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Thursday, 12 April 2018

In this issue: Today's edition of the ILC 2018 daily news includes highlights from the opening ceremony and plenary session, delegates' thoughts on the new meet the expert sessions, key points from the new EASL Clinical Practice Guidelines for the Management of HCC, top picks from parallel sessions in speciality tracks, and what not to miss on Friday. Scroll down to read more!

Professor Tilman Sauerbruch and Professor Tom Hemming Karlsen welcomed thousands of delegates to ILC 2018. Together they urged delegates to enjoy the congress and emphasized EASL’s ongoing commitment to educating doctors and improving the lives of everyone affected by liver disease. The need for such a commitment was reiterated by Tatjana Reic, President of the European Liver Patients’ Association and Michael Ninburg, President of the World Hepatitis Alliance. The vision of beating liver disease was evident in the parallel sessions, and the collaborative EASL–CDC symposium was an exciting evolution of the ‘Home of Hepatology’ concept. In the fellowships session Massimo Pinzani explained what’s new in the EASL fellowship programmes, and previous fellows shared their research and experiences.

Opening plenary showcases key data

In the opening presentation, results from the International Club of Ascites Global study stressed an urgent need to develop different empirical antibiotic strategies across different parts of the world to combat the threat of multi-drug-resistant bacteria in patients with cirrhosis.

On a more positive note, the final results of a Phase 2b clinical trial of Myrcludex B in combination with tenofovir in patients with chronic HBV/HDV co-infection showed dose-dependent antiviral efficacy against HDV with good tolerability.

Other promising clinical study data were also presented in this session:
  • Year 2 data from the Phase 2b CENTAUR study confirmed the antifibrotic activity and tolerability of cenicriviroc in adults with NASH and liver fibrosis
  • A new transcriptome-based classification of extrahepatic cholangiocarcinoma was described that could pave the way towards more precise therapeutics, by identification of potential drug targets
  • Finally, preliminary data suggest that 8 weeks of elbasvir/grazoprevir might be effective for first-line treatment of non-cirrhotic patients with HCV GT4, with a SVR12 of 93%
  • Although the results of the STAH trial show that the addition of cTACE to sorafenib did not improve overall survival versus sorafenib alone, a survival benefit was seen for those patients who received sorafenib with ≥2 sessions of cTACE
Meet the experts

Delegates were excited to have the opportunity to meet face-to-face with top experts in their fields of interest and this morning's sessions were full to capacity. Experts were kept busy with a range of challenging questions that they were able to answer in more depth than in a standard scientific session. Don't forget, there there will be more meet the expert sessions over the next three days!
New hopes and remaining needs in HCC

HCC was a key theme of ILC 2018 today, with much positive feedback on the new EASL Clinical Practice Guidelines for the management of hepatocellular carcinoma, presented today and now available from the Journal of Hepatology. Key new additions highlighted by session attendees included:
  • The broadening of criteria for surgical resection
  • The inclusion of recommendations for new targeted therapies for advanced HCC
  • The recommendation that coffee consumption should be encouraged in patients with chronic liver disease to reduce the risk of HCC
Another important addition was the consideration of the apparently high rate of HCC recurrence in patients receiving DAAs; currently the benefit of HCV cure must be weighed against a potentially increased HCC recurrence risk and close surveillance is advised in these patients.

Of relevance to this recommendation, in the HCC scientific session, compliance to HCC surveillance and liver function impairment were proposed as possible reasons for the increased HCC incidence following DAA treatment, while data from France suggested that post-treatment changes in liver stiffness measurement may not be useful for predicting HCC risk in these patients.

Also in the HCC scientific session an interesting new approach using personalized immunotherapy to treat HBV-related HCC was proposed. Adoptive transfer of T cells engineered to carry HBV-specific T cell receptors showed promising signs of clinical effectiveness in a patient with HCC metastases in the lungs following liver transplant.

Don't Miss - Breakfast morning rounds:
South 1 and West 1–3, 7:30–08:20
Parallel sessions: latest advances in hepatology

UDCA: Potential additional mechanisms of action

Prolonged liver transplant-free survival was demonstrated in some patients despite no improvements in alkaline phosphatase and/or bilirubin, suggesting that UDCA might have additional mechanisms of action.

Life after liver transplant 
A pan-European study found the proportion of LT carried out for NASH increased from 1.2% in 2002 to 8.7% in 2016. Recipient age, BMI, MELD score, donor blood group and organ type predicted post-transplant survival.

