Chronic hepatitis C virus (HCV) infection remains a major global public health challenge. Despite the availability of highly effective therapies capable of curing the vast majority of patients, millions remain undiagnosed and often present for medical care at advanced stages of disease. This delay not only increases mortality and the burden of cirrhosis and hepatocellular carcinoma but also affects quality of life, productivity, and healthcare system costs. In this context, screening emerges as a cornerstone for achieving HCV elimination. It enables the identification of hidden cases, early treatment initiation, prevention of complications, and reduction of community transmission. At the population level, prioritizing individuals with the highest likelihood of transmitting infection produces a multiplier effect, while both universal and risk-based strategies have consistently proven cost-effective, generating medium-term savings. In Latin America, the epidemiological landscape is heterogeneous. While overall prevalence in the general population is relatively low, high endemicity persists in vulnerable groups such as people who inject drugs, incarcerated individuals, and patients undergoing hemodialysis. Major barriers include fragmented health systems, lack of clinical registries, stigma, and restricted access to diagnosis and therapy. Yet, the region also holds clear opportunities: simplified diagnostic pathways using rapid testing and reflex algorithms, micro-elimination in key populations, pooled procurement of antivirals through the Pan American Health Organization, and the integration of digital health and telemedicine. In conclusion, HCV screening constitutes both a public health necessity and an ethical obligation. Its organized and sustainable implementation is essential to translate therapeutic efficacy into collective benefit and to accelerate progress toward the elimination of hepatitis C.

Liver diseases constitute the fifth leading cause of death in Mexico, and metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the main causes. MASLD, formerly known as non-alcoholic fatty liver disease (NAFLD), is estimated to affect one in three adults worldwide, and limited evidence suggests that its prevalence in Mexico may approach 50%. Social and commercial determinants of health are key drivers of this situation, and genetic susceptibility also appears to play a notable role. MASLD is increasingly recognized as a condition requiring multidisciplinary collaboration across multiple disease specialties, since it shares risk factors, pathophysiological mechanisms, and clinical trajectories with obesity, type 2 diabetes, dyslipidemia, and cardiovascular disease. While some of the building blocks for an effective response to MASLD and other forms of steatotic liver disease (SLD) are already in place in Mexico, there is an unrealized opportunity for the national health system and medical community to define and implement a more cohesive and effective public health response. Recommendations include increasing the timely diagnosis of SLD and improving models of care. More broadly, MASLD and other forms of steatotic liver disease must be integrated into national noncommunicable disease strategies and clinical practice guidelines, especially those addressing diabetes, obesity, and unhealthy lifestyles. Mexico should also strengthen multisectoral policies regarding unhealthy foods and alcohol, improve healthcare coverage, and invest in research and innovation to contribute to equitable and comprehensive care for MASLD and other forms of SLD, such as alcohol-related liver disease.

