using multiplex Luminex assays at the time of transplant. Clinical, demographic, and laboratory data were extracted from institutional databases. Main Outcomes and Measures: The primary outcome was all-cause mortality within 1 year of LT. Secondary outcomes included graft survival, infections, rejection, readmissions, and 24-month survival. Results: A total of 779 adult LTs were performed between 2007 and 2017, with prospective biomarker analysis of 279 consecutively enrolled LT recipients between 2018 and 2022. Median (IQR) participant age was 56.7 (48.2-62.5) years, and 110 of 279 patients (39.4%) were female. Pre-LT plasma levels of B-cell activating factor, C-C motif chemokine ligand 1, eotaxin, fractalkine, interleukin 1β (IL-1β), sIL-6Rβ, metalloproteinase (MMP) 2, and MMP3 were significantly associated with 1-year post-LT mortality. Multivariable Cox proportional hazards modeling identified fractalkine and MMP3 as independent predictors of early post-LT mortality. These were used to develop the Liver Immune Frailty Index (LIFI), stratifying patients into low, moderate, and high risk. One-year mortality was 1.9%, 10.3%, and 63.6% for LIFI-low, -moderate, and -high, respectively. Relative risk of death within 1 year was 5.43 (95% CI, 1.59-18.60; P < .001) for LIFI-moderate and 33.41 (95% CI, 11.48-97.25; P < .001) for LIFI-high compared to LIFI-low. LIFI demonstrated strong discrimination (C statistic, 0.83) and was associated with post-LT infections, longer hospital stays, and reduced patient survival. Conclusions and Relevance: Per the results of this diagnostic/prognostic study, LIFI identifies LT candidates with severe immune dysfunction at high risk for early post-LT mortality, offering a preoperative, objective tool to refine transplant candidacy, guide perioperative management, and improve LT outcomes.

  PublisherOA PDFDOI

• Comparative Efficacy of Bulevirtide, Interferons, and Nucleos(t)ide Analogs for Chronic Hepatitis Delta: A Systematic Review and Network Meta‐Analysis

  International Journal of Hepatology · 2026-01-01

  articleOpen accessSenior author

  Background Chronic hepatitis D virus (HDV) continues to be a global health concern, and the infection remains challenging to treat. Over the past few decades, pegylated interferons, typically in combination with therapy for hepatitis B, have become the standard of care, with considerable side effects and frequently unsatisfactory results. Several new therapies are emerging, including bulevirtide and lonafarnib. We conducted a systematic review and network meta‐analysis (NMA) to compare the efficacy of bulevirtide, interferons, and nucleos(t)ide analogs, alone or in combination, for the treatment of chronic hepatitis D. Methods PubMed, Embase, and Cochrane databases were searched for randomized controlled trials and nonrandomized interventional studies assessing HDV RNA suppression, biochemical response, combined response, and histological improvement with various therapies. NMA was performed using a frequentist random‐effects model. Odds ratios (OR) with 95% confidence intervals (CI) were calculated and forest plots were generated. Results Thirteen studies ( n = 922) were included, studying nine possible treatment arms. At the end of treatment, 31.8% achieved a virological response. Bulevirtide monotherapy (OR 38.63, p &lt; 0.05) and combinations with NA (OR 69.36, p &lt; 0.05) and peginterferon alpha (OR 260.08, p &lt; 0.05) significantly suppressed HDV RNA, with the bulevirtide–peginterferon alpha combination having the highest HDV RNA suppression. At ≥ 24‐week follow‐up, no regimen maintained significant HDV RNA suppression. Biochemical response was achieved in 42.7% at the end of treatment; however, no group reached statistical significance versus control, though bulevirtide and its combination with peginterferon alpha outperformed peginterferon alpha alone. Combined response was highest with bulevirtide–peginterferon alpha (OR 112.69, p &lt; 0.05), followed by bulevirtide monotherapy. Histological response (five studies, n = 183) was not statistically significant with any intervention compared with control. Conclusion Bulevirtide and peginterferon alpha combination therapy may offer the most promising treatment for chronic hepatitis D. More studies are needed to assess the efficacy of this regimen and establish the optimum dose and duration of treatment.

