Liver cirrhosis

  • Review Article |

    Chemokines have an important role in liver diseases such as alcohol-associated liver disease, nonalcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma. This Review describes the regulation of chemokines in the liver, their roles in liver diseases and the potential therapeutic targets.

    • Sheng Cao
    • , Mengfei Liu
    •  & Vijay H. Shah
  • Review Article |

    This Review provides mechanistic and clinical insights into COVID-19 in the context of liver disease, discussing the potential underlying biology and clinical features of SARS-CoV-2 infection in patients with pre-existing liver conditions. The management of these patients is also discussed, including SARS-CoV-2 vaccination strategies.

    • Thomas Marjot
    • , Gwilym J. Webb
    •  & Eleanor Barnes
  • Review Article |

    The common end stage of liver disease is decompensated cirrhosis and the further development towards acute-on-chronic liver failure. In this Review, the authors discuss the possible pathogenic, diagnostic and therapeutic role of the gut microbiota in decompensation of cirrhosis and progression to acute-on-chronic liver failure.

    • Jonel Trebicka
    • , Peer Bork
    •  & Manimozhiyan Arumugam
  • Review Article |

    Telomerase is a key enzyme for cell survival that prevents telomere shortening. In this Review, the roles of telomeres and telomerase in cirrhosis and liver carcinogenesis are discussed, in addition to their potential in clinical practice as biomarkers and therapeutic targets.

    • Jean-Charles Nault
    • , Massih Ningarhari
    •  & Jessica Zucman-Rossi
  • Review Article |

    Alcoholic liver disease (ALD) is a leading cause of morbidity and mortality worldwide. Here, Bajaj discusses clinical studies on the gut microbiota in individuals with ALD and explores the specific alterations in the gut–liver–brain axis that might alter patient outcomes.

    • Jasmohan S. Bajaj
  • Review Article |

    Liver microcirculatory dysfunction is one of the key mechanisms that promotes the progression of chronic liver disease. In this Review, the authors explore the role of liver microcirculatory dysfunction in cirrhotic portal hypertension, the preclinical models used to study liver circulation and potential therapeutics.

    • Jordi Gracia-Sancho
    • , Giusi Marrone
    •  & Anabel Fernández-Iglesias
  • Review Article |

    Current approaches to manage decompensated cirrhosis are based on targeted strategies aimed at preventing or treating specific complications of the disease. Here, Bernardi and Caraceni discuss the shift in focus from individual treatments targeting individual complications to disease-modifying agents able to slow the progression of decompensation.

    • Mauro Bernardi
    •  & Paolo Caraceni
  • Review Article |

    The liver regulates immune defence during sepsis, but is also a target for sepsis-related injury. Liver dysfunction can affect the prognosis of sepsis, particularly in patients with cirrhosis. In this Review, the importance of the liver in sepsis, the factors contributing to sepsis in patients with liver cirrhosis and new therapeutic strategies are discussed.

    • Pavel Strnad
    • , Frank Tacke
    •  & Christian Trautwein
  • Review Article |

    Elastography techniques for the noninvasive assessment of liver fibrosis, disease severity and prognosis are increasingly included in guidelines and clinical practice. In this Review, the authors summarize the problems of noninvasive tests in general, and provide an overview on available techniques and developments in liver elastography.

    • Mireen Friedrich-Rust
    • , Thierry Poynard
    •  & Laurent Castera
  • Review Article |

    The circadian clock plays a central part in the regulation of liver function. In this Review, Tahara and Shibata discuss the mechanisms by which the circadian clock controls hepatic metabolism and the processing of xenobiotics, and how clock dysfunction can influence liver disease.

    • Yu Tahara
    •  & Shigenobu Shibata
  • Review Article |

    Acute-on-chronic liver failure (ACLF) is a distinct clinical entity with a serious risk of death. However, much debate surrounds the pathogenesis and definitions of this disease. Sarin and Choudhury describe the differences and similarities between Eastern and Western definitions of ACLF and present a common approach to manage these patients for better clinical outcomes.

    • Shiv K. Sarin
    •  & Ashok Choudhury
  • Review Article |

    Traditionally, the diagnosis of hepatorenal syndrome has been based on stringent criteria that are not ideal for patients with cirrhosis and kidney injury, leading to underdiagnosis. Acute kidney injury is now proposed to characterize renal disease in patients with cirrhosis. Florence Wong describes the evolution of these criteria that have addressed this issue and improved care for these patients.

    • Florence Wong
  • Review Article |

    Biliary atresia is a severe cholangiopathy with a poorly defined pathogenesis and treatment strategy that leads to end-stage cirrhosis in most children. The authors of this Review bring together the most up-to-date understanding of the pathogenesis of biliary atresia, how environmental and genetic factors create various clinical phenotypes and provide insights into future clinical trial design.

    • Akihiro Asai
    • , Alexander Miethke
    •  & Jorge A. Bezerra
  • Review Article |

    The balance of procoagulants and antihaemostatic factors, which usually results in haemostasis is more fragile in patients with liver disease. Owing to this added complexity, treating coagulopathy in patients with liver disease can be difficult. As the pathophysiology of coagulopathy is a rapidly progressing field, this Review aims to provide a therapeutic framework by setting out a clinical rationale for the use of available procoagulants.

    • Neeral L. Shah
    • , Nicolas M. Intagliata
    •  & Stephen H. Caldwell
  • Review Article |

    Portal vein thrombosis (PVT) is a fairly common complication of liver cirrhosis. In this Review, the authors discuss the evidence regarding the management of PVT in patients with liver cirrhosis and propose an exploratory and preliminary algorithm, noting the limited data and low-quality evidence available to date.

    • Xingshun Qi
    • , Guohong Han
    •  & Daiming Fan
  • Review Article |

    Cardiac dysfunction has been reported in patients with cirrhosis—nearly half of whom have been shown to have abnormalities in cardiac function—and improved understanding of these changes has led to the definition of so-called cirrhotic cardiomyopathy. Here, the authors describe the underlying pathophysiology, clinical features, diagnosis and treatment of cirrhotic cardiomyopathy.

    • Signe Wiese
    • , Jens D. Hove
    •  & Søren Møller
  • Review Article |

    This Review describes advances in artificial and bioartificial liver support systems and current developments. The evolving field of hepatocyte transplantation as a less invasive alternative to whole-organ transplantation is also reviewed, and a detailed overview of cutting-edge hepatic tissue engineering is included. Challenges and opportunities of the different approaches are analysed with respect to clinical relevance, as well as basic science concerns.

    • Benjamin Struecker
    • , Nathanael Raschzok
    •  & Igor M. Sauer
  • Review Article |

    Variceal bleeding is a life-threatening condition. Here the au-thors summarize recent clinical findings and present the most updated advances on the management of gastro-oesophageal varices and variceal bleeding.

    • Julia O'Brien
    • , Christos Triantos
    •  & Andrew K. Burroughs
  • Review Article |

    Managing patients with decompensated cirrhosis related to hepatitis B or hepatitis C is challenging, and liver transplantation is often seen as the only viable option. However, the authors of this Review discuss other treatment options that are available. Treatment should focus on controlling the complications of cirrhosis, surveillance for hepatocellular carcinoma and, if applicable, preparation for liver transplantation.

    • Scott A. Fink
    •  & Ira M. Jacobson