Introduction and Objectives Tracking simultaneous liver–kidney transplantation SLKT trends supports clinical decision-making, center-level improvements, and regional policy development. We aimed to describe changes in donor and recipient characteristics, transplant indications, and 1-year outcomes in Latin America from 2003 to 2025. Materials and Methods Retrospective cohort study including SLKT recipients from seven Latin American countries. Data were analyzed across six eras: 2003–2009, 2010–2013, 2014–2016, 2017–2018, 2019–2021, and 2022–2025. Outcomes included 1-year patient survival and 1-year renal function (estimated glomerular filtration rate (eGFR) ≥ 45 mL/min/1.73 m2, a surrogate of adequate graft performance linked to favorable long-term outcomes). Results A total of 305 patients were included. Recipient age and sex remained stable. Diabetes prevalence increased from 6% to 46%; hypertension and dyslipidemia varied minimally. Indications for liver transplantation shifted: cirrhosis declined from 82% to 56%, while polycystic disease rose to 26%. HCV-related cirrhosis fell from 38% to 18%; MASLD increased from 11% to 37%. Alcohol-related cirrhosis fluctuated, peaking at 48%. Diabetes became the leading indication for kidney transplantation, while glomerulonephritis declined. MELD exceptions increased, reaching 50% by 2022–2025. Donor characteristics remained stable. One-year survival improved from 66% (95% CI, 49–82) to 92% (95% CI, 84–100). Approximately 70% of recipients met the threshold of eGFR ≥ 45 across all periods. Conclusions Despite a more complex recipient profile and evolving transplant indications, SLKT outcomes in Latin America have shown steady improvement over the past two decades. This progress reflects the growing expertise and coordination within transplant systems, highlighting the need to sustain region-specific data collection efforts.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a silent epidemic having substantial clinical implications, with liver transplantation being one of the areas most impacted. The increasing prevalence of metabolic fatty liver disease has reduced the quality of available donor organs. While noninvasive methods are increasingly applied to evaluate liver steatosis in deceased donors, liver biopsy remains the gold standard. Many aspects of liver biopsies are not yet fully standardized. Macrovesicular hepatic steatosis is associated with decreased allograft quality and poorer short- and long-term transplant outcomes, especially in moderate and severe steatotic cases. Donation after cardiac arrest further exacerbates these poor outcomes. Matching marginal allografts with suitable recipients based on recipient characteristics is crucial for improving transplant outcomes. Living donor liver transplant is a feasible option for addressing organ shortages. Noninvasive evaluation is preferred for assessing liver health; however, when the results are inconclusive, a liver biopsy is recommended. Lifestyle modifications can improve graft, living donor and recipient outcomes. Analysis of the impact of MASLD on the donor pool and the implementation of new optimization strategies are essential to ensure the sustainability of transplantation as a curative treatment for advanced liver cirrhosis. The aim of this review was to summarize the effect of MASLD on the liver donor population, highlighting how to evaluate steatosis in donors, and to discuss its clinical implications as well as strategies to optimize organ allocation in the MASLD era.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, predominantly linked with cirrhosis and chronic hepatitis B. In Latin America, disparities in healthcare access complicate HCC management. A recent expert meeting emphasized the importance of identifying at-risk populations for effective screening and surveillance, underlining the need for structured routine programs. Early detection of HCC improves outcomes and increases survival rates. Surveillance programs are essential, yet access to healthcare and treatment varies significantly across Latin America, making timely diagnosis and intervention challenging. Additionally, recent shifts in disease etiology, notably the rising prevalence of MASLD, further complicate HCC detection. Effective HCC surveillance relies on cost-efficient diagnostic tools. Ultrasound is the main screening method, though it has moderate sensitivity. In obese patients, achieving adequate visualization is particularly difficult. Combining ultrasound with alpha-fetoprotein (AFP) improves diagnostic accuracy. Biomarkers such as AFP are commonly used to diagnose and monitor HCC, but their predictive value remains limited. Integrating biomarkers with ultrasound or other novel markers may enhance detection; however, further research is necessary to validate these strategies. In conclusion, HCC surveillance remains a significant challenge in our region. A comprehensive, multifaceted approach is needed to improve early detection and clinical outcomes.

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies.

Introduction and Objectives: Primary biliary cholangitis (PBC) is an autoimmune cholestatic disease, typically diagnosed by the presence of anti-mitochondrial antibodies (AMA). Whether AMA-negative PBC represents a distinct clinical phenotype remains controversial. This study aimed to characterize the epidemiological profile of PBC according to AMA status in Latin America. Materials and Methods: This ongoing, retrospective, international multicenter cohort study, sponsored by ALEH, includes PBC patients from multiple Latin American countries. Patients were stratified by AMA status; those with autoimmune hepatitis-PBC overlap were excluded. Results: Data from 1,204 patients were analyzed: Brazil (48.3%), Argentina (23.4%), Chile (10.8%), Mexico (7.4%), and others. Most were female (92.3%) with a mean age at diagnosis of 53±13 years; 22.2% had cirrhosis at baseline. Overlap syndrome was excluded. AMA were positive in 76.8%. AMA-positive and AMA-negative patients had similar rates of female sex (92.5% each, p=0.963), baseline cirrhosis (22.4% vs. 23.6%, p=0.706), and symptomatic presentation (77.5% vs. 79.4%, p=0.544). MASLD was more frequent among AMA-negative patients (7.5% vs. 3.8%, p=0.024), which also had higher rates of sp100 (9.1% vs 2.5%, p< 0.001) and gp210 (7.3 vs 3.3%, p< 0.001) positivity. Treatment with UDCA was performed in 95.2% of patients and, from those, 28.3% had second line treatment indicated due to incomplete response to UDCA. AMA-positive patients showed higher response to ursodeoxycholic acid (UDCA) at 12 months, including ALP normalization (29.7% vs. 21.2%, p=0.035) and deep response (17.5% vs. 8.6%, p=0.007). Similar findings were observed after 12 months of fibrate therapy (34.8% vs. 9.4%, p=0.005). No difference was found in transplant-free survival (p=0.213). Conclusions: AMA-negative PBC patients in Latin America present similar baseline features but have lower response rates to UDCA and fibrates, supporting the hypothesis of a biologically distinct disease subset.

