bluuebunny/crossref_metadata_2025_split huggingface dataset:
1010 Risk Factors for Recurrent Primary Sclerosing Cholangitis (rPSC) After Orthotopic Liver Transplant
Authors: Schoech Michael , Sherman Kenneth 
Published: October 2019

INTRODUCTION:
Recurrent primary sclerosing cholangitis after liver transplantation occurs in approximately 10-25% of patients. rPSC is the leading cause of graft loss and mortality and significantly increases the need for retransplantation. Prior studies have suggested that Inflammatory bowel disease (IBD) with an intact colon is risk factor for the development of rPSC. Our aim was to evaluate whether IBD with or without a colectomy significantly affected the development of rPSC, identify other risk factors for recurrence, and define the overall recurrence rate.

METHODS:
In this ongoing single center, retrospective cohort, 1086 transplants were performed at University of Cincinnati between 2003 to 2019. rPSC was defined using the Mayo Clinic criteria. A total of sixteen risk factors were considered including: age, gender, type of anastomosis, type of transplant, hepatic artery thrombosis, acute cellular rejection, IBD, type of IBD, colectomy, timing of colectomy, cholangiocarcinoma, MELD score, cold ischemic time, hepatitis B core antibody donor status, and smoking. Data were analyzed using Statistix 10.0 with an alpha = 0.05.

RESULTS:
53/1086 liver transplants (4.9%) were performed in 48 patients for primary sclerosing cholangitis (PSC). Within the PSC group, the median age at transplant was 49 years with 72.5% male. The median MELD at transplant was 22, median cold ischemic time of 363 minutes, and a median follow-up of 47.5 months. 35 patients (68.6%) had IBD including 20 (57.1%) with ulcerative colitis. 9 patients (18.4%) developed rPSC in a median of 65 months. Among these, 67% developed subsequent graft loss from rPSC and 33% underwent retransplant (P < 0.03). As anticipated, HAT was a negative predictor for development of rPSC. There were no statistically significant risk factors for the development of rPSC, but rPSC patients were slightly younger (P < 0.06). In rPSC, graft loss (P < 0.004) and time to death (P < 0.007) occurred significantly later (107 and 102 months respectively) than in patients without rPSC.

CONCLUSION:
The overall recurrence rate of PSC (18.4%) is similar to prior studies without any discernable risk factors in this cohort. IBD and colectomy did not significantly reduce the rate of rPSC. rPSC leads to delayed graft loss and mortality with a high rate of retransplantation indicating an insidious disease process. Longer follow-up may increase the rate of rPSC, graft loss and mortality as a subset of individuals in the cohort were transplanted prior to the median recurrence time.
1017 HEP C: Helping Everyone Provide a Cure
Authors: Burke Sean M. , Bhavsar Indira , Dowdell Kimberly , Argo Curtis 
Published: October 2019

INTRODUCTION:
The incidence of chronic liver disease in the United States is increasing and leading to a disproportionate number of patients for every gastroenterologist and a growing coverage gap in care. Electronic consultation (eConsult) is an asynchronous, text-based question-response between provider and consultant without consultant-patient contact that may improve access to hepatitis C virus (HCV) treatment. The purpose of this study is to assess treatment and referral patterns of HCV infections among primary care physicians and to further assess the role of eConsults in the treatment of chronic hepatitis C (CHC).

METHODS:
Primary care physicians (PCPs) associated with a large tertiary teaching hospital with a robust eConsult program were surveyed via an optional online questionnaire. Responses from urban, suburban, and rural resident and attending practitioners were anonymously recorded over a three month time spanning from March 1, 2019 to June 1, 2019 with regard to their current evaluation and management of patients with CHC.

RESULTS:
Fifty nine responses to the survey were generated. Of those surveyed, 0 providers treated HCV without referral to a specialist. The top three issues identified as barriers to treatment included “not enough information on protocol”, “not enough volume of patients to make it worth learning”, and “administrative hurdles.” 83% of those surveyed would be more open to treating HCV if they were provided administrative assistance and indicated that a centralized eConsult for HCV treatment provided adequate administrative support. 41% of physicians surveyed reported that less than half of their patients referred for treatment are ultimately linked to specialty care. Only 22% of providers felt that patient satisfaction would be negatively impacted without a subspecialty consult to manage HCV treatment.

