LIVER: Edited by Don C. Rockey
The Hepatology field continues to see remarkable advances. One of the most noteworthy stories in all of hepatology is of liver transplantation. When originally conceived, it was considered largely experimental and risky, but now liver transplantation is recognized as one of the truly life-saving interventions in medicine – and has become standard-of-care treatment for essentially all forms of end-stage liver disease (as well as a variety of other indications). Remarkably, the field has progressed to the point now that the challenge has shifted from one of how best to perform transplantation and how best to manage patients after transplantation so as to ensure the best outcome, but one of how best to allocate organs in the multitude of patients with liver disease who qualify for transplantation. Indeed, many patients die every year while on the waiting list. Thus, the current US allocation system is undergoing enormous change – and policies aimed at resolving inequity produced by historical geographic arrangements are being developed. Thus, in this issue, we are pleased to welcome an extremely timely review by Dr Avash Kalra and Dr Scott Biggins focused on current controversies in the organ allocation system for liver transplantation.
Another enormous advance in the Hepatology field is in the area of hepatic C virus (HCV) therapy. Just several years ago, two novel direct acting antiviral agents (DAAs), telaprevir and boceprevir, were introduced. These agents provided significantly greater cure rates than the previous interferon-based therapies and paved the way for even more effective agents. In fact, the field has progressed so rapidly that these agents are now obsolete. In the fall of 2013, sofosbuvir and simeprivir, two additional novel DAAs, were approved by the United States Food and Drug Administration (FDA). The field has evolved so rapidly that many further questions have become paramount. For example, questions are now focused on which patients are the best candidates, and can (or should) patients with HCV and a variety of comorbid disorders be treated? One such group includes patients with hepatocellular carcinoma (HCC) – is antiviral therapy effective in this population? Additionally, it has been suggested that rates of HCC recurrence in patients with a history of HCC can potentially be increased or decreased by DAA therapy. Therefore, it is extremely appropriate for a review by Drs Tatyana Kushner, Douglas Dieterich, and Behnam Saberi, who have provided an overview of this topic and highlight important considerations for practioners who are considering DAA therapy for patients with HCV and HCC.
Portal hypertension is a well known complication of cirrhosis that can be associated with a variety of clinical syndromes including the development of ascites, spontaneous bacterial peritonitis, hepatic hydrothorax, portal hypertensive gastropathy, and variceal hemorrhage. Although the most common cause of portal hypertension is advanced fibrosis and cirrhosis, a number of patients present with portal hypertension without significant fibrosis (and no evidence of histological cirrhosis). This entity, so called non-cirrhotic portal hypertension, represents a heterogeneous group of liver disorders. These diseases are critical for practioners at all levels to be aware of, and more importantly, it is critical to appreciate that the management of noncirrhotic portal hypertension differs from that of cirrhosis-related portal hypertension. Thus, in this issue, Drs Ben Da, Christopher Koh, and Theo Heller have provided an outstanding overview of the diseases that cause noncirrhotic portal hypertension and their management.
One of the most notable systemic diseases that involves the liver is cystic fibrosis. This autosomal recessive disease resulting from mutations in the gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR) protein, can lead to a variety of liver-related disorders, including cirrhosis. Indeed, some of the most challenging patients in medicine include those with combined cystic fibrosis liver and lung disease. In this issue, Drs. Natasha Kamal, Pallavi Surana, and Christopher Koh provide a state of the art review on CF liver disease and highlight potential novel therapeutic approaches.
Financial support and sponsorship
Conflicts of interest
Research funding has been provided to the author's Institution (not the author himself) from the following commercial entities for research purposes: Actelion Pharmaceuticals; Gilead Sciences; Galectin Therapeutics; Connatus Pharmaceuticals; Shire; Intercept Pharmaceuticals; Cumberland Pharmaceuticals; and Mallinckrodt Pharmaceuticals.