About

Veeral Ajmera is an Associate Professor of Clinical Medicine at UC San Diego, based in the Vc-health Sciences department. His research focuses on liver diseases, particularly nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD). He employs multimodal approaches to characterize disease severity and prognosis, utilizing biomarkers, imaging, and clinical data. Ajmera has contributed to understanding the genetic and social determinants influencing liver disease progression and outcomes, including disparities in liver transplant access and outcomes among different populations. His work includes clinical trials and studies on the utility of biomarkers such as phosphatidylethanol for detecting alcohol use and subclassifying liver disease, as well as developing noninvasive pathways for fibrosis stratification. He has been the principal investigator on NIH-funded projects and has authored numerous publications in the field of gastroenterology and hepatology.

Research topics

• Gastroenterology
• Internal medicine
• Medicine
• Radiology
• Pathology
• Endocrinology
• Biology

Selected publications

• Monogenic and Polygenic Risk in Common Liver Diseases: Implications for Clinical Care

  Gastroenterology · 2026-04-01

  article1st authorCorresponding
  PublisherDOI

• Global Longitudinal Assessment of <scp>MASLD</scp> Using Magnetic Resonance Elastography ( <scp>GOLDMINE</scp> ): A Multi‐Center, International Prospective Cohort Study of Imaging Biomarkers in <scp>MASLD</scp> Clinical Outcomes

  Alimentary Pharmacology & Therapeutics · 2026-04-22 · 3 citations

  article

  BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) exhibits marked heterogeneity in fibrosis progression and liver-related outcomes. Liver biopsy is not feasible for longitudinal risk stratification at scale, creating a need for validated non-invasive biomarkers, particularly imaging biomarkers, that can predict clinically meaningful disease progression and liver-related outcomes. AIMS: To describe the design and rationale of the GOLDMINE study, established to determine whether non-invasive imaging biomarkers predict MASLD progression and liver-related clinical outcomes. METHODS: GOLDMINE is an investigator-initiated, multi-centre, international longitudinal cohort enrolling up to 1000 adults with either biopsy-proven MASLD or MASLD cirrhosis across the full fibrosis spectrum. Participants are recruited from 15 sites in the US and 4 international sites (Japan, Singapore and France). At baseline, participants undergo clinical phenotyping, vibration-controlled transient elastography, and advanced magnetic resonance imaging (MRI), including proton-density-fat-fraction and magnetic resonance elastography (MRE). MRI (and biospecimen banking) is repeated at 2-year intervals (years 2 and 4), with annual follow-up visits for up to 10 years. Baseline liver histology is centrally processed, digitized and reviewed by a single expert hepatopathologist; all MRI/MREs are centrally interpreted. RESULTS: The prespecified clinical outcomes include progression to cirrhosis, clinically significant portal hypertension, major adverse liver-related outcomes (ascites, hepatic encephalopathy, portal hypertensive bleeding, liver transplantation/qualification), hepatocellular carcinoma, major adverse cardiovascular events, and all-cause mortality, with independent central adjudication of all events. CONCLUSIONS: GOLDMINE establishes a rigorously phenotyped MASLD cohort integrating centralized histology, advanced MRI-based biomarkers, longitudinal biobanking, and adjudicated outcomes, providing a platform to validate imaging and blood-based prognostic biomarkers in MASLD.

  PublisherDOI

• Spontaneous Recovery and Mortality in Patients with ALD Referred for Early Liver Transplantation

  The American Journal of Gastroenterology · 2026-04-22

  article

  INTRODUCTION: Alcohol-associated liver disease (ALD), including alcohol-associated hepatitis (AH), is the leading cause of liver transplant (LT) in the United States (US), and acceptance of LT without a mandatory period of abstinence is increasing. However, some patients may achieve spontaneous recovery (SR) without LT. We evaluated predictors of mortality and SR among patients with ALD referred for early LT. METHODS: RESOLVE-ALD is a retrospective cohort of adults with ALD and <6 months of sobriety referred for early LT between 2018-2021 at six transplant centers across the US. Fine-Gray competing risk regression evaluated predictors of 12-month mortality, with LT considered as a competing risk. Multivariable logistic regression identified predictors of 12-month SR, defined by the expanded Baveno VII criteria. RESULTS: Of 607 patients, the median MELD 3.0 was 29 (IQR 22-36); the median time from last drink was 2.6 months (IQR 1.1-4.1). Independent predictors of 12-month mortality included higher INR (sHR 1.49, 95% CI 1.23-1.79) and higher BUN (sHR 1.16 per 10 mg/dL, 95% CI 1.07-1.25). After 12 months, 18.5% achieved SR without LT. Predictors of SR at 12 months were lower INR (OR 0.52, 95%CI 0.31-0.83) and higher platelet count (OR 1.04 per 10x103/µL, 95%CI 1.01-1.08). CONCLUSIONS: Among patients with ALD and short-term abstinence, BUN and platelets are novel predictors of outcomes, along with INR. Utilizing these predictors - or recalibrating existing MELD coefficients - in this unique patient population may help refine medical selection criteria and improve utility and equity in access to early LT.