Introduction and Objectives: Approximately 40% of patients with primary biliary cholangitis (PBC) exhibit an incomplete biochemical response to ursodeoxycholic acid (UDCA) and require second-line therapy. Fibrates are widely available in Latin America and commonly used off-label in this setting. We aimed to evaluate clinical and biochemical outcomes in PBC patients with incomplete UDCA response treated with different fibrates. Materials and Methods: This ongoing, retrospective, multicenter cohort study (ALLATIN), sponsored by ALEH, includes PBC patients from several Latin American countries. For this analysis, only patients with incomplete response (based on biochemical criteria or physician judgment), who received fibrates, were included. Results: Among 1,204 patients, 342 received fibrates; 263 (76.7%) were treated for incomplete UDCA response (93.2% female; mean age: 50 ± 11 years; 76.5% AMA-positive; 19.6% with cirrhosis). Bezafibrate, fenofibrate, and ciprofibrate were used in 72.2%, 7.2%, and 17.9% of cases. Median ALP before fibrates was 1.9xULN (IQR 1.4-3.0); median time from UDCA start to fibrate use was 30 months (IQR 13-69). At 6 months (n = 153), ALP normalization occurred in 42.5%, while 67.3% and 50.3% met Toronto and POISE criteria, respectively; 30.9% achieved deep response (normal ALP and bilirubin <0.6×ULN). At 12 months (n=150), rates remained stable. No differences were observed across fibrate types (p>0.4). Liver transplantation or death occurred in 24 patients (9.1%) over 87 months (IQR 44-135), associated with cirrhosis at diagnosis (OR 9.9; 95%CI 3.3-29.9; p<0.001) and response at 6 months by Toronto criteria (OR 0.31; 95%CI 0.1-0.9; p=0.035). Discontinuation occurred in 13.7%; adverse events included renal injury (n=1), myalgia (n=4), liver injury (n=4), and abdominal pain (n=4). Conclusions: Fibrates showed high efficacy regardless of agent used. Biochemical response plateaued by 6 months and predicted long-term outcomes. These findings support early assessment and a pragmatic approach to second-line therapy in PBC, independent of fibrate type.

INTRODUCTION AND OBJECTIVES:Hepatic encephalopathy (HE) is a frequent and severe complication of cirrhosis, leading to rapid deterioration and increased mortality. Management varies across Latin America due to differences in disease awareness, diagnostic and therapeutic resources, and healthcare system structures. Standardized guidelines are crucial to improve outcomes. MATERIALS AND METHODS:To evaluate therapeutic strategies and develop region-specific recommendations, the Latin American Association for the Study of the Liver (ALEH) convened 15 experts from 9 countries. The consensus process, conducted in 9 phases using the Nominal Group Technique, included virtual meetings, platform-based collaboration, virtual voting, and two in-person sessions to finalize recommendations and the publication draft. RESULTS:The panel issued 23 recommendations covering the treatment of minimal and overt HE, as well as the prophylaxis and management of recurrent HE in cirrhotic patients. CONCLUSIONS:This consensus provides updated, evidence-based guidelines emphasizing early diagnosis and effective management. It aims to optimize clinical outcomes, standardize treatment approaches, and enhance patient quality of life. Additionally, these recommendations seek to reduce morbidity, mortality, and hospital readmissions, addressing key challenges in the Latin American healthcare landscape.