CONCLUSION:
Our results indicate that PCPs do not routinely treat CHC infection though the vast majority of them would be interested in doing so given the percentage of their patients left without linkage to specialty care. This study identifies eConsults as a modality for expanding treatment of CHC by task-shifting treatment of the disease to PCPs through a uniform and stream-lined eConsult model, which would ultimately improve access to care, improve healthcare expenditures, and limit the direct burden placed on patients to see multiple providers.
1021 Regional Disparities and Trends of Liver Cancer in the USA: Shedding Lights on Potential Preventable Lethal Disease
Authors: Raed Anas , Bhagatwala Jigar , Sherid Muhammed , Rassameehiran Supannee , Sifuentes Humberto , Sharma Amol , Sridhar Subbaramiah 
Published: October 2019

INTRODUCTION:
Liver and intrahepatic bile duct cancer are the second aggressive cancer with 5-year survival rate of 18%. Also, they are the fourth most common cause of GI malignancy, and there incidence has tripled since 1980. Hence, our objectives were to study incidence trends of liver cancer (LC) by geographic location, specifically by regions and states.

METHODS:
Data was extracted from National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) for the period 2001-2015. Age-adjusted incidence and annual percent change (APC) were calculated in a step-wise manner to examine the trends among each of four US regions, followed by 13 individual SEER-reported states. SEER Stat software was used to analyze this data.

RESULTS:
The incidence rates of LC in population younger than 50 years have been trending in all US regions. When reporting incidence rates of LC in population younger than 50 years by states, the rates have been trending down in all US states except state of Kentucky and Iowa which rates have been increasing with APC of 2.8 (CI: 0.7, 5.0), 2.7 (CI: 0.2, 5.3), respectively (Table 2). The incidence rates of LC in population 50 years or older have been increasing the in all US regions with highest rates in South with APC of 5.2 (CI: 4.8, 5.6) (Table 1). When reporting incidence rates of LC in population 50 years or older by states, the rates was the highest in state of Utah and Kentucky with APC of 7.1 (CI: 5.9, 8.4) and 6.6 (CI: 5.8, 7.3), respectively.

CONCLUSION:
This epidemiological data shows the disparities of LC by geographic location. Our outcomes of geographical variation of incidence rates of LC may help to initiate programs to target high risk regions and states.
1022 Regional Variations and Trends in the Gallbladder Cancer in the USA
Authors: Raed Anas , Bhagatwala Jigar , Sherid Muhammed , Sifuentes Humberto , Sridhar Subbaramiah , Sharma Amol 
Published: October 2019

INTRODUCTION:
Gallbladder cancer (GBC) is the most common malignancy of the biliary tract. The regional and interstate variations in the US are unknown but are of high importance for epidemiology and preventive strategies. We investigated the regional and state-specific incidence and annual percent change (APC) of various histologic types of in the US over last 15 years.

METHODS:
Data was extracted from National Program of Cancer Registries (NPCR) for the period 2001-2015 and Surveillance, Epidemiology and End Results (SEER) for the period 2000-2015. Age-adjusted incidence and APC were calculated in a stepwise manner to examine the trends among each of four US regions, followed by 13 individual SEER-reported states. SEER Stat software was used to analysis.

RESULTS:
There were 54,224 GBC cases from 2001 to 2015. The incidence of GBC remained unchanged in four regions of the US between 2001-2015. However, a significant increase in the incidence rate of other-type of GBC histology was noted compared to the rest of the histologies with APC of 1.9% in the South (CI: 1.1, 2.8%). A rising but non-significant increase in APC of GBC was noted in the West, Northeast, Midwest with APC of 1.1% (CI: 0.0, 2.2%), 0.6% (CI: -0.3, 1.4%), 0.2% (-0.8, 1.3%), respectively (Table 1). Corresponding to NPCR data, all 13 SEER-reported states showed mixed pattern of increase and decrease in the APC of GBC incidence rate. When we noticed an upward trend of GBC incidence rate, it was mainly due to other histology such as California and New Jersey with APC 2.2% (CI: 1.1, 3.4%), 1.7% (CI: 0.0, 3.4%), respectively (Table 2). The only exception was Washington where the trend was mainly due to adenocarcinoma 2.3 (0.1, 4.6).

