Given that little is known about the prevalence of, and factors associated with, liver fibrosis in the general population, we aimed to investigate this in a large, well-characterized cohort by means of transient elastography (TE). This study was part of the Rotterdam Study, a population-based study among individuals 45 years. All participants underwent abdominal ultrasound and TE. Liver stiffness measurement (LSM) 8.0 kilopascals (kPa) was used as a cutoff suggesting clinically relevant fibrosis. Of 3,041 participants (age, 66.0 6 7.6 years) with reliable LSM, 169 (5.6%) participants had LSM 8.0 kPa. Age (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 1.72-3.36; P < 0.001), alanine aminotransferase (ALT; OR, 1.24; 95% CI: 1.12-1.38; P < 0.001), smoking (OR, 1.77; 95% CI: 1.16-2.70; P 5 0.008), spleen size (OR, 1.23; 95% CI: 1.09-1.40; P 5 0.001), hepatitis B surface antigen, or antihepatitis C virus positivity (OR, 5.38; 95% CI: 1.60-18.0; P 5 0.006), and combined presence of diabetes mellitus (DM) and steatosis (OR, 5.20; 95% CI: 3.01-8.98; P < 0.001 for combined presence) were associated with LSM 8.0 kPa in multivariable analyses. The adjusted predicted probability of LSM 8.0 kPa increased per age decade, with probabilities ranging from 1.4% (0.9-3.6) in participants ages 50-60 years to 9.9% (6.8-14.5) in participants >80 years. Participants with both DM and steatosis had the highest probabilities of LSM 8.0 kPa (overall probability: 17.2% [12.5-23.4]; this probability did not increase with age [P 5 0.8]). Conclusion: In this large population-based study of older adults, LSM 8.0 kPa, suggestive of clinically relevant fibrosis, was present in 5.6% and was strongly associated with steatosis and DM. In the context of an aging population and an increased prevalence of DM and obesity, this study illustrates that liver fibrosis may become a more prominent public health issue in the near future. (HEPATOLOGY 2016;63:138-147)

Purpose: To classify healthy and diseased livers by texture analysis (TA). Materials and Methods:We studied 43 patients divided into four groups according to their clinical stage and 10 controls on a 1.5-T magnetic resonance (MR) imager, using a T2-weighted breath-hold sequence. For the TA, features of the first and second order were used, and several classification procedures were applied for the classification of patients and controls. The choice of features was performed manually and by use of the Fischer coefficient, average correlation coefficients between features and multidimensional discrimination measure.Results: All the statistical methods employed were able to differentiate between controls and patients in each group. The classification error varied around 8%. Conclusion:We have shown that texture analysis can be successfully used for separating cirrhotic patients and healthy volunteers. Different sets of TA features can be used for a similar classification of patients.

There are scarce data on the impact of COVID-19 pandemic on liver transplantation (LT) in Europe. The aim of this study was to obtain a preliminary data on incidence, management, and outcome of COVID-19 in liver transplant recipients and candidates in Europe. An Internet-based survey was sent to the centers affiliated with European Liver Transplant Registry (ELTR). One hundred nine out of 149 (73%) of ELTR centers located in 28 European countries (93%) responded. Ninety-four (86%) of the centers tested all donors, and 75 (69%) centers tested all LT recipients for SARS-CoV-2. Seventy-three (67%) centers selected recipients for LT in the COVID-19 pandemic, whereas 33% did not. Eighty-eight centers reported COVID-19 infection in 57 LT candidates and in 272 LT recipients. Overall crude incidence of COVID-19 among LT candidates and recipients was estimated 1.05% (range 0.5-20%) and 0.34% (range 0.1-4.8%), respectively, and it was significantly higher among candidates (P < 0.001). Crude rate of death was 18% (10/57) among candidates and 15% (36/244) among recipients. This first large-scale European snapshot study clearly shows that both LT candidates and recipients are at a high risk for COVID-19. These results plead for an early and pro-active screening of COVID-19 symptoms in these populations.

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Severe complication rate and mortality were low. Performing multiple biopsy passes was not associated with severe complications, whereas hepatic malignancy or elevated international normalized ratio were associated with an increased risk.