Shiv Kumar Sarin

Institute of Liver and Biliary Sciences | ILBS · Hepatology

Background Post-transjugular intrahepatic portosystemic shunt (TIPS) liver failure (PTLF) is a serious complication of TIPS procedure with poor patient prognosis. This study tried to investigate the incidence of PTLF following elective TIPS procedure and evaluated possible predictive factors for the same. Methods A retrospective analysis of patien...

Background Metabolic associated fatty liver disease (MAFLD) is a relatively new term with limited studies done in South Asian population. Aim To determine prevalence and clinico‐epidemiological characteristics of MAFLD in general population. Methods A cross‐sectional study was conducted in randomly selected regions across Delhi, India. Data were...

Background and aims Portosinusoidal vascular disease (PSVD) is a broad term encompassing varied histological patterns with changes in portal tracts and sinusoids without cirrhosis. We aimed to assess whether there is any clinical and pathological difference among the various histological categories of PSVD. Patients and methods This study included...

Background and Aims Hepatitis B virus X protein (HBx) play a key role in pathogenesis of HBV‐induced hepatocellular carcinoma (HCC) by promoting epithelial to mesenchymal transition (EMT). In this study, we hypothesized that inhibition of HBx is an effective strategy to combat HCC. Methodology and Results We designed and synthesized novel HBx gene...

Transjugular intrahepatic portosystemic shunt (TIPS) is known to benefit patients with decompensated liver disease by alleviating portal pressure. However, TIPS creation is technically difficult and challenging to perform in patients with chronic portal vein thrombosis (PVT) (4,5). Multiple endovascular techniques for portal vein recanalization wit...

Background and Aims The administration of an appropriate empirical antibiotic treatment is essential in cirrhosis and severe bacterial infections. We aimed to investigate the predictors of clinical response of empirical antibiotic treatment in a prospective cohort of patients with cirrhosis and bacterial and fungal infections included in the Intern...

Pregnancy being an immune compromised state, coronavirus disease of 2019 (COVID‐19) disease poses high risk of premature delivery and threat to fetus. Plasma metabolome regulates immune cellular responses, therefore we aimed to analyze the change in plasma secretome, metabolome, and immune cells with disease severity in COVID‐19 positive pregnant f...

Background Severe alcohol-associated hepatitis (SAH) presenting as acute-on-chronic liver failure (ACLF) has high mortality. Severe hepatic inflammation and ongoing hepatocellular cell death lead to rapid rise in portal pressure, a hyperdynamic circulation that might precipitate infections and organ failures. Methods Consecutive SAH patients were...

Hepatocellular carcinoma (HCC) is one of the leading cancers worldwide. Classically, HCC develops in genetically susceptible individuals who are exposed to risk factors, especially in the presence of liver cirrhosis. Significant temporal and geographic variations exist for HCC and its etiologies. Over time, the burden of HCC has shifted from the lo...

Hepatitis B virus x (HBx) is a multifunctional protein coded by the Hepatitis B virus that is involved in various cellular processes such as proliferation, cell survival/apoptosis, and histone methylation. HBx was reported to be associated with liver "cancer stem cells." The stemness inducing properties of HBx could also facilitate the generation o...

Background and aims: The relationship between ammonia and liver-related complications (LRCs) in acute-on-chronic liver failure (ACLF) patients is not well defined. This study aimed to evaluate the association of ammonia levels with LRCs in patients with ACLF. The study also evaluated the role of ammonia in predicting mortality and progression of LR...

Small-for-size syndrome (SFSS) is a well-recognized complication following liver transplantation (LT), with up to 20% developing this following living donor LT (LDLT). Preventing SFSS involves consideration of factors before the surgical procedure, including donor and recipient selection, and factors during the surgical procedure, including adequat...

Background Hepatitis B virus (HBV) modulates epigenetic landscape by epigenetic regulators. HBsAg seroconversion is possible with immune activation, therefore we aimed to investigate epigenetic modulation in HBV reactivation (rHBV) for viral clearance and seroconversion. Methods Sixteen retrospectively collected rHBV patients [Seroconverters (SC,...

HBx is a multifunctional protein coded by the Hepatitis B virus which is involved in various cellular processes such as proliferation, cell survival/apoptosis, and histone methylation. HBx was reported to be associated with liver ‘cancer stem cells’. The stemness inducing properties of HBx could also facilitate the generation of pluripotent stem ce...

Liver failure is failure of regeneration. Underlying cause of regeneration failure in cirrhosis is not well-defined. Bone marrow stem cells (BMSC) and their progeny play a central role in tissue repair and regeneration and are defective in patients with chronic liver failure. Whether BM failure is cause or consequence of liver failure in cirrhosis...