  PublisherDOI

• Which Frailty Tools Best Predict Waitlist Outcomes? Insights From High- vs. Low-MELD Liver Transplant Candidates

  American Journal of Transplantation · 2026-01-01

  articleOpen access
  PublisherOA PDFDOI

• Development of an AI-driven body composition analysis platform for objective evaluation of liver transplant recipient myosteatosis

  American Journal of Transplantation · 2026-01-01

  article
  PublisherDOI

• Trends in Early-Onset Colorectal Adenocarcinoma and Neuroendocrine Tumors Across Racial and Ethnic Groups

  Journal of Clinical Medicine · 2026-02-07

  articleOpen access

  Background: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is increasing despite declining colorectal cancer (CRC) rates among older adults. Emerging evidence suggests widening racial and ethnic disparities. We aimed to characterize long-term EOCRC incidence and mortality trends across racial and ethnic groups in the United States with comparisons by tumor subtype. Methods: We conducted a population-based analysis using United States Cancer Statistics data (2001–2021) for EOCRC incidence and National Center for Health Statistics data (2000–2022) for mortality. Analyses were stratified by race/ethnicity and histology. Trends were quantified using average annual percent change (AAPC) with 95% confidence intervals (Cis). Results: Among 474,601 early-onset adenocarcinoma (EO-ADC) cases, incidence increased in all racial and ethnic groups except Non-Hispanic Black individuals, in whom incidence declined (AAPC = −0.35%, 95% CI −0.63 to −0.08; p = 0.01). The steepest incidence increases occurred among American Indian/Alaska Native (AIAN; AAPC = 3.39%, 95% CI 2.70–4.15), Hispanic (AAPC = 0.94%, 95% CI 0.61–1.30), and Asian/Pacific Islander populations (AAPC = 0.64%, 95% CI 0.37–0.95; all p &lt; 0.001). EOCRC mortality increased among AIAN (AAPC = 2.67%, 95% CI 1.26–4.26; p = 0.001) and Hispanic populations (AAPC = 0.81%, 95% CI 0.39–1.27; p &lt; 0.001), but declined among Black individuals (AAPC = −1.08%, 95% CI −1.29 to −0.77; p &lt; 0.001). Neuroendocrine tumors increased more rapidly than adenocarcinomas across all groups. Conclusions: EOCRC incidence and mortality are rising most rapidly among AIAN and Hispanic populations. Distinct incidence trajectories of colorectal neuroendocrine tumors compared with adenocarcinomas highlight the importance of histology-specific analyses for accurate epidemiologic interpretation.

  PublisherOA PDFDOI

• Redefining liver transplant priority: Waitlist outcomes for HCC after MMaT-3 donor hospital-based allocation reform

  Liver Transplantation · 2026-04-24

  article

  In 2022, the United Network for Organ Sharing (UNOS) revised the liver transplant allocation policy to calculate the median MELD at Transplant minus 3 points (MMaT-3) around the donor hospital instead of the transplant center, aiming to reduce disparities among MELD exception candidates. We evaluated the impact of this revised policy on waitlist outcomes in patients with or without hepatocellular carcinoma (HCC). Using the OPTN/UNOS registry, we identified all adult transplant candidates between October 8, 2015, and March 31, 2024, and stratified by policy eras: Pre-MMaT-3 (n=25,580), MMaT-3 Recipient (n=13,311), and MMaT-3 Donor (n=10,027). Fine-Gray competing risk models were performed to estimate waitlist removal due to dropout (death or removal due to clinical deterioration), due to clinical improvement, or transplantation by HCC status. During Pre-MMaT-3, candidates with HCC had a significantly higher probability of transplant than those without HCC [adjusted subdistribution hazard ratio (aSHR) 2.03, 95% CI: 1.95-2.12, p <0.001]. This advantage declined in the MMaT-3 Recipient era (aSHR 1.39, 95% CI: 1.31-1.47, p <0.001) and disappeared in the MMaT-3 Donor era (aSHR 0.98, 95% CI: 0.88-1.09, p =0.73). Waitlist dropout, initially similar for HCC candidates than non-HCC (aSHR 0.93, 95% CI: 0.86-1.01, p =0.08), increased following MMaT-3 Recipient (aSHR 1.21, 95% CI: 1.07-1.36, p =0.01) and Donor (aSHR 2.06, 95% CI: 1.64-2.60, p <0.001) eras. Importantly, within-HCC cohort, waitlist mortality analysis improved after the MMaT-3 Donor era ( aSHR 0.79, p =0.01), while maintaining reduced wait times and stable transplant rates. The MMaT-3 Donor policy effectively deprioritized HCC for transplantation, while improving waitlist mortality within the HCC group. Ongoing evaluation is essential to guide equitable liver allocation.

