International Hepatology

July 28, 2024, marks the 14th World Hepatitis Day. Recently, the National Disease Control and Prevention Administration released a report on the national legal infectious disease situation for May 2024, revealing that viral hepatitis remains the most prevalent category B infectious disease. In light of this, Hepatology Digest interviewed Dr. Jidong Jia from Beijing Friendship Hospital, Capital Medical University, to discuss the transmission routes of hepatitis, prevention measures, and more. Below is the transcript of the interview.

The Journal of Hepatology (JOH) recently published an online systematic review and individual patient data meta-analysis conducted by Cedars-Sinai Medical Center in Los Angeles. The study investigates the impact of using immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC) before liver transplantation on various key clinical outcomes post-transplantation. The findings reveal that while ICIs treatment may increase the risk of post-transplant rejection, the overall risk remains manageable, with patient age and ICI clearance time being closely related to rejection risk. This study provides valuable clinical data to support the use of ICIs before liver transplantation, offering new insights and directions for research and clinical practice in this area.

HBV infection is a global public health issue, with its chronic progression leading to severe liver diseases such as chronic hepatitis B (CHB), cirrhosis, and hepatocellular carcinoma (HCC). In recent years, the phenomenon of HBV DNA integrating into the host genome has garnered widespread attention as it unveils new mechanisms of HBV pathogenesis and significantly impacts the diagnosis, treatment, and prognosis of HBV-related diseases. Recently, Dr. Fabien Zoulim from Lyon Hepatology Institute, France, published a comprehensive review article in the Journal of Hepatology (JOH), detailing the mechanisms of HBV DNA integration, its impact on liver disease progression, and its implications for the functional cure of CHB. This review aims to provide new perspectives and methods for the prevention and treatment of CHB

Portal hypertension can lead to complications such as variceal bleeding and ascites. Transjugular intrahepatic portosystemic shunt (TIPS) creates an artificial channel between the hepatic vein and portal vein to reduce portal pressure. TIPS is the only minimally invasive method that can reduce or even normalize portal pressure and is effective in controlling variceal bleeding and refractory ascites. However, American, Chinese, and European guidelines recommend endoscopic treatment, non-selective beta-blockers, and paracentesis as the first-line treatments for variceal bleeding and ascites related to portal hypertension, with TIPS recommended as an alternative treatment. One of the main reasons is that TIPS can induce overt hepatic encephalopathy (HE), with an incidence rate of 10% to 50%, negatively affecting patients' quality of life and increasing mortality. Even with multiple treatments, the recurrence rate of HE remains high. These factors make predicting the risk of overt HE crucial for determining patient eligibility for TIPS. Recently, a study by Dr. Ligong Lu from Zhuhai People's Hospital, published in Hepatology International, explored the feasibility of using liver vascular assessments to predict HE, providing evidence to support the selection of suitable patients for TIPS treatment.

It is estimated that 25% of adults worldwide are affected by metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD is characterized by at least 5% liver fat content in individuals who do not consume alcohol or consume very little. MASLD represents the liver manifestation of metabolic syndrome and is closely associated with obesity, insulin resistance, and type 2 diabetes (T2DM). About 20% to 30% of MASLD patients progress to metabolic dysfunction-associated steatohepatitis (MASH), characterized by steatosis, inflammation, and hepatocellular ballooning, with or without fibrosis. It is estimated that 20% of MASH patients will further develop end-stage liver disease. A weight loss of 3% to 5% can improve MASLD, while a weight loss of ≥10% is associated with MASH regression and fibrosis regression, indicating the critical role of obesity in the progression of these diseases. Recently, a study published in the Journal of Hepatology suggests that a GLP-1R/GCGR dual agonist may provide an effective treatment for MASLD and obesity.

As of 2022, there are 257.5 million people worldwide who are HBsAg positive. Decompensated cirrhosis and hepatocellular carcinoma (HCC) are the leading causes of death among chronic HBV patients. Liver biopsy is the "gold standard" for diagnosing fibrosis stages, but its invasive nature makes many patients reluctant to undergo the procedure. Recently, a study published in Hepatology International explored the value of serum N-glycan markers in diagnosing liver fibrosis.

Recently, a study by Italian scholar Dr. Silvia Nardelli, published in the Journal of Hepatology, found that even if cirrhotic patients develop overt hepatic encephalopathy (OHE) after undergoing transjugular intrahepatic portosystemic shunt (TIPS) surgery, their mortality rate does not significantly increase. This conclusion challenges previous perceptions of the negative impact of OHE in non-TIPS contexts, offering new hope and management strategies for cirrhotic patients.

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Early detection, diagnosis, and intervention can significantly reduce mortality rates. HCC development is driven by a series of complex processes, often starting from hepatitis and cirrhosis. During this progression, subtle changes in cellular gene expression, major shifts in molecular signaling pathways, and significant changes in tissue structure and organ function collectively accelerate HCC formation and progression, leading to changes in liver imaging. Researchers have used radiomics and deep learning technologies to timely and accurately identify and intervene in the formation stage of HCC, named the Transition Stage, potentially revolutionizing early prevention and intervention strategies for HCC.

Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis and hepatocellular carcinoma (HCC). In recent years, the treatment of HCV infection has undergone revolutionary changes, transforming chronic HCV infection into a curable disease. Although direct-acting antiviral (DAA) therapy can effectively clear HCV, improve liver fibrosis, and reduce the risk of HCC, certain factors such as age, liver fibrosis, metabolic diseases, genetic factors, and treatment regimens still put some patients at high risk for HCC even after HCV clearance. A recent study on the long-term prognosis of patients with advanced chronic liver disease post-HCV cure reveals that these patients continue to face risks of hepatic decompensation and HCC. This finding is crucial for developing long-term management strategies for cured HCV patients.

Liver cancer is a highly prevalent and poorly prognosed malignancy, with a postoperative recurrence rate as high as 60%-70%. Postoperative minimal residual disease (MRD) is the main culprit behind cancer recurrence and metastasis, but currently, methods to detect MRD in liver cancer are very limited. At the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, a prospective study reported by Dr. Jia Fan, Dr. Jian Zhou, and Dr. Xinrong Yang’s team from Zhongshan Hospital affiliated with Fudan University shows that circulating tumor DNA (ctDNA) can serve as an ideal marker for detecting postoperative MRD in liver cancer, effectively warning of recurrence and metastasis. Furthermore, ctDNA monitoring of MRD can guide postoperative adjuvant therapy decisions and monitor the efficacy of drug treatments, thereby aiding in the precise management of liver cancer throughout the postoperative period and significantly improving patient prognosis.