In this video, Dr Fricker discusses sessions on managing patients with cirrhosis held at the recent virtual meeting of the American Association for the Study of Liver Diseases.

Zachary Fricker, MD, is a transplant hepatologist from Beth Israel Deaconess Medical Center in Boston, Massachusetts.

TRANSCRIPT

Hi, my name is Zachary Fricker. I'm a transplant hepatologist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts and instructor of medicine at Harvard Medical School.

I'm here to review a bit of updated information related to decompensations in patients with cirrhosis and their prevention from the AASLD Liver Meeting 2020.

I'm happy to present a little bit of data of which I'm a coauthor. Our group has created a model for prediction of perioperative mortality in patients with cirrhosis, which we feel is an improvement upon existing models. It covers a broader array of surgeries in more detail related to the operation itself.

We initially presented data at last year's liver meeting using data derived from a large cohort through the Veterans Affairs healthcare system, which showed a significantly improved calibration compared to the current standard, which we believe is the Mayo risk model.

I'm pleased to report this improvement persisted in validation and external cohort using approximately 400 surgeries done on patients with cirrhosis at the Beth Israel Deaconess Medical Center over a period of approximately 5 years.

We show an improved area on a receiver-operating curve for prediction of postoperative mortality over a number of short and medium term intervals, as well as a dramatically improved calibration compared to existing models.

There is a calculator available for free use online at vocalpennscore.com which can generate short-term and medium-term predictions of postoperative mortality for you, using some basic clinical information you'll likely already have about your patients in the preoperative setting.

There's also a wealth of other excellent information presented at the meeting related to prevention of decompensations and complications of portal hypertension, including some data from a group in Denmark that retrospectively analyzed trial data demonstrating an decreased risk of sepsis in patients who are on beta blockers, as well as a number of studies in the role of fecal microbiota transplants in the management of complications or their prevention in cirrhosis, including data from Jasmohan Bajaj from VCU [Virginia Commonwealth University] suggesting there may be a decrease in alcohol cravings in patients after a fecal transplant, as well as a decrease in antibiotic resistance.

There was also some fascinating data related to the role of the microbiome in alcoholic hepatitis, suggesting that mice receiving fecal transplant from those with alcoholic hepatitis will generate a similar disease state without access to ethanol.

Much of this is still preclinical, but it remains an area of interesting research and I think likely to be something that generates actionable clinical interventions in the next few years.

Thank you very much. I look forward to seeing everyone, hopefully, in person next year.