CONCLUSION:
The GBC incidence appears to be disproportionately higher in some states, predominantly the “other” histological type. Further public health initiatives need to investigate any potential causes for the regional disparities of increasing EAC incidence.
1025 Frequency of Diagnosed Acute Intermittent Porphyria in a National Health Care Database
Authors: Silver Samuel , Erwin Angelika L. , Meninger Stephen , Ko John J. , Tkacz Joseph , Noxon Virginia , Conradt Christian 
Published: October 2019

INTRODUCTION:
Acute hepatic porphyria (AHP) refers to a family of rare, genetic diseases caused by deficient activity of enzymes involved in the heme biosynthesis pathway in the liver, with acute intermittent porphyria (AIP) being the most common subtype. Accumulation of neurotoxic heme intermediates may result in potentially life-threatening acute attacks and chronic symptoms that negatively impact daily functioning and quality of life. Although AIP-related genetic mutations are relatively common (1:1,700), clinical penetrance of the disease is estimated around 1%. European data suggest that the diagnosed prevalence of AHP is approximately 1 per 100,000 individuals. Epidemiologic data specific to AIP are limited. The study aimed to identify AIP patients diagnosed in a nationally representative health care database to estimate prevalence, commonly reported clinical presentations, and health care resource utilization of AIP in the United States.

METHODS:
This retrospective analysis utilized the IBM® MarketScan® Commercial Claims and Medicare Supplemental Databases. Patients with at least one claim for AIP (ICD-10 diagnosis code E80.21) between October 1, 2015 – June 30, 2018 were selected for analyses. The subset of AIP patients with continuous enrollment for one year preceding and following their first observed AIP diagnosis (index diagnosis) were identified for the measurement of baseline characteristics and outcomes post-index, including healthcare resource utilization (HCRU), medications (including hemin), symptoms, and the frequency of comorbid diagnoses.

RESULTS:
Approximately 37 million patients within the MarketScan® databases had a medical or pharmacy claim between October 1, 2015 and June 30, 2018; a total of 361 of these patients were identified with a diagnosis of AIP. Among these 361 AIP patients, a partial prevalence estimate of AIP on June 30, 2018 was calculated to be 0.98 per 100,000 (214 AIP patients per 21,807,137 people enrolled on June 30, 2018). Sensitivity analyses around claims-based definitions for identifying AIP revealed 140 patients with ≥2 claims for AIP and 31 AIP patients receiving hemin (Table 1).

CONCLUSION:
Results from this national representative healthcare claims database demonstrated the frequency of diagnosed AIP in the United States to be similar to estimations previously published in global and European-specific AIP epidemiology studies.
1033 Quality Metrics Adherence Assessment for Patients With Chronic Hepatitis B Virus Seen in Gastroenterology Clinics
Authors: Kutaimy Raya , Benjaram Sindhuri , Naylor Paul , May Elizabeth , Mutchnick Milton , Ehrinpreis Murray N. 
Published: October 2019

INTRODUCTION:
The American Association for the Study of Liver Disease (AASLD) guidelines for hepatitis B management have progressed over time. However, adherence to quality metrics for chronic hepatitis B (CHB) care needs to be evaluated, especially in settings where liver specific clinics are not part of the system. Our study aims to evaluate the adherence to quality of care metrics in CHB patients in a predominately African American patient population general Gastroenterology clinic in an academic medical center.

METHODS:
We performed a cohort chart review on 92 patients with ICD 9 or 10 codes for CHB. Patients co-infected with HIV were excluded from analysis as they were treated by Infectious Disease clinics. We identified 45 patients following up with our Gastroenterology clinic for CHB with a visit between 2017 and 2018. We gathered demographic data. Adherence metrics were collected including HAV vaccination, treatment guideline relevant metrics, timely measurement of alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), platelets and hepatitis B virus DNA level check to monitor for treatment response HBV status. Hepatocellular carcinoma screening measure.

