As detected by cross-sectional imaging, severe muscle depletion, which is termed sarcopenia, holds promise for prognostication in patients with cirrhosis. Our aims were to describe the prevalence and predictors of sarcopenia in patients with cirrhosis listed for liver transplantation (LT) and to determine its independent prognostic significance for the prediction of waiting-list mortality. Adults listed for LT who underwent abdominal computed tomography/magnetic resonance imaging within 6 weeks of activation were retrospectively identified. The exclusions were hepatocellular carcinoma, acute liver failure, prior LT, and listing for multivisceral transplantation or living related LT. Sixty percent of the 142 eligible patients were male, the median age was 53 years, and the median Model for End-Stage Liver Disease (MELD) score at listing was 15. Fortyone percent were sarcopenic; sarcopenia was more prevalent in males versus females (54% versus 21%, P < 0.001) and increased with the Child-Pugh class (10% for class A, 34% for class B, and 54% for class C, P ¼ 0.007). Male sex, the dry-weight body mass index (BMI), and Child-Pugh class C cirrhosis (but not the MELD score) were independent predictors of sarcopenia. Sarcopenia was an independent predictor of mortality (hazard ratio ¼ 2.36, 95% confidence interval ¼ 1.23-4.53) after adjustments for age and MELD scores. In conclusion, sarcopenia is associated with increased waiting-list mortality and is poorly predicted by subjective nutritional assessment tools such as BMI and subjective global assessment. If this is validated in larger studies, the objective assessment of sarcopenia holds promise for prognostication in this patient population. Liver Transpl 18:1209-1216, 2012. V C 2012 AASLD. See Editorial on Page 1136The adoption of the Model for End-Stage Liver Disease (MELD) score for the allocation of deceased donor hepatic grafts has resulted in reductions in waiting-list mortality and the time to liver transplantation (LT). 1,2 Despite these advantages, the MELD score has recognized limitations, 3,4 including inferior performance in predicting mortality in a subgroup of patients with lower MELD scores. [5][6][7] In order to optimize the utility of the MELD score for the prediction of waiting-list mortality in a broader range of patients and to identify those patients at the greatest risk of deterioration,

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Objectives: We aimed to explore the prevalence of portal hypertension in the most common etiologies of patients with compensated advanced chronic liver disease (cACLD) and develop classification rules, based on liver stiffness measurement (LSM), that could be readily used to diagnose or exclude clinically significant portal hypertension (CSPH) in clinical practice. Methods: International cohort study including patients with paired LSM/hepatic venous pressure gradient (HVPG), LSM ≥10kPa and no prior decompensation. Portal hypertension was defined by an HVPG>5 mmHg. A positive predictive value (PPV) ≥90% was considered to validate LSM cut-offs for CSPH (HVPG≥10 mmHg), while a negative predictive value ≥90% ruled out CSPH. Results: 836 patients were evaluated: hepatitis C (HCV, n=358), non-alcoholic steatohepatitis (NASH, n=248), alcohol (ALD, n=203) and hepatitis B (HBV, n=27). Portal hypertension prevalence was >90% in all cACLD etiologies, except for NASH patients (60.9%), being even lower in NASH obese patients (53.3%); these lower prevalences of portal hypertension in NASH patients were maintained across different strata of LSM values. LSM≥25 kPa was the best cut-off to rule in CSPH in ALD, HBV, HCV and non-obese NASH patients, while in obese NASH patients the PPV was only 62.8%. A new model for NASH patients (ANTICIPATE-NASH model) to predict CSPH considering BMI, LSM and platelet count was developed and a nomogram constructed. LSM≤15 kPa plus platelets ≥150x10 9 /L ruled out CSPH in most etiologies. Conclusions: Patients with cACLD of NASH etiology, especially obese NASH patients, present lower prevalences of portal hypertension compared to other cACLD etiologies. LSM≥25 kPa is sufficient to rule in CSPH in most etiologies, including non-obese NASH patients, but not in obese NASH patients. Response to Reviewers:Point-by-point answers to reviewers' comments: Editor/Editorial Board Comments: Editors: After reviewing the manuscript and the comments from the peer reviewers, we would like to ask the authors to address the following issues raised by the editors:1. Was there any correlation of their findings with EGD, and specifically with the absence/presence of high-risk esophageal varices warranting prophylaxis with betablockers or endoscopic band ligation? This a very good point, but information regarding endoscopy was not requested to the participating centers (only LSM and HVPG were available) and it was not an objective of this study. Only the "ANTICIPATE" cohort had endoscopy data and this has been published in the "Anticipate" paper (Hepatology 2016; 64:2173-84) and the Expanded Baveno paper (Hepatology 2017; 66:1980-8).2. Can the authors please convert lab values in table 1 from SI to conventional units? Done.3. We request the authors provide clearer instructions on how to use the nomogram from figure 3. Maybe they can provide an example or improve the instructions, something similar to what was described for the nomogram in figure 4 of the Hepatology 2016 paper on the "Anticipate" study. Thank you for the...

Hepatitis B virus (HBV) infection is an important public health problem in Canada. In keeping with evolving evidence and understanding of HBV pathogenesis, the Canadian Association for the Study of Liver Disease periodically publishes HBV management guidelines. The goals of the 2018 guidelines are to (1) highlight the public health impact of HBV infection in Canada and the need to improve diagnosis and linkage to care, (2) recommend current best-practice guidelines for treatment of HBV, (3) summarize the key HBV laboratory diagnostic tests, and (4) review evidence on HBV management in special patient populations and include more detail on management of HBV in pediatric populations. An overview of novel HBV tests and therapies for HBV in development is provided to highlight the recent advances in HBV clinical research. The aim and scope of these guidelines are to serve as an up-to-date, comprehensive resource for Canadian health care providers in the management of HBV infection.

MMF is effective and well tolerated by patients with autoimmune hepatitis who do not respond to, or are intolerant of, conventional immunosuppressive agents.