Introduction Liver transplantation (LT) significantly improves survival and quality of life for patients with end-stage liver disease. Whilst it is believed that need for LT vastly exceeds organ supply, quantifying the demand accurately is challenging. The performance metrics of the transplant system, such as waitlist mortality, may be misleading as they capture only patients who are referred, evaluated and listed for LT. Although means of increasing organ availability are available, they have financial costs and may be technically and ethically challenging (such as live donation and normothermic regional perfusion). The imperative to embrace these techniques can be obscured if the waitlist is assumed to be representative of the actual demand for transplantation.Methods An international comparative analysis of transplantation, donation and waitlist outcomes versus measures of demand for LT was performed using publicly available data.Results The comparative analysis revealed no correlation between disease prevalence and waitlist metrics across jurisdictions internationally, suggesting that waitlisting practices are largely independent of actual LT demand and are constrained by other factors.Conclusion Adult LT systems globally are supply driven and uncorrelated to demand, implying that all jurisdictions are unable to meet the demand of their community and are limited by the supply of viable organs. The study underscores the inadequacy of waitlist data in representing true demand and highlights the need for improved data to inform LT policy and practice to improve access to this life-enhancing and life-saving treatment.

Hepatocellular carcinoma (HCC) is a rapidly increasing healthcare burden in Australia. We aimed to evaluate the contemporary epidemiology, clinical characteristics, and real-world patterns of care for HCC in Australia using a prospective multicentre clinical quality registry. This interim analysis utilised data from the Upper Gastrointestinal Cancer Registry (UGICR) HCC module, a multicentre clinical quality registry involving 17 major centres across all mainland Australian states. Patients with a new diagnosis of HCC from 1 January 2021 were included. Clinical characteristics and initial treatment modalities were compared between liver transplant centres (LTCs) and non-transplant centres (NTCs). A total of 489 patients were analysed (333 LTC, 156 NTC). The cohort was predominantly male (76.7

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is one of the preferred interventional radiology techniques for reducing clinically significant portal pressures in patients with cirrhosis and complications from portal hypertension when pharmacological therapy or endoscopic interventions have failed or been insufficient. Recent advances in TIPS procedural techniques and stent technology, along with emerging indications for TIPS, warrant a review of current practices and establishment of consensus recommendations in Australia, where TIPS remains underused. This TIPS consensus statement is the first such guideline in Australia. It outlines 69 evidence-based practice recommendations and the evidence underlying them. The recommendations are intended for use by health care professionals in Australia who manage adult patients with portal hypertensive complications of liver disease, where such patients are being considered for TIPS implantation, including pre-, peri- and post-procedural aspects of care. Methods and results: This consensus statement has been developed by specialists in hepatology and interventional radiology, with input from specialists in cardiology, hematology and primary care, including medical practitioners, nurses and clinical researchers. The statement deals with four domains related to TIPS: preparation for TIPS, patient selection and pre-TIPS workup; best procedural practice; postoperative care and follow-up; and indications for TIPS. Two rounds of a modified Delphi process were used to reach consensus on the recommendations. Conclusions: Adoption of and adherence to the evidence-based recommendations in this consensus statement should reduce clinical variation. Ultimately, this should lead to system-level improvements in quality of care and outcomes for patients undergoing TIPS implantation. These recommendations summarize the complete document, available at https://www.gesa.org.au/resources/ .

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.

Hepatocellular carcinoma (HCC) incidence and mortality rates are increasing at a greater pace than any other cancer in Australia. Cirrhosis is the major risk factor for HCC, and early detection of HCC through surveillance of people with cirrhosis can improve outcomes. However, cirrhosis is under-detected in primary care settings, with 60

BACKGROUND AND AIMS:Discontinuing nucleos(t)ide analogues (NAs) may lead to functional cure (HBsAg loss) in selected patients with chronic hepatitis B (CHB). We evaluated the rates and predictors of HBsAg loss during long-term follow-up in a prospective cohort. METHODS:This real-world extension study followed participants from a prospective trial of NA discontinuation. All patients had HBeAg-negative CHB without cirrhosis. Efficacy outcomes (including HBsAg loss and decline) and safety outcomes [including hepatitis flare and hepatocellular carcinoma (HCC)] were evaluated. RESULTS:Amongst 97 participants (85% Asian), with a median follow-up of 7 years, the cumulative incidence of HBsAg loss was 10%, 13% and 22% at 5, 7 and 9 years after stopping NA. HBsAg loss was associated with a lower end-of-treatment (EOT) HBsAg level (HR = 0.28, p < 0.001), older age (HR = 1.14, p = 0.005) and peak off-treatment HBV DNA level (OR = 0.50, p = 0.002). Participants with EOT HBsAg level ≤ 10 IU/mL experienced early HBsAg loss (< 96 weeks) without ALT flares whilst those with EOT HBsAg level ≥ 10 IU/mL experienced late (≥ 96 weeks) HBsAg loss, often following ALT flares (5/8 cases). No cases of hepatic decompensation, liver transplantation or death occurred. Median liver stiffness did not increase. HCC was diagnosed in three individuals (4.4/1000 person-years). CONCLUSION:The rate of functional cure increased during long-term follow-up but remained low. EOT HBsAg strongly predicted the likelihood and timing of HBsAg loss. ALT flares were associated with HBsAg decline, and in some cases, with delayed HBsAg loss. TRIAL REGISTRATION:The clinical study was supported by the National Health and Medical Research Council of the study clinical trial ID is NCT02581033.