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Summary: Background: In cirrhosis patients with acute variceal bleeding (AVB), the optimal duration of vasoconstrictor therapy after endoscopic haemostasis is unclear. Aims: We aimed to compare efficacy of 1‐day versus 3‐day terlipressin therapy in cirrhosis patients with AVB post‐endoscopic intervention. The primary objective was to compare rebleeding at 5 days between the two arms. Secondary objectives included rebleeding and mortality rates at 6 weeks. Methods: In this open‐label, randomised controlled trial, cirrhosis patients with AVB were randomised to either 1‐day or 3‐day terlipressin therapy. Results: A total of 150 cirrhosis patients with AVB were recruited to receive either 1 day (n = 75) or 3 days (n = 75) of terlipressin therapy. One patient from 1‐day arm was excluded. Modified intention‐to‐treat analysis included 149 patients. Baseline characteristics were comparable between the two groups. Rebleeding at 5 days: 3 (4.1%; 95% confidence interval [CI]: 0.4–9.0) versus 4 (5.3%; 95% CI: 2.0–10.0), risk difference (RD) p = 0.726 and 5‐day mortality rates: 1 (1.4%; 95% CI: 0–7.3) versus 1 (1.3%; 95% CI: 0.2–7.0), RD p = 0.960 were similar. Rebleeding at 42 days: 9 (12.2%; 95% CI: 7.0–20.0) versus 10 (13.3%; 95% CI: 7.0–20.0), RD p = 0.842 and mortality at 42 days: 5 (6.8%; 95% CI: 3.0–10.0) versus 4 (5.3%; 95% CI: 2.0–10.0), RD p = 0.704 were also similar. Patients in the 1‐day terlipressin therapy arm experienced significantly fewer adverse effects compared with those receiving 3 days of terlipressin therapy: 28 (37.8%) versus 42 (56%), p = 0.026. Conclusions: Our results suggest that 1 day of terlipressin therapy is associated with similar 5‐day and 42‐day rebleeding rates, 42‐day mortality and an overall superior safety profile compared with 3‐day of terlipressin therapy. These findings require to be validated in double‐blinded, larger, multiethnic and multicentre studies across the various stages of cirrhosis (CTRI/2019/10/021771). [ABSTRACT FROM AUTHOR]

Background: Acute‐on‐chronic liver failure (ACLF) is associated with a high short‐term mortality rate in the absence of liver transplantation. The role of therapeutic plasma exchange (TPE) in improving the outcomes of ACLF and acute decompensation (AD) is unclear. In this retrospective analysis, we aimed to determine the impact of TPE on mortality in patients with ACLF. Methods: ACLF patients receiving TPE with standard medical treatment (SMT) were propensity score matched (PSM) with those receiving SMT alone (1:1) for sex, grades of ACLF, CLIF C ACLF scores, and the presence of hepatic encephalopathy. The primary outcomes assessed were mortality at 30 and 90 days. Survival analysis was performed using Kaplan Meier survival curves. Results: A total of 1151 patients (ACLF n = 864 [75%], AD [without organ failure] n = 287 [25%]) were included. Of the patients with ACLF (n = 864), grade 1, 2, and 3 ACLF was present in 167 (19.3%), 325 (37.6%), and 372 (43.0%) patients, respectively. Thirty‐nine patients received TPE and SMT, and 1112 patients received only SMT. On PSM analysis, there were 38 patients in each group (SMT plus TPE vs SMT alone). In the matched cohort, the 30‐days mortality was lower in the TPE arm compared to SMT (21% vs 50%, P =.008), however, the 90‐day mortality was not significantly different between the two groups (36.8% vs 52.6%, P =.166); HR, 0.82 (0.44‐1.52), P =.549. Conclusion: TPE improves short‐term survival in patients with ACLF, but has no significant impact on long‐term outcomes. Randomized control trials are needed to obtain a robust conclusion in this regard. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Vaishnav et al papers. To view these articles, visit https://doi.org/10.1111/apt.17868 and https://doi.org/10.1111/apt.17976 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Vaishnav et al papers. To view these articles, visit https://doi.org/10.1111/apt.17868 and https://doi.org/10.1111/apt.17882 [ABSTRACT FROM AUTHOR]

Direct‐acting antiviral (DAA) drugs are associated with high (>95%) sustained virological response at 12 weeks (SVR12) in chronic hepatitis C (CHC) patients. There is a paucity of data regarding the characteristics and re‐treatment outcomes of DAA treatment failure patients. In a retrospective analysis of the prospectively collected database, we assessed the outcomes of re‐treatment among patients with previous DAA failure. Patients' characteristics, viral characteristics, including resistance‐associated substitutions (RAS) in a subgroup of patients, SVR12, and clinical outcomes were studied. Of 40 patients with DAA failure, among whom 36 were retreated, mean age was 45.7 years, 63.9% (n = 23) were male, 63.9% (n = 23) had a genotype‐3 infection and 63.9% (n = 23) were cirrhotic. The re‐treatment regimens included a combination of pan‐genotypic DAA, mainly sofosbuvir and velpatasvir with or without ribavirin. Three patients who declined retreatment and one who was still on treatment was excluded. For patients who completed re‐treatment, SVR12 was 100% irrespective of genotypes. SVR12 among genotype 3 was 75% (15 of 20) when lost to follow‐up was considered a treatment failure. Six patients died due to liver‐related causes, including five (83.3%) with hepatocellular carcinoma. RAS analysis in 17 randomly selected patients did not reveal any dominant substitutions in NS5A or NS5B region affecting SVR12, though several novel mutations were observed. In conclusion, re‐treatment of CHC patients with prior DAA failure using pan‐genotypic DAA is associated with high SVR12 rates irrespective of genotype or the presence of RAS. [ABSTRACT FROM AUTHOR]

Background and Aim: The FibroScan–aspartate aminotransferase (FAST) score was developed for identifying patients with non‐alcoholic steatohepatitis, who also have an elevated non‐alcoholic fatty liver disease (NAFLD) activity score (NAS) ≥ 4 and significant fibrosis (F ≥ 2). We aimed to validate it in our NAFLD cohort and assess if it correlates with the histological changes after bariatric surgery. Methods: Patients with NAFLD, including those undergoing bariatric surgery, were included. The FAST score was calculated using liver stiffness measure, controlled attenuation parameter, and aspartate aminotransferase. Calibration and discrimination of the model were assessed by calibration plots and area under the receiver operating characteristic curve, respectively. Sensitivity and specificity were assessed at the rule‐out and rule‐in cutoffs (≤0.35 and ≥0.67), respectively. Changes in the NAS and FAST scores were compared in the bariatric cohort 1 year after surgery. Results: The cohort composed of 309 patients, of which 48 patients underwent repeat liver biopsy at 1 year. The model showed good discrimination with area under the receiver operating characteristic curve of 0.79 (0.74–0.84); however, it was not satisfactorily calibrated (Hosmer–Lemeshow test, P = 0.008). The sensitivity and specificity at the rule‐out and rule‐in cutoffs were 0.90 and 0.84, respectively. A significant correlation was seen between the 1‐year reduction in the NAS and FAST scores (r = 0.38, P = 0.009). A significant reduction in the median FAST score was seen in patients who had ≥2‐point reduction in NAS after bariatric surgery. Conclusion: FibroScan–aspartate aminotransferase score demonstrated good discrimination for fibrotic non‐alcoholic steatohepatitis in our cohort. However, a miscalibration resulted in overprediction. The score correlated well with the histological response to interventions for NAFLD. [ABSTRACT FROM AUTHOR]