RESULTS:
Our patient population was 65% African American,17% Asian,13% Caucasian and 5% other races. All treated patients had >2000 in HBV DNA levels and high ALT prior to treatment, whereas untreated patients had low HBV DNA and normal ALT with the exception of 1 patient under consideration for treatment. Hepatocellular cancer screening adherence was significantly high in both treated (80%) and untreated (84%) patients with 6 monthly imaging studies. Both treated and untreated patient had relatively high compliance (68%) with HAV vaccination. All the patients had ALT, AST and platelets so that APRI score could be checked every 6 months to provide an indirect assessment of fibrosis. Timely evaluation of fibrosis specific assessments has not been completed in most of the cases, and there was no consensus with respect to the preferred method for assessing fibrosis.

CONCLUSION:
Our finding reflects satisfactory adherence with AASLD guidelines particularly in areas of treatment indications, regular laboratory check, hepatocellular carcinoma screening and compliance with HAV vaccination. However, fibrosis evaluation was suboptimal according to guidelines. Given the access to Fibroscan in our practice, once yearly assessment is being recommended for our patients. Supported in part by an Investigator Initiated Grant from Gilead Sciences.
1046 Quantifying Risk Factors and Comparing Clinical Parameters for Cirrhotic and Non-Cirrhotic Hepatocellular Carcinoma (HCC) in Non-Alcoholic Steatohepatitis (NASH)
Authors: Desai Aakash , Twohig Patrick , Sandhu Sonia , Sandhu Dalbir S. 
Published: October 2019

INTRODUCTION:
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer-related death in the United States. HCC is historically associated with cirrhosis from Hepatitis B virus, Hepatitis C virus (HCV), and alcohol abuse. Nonalcoholic fatty liver disease (NAFLD) is a key risk factor for the development of HCC. The prevalence of obesity and metabolic syndrome in the United States has likely contributed to the HCC epidemic. Epidemiological data reports that two-thirds of obese people have fatty liver ranging from steatosis to steatohepatitis, which in turn can progress to cirrhosis in 3-15% and eventually to HCC. The primary aim of our study is to ascertain the differences between cirrhotic and non-cirrhotic NASH-HCC patients based on demographics, risk factors, and laboratory abnormalities. Additionally, we wanted to quantify the risk factors that increase the likelihood of HCC in NASH patients.

METHODS:
We performed a retrospective analysis in the IBM Explorys database which has 63781930 unique patient data in the US. Data is reported as counts and percentages and an independent two sample t-test was used to compare epidemiological, clinical and laboratory features between cirrhotic and non-cirrhotic NASH-HCC. Odds ratios were calculated to determine the relationship between NASH-HCC sub-groups and risk factors and converted into Forest plots.

RESULTS:
There were 1120 cases of NASH-HCC of which 1040 were cirrhotic and 80 were non-cirrhotic. Patients with cirrhotic NASH-HCC were more likely to have type 2 diabetes mellitus, chronic kidney disease, coronary artery disease, and elevated alpha fetoprotein, direct bilirubin and INR compared to their non-cirrhotic counterpart. Patients with type 2 diabetes (OR 70, 95%CI 59.4-82.5) had the highest risk for HCC in cirrhotic NASH. Patients with elevated ferritin (OR 25, 95%CI 15.1-41.5) had the highest risk for HCC in non-cirrhotic NASH.

CONCLUSION:
Patients with type 2 diabetes are at the highest risk for HCC in NASH cirrhosis patients compared to other components of metabolic syndrome. Elevated ferritin levels conferred the highest risk for development of NASH-HCC in non-cirrhotic patients. OSA has been shown to promote HCC in early studies and our findings demonstrate similar but notable risk in both sub-groups. Identifying key differences in the epidemiology and disease traits of cirrhotic and non-cirrhotic NASH-HCC could be used to assist with the early identification of patients that are at risk for HCC
1047 Changes in Liver Fibrosis Scores in Patients With New Onset Type 2 Diabetes on Triple Therapy With Exenatide/Pioglitazone/Metformin vs. Conventional Therapy: Year Two Results
Authors: Lavrynenko Olga , Abdul-Ghani Muhammad , Alatrach Mariam , DeFronzo Ralph , Alkhouri Naim 
Published: October 2019

INTRODUCTION:
Patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM) are at higher risk of developing advanced fibrosis. Certain diabetes medications such as pioglitazone and GLP1 agonists have shown some efficacy against NAFLD in small clinical trials. The Durability of Combination Therapy With Exenatide/Pioglitazone/Metformin vs. Conventional Therapy in New Onset T2DM trial is an ongoing interventional trial assessing the effects of two different approaches to treating T2D (ClinicalTrials.gov Identifier: NCT01107717). The aim of the current study was to evaluate the effects of these two approaches on liver fibrosis scores after two years of treatment.