Retrospective data from the Tours University Hospital, France, showed that hepatorenal syndrome, classically considered as reversible, appears to be a predictive factor for post-LT chronic kidney disease. 

A study from the University Hospital Essen, Germany, showed that LT recipients who developed donor-specific antibodies (DSA) had a higher risk of complications, suggesting that DSA detection and monitoring may be important to maintain graft quality and survival.


New directions in pathophysiology: stem cells

Dr Carola Maria Morell described modelling experiments showing that human induced pluripotent stem cells can mimic mechanisms of hepatocyte steatosis and lipotoxicity, including the inflammatory and fibrotic response associated with NAFLD progression - an important step towards developing targeted therapies for the disease.

Dr Anabel Fernández-Iglesias reported improvements in portal pressure and liver microcirculatory dysfunction after transplantation of human pluripotent stem cells in an animal model of cirrhosis, suggesting that stem cell transplant may represent a viable therapy for portal hypertension in patients with chronic liver disease. 


New directions in pathophysiology: the gut microbiome

It is by now well-known that the gut microbiome is associated with NAFLD. Dr Cyrielle Caussy presented an interesting way that this could be manipulated as a biomarker for NAFLD severity, showing that 3-(4-hydroxyphenyl) lactate (a singular metabolite of gut microbiome) shares gene-effect with hepatic steatosis and fibrosis.

Dr Cristina Sole described how an analysis of stool samples from 200 patients with cirrhosis using quantitative metagenomics revealed a significant loss of gene richness that correlated with disease stage. Gene richness was strikingly low in patients with ACLF. 

Dr Jasmohan Bajaj showed that a Mediterranean style diet, rich in in vegetables and fermented milk products, along with coffee, tea and chocolate is associated with greater gut microbial diversity and a lower risk of hospitalization in patients with liver cirrhosis.

New Public Health track: a welcome addition to ILC 2018
This new session covered a range of topics in viral hepatitis and NAFLD/NASH. Health state transition models predicted lower morbidity and mortality with early treatment of HCV with DAAs and lower lifetime costs, that ultrasound surveillance for HCC was cost effective in HCV-related cirrhosis after SVR and molecular phylogenetic analyses were able to link cases of an HAV outbreak among MSM in Italy to three European outbreaks, suggesting that efforts to increase HAV vaccine coverage in high-risk groups are required.

In a thought provoking presentation very low food security was shown to almost triple the risk of developing advanced liver fibrosis in people with both diabetes and NAFLD, highlighting that as well as the established risk factors for advanced fibrosis, socioeconomic factors must also be considered.
Don't miss
Summary slide decks for the latest EASL clinical practice guidelines are now available on the ILC 2018 website
Industry symposia - perspectives, advances and frontiers

Celsion: Emerging Horizons in HCC: From Palliation to Cure

Co-chairs and HCC experts Dr Ghassan Abou-Alfa and Professor Riccardo Lencioni led this engaging symposium and challenged the audience to reconsider current treatment paradigms in HCC, particularly for patients once only considered for palliative treatment who can now be targeted for cure. New developments in treating intermediate-size HCC were discussed, including the role of tyrosine kinase inhibitors and immuno-oncology.


Bristol-Myers Squibb: Advanced NASH and HCC – The New Frontiers

An expert panel led by Lawrence Serfaty discussed the pathophysiology and potential complications of advanced NASH and HCC. Attendees gained insights into treatment innovations including immunotherapy, targeted therapies, and combination therapies.

Gilead: Shaping tomorrow together: advances driven by commitment in HBV care

Dr Fabien Zoulim and the expert panel explored future possibilities and priorities for the management of hepatitis B, how our current experience can best be used to shape that future and whether the prospect of moving from virologic control to elimination of HBV infection is a realistic proposition.


Gilead: Shaping tomorrow together – from aspiration to achievement in HCV Care

An eminent panel of hepatologists and virologists encouraged delegates to engage across disciplines and the wider community to move towards HCV elimination by establishing short term, achievable targets and goals. 


Intercept: Primary biliary cholangitis (PBC): old disease, new perspectives

Olivier Chazouillères chaired an exploration of best practice in PBC care, focusing on second-line therapy obeticholic acid for patients with inadequate response to standard-of-care. Delegates gained insight from a patient group representative, and heard about new long-term study results and real-world data.


‘Today at ILC’ was supported by grants from: Abbvie, Alexion, Boehringer Ingelheim, Gilead, Janssen, MSD and Pfizer.

Copyright © 2018 EASL, The Home of Hepatology, All rights reserved.

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Photo copyright: Les Lucioles