Liver transplantation (LT) is a well-established therapy for patients with decompensated cirrhosis and early-stage hepatocellular carcinoma. Liver transplantation activity varies sharply across Latin American (LATAM) countries due to differences in resources, expertise, and funding and local attitudes toward organ donation and transplantation. This current guidance of postoperative care after LT is the first position paper of the Latin American Association for the Study of the Liver (ALEH) Special Interest Group (SIG), drawing evidence-based recommendations regarding immediate and long-term postoperative care of LT recipients, taking into consideration their applicability in Latin America.

Alcohol-associated liver disease (ALD) represents one of the deadliest yet preventable consequences of excessive alcohol use. It represents 5.1% of the global burden of disease, mainly involving the productive-age population (15-44 years) and leading to an increased mortality risk from traffic road injuries, suicide, violence, cardiovascular disease, neoplasms, and liver disease, among others, accounting for 5.3% of global deaths. Daily alcohol consumption, binge drinking (BD), and heavy episodic drinking (HED) are the patterns associated with a higher risk of developing ALD. The escalating global burden of ALD, even exceeding what was predicted, is the result of a complex interaction between the lack of public policies that regulate alcohol consumption, low awareness of the scope of the disease, late referral to specialists, underuse of available medications, insufficient funds allocated to ALD research, and non-predictable events such as the COVID-19 pandemic, where increases of up to 477% in online alcohol sales were registered in the United States. Early diagnosis, referral, and treatment are pivotal to achieving the therapeutic goal in patients with alcohol use disorder (AUD) and ALD, where complete alcohol abstinence and prevention of alcohol relapse are expected to enhance overall survival. This can be achieved through a combination of cognitive behavioral, motivational enhancement and pharmacological therapy. Furthermore, the appropriate use of available pharmacological therapy and implementation of public policies that comprehensively address this disease will make a real difference.

Conflict of interest: No Introduction and Objectives: Simultaneous liver-kidney transplantation (SLKT) is increasingly performed worldwide. We aimed to evaluate the characteristics and outcomes of SLKT patients in Latin America. Patients / Materials and Methods: We conducted a multicenter, international retrospective cohort study of adult patients who underwent SLKT. Overall survival and survival with functional grafts (both liver and kidney) were estimated using the Kaplan-Meier method. Results and Discussion: 293 patients who underwent SLKT between 2003 and 2024 from Argentina, Brazil, Colombia, Chile, Mexico, Peru, and Uruguay were included. Patients had a median age of 56 (IQR: 47–61), and 63% were male. Primary indications for liver transplantation were decompensated cirrhosis (69%) and polycystic disease (19%). The most common etiologies of cirrhosis were viral (36%), alcohol-related (35%), and metabolic-associated steatotic liver disease (27%). Ninety-three percent of kidney indications were due to chronic kidney disease, primarily polycystic kidney disease (26%), diabetic nephropathy (25%), and hypertensive nephropathy (11%). Among patients transplanted for acute kidney injury, 75% had hepatorenal syndrome. Overall, 55% were on pre-transplant renal replacement therapy (RRT). Thirty-eight percent accessed transplantation with MELD exceptions. The median MELD-Na score was 24 (19-30), 25 (21-32) in those without supplementary MELD, and 20 (17-25) in those with supplementary MELD. Fourteen percent had a prior isolated transplant (kidney 50% and liver 50%. Twenty-five percent required RRT, and 18% underwent abdominal re-operation within the first post-transplant week. During long follow-up, 13% experienced major cardiovascular events, and 7% experienced oncological complications. Other recipient and donor characteristics are presented in the table. One-year overall survival was 77% (95% CI 72-82); at 5 years, it was 67% (95% CI 60-72); and at 10 years, it was 59% (95% CI 51-66). Survival with functional grafts at 1 year was 77% (95% CI 72-82); at 5 years, it was 65% (95% CI 58-70); and at 10 years, it was 54% (95% CI 46-62). Conclusions: For the first time, data from the region demonstrate that long-term patient survival following SLKT meets international standards.