METHODS:
Newly diagnosed, drug-naïve T2DM patients were enrolled into the study. Medical history, clinical characteristics were obtained, and blood was drawn for the measurement of plasma glucose concentration, HbA1c, CBC, and blood chemistries. Subjects were randomized to receive in an open label fashion an initial combination therapy with metformin (2000 mg) plus pioglitazone (45 mg) and exenatide 10 µg BID (triple therapy) or sequential addition of metformin followed by sulfonylurea and insulin (conventional therapy) to maintain HbA1c < 6.5%. Subjects were seen every 3 months for follow-up visits and at 2 years all baseline measurements were repeated. Liver fibrosis scores that were calculated included AST/ALT ration, APRI, FIB-4 and NFS.

RESULTS:
Baseline characteristics are listed in Table 1; patients were well matched. Liver fibrosis scores at baseline and at 2 years are listed in Table 2. To compare the effect of each therapy on liver fibrosis scores, the ratio between the 2-year values of liver fibrosis scores to the baseline values was compared amongst the two treatment groups with ANOVA. Both therapies significantly reduced liver fibrosis scores but no significant difference was noted between the two treatment arms.

CONCLUSION:
In this randomized trial in patients with new-onset T2D, good control of HbA1c was associated with reduction in liver fibrosis scores at 2 years but the use of pioglitazone and GLP1 agonist did not have an added benefit over conventional therapy. The effects of longer duration of treatment are currently being evaluated in addition to assessment of fibrosis by Fibroscan and MR elastography.
1049 The Palliative Performance Scale Among Patients Evaluated for Liver Transplantation
Authors: Duffey Katherine , Amin Avani , Nahar Ritu , Shen Katie , Shah Mital , Guirguis Shady , Halegoua-DeMarzio Dina 
Published: October 2019

INTRODUCTION:
Patients being evaluated for liver transplantation (LT) often suffer from poor health-related quality of life. While several quality measures exist for palliative care in cancer patients, there are limited cirrhosis-specific palliative care tools. The Palliative Performance Scale (PPS) is a prognostication tool that measures a patient’s functional status based on ability to ambulate, activity level, evidence of disease, self-care abilities, oral intake, and level of consciousness, where a patient with a PPS of 100% is functionally healthy. We aim to observe how PPS at initial transplant evaluation relates to patient demographics, decompensation, and transplant outcomes to establish its potential role in the LT population.

METHODS:
We examined the records of patients who completed LT evaluation at our mid-size liver transplant center. Between March and December 2018, we calculated the PPS as a part of new outpatient LT evaluations. Descriptive statistics were used to evaluate relationships between patient PPS scores and MELD, disease characteristics, and outcomes.

RESULTS:
Forty-nine patients completed LT evaluation, of which 71% (N = 35) were male and 80% (N = 39) were white. The average age at the time of evaluation was 63. The most common etiology of cirrhosis was NASH (35%, N = 17), followed by alcohol (29%, N = 14), and HCV (25%, N = 12). Among the three most common etiologies, those with alcoholic cirrhosis had the lowest average PPS scores (76), patients with HCV had the highest (90). During the study period, 8 patients were transplanted. Their average PPS at the time of evaluation was 76 compared to 80 among those who were not transplanted. When compared to men, women had a higher MELD (15 vs 13), and lower PPS (74 vs 82). The rates of decompensation among patients with a PPS of 100, 80, and 70 were 55%, 86%, and 93%, respectively.

CONCLUSION:
This pilot study examines the utility of PPS for patients undergoing LT evaluations, and several trends were elucidated warranting further evaluation. There was not a clear linear relationship between MELD and PPS, indicating that patients with end-stage liver disease have a variable symptom burden even at advanced disease states. The functional status of patients appeared to vary significantly between etiology, gender, and transplantation. Importantly, our data suggests that patients with documented decompensations had lower PPS, indicating a possible role for the PPS to better characterize the functional status and disease burden of these patients.