Autoimmune hepatitis (AIH) is a rare, immune-mediated liver disease. It has a heterogeneous nature with varied clinical presentations. The management of patients with AIH is challenging in many ways. The main difficulties are inexperience due to the rarity of the disease, diagnostic confusion in controversial areas such as variant/overlap cases, acute presentations, the presence of non-alcoholic fatty liver disease or drug-induced liver injury features, and the long and complex course of treatment. Here, we provide a clear, concise, and visualized review regarding the diagnosis and treatment of AIH, including illustrative cases.

It was aimed to investigate the frequency of metabolic dysfunction-associated steatotic liver disease (MASLD) in type 2 diabetes mellitus (T2DM) patients with non-invasive tests. We prospectively evaluated the frequency of MASLD and fibrosis stage of the liver with biomarkers based on blood tests and FibroScan^® in adult patients with T2DM who were followed up from the outpatient clinic in a tertiary center. Liver stiffness measurement (LSM) ≥ 8 kPa was accepted as clinically significant fibrosis (≥ F2), and ≥ 12 kPa was accepted as advanced fibrosis (F3-4) in FibroScan^® measurements. The cut-off value of the CAP score was accepted as 275 dB/m for steatosis. There were 504 patients with T2DM in the study. 54.2% were female. 252 (50%) patients had MASLD. 30.6% had clinically significant fibrosis, and 13.5% had advanced fibrosis. The degree of steatosis in the patients increased, the frequency of clinically significant fibrosis increased (p < 0.05). The frequency of MASLD significantly increased as BMI increased (p < 0.05). Diabetic nephropathy and neuropathy were more common in MASLD patients (p < 0.05). There was a significant relationship between clinically significant fibrosis and nephropathy (p < 0.001). MASLD and significant liver fibrosis are highly common in patients with T2DM. As the severity of liver steatosis increases, fibrosis stage progresses.

Background: Treatment using direct-acting antivirals provides high rates of sustained virologic response and a favorable safety profile patients with chronic hepatitis C virus infection. However, data on efficacy of direct-acting antivirals in kidney transplant recipients still limited.Aims: To evaluate the safety and efficacy of fixed-dose sofosbuvir/ ledipasvir combination in kidney transplant recipients.Study Design: Retrospective, observational, single-center study. Methods: Data of 29 kidney transplant recipients who received fixed-dose safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination for 12 or 24 weeks with or without ribavirin were analyzed. The primary outcome was SVR12, which was defined as undetectable HCV-RNA levels 12 weeks after the treatment. Secondary outcomes were graft function, proteinuria, and calcineurin inhibitor trough level variability.Results: The predominant hepatitis C virus genotype was 1b (n = 19, 65.6%). All patients achieved SVR12. No graft failures nor deaths were reported during the study period. Throughout and after the treatment, the levels of aspartate aminotransferase [21 (range: 18-29.5) to 16 (range: 14-20) U/l,p < 0.001] and alanine aminotransferase [22 (range: 15-34) to 14 (range: 12-17.5) U/l, p < 0.001] improved significantly, unlike bilirubin, hemoglobin, and platelet levels. Renal function remained stable. Dose adjustments for calcineurin inhibitors were required. Serious adverse events were not observed. Conclusion: Safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination was effective and safe in kidney transplant recipients with hepatitis C virus. However, cautious monitoring of trough levels of calcineurin inhibitorss is needed due to potential drug-drug interactions during the treatment episode.

Early diagnosis of hepatocellular carcinoma (HCC) is essential in improving survival, creating a need for new markers in the early diagnosis and surveillance of HCC. This study aims to investigate the prediction of the GALAD score, which consists of gender, age, AFP, AFP-L3, and DCP, in the diagnosis of HCC in cirrhotic patients with normal AFP levels. GALAD scores were determined in 100 patients with cirrhosis and normal AFP in a tertiary center. The role of the GALAD score in the surveillance of HCC was investigated prospectively. 100 cirrhotic patients (59 male, mean age 60.4 ± 13.6 years) participated. GALAD score was higher in cases with HCC (GALAD = -0.66 in cases with HCC, and − 3.10 in cases without HCC, p < 0.001). The cut-off value of the GALAD score in the diagnosis of HCC was found to be -1.93 according to ROC analysis (AUC of 0.798, 95% CI: 70.5–89.1, sensitivity = 71%, specificity = 71%). In regression analysis, the risk of developing HCC was 3.4 times higher in patients with a GALAD score ≥ -1.93. The GALAD score is an important marker for the surveillance of HCC in cirrhotic patients with normal AFP.

This study aims to investigate antiviral effectiveness, side effects, and disease outcomes in patients who have been using entecavir (ETV) and tenofovir disoproxil fumarate (TDF) for a long-term in chronic hepatitis B. Patients with chronic hepatitis B who had been using TDF or ETV for at least 10 years were included in this retrospective study. Co-infected patients, those receiving immunosuppressive therapy, and transplant patients were excluded. Of the study’s total 173 patients (baseline mean age 43.4 ± 11.7 years), 110 (63.6%) were men. Thirty-three (19.1%) patients were cirrhotic, and hepatitis B e-antigen was negative in 131 (75.7%) patients at the baseline. Ninety-two (53.2%) patients used TDF and 81 (46.8%) used ETV for a mean of 156.76 ± 21.60 (120–204) months. Hepatitis B virus (HBV)-DNA negativity (<10 IU/mL) was achieved in 97.7% of all patients. Biochemical remission was achieved in 98.3% of all patients at the last visit. HBsAg became negative in only 5 (2.9%). Hepatocellular carcinoma (HCC) developed in 9 (5.2%) patients. All HCCs occurred after the 5th year of treatment. The age at HBV diagnosis was higher in HCC patients (P = .023), but the most important risk factor for the development of HCC was to have cirrhosis at baseline. Eight (4.6%) patients died in the follow-up, and 2 were due to liver disease and the remaining non-liver disease. At the end of follow-up, HBV-DNA negativity was achieved in almost all patients, and HBsAg sero-clearance was rarely achieved. Very few patients developed HCC and the long-term mortality rate was similar to the general population.