Introduction and Objectives Little is known about current practice of liver transplantation (LT) in Latin American countries (LATAM). This study aimed to describe LT activity, immunosuppression protocols and policies regarding prophylaxis of cytomegalovirus (CMV) infection and hepatitis B virus (HBV) recurrence in different active LATAM centers. Materials and Methods A web-based survey with 20 questions regarding LT practice was sent to all members of ALEH LT SIG in December 2022. Results 22 centers performing 35 [5-160] LT per year from Brazil (n=5), Argentina (n=4), Chile (n=4), Ecuador (n-2), Mexico (n=2), Colombia (n=1), Costa Rica (n=1), Peru (n=1), Dominican Republic (n=1) and Uruguay (n=1) answered the survey. Tacrolimus, mycophenolate and prednisone was the main immunosuppressive regimen employed by most (72%) centers and 81% of them referred basiliximab use for induction therapy in selected patients. Tailoring of immunosuppression was universally accepted, particularly in autoimmune hepatitis (AIH) (59%), hepatocellular carcinoma (54%) kidney dysfunction (77%) and primary biliary cirrhosis (33%). Weaning of corticosteroids at three, six and 12 months after LT was reported, respectively, by 41%, 36% and 23% of the centers, but policy for lifelong corticosteroid use in AIH-transplanted subjects was commonly observed (90%). Just four centers are currently performing protocol liver biopsies, while 18 of them are considering liver biopsy prior to steroid pulse therapy. HBIG and nucleos(t)ide analogs are used in most instances (73%) for HBV recurrence prevention, whereas CMV infection prophylaxis was shown to vary sharply across centers. Of note, all but two of them referred major changes in LT practice over the years due to economical restraints. Conclusions Compliance with standard of care recommendations for management of LT was reported by most centers. Heterogeneity in practices regarding HBV infection recurrence and CMV prophylaxis may reflect local financial restraints and point to the importance of developing ALEH guidelines to encourage LT activity in LATAM.

Patients with chronic liver disease of any etiology who become infected with SARS-CoV-2 have been found to have a higher risk of mortality compared to those patients who do not have chronic liver disease. A literature review was conducted in the relationship between COVID 19 and preexistence of liver disease. The proportion of COVID-19 patients with abnormal liver function on admission ranged from 40 % to 75 % and the proportion with liver injury was close to 30%. Current studies show an important association between preexisting liver disease and COVID-19. The presence of cirrhosis is now an independent predictor of severity for COVID-19 and prolonged hospitalization in this group of patients. Patients with cirrhosis have a higher mortality rate, and this rate rises with increasing severity.