  PublisherDOI

• Factors associated with protection from MASLD in type 2 diabetes: A prospective study integrating longitudinal MRI/MRE and stable isotope tracing

  JHEP Reports · 2026-01-08

  articleOpen access

  Background & Aims: Type 2 diabetes is one of the strongest risk factors for the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). In this study, we aimed to identify factors associated with protection from MASLD in a prospective cohort of individuals with type 2 diabetes. Methods: This prospective study included 148 individuals with type 2 diabetes who underwent advanced liver phenotyping using MRI and MRE techniques at baseline and 2-year follow-up. Protection from MASLD was defined as the absence of hepatic steatosis (MRI-proton density fat fraction <5%) and significant fibrosis (MRE <3 kPa) at both time points. Factors associated with protection from MASLD were assessed using Firth's penalized logistic regression. Regularized logistic regression models were fitted as complementary analyses. Results: lipogenesis in those free from MASLD. Conclusions: Managing modifiable risk factors, such as body weight and lipid profile, may be critical for preventing MASLD development in individuals with type 2 diabetes. Impact and implications: lipogenesis may underlie this protective phenotype. These findings suggest that managing modifiable risk factors, such as body weight and lipid profile, may be critical for preventing MASLD development and progression in individuals with type 2 diabetes.

  PublisherDOI

• 987 COMBINING VIBRATION CONTROLLED TRANSIENT ELASTOGRAPHY AND ENHANCED LIVER FIBROSIS SCORE LOWERS THE FALSE POSITIVE RATE FOR IDENTIFYING AT-RISK MASH IN PATIENTS WITH CLASS 2 OR HIGHER OBESITY

  Gastrointestinal Endoscopy · 2026-05-01

  article1st authorCorresponding
  PublisherDOI

• 987 COMBINING VIBRATION CONTROLLED TRANSIENT ELASTOGRAPHY AND ENHANCED LIVER FIBROSIS SCORE LOWERS THE FALSE POSITIVE RATE FOR IDENTIFYING AT-RISK MASH IN PATIENTS WITH CLASS 2 OR HIGHER OBESITY

  Gastroenterology · 2026-05-01

  article1st authorCorresponding
  PublisherDOI

• Gender disparity in access to early liver transplant among patients with alcohol associated liver disease and limited sobriety is mediated by psychosocial factors

  Liver Transplantation · 2025-10-07 · 2 citations

  articleOpen access

  BACKGROUND: Early liver transplant (LT) is associated with favorable outcomes in select patients with severe alcohol associated liver disease (ALD). Sex-based disparities in liver transplant have been recognized, but there are limited data on gender disparities in access to early LT for patients with ALD. METHODS: RESOLVE-ALD is a multicenter cohort of patients with ALD referred for LT evaluation with <6 months of sobriety at 6 US centers between 2018 and 2021. The primary outcome was waitlist enrollment. Secondary outcomes were waitlist removal and receipt of LT. Multivariable logistic regression was used to evaluate the association between gender and listing for LT. Mediation analyses were performed to evaluate mechanisms for disparities in listing. RESULTS: In all, 617 patients were identified, including 376 men (61%) and 241 women (39%). Women had 36% lower odds of listing for LT (95% CI 0.42-0.91) compared with men, adjusting for other predictors of listing. Adjusted for MELD-Na, abstinence period, and serum albumin levels, women had 2.68-times higher odds of waitlist removal ( p <0.01) and 2.04-fold lower odds of receiving an LT ( p =0.01) compared with men. Mood disorders (depression or anxiety) and unemployment status exerted significant indirect effects on the relationship between gender and listing ( p- values <0.05). Gender differences in listing were significantly different, with lower MELD-Na and bilirubin levels and more days abstinent. Two-year post-LT survival was similar in men and women (91.5% vs. 97.4%, p =0.15). CONCLUSIONS: Notable gender disparities in access to LT exist among patients with ALD evaluated with <6 months of sobriety. Lower waitlisting in women is mediated by higher rates of psychiatric conditions and lower rates of employment, though gender-specific alcohol-associated bias may also contribute.

