There is increasing evidence that early liver transplantation (eLT), performed within standardized protocols can improve survival in severe alcoholic hepatitis (sAH). The aim of the study was to assess outcomes after eLT for sAH in four Italian LT centres and to compare them with non-responders to medical therapy excluded from eLT. Patients admitted for sAH (2013 – 2019), according to NIAAA criteria, were included. Patients not responding to medical therapy were placed on the waiting list for eLT after a strict selection. Histological features of explanted livers were evaluated. Post-transplant survival and alcohol relapse were evaluated. 93 patients with severe AH were evaluated (65.6% male, median [IQR] age: 47 [42-56] years). 45/93 patients received corticosteroids, 52/93 were non-responders and amongst these, 20 patients were wait-listed. Sixteen patients underwent LT. Overall, 6, 12 and 24-month survival rates were 100% significantly higher compared with non-responders to medical therapy who were denied LT (45%, 45% and 36%; p<0.001). 2/16 patients resumed alcohol intake, one at 164 days and one at 184 days. Early LT significantly improves survival in sAH non-responding to medical therapy, when a strict selection process is applied. Further studies are needed to properly assess alcohol relapse rates.

Worldwide, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) significantly increases mortality and morbidity. The Coronavirus Disease 2019 (COVID-19) outbreak has had a considerable impact on healthcare systems all around the world, having a significant effect on planned patient activity and established care pathways, in order to meet the difficult task of the global pandemic. Patients with hepatocellular carcinoma (HCC) are considered a particularly susceptible population and conceivably at increased risk for severe COVID-19 because of two combined risk factors: chronic advanced liver disease and HCC itself. In these challenging times, it is mandatory to reshape clinical practice in a prompt way to preserve the highest standards of patient care and safety. However, due to the stay-at-home measures instituted to stop the spread of COVID-19, HCC surveillance has incurred a dramatic drop, and care for HCC patients has been rearranged by refining the algorithm for HCC treatment to the COVID-19 pandemic, permitting these patients to be safely managed by identifying those most at risk of neoplastic disease progression.

Background and aims: Management of severe thrombocytopenia poses significant challenges in patients with chronic liver disease. Here, we aimed to evaluate the first real-world European post-marketing cohort of cirrhotic patients treated with lusutrombopag, a thrombopoietin receptor agonist, verifying the efficacy and safety of the drug. Methods: In the REAl-world Lusutrombopag treatment in ITalY (REALITY) study, we collected data from consecutive cirrhotic patients treated with lusutrombopag in 19 Italian hepatology centers, mostly joined to the “Club Epatologi Ospedalieri” (CLEO). Primary and secondary efficacy endpoints were the ability of lusutrombopag to avoid platelet transfusions and to raise the platelet count to ≥50,000/μL, respectively. Treatment-associated adverse events were also collected. Results: A total of 66 patients and 73 cycles of treatment were included in the study, since 5 patients received multiple doses of lusutrombopag over time for different invasive procedures. Fourteen patients (19%) had a history of portal vein thrombosis (PVT). Lusutrombopag determined a significant increase in platelet count [from 37,000 (33,000–44,000/μL) to 58,000 (49,000–82,000), p < 0.001]. The primary endpoint was met in 84% of patients and the secondary endpoint in 74% of patients. Baseline platelet count was the only independent factor associated with response in multivariate logistic regression analysis (OR for any 1000 uL of 1.13, CI95% 1.04–1.26, p 0.01), with a good discrimination power (AUROC: 0.78). Notably, a baseline platelet count ≤ 29,000/μL was identified as the threshold for identifying patients unlikely to respond to the drug (sensitivity of 91%). Finally, de novo PVT was observed in four patients (5%), none of whom had undergone repeated treatment, and no other safety or hemorrhagic events were recorded in the entire population analyzed. Conclusions: In this first European real-world series, lusutrombopag demonstrated efficacy and safety consistent with the results of registrational studies. According to our results, patients with baseline platelet counts ≤29,000/μL are unlikely to respond to the drug.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, and liver transplantation (LT) remains the only curative treatment addressing both tumor burden and underlying liver disease. Despite an adequate candidate selection, HCC recurrence after LT occurs in 8–20% of cases and is associated with a poor prognosis, particularly in patients who experience an early relapse. The management of HCC recurrence remains particularly challenging due to the lifelong immunosuppression required after LT, which may promote tumor progression and restrict therapeutic options. This review synthesizes the current evidence on systemic therapies for recurrent HCC after LT, focusing on tyrosine kinase inhibitors (TKIs), immunotherapy, and the current available immunosuppression strategies. Unfortunately, in this setting, robust prospective studies are lacking, and clinical decision-making remains based on retrospective data and expert consensus. Future research should prioritize the prospective evaluation of systemic regimens, integration of immunosuppression modulation, and careful exploration of immunotherapy or new target therapies in this special population.