Liver diseases related to health behaviors are emerging as the most common causes of chronic liver disease and cirrhosis world-wide. Harmful alcohol use can culminate in different manifestations of liver disease from steatosis to a severe acute steatohepatitis, cirrhosis and liver cancer. Historically, alcoholic hepatitis, alcoholic liver disease and alcoholism were the terms used to describe alcohol-related liver conditions and the disorder associated with their development, respectively. These terms, we now realize, are hugely stigmatizing. Stigma has a major impact on liver diseases, leading to discrimination, reduction in healthcare-seeking behaviour, and reduced allocation of resources, which all result in poor clinical outcomes.1 With the rise in recent years of alcohol as a major cause of liver-related morbidity and mortality, there is a need for the hepatology community to change its terminology; this statement is intended to be an important first step in advancing a non-stigmatizing, person-centric approach. The transition away from the use of alcoholic is already well-underway, with more than 500 publications since 2018 utilizing “alcohol-associated” or “alcohol-related” as alternatives to alcoholic. This is gratifying, but to assist further in bringing uniformity to the published research and review articles on the topic of alcohol and liver disease, there is agreement on banning the term “alcoholic” from our medical lexicon and instead using “alcohol-associated” or “alcohol-related”. Both convey the desired qualities of being non-stigmatizing and establish alcohol as the key determinant of the liver condition. There should also be agreement on the acronyms used – with use of ALD (alcohol-associated or alcohol-related liver disease) and AH (alcohol-associated or alcohol-related hepatitis). This may make literature searches that include both older and newer papers more straightforward. The NIAAA (National Institutes of Health Alcohol and Addiction Division) favours the term “alcohol-associated” and this is the term adopted by AASLD.2 In European institutions the term “alcohol related”, as suggested in the EASL guideline from 2019, has been adopted.3 Liver societies play a key role in shaping clinical care, research and public policy. With this responsibility in mind, we suggest the following terminology be adopted widely (Table 1). TABLE 1 - Suggested changes in terminology Current/Prior Terms Preferred/Recommended Terms Abbreviation Alcoholism Alcohol use disorder AUD Alcoholic Person with alcohol use disorder Alcoholic hepatitis Alcohol-associated hepatitis or alcohol-related hepatitis AH Alcoholic liver disease Alcohol-associated liver disease or Alcohol-related liver disease ALD Alcoholic cirrhosis Alcohol-associated cirrhosis or Alcohol-related cirrhosis AC Additionally, we endorse a “person-first” approach rather than a condition-first approach. Specifically, we recommend describing “an individual with alcohol-associated cirrhosis” rather than ‘alcohol-associated cirrhotic”. Utilizing people-first language when describing individuals with medical conditions has been a widely accepted norm, with recent emphasis on persons with obesity (rather than obese persons). Looking forward, we would encourage journal editors, conference organizers, researchers and educators to adopt this person-first language. Finally, as clinicians and researchers, we must acknowledge that in addition to using the “right terms”, there is a need to create the “right environment” for persons with alcohol use disorder and liver disease to receive care. This requires that clinicians as well as their support staff and research coordinators receive education regarding alcohol use disorder and can interact with persons with alcohol use disorder in an unbiased and non-stigmatizing manner. Provision of a supportive clinical and research environment is critical if we are to be effective in improving the lives of persons with ALD. The AASLD, ALEH, APASL, and EASL condemn the use of stigmatizing language, images, attitudes, and policies related to alcohol use disorder and associated liver diseases and are united in our commitment to harmonize terms and the desire to advance clinical care and research by removing stigmatizing terminology.

Although the WHO strategy aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030, national strategies are variable worldwide. This study aimed to assess the establishment of different policies and strategies to eliminate HCV in the Americas. We conducted a 23-item survey about HCV-related policies and strategies among gastroenterologists and hepatologists in the Americas. The survey was carried out electronically (2022–2023). Data were compared with governmental institutions, regulatory agencies, scientific societies, and scientific publications. We estimated an index obtained from a regression scoring method through exploratory analysis, and row values were normalized from 0 to 100. We obtained 52 responses from 19 countries. The median HCV-related policies index was 51.4 [IQR:27.3–70.1]. The lower establishment of HCV-related policies was observed in Ecuador (0.0), Honduras (6.6), and Costa Rica (9.8), while the highest performance was observed in Argentina (94.1), Colombia (94.7), and Canada (100)(Figure 1A). Fifteen (78.9%) countries have adopted a national strategic plan to eliminate HCV. Three (15.8%) countries have universal screening for HCV infection (Figure 1B). After a positive HCV serological test, 10 (52.6%) countries perform reflex testing to confirm HCV diagnosis using the same sample. However, only 7 (36.8%) countries have an alert system for the requesting physician. Twelve (63.2%) countries have a direct referral system for specialized care of HCV-positive cases. Universal access to direct-acting antivirals (DAAs) exists in 15 (78.9%) countries. Universal access to DAAs was not widely available in Cuba, Ecuador, Venezuela, and the United States. Seven (36.8%) countries have generic DAAs available. Only 3 (15.8%) countries performed a retrospective search for HCV-positive cases that could have been lost to follow-up. Although most countries have adopted a national strategic plan to eliminate HCV, there are several issues and barriers to elimination in the Americas.