"“Action without vision is only passing time, vision without action is merely daydreaming, but vision with action can change the world.” - Nelson Mandela" On 22 May 2023, at the Geneva headquarters of the European Association for the Study of the Liver (EASL), we convened a groundbreaking event on the sidelines of the 76th World Health Assembly (W...

Background Renal tubular epithelial cells (RTECs) cause maladaptive repair and perpetuate renal fibrosis. Aim To evaluate urinary neutrophil gelatinase‐associated lipocalin (NGAL) and RTEC as risk factors for non‐resolution of acute kidney injury (AKI–NR) at day seven and chronic kidney disease (CKD) in critically ill patients with cirrhosis. Met...

Background: & Amis: Widespread use of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection has resulted in increased numbers of patients with hepatocellular carcinoma (HCC) after achieving sustained virologic response ('post-SVR HCC') worldwide. Few data compare regional differences in presentation and prognosis of patients with p...

Objectives Direct intrahepatic portosystemic shunt (DIPS) stent placement is an effective treatment for patients with Budd-Chiari syndrome (BCS); however, thrombotic occlusion of DIPS stent remains a cause of concern. The purpose of this study is to describe a novel technique of balloon-occluded-thrombolysis (BOT) for occluded DIPS stent, and compa...

Background aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach results: We developed an aligned, prioritized action agenda for the global fatty liver diseas...

Nonalcoholic fatty liver disease (NAFLD), once considered a benign condition, has been associated with several cardiometabolic complications over the past two decades. The worldwide prevalence of NAFLD is as high as 30%. NAFLD requires the absence of a “significant alcohol intake.” Conflicting reports have suggested that moderate alcohol consumptio...

Background & aims: Lymphatic vessels (LVs) are crucial for maintaining abdominal fluid homoeostasis and immunity. In cirrhosis, mesenteric LVs (mLVs) are dilated and dysfunctional. Given the established role of vascular endothelial growth factor-C (VEGF-C) in improving LVs, we hypothesised that VEGF-C treatment could ameliorate the functions of mL...

Background & aims An estimated 38% of adults worldwide have NAFLD. From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised research agenda for the global fatty liver disease community of practice. Methods Nine co-chairs drafted...

https://www.journal-of-hepatology.eu/article/S0168-8278(23)03138-0/pdf

Dilated and dysfunctional gut lymphatic vessels (LVs) have been reported in experimental cirrhosis. Here, we studied LVs in duodenal (D2)-biopsies of liver cirrhosis patients and investigated the prognostic role of a LV marker, podoplanin (PDPN), in predicting the mortality of patients with cirrhosis. A prospective, single-center cohort study was p...

Objective: To assess the efficacy and outcomes of percutaneous ablative therapies for hepatocellular carci�noma (HCC) in the caudate lobe. Methods: Patients within Milan criteria, who underwent thermal ablation (RFA/MWA) for HCC were analyzed. Based on the inclusion-criteria, patients were catego�rized in two groups. Group-1 (caudate-lobe HCC) a...

Objectives: To evaluate the feasibility, safety, and efficacy of add-on transjugular-intrahepatic-portosystemic shunt (TIPS) for portal vein recanalization (PVR) in cirrhotic patients with non-tumoral chronic portal vein thrombosis (PVT) after 6 months of monitored anticoagulation therapy (ACT). Methods: We conducted a retrospective search of th...

Background aims: With distinct mechanisms of action, the combination of tropifexor (TXR) and cenicriviroc (CVC) may provide an effective treatment for non-alcoholic steatohepatitis. This randomized, multicenter, double-blind, phase 2b study assessed the safety and efficacy of TXR and CVC combination, compared with respective monotherapies. Approa...

Background Pregnancy being immune compromised state, COVID-19 disease poses high risk of premature delivery and threat to fetus. Plasma metabolome regulates immune cellular responses and we aimed to analyze the plasma secretome, metabolome and immune cells in COVID-19 positive pregnant mother and cord blood. Methods COVID-19 RT-PCR positive pregna...

Background: Cirrhosis, the end result of liver injury, has high mortality globally. The effect of country-level income on mortality from cirrhosis is unclear. We aimed to assess predictors of death in inpatients with cirrhosis using a global consortium focusing on cirrhosis-related and access-related variables. Methods: In this prospective obser...

Background: The stoppage of nucleoside analog (NA) can lead to immune flare and loss of HBsAg in a proportion of HBeAg-negative chronic hepatitis B (CHB) patients. HBsAg loss could be improved by instituting Peg-Interferon therapy in those who show an immune flare after the stoppage of NA. We investigated the immune drivers of HBsAg loss in NA-tre...