  PublisherOA PDFDOI

• Balancing Spontaneous Recovery and Mortality: Evaluating Model Performance in Patients with ALD Referred for Early Liver Transplantation

  American Journal of Transplantation · 2025-08-01 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Noninvasive pathway for stratifying fibrosis in suspected metabolic dysfunction and alcohol-associated liver disease (MetALD)

  Hepatology Communications · 2025-05-16 · 9 citations

  articleOpen access

  BACKGROUND: Metabolic dysfunction and alcohol-associated liver disease (MetALD) may increase liver fibrosis progression, but data on screening are scarce. We aimed to assess the performance of noninvasive tests (NITs) for detecting significant fibrosis in individuals with suspected MetALD. METHODS: This is a cross-sectional study of prospectively enrolled adults identified as overweight or obese. We included adults with suspected MetALD defined by ≥1 of 5 cardiometabolic criteria and self-reported alcohol use within MetALD ranges or lower self-reported alcohol use but with phosphatidylethanol (PEth) levels ≥25 ng/mL. Clinical assessment included contemporaneous magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE). Significant fibrosis was defined as MRE ≥3.14 kPa (or VCTE ≥7.6 kPa if MRE was missing). Analyses included AUROCs. RESULTS: Among 617 individuals screened, we identified 97 (15.7%) with suspected MetALD. The mean age was 50.6±12.8 years, 67% were men, the mean body mass index was 31.4±6.5 kg/m2, 12.4% had diabetes, and 8% had significant fibrosis. Fibrosis-4 ≥1.3 demonstrated good performance for significant fibrosis (AUROC: 0.78, 95% CI: 0.58-0.98, sensitivity 80%, specificity 76%, positive predictive value 17%, and negative predictive value 98%). VCTE ≥8 kPa also had good performance (AUROC: 0.85, 95% CI: 0.66-1.00, sensitivity 80%, specificity 91%, positive predictive value 36%, and negative predictive value 99%). A stepwise approach using fibrosis-4 followed by VCTE yielded a low false negative rate (2% misclassified as low risk). CONCLUSIONS: A clinical care algorithm utilizing a stepwise approach with fibrosis-4 and VCTE shows adequate performance in detecting significant fibrosis in individuals with suspected MetALD.

  PublisherDOI

• Inherited Genetic Risk of Liver Fibrosis in Lean Versus Nonlean Metabolic Dysfunction–Associated Steatotic Liver Disease ( <scp>MASLD</scp> )

  Alimentary Pharmacology & Therapeutics · 2025-10-28 · 5 citations

  articleSenior authorCorresponding

  INTRODUCTION: Previous studies have revealed conflicting results regarding liver fibrosis risk in lean metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to compare the risk of significant fibrosis in lean versus nonlean MASLD and identify fibrosis-associated factors in lean MASLD. METHODS: The study was a cross-sectional analysis of prospectively enrolled adults with MASLD. Individuals with lean MASLD were age- and sex-matched with nonlean MASLD. Fibrosis assessment included vibration-controlled transient elastography, magnetic resonance elastography and liver biopsy. A genetic risk score (GRS), summating the effect alleles of PNPLA3 and TM6SF2 minus the protective HSD17B13 genotype, was estimated to consider inherited genetic risk across BMI categories. Results were validated in an external Latin American cohort. RESULTS: 11.6 years and 69.2% were female. 44 (14.1%) individuals were lean, 90 (28.9%) were overweight, 90 (28.9%) had class I obesity and 88 (28.1%) had class II or greater obesity. The prevalence of significant fibrosis was 27.3% in lean and 31.1% in nonlean (p = 0.653). Individuals with a high GRS had a higher prevalence of significant fibrosis compared to patients with low GRS (36.5% vs. 25.2%, p = 0.043) and the prevalence of significant fibrosis was similar in lean and nonlean patients with high GRS (31.3% vs. 37.1%, p = 0.645). The Latin American cohort exhibited similar results. CONCLUSIONS: The prevalence of significant fibrosis and the effect of GRS were similar in lean and nonlean MASLD, highlighting that lean MASLD patients may have a comparable risk to overweight and obese MASLD.

  PublisherDOI

Recent grants

• A Novel Multimodal Approach to Characterize NAFLD Severity and Prognosis

  NIH · $1.1M · 2019–2025

Frequent coauthors

• Rohit Loomba

  72 shared

• Lisa Richards

  University of California, San Diego

  25 shared

• Daniel Q. Huang

  National University Health System

  23 shared

• Nobuharu Tamaki

  Musashino Red Cross Hospital

  22 shared

• Ricki Bettencourt

  21 shared

• J. Jeffrey Carr

  Vanderbilt University Medical Center

  20 shared

• Cyrielle Caussy

  20 shared

• Claude B. Sirlin

  The University of Texas Southwestern Medical Center

  19 shared

Education

• Ph.D., Molecular and Computational Biology

  University of California, San Diego

  2009

• M.S., Molecular and Computational Biology

  University of California, San Diego

  2005

• B.S., Biology

  University of California, San Diego

  2003