Liver disease; post-transplant complications, fatty liver in pregnancy and the normal range for ALT in a Vietnamese population

In this month’s blog we have take a look at three recent articles published in BMJOG all discussing liver disease. As always, there are a fantastic range of articles published within the last month and these can all be accessed free-of-charge on the website.

First up we look at the review article by Fasullo and colleagues, on biliary complications after liver transplant: advances in pathophysiology, diagnosis, and treatment. This excellent article gives focused and relevant advice on diagnosis and management of these frequently faced problems. The authors point to up to 32% of patients having a biliary complication post-transplant. These include strictures (anastomotic and non-anastomotic), bile leaks, stones, and sphincter of Oddi dysfunction. The authors point to prompt recognition and accurate management being critical in preventing mortality, which may occur in up to 20% of patients left untreated, with up to 13% requiring re-translation. For a full overview please read the article!

Secondly, we look to see if fatty liver index can be used for to predict non-alcoholic fatty liver disease (NAFLD) in pregnancy with Koralegedara and colleagues. Using a cohort of patients from Sri Lanka, the team determined mathematical models to predict fatty liver disease in pregnant women. Fatty liver assigned as 0, I or II by ultrasound and regression models were used to identify patients scoring fatty liver score II. In total the team developed 6 models and testes the validity using AUROC. Using over 600 patients  the significant predictive factors were age (OR: 1.6), body mass index (OR: 1.7) and gamma-glutamyl transferase levels (OR: 2.1). The best overall prediction model results in an AUC of 0.84 for predicting fatty liver II and contained all potential clinical parameters. The authors conclude that this fatty liver index can be used to predict NAFLD in resource variable environments but the index must be tested and validated on an external cohort.

Finally, we take a quick look at a very intriguing article. The normal ranges for blood results can vary between sexes, ages and populations, and getting these correct is vital for interpretation. In their article, Huong et al look at the upper limit of normal for serum alanine aminotransferase value in Vietnamese population. 6677 patients were used to determine the value, following exclusion of all patients with a factor known to impact on ALT value (hepatitis, overweight, age etc.) the authors determined that the median ALT level in the healthy group was 18 in men and 13 in women. The upper limited of normal, defined as the 95th percentile of the healthy group was 40 U/L in men and 28 U/L in women. The authors hope that these data can aid with identification of abnormality in this population.

This month we have also seen a return to face-to-face meetings in the UK, with BSG Live and in Europe, with the paediatric-focused ESPGHAN annual congress. It’s been great to get back to seeing colleagues but it’s absolutely vital that these meetings return in a sustainable and climate-friendly way. More on green-policy in gastroenterology in future blogs.

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