Metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant global health issue, affecting over 30% of the population worldwide due to the rising prevalence of metabolic risk factors such as obesity and type 2 diabetes mellitus. This spectrum of liver disease ranges from isolated steatosis to more severe forms such as steatohepatitis, fibrosis, and cirrhosis. Recent studies highlight the role of gut microbiota in MASLD pathogenesis, showing that dysbiosis significantly impacts metabolic health and the progression of liver disease. This review critically evaluates current microbiome-centered therapies in MASLD management, including prebiotics, probiotics, synbiotics, fecal microbiota transplantation, and emerging therapies such as engineered bacteria and bacteriophage therapy. We explore the scientific rationale, clinical evidence, and potential mechanisms by which these interventions influence MASLD. The gut-liver axis is crucial in MASLD, with notable changes in microbiome composition linked to disease progression. For instance, specific microbial profiles and reduced alpha diversity are associated with MASLD severity. Therapeutic strategies targeting the microbiome could modulate disease progression by improving gut permeability, reducing endotoxin-producing bacteria, and altering bile acid metabolism. Although promising, these therapies require further research to fully understand their mechanisms and optimize their efficacy. This review integrates findings from clinical trials and experimental studies, providing a comprehensive overview of microbiome-centered therapies’ potential in managing MASLD. Future research should focus on personalized strategies, utilizing microbiome features, blood metabolites, and customized dietary interventions to enhance the effectiveness of these therapies.

Post‐transplant diabetes mellitus (PTDM) is a significant contributor to morbidity and mortality in liver transplant recipients (LTRs). With concurrent comorbidities and use of various immunosuppression medications, identifying a safe and personalized regimen for management of PTDM is needed. There are many comorbidities associated with the post‐transplant course including chronic kidney disease, cardiovascular disease, allograft steatosis, obesity, and de novo malignancy. Emerging data suggest that available diabetes medications may carry beneficial or, in some cases, harmful effects in the setting of these co‐existing conditions. Sodium‐glucose co‐transporter 2 inhibitors and glucagon‐like peptide 1 receptor agonists have shown the most promising beneficial results. Although there is a deficiency of LTR‐specific data, they appear to be generally safe. Effects of other medications are varied. Metformin may reduce the risk of malignancy. Pioglitazone may be harmful in patients combatting obesity or heart failure. Insulin may exacerbate obesity and increase the risk of developing malignancy. This review thoroughly discusses the roles of these extra‐glycemic effects and safety considerations in LTRs. Through weighing the risks and benefits, we conclude that alternatives to insulin should be strongly considered, when feasible, for personalized long‐term management based on risk factors and co‐morbidities.

Background: Severe alcohol‐associated hepatitis (sAH) is a life‐threatening condition. Despite advances in clinical management, prognosis remains poor and long‐term effectiveness of available therapies is uncertain. We conducted a systematic review and meta‐analysis to evaluate short‐term mortality (28, 60, and 90‐day) trends in sAH over the past five decades.Methods: We searched PubMed, EMBASE, and Scopus from database inception to February 2024 for studies reporting 28, 60, and 90‐day mortality in patients with sAH. Pooled mortality estimates were calculated using a random‐effects meta‐regression model. We assessed heterogeneity using the I² statistic and explored sources of heterogeneity through subgroup and meta‐regression analyses. Separate Bayesian mixed‐effects binomial models were used to estimate the posterior distribution of mortality probability, updated sequentially across calendar time.Results: 34 studies comprising 1586 patients with sAH were included. Pooled mortality rates were 26.8% (95% CI: 21.0%–33.5%) at 28 days, 35.1% (95% CI: 28.3%–42.5%) at 60 days, and 43.7% (95% CI: 34.6%–53.3%) at 90 days. Mortality increased steadily with follow‐up time. Substantial heterogeneity was observed, as expected in pooled proportion meta‐analysis (I² > 80%). Although cumulative Bayesian analysis showed that average 28‐day mortality declined from over 50% in the 1970s to ~25% after 2000, a formal decade‐based analysis indicated no statistically credible improvement in short‐term mortality was detected overall in the past four decades. In multivariable models adjusting for follow‐up time, the Model for End‐Stage Liver Disease (MELD) score was significantly associated with mortality.Conclusions: Short‐term mortality in sAH remains high and has not improved in recent decades. These findings highlight the urgent need for effective therapies, improved patient selection for early liver transplantation, and better prognostic tools to guide clinical decision‐making.

Combination anti-retroviral therapy has drastically improved solid organ transplantation outcomes in persons living with HIV. DAA therapy has led to the successful eradication of HCV. While recent data have suggested improvement in outcomes in HIV/HCV-coinfected liver transplant recipients, temporal trends in patient survival within pre- and post-DAA eras are yet to be elucidated. The UNOS database was utilized to identify deceased donor liver transplant recipients between 1 January 2000 and 30 September 2020 and stratify them by HIV and HCV infection status. A total of 85,730 patients met the inclusion criteria. One-year and five-year patient survival improved (93% and 80%, respectively) for all transplants performed post-2015. For HIV/HCV-coinfected recipients, survival improved significantly from 78% (pre-2015) to 92% (post-2015). Multivariate regression analyses identified advanced recipient age, Black race, diabetes mellitus and decompensated cirrhosis as risk factors associated with higher one-year mortality. Liver transplant outcomes in HIV/HCV-coinfected liver transplant recipients have significantly improved over the last quinquennium in the setting of the highly effective combination of ART and DAA therapy. The presence of HIV, HCV, HIV/HCV-coinfection and active HCV viremia at the time of transplant do not cause higher mortality risk in liver transplant recipients in the current era.

Stool ova and parasite (O&P) examinations are routinely ordered initial tests in patients admitted to the hospital with acute diarrhea, despite low test positivity rates. We examined the diagnostic...