Background and aim: High mean arterial pressure (MAP) improve renal outcomes in cirrhosis patients, however, it has not been studied in critically ill cirrhosis with septic shock (CIC). We compared the efficacy of high (80-85 mm Hg; H-MAP) versus low (60-65; L-MAP) strategy in improving 28-day mortality in CIC. Reversal of shock, acute kidney inju...

Background and aims: Acute liver failure (ALF) has a high mortality. Alterations in albumin structure and function have been shown to correlate with outcomes in cirrhosis. We undertook a bio-molecular analysis of albumin to determine its correlation with hepatocellular injury and early mortality in ALF. Method: Altogether 225 subjects (200-ALF,...

Acute on chronic liver failure (ACLF) is an acute deterioration of liver function manifesting as jaundice and coagulopathy with the development of ascites, with a high probability of extrahepatic organ involvement and high 28-day mortality. The pathogenesis involves extensive hepatic necrosis, which is associated with severe systemic inflammation a...

Background: Hepatocellular cancer (HCC) typically arises in the background of cirrhosis. The epidemiology of HCC has changed in recent years due to availability of newer antivirals, changing life-styles and greater possibility for early detection. We undertook a multicentric national sentinel surveillance for liver cirrhosis and HCC to assess the...

Background and Aims: Severe alcoholic hepatitis (SAH) has a high mortality and corticosteroid therapy is effective in 60% patients. Reliable indicators of response to therapy and mortality in SAH are needed. A total of 223 SAH patients, 70 in derivative [50 responders (R) and 20 non-responders (NR)] and 153 in validation cohort [136R, 17NR] were su...

Background: Alcohol relapse after liver transplantation has a negative impact on outcomes. There is limited data on its burden, the predictors, and the impact following live donor liver transplantation (LDLT). Methods: A single-center observational study was carried out between July 2011 and March 2021 for patients undergoing LDLT for Alcohol as...

Background & aims: Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH. Methods: This was a retrospective cohort...

Introduction and Objectives: Alcohol-associated hepatitis (AH) is a severe entity associated with high mortality. Corticosteroids might be used in cases with severe disease and several dynamic models can predict mortality and response to corticosteroids in AH patients. However, there is no consensus on the best of them. This study aimed to evaluate...

Background: Hepatopulmonary syndrome (HPS) is characterized by a defect in arterial oxygenation induced by pulmonary vascular dilatation in liver disease patients. Fingolimod, a sphingosine-1-phosphate (S1P) receptor modulator, suppresses vasodilation by reducing nitric oxide (NO) production. We investigated the role of S1P in HPS patients and of...

Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2), is a causative agent of current global pandemic of Coronavirus disease-19 (COVID-19). Due to propagated outbreak and global vaccination drive an immense immunological selection pressure has been exerted on SARS CoV-2 leading to evolution of new variants. This study was perfor...

Background and aims: Early identification of non-response to steroids is critical in patients with autoimmune hepatitis (AIH) causing acute-on-chronic liver failure (ACLF). We assessed if this non-response can be accurately identified within first few days of treatment. Methods: Patients with AIH-ACLF without baseline infection/hepatic encephalo...

Background: Transjugular-intrahepatic portosystemic-shunt (TIPS) and SX-Ella stent Danis (DE stent) are available rescue therapies for refractory variceal bleeding in cirrhosis. Any delay in appropriate therapy is associated with high mortality. Determining the best timing for rescue TIPS is crucial and largely unknown. Methods: Cirrhotic patien...

Purpose of Review Gastric varices (GV) are seen commonly in patients with portal hypertension and esophageal varices, more so in variceal bleeders. Compared to esophageal varices, there is limited data on the management of GV and ectopic varices. The current review provides a practical and updated approach for the management of patients with GV and...

Background: Patients with cirrhosis and treatment non-responsive spontaneous bacterial peritonitis (SBP) have high mortality. We aimed to investigate whether GM-CSF can improve SBP response rates. Patients and methods: In this open label RCT, 131 cirrhosis patients with difficult-to-treat SBP (DTT SBP) were randomized to receive meropenem alone...

Background and aims: Cardiovascular disease is the leading cause of mortality in NAFLD. The aim of this study was to evaluate the effects of saroglitazar, a dual PPAR α/γ agonist, on serum lipids in patients with NAFLD METHODS: A total of 221 patients (Saroglitazar [130], placebo [91]) with NAFLD from phase 2 and 3 double blinded placebo-controlle...

Background With the improvement in noninvasive diagnostic imaging modalities, Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has evolved into a primarily therapeutic procedure. Besides being efficacious and one of the most commonly done procedures, ERCP is also associated with a high risk of complications. However, there is a lack of studie...