Introduction and Objectives Body composition (BC) has been linked to liver steatosis. The aim of this study is to describe differences in BC in MAFLD patients. Materials and Methods Liver steatosis was evaluated by controlled attenuation parameter, patients were classified according to body mass index (BMI) and definitions of MAFLD in five groups: G1:<25kg/m2-non-MAFLD; G2: <25kg/m2-MAFLD; G3: 25-30kg/m2-MAFLD; G4:>30kg/m2-MAFLD and metabolically healthy (<3 metabolic abnormalities) (MH) and G5: >30kg/m2-MAFLD and metabolically unhealthy (MU). BC was assessed by bioelectrical impedance obtaining measurements of resistance; reactance; phase angle; percentages of fat; total body water (TBW%); intracellular and extracellular water (ICW%, ECW%) and skeletal muscle mass (SMM%). Differences in BC was analyzed by Kruskall-Wallis test. Continuous data showed as median and IQR. Results 140 patients were included (G1 n=30; G2 n=24; G3 n=30; G4 n=26; G5 n=30). 56.4% (n=79) were male with median of age of 49 [41- 55] years. Overweight/obese MAFLD patients showed significant lower resistance and reactance levels (p0.05). According to vectorial analysis, chaquexia was observed in 18.4% (n=7) of patients in G4 and 15.8% (n=6) in G5 patients. Fat% was higher in patients of G5 (MU) than G2 (34.3[29.8-40.4], p=0.02) and G3 (35[31.1-38.3], p=0.01). Obese MAFLD patients showed lower TBW%, ICW% and ECW% (p0.001). (Figure). SMM% was lower in MU obese patients (29.1[26.3-31.1]) compared to healthy controls (33.4[29.3-36.8], p=0.006) and overweight patients (32[29.7-34.4], p=0.02). Phase angle did not show significant differences. Conclusions Overweight/obese MAFLD patients shows BC abnormalities in comparison with healthy controls and lean MAFLD patients. Resistance, reactance, body water and skeletal muscle mass are significant lower in both metabolically healthy/unhealthy obese patients. Changes could be explained for the sarcopenia and fat-muscle interchange and no necessary for the presence of metabolic abnormalities.

Introduction and Objectives Acute variceal hemorrhage (AVH) is a serious complication of portal hypertension and is associated with high mortality and high cost. Limited information exists regarding AVH management in Latin America (LATAM). This study aimed to gather data on AVH management and resource availability across LATAM. The goal was to bridge the knowledge gap, enhance medical attention, and optimize specialized care for patients with AVH in the region. Materials and Methods A survey was conducted using Microsoft Forms with recruitment via social media invitations and collaboration with local medical associations. It gathered data on demographics, clinical practices, and specialized resource availability. The LATAM countries were classified based on economic development (World Bank's classification system). Variables are described using percentages or medians and interquartile ranges and compared among socioeconomic regions using a chi-square test or analysis of variance as appropriate. Results In total, 798 respondents from 20 LATAM countries completed the survey. The median age was 39 years, with 80% attending specialists, 14% residents, and 6% fellows. Countries were represented by 6% high-income, 72% upper-middle income, and 21% lower- middle income populations. Gastroenterology (62%) was the predominant specialty, followed by internal medicine (23%), gastrointestinal endoscopy (18%), and hepatology (18%). Tertiary care centers accounted for 45% of the participants primary activities, followed by second-level care (30%) and private practice (21%). As for the existence of endoscopy suites, there were no differences between surveyed countries but their availability 24/7 remains higher in high income countries. The availability of vasoactive drugs correlated with economic development. The detailed findings are presented in Table 1. Conclusions In LATAM, the absence of standardized protocols, limited resources, and expertise pose challenges in AVH management. Enhancing access to specialized care and implementing standardized protocols is crucial to improve patient outcomes in the region.

To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.

Currently, chronic liver diseases have conditioned morbidity and mortality, many of these with a metabolic, toxicologic, immunologic, viral, or other etiology. Thus, a transcription factor that has been of huge importance for biomedical research is NRF-2. The latter is considered a principal component of the antioxidant mechanism, and it has been acknowledged that it impairs the function of NRF-2 in many liver diseases and that it forms an essential part of the pathologic changes that occur in the liver to contain inflammation and damage. Within the investigations and experiments carried out, there are isolated drugs, many of them related to plants and natural extracts that possess antioxidant properties through the NRF-2 signaling pathway, or even involving the stimulation of the transcription target proteins of NRF-2. Notwithstanding all of these experimental findings, to date there is not sufficient clinical evidence to justify the use of NRF-2 in medical practice.