  PublisherDOI

• Update on Medical Management and Liver Transplantation in Primary Biliary Cholangitis: A Narrative Review

  Livers · 2026-03-11

  articleOpen accessSenior author

  Primary Biliary Cholangitis (PBC) is a chronic, immune-mediated cholestatic liver disease characterized by progressive intrahepatic bile duct destruction, leading to pruritus, fatigue, cirrhosis, and eventually hepatocellular carcinoma. Early diagnosis has improved with the development of sensitive serologic assays (e.g., antimitochondrial antibodies, antinuclear antibodies) and the introduction of newer biomarkers. Risk stratification has become standardized with the help of GLOBE and UK-PBC scores, alongside non-invasive tools such as vibration-controlled transient elastography, enabling earlier intervention. Ursodeoxycholic acid (UDCA) is the first-line therapy; however, 30–40% of patients show an incomplete response, increasing their risk of liver failure and mortality. Second-line therapies have emerged which provide viable treatment avenues for those who do not respond to UDCA or are unable to tolerate it. However, in certain situations, such as decompensated cirrhosis, carcinoma, or refractory pruritus, liver transplantation constitutes the only curative therapy. While PBC has excellent post-liver transplant (post-LT) outcomes, patients with PBC face higher waitlist mortality as they tend to have lower MELD scores. Management post-LT includes the use of UDCA, immunosuppressants, and surveillance for recurrent PBC. Our review highlights the recent advances in medical management and transplant risk stratification of patients at risk of decompensation, as well as the perioperative transplant period outcomes and long-term post-transplant management strategies in patients with PBC.

  PublisherOA PDFDOI

• EUS GUIDED ELASTOGRAPHY AS A TOOL FOR DIAGNOSIS OF ADVANCED FIBROSIS USING LIVER BIOPSY AS GOLD STANDARD WITH EXTERNAL VALIDATION

  Gastrointestinal Endoscopy · 2025-05-01

  article
  PublisherDOI

• Sa1618: SAFETY AND EFFICACY OF ENDOSCOPIC SLEEVE GASTROPLASTY AFTER LIVER TRANSPLANTATION

  Gastroenterology · 2025-05-01

  article
  PublisherDOI

• Impact of Active Hepatitis C Virus Infection on Post-Liver Transplantation Outcomes in the Direct-Acting Antiviral Era

  American Journal of Transplantation · 2025-08-01

  article
  PublisherDOI

Frequent coauthors

• Robert S. Brown

  Weill Cornell Medicine

  27 shared

• Milan Kinkhabwala

  24 shared

• Ahmed Al‐Khazraji

  20 shared

• John F. Reinus

  Montefiore Medical Center

  20 shared

• Kaveh Hajifathalian

  Rutgers, The State University of New Jersey

  20 shared

• Yazan Abboud

  Rutgers, The State University of New Jersey

  20 shared

• Mark W. Russo

  Atrium Medical Cente

  18 shared

• Jean C. Emond

  NewYork–Presbyterian Hospital

  16 shared

Education

• M.D.

  University of Medicine and Dentistry of New Jersey

  1988

Awards & honors

• 2011, Physician of the Year, NY Chapter of the American Live…