Saleh M. Elwir M.D.

Montano-Loza, A. J., Ronca, V., Ebadi, M., Hansen, B. E., Hirschfield, G., Elwir, S., Alsaed, M., Milkiewicz, P., Janik, M. K., Marschall, H. U., Burza, M. A., Efe, C., Calışkan, A. R., Harputluoglu, M., Kabaçam, G., Terrabuio, D., de Quadros Onofrio, F., Selzner, N., Bonder, A., Parés, A., Llovet, L., Akyıldız, M., Arikan, C., Manns, M. P., Taubert, R., Weber, A. L., Schiano, T. D., Haydel, B., Czubkowski, P., Socha, P., Ołdak, N., Akamatsu, N., Tanaka, A., Levy, C., Martin, E. F., Goel, A., Sedki, M., Jankowska, I., Ikegami, T., Rodriguez, M., Sterneck, M., Weiler-Normann, C., Schramm, C., Donato, M. F., Lohse, A., Andrade, R. J., Patwardhan, V. R., van Hoek, B., Biewenga, M., Kremer, A. E., Ueda, Y., Deneau, M., Pedersen, M., Mayo, M. J., Floreani, A., Burra, P., Secchi, M. F., Beretta-Piccoli, B. T., Sciveres, M., Maggiore, G., Jafri, S. M., Debray, D., Girard, M., Lacaille, F., Lytvyak, E., Mason, A. L., Heneghan, M. and Oo, Y. H. (2022). “Risk factors and outcomes associated with recurrent autoimmune hepatitis following liver transplantation.” J Hepatol.

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BACKGROUND & AIMS: The impact of recurrent autoimmune hepatitis (AIH) post-liver transplant on patient and graft survival is not well characterised. We evaluated a large, international multi-center cohort to identify the probability and risk factors associated with recurrent AIH and the association between recurrent disease and patient and graft survival. METHODS: We included 736 patients (77% female, mean age, 42±1 years) with AIH who underwent LT from January 1987 through June 2020, among 33 centers in North America, South America, Europe and Asia. Clinical data before and after LT, biochemical data within the first 12 months after LT, and immunosuppression after LT were analyzed to identify patients with higher risk of recurrence of AIH based on histological diagnosis. RESULTS: AIH recurred in 20% of patients after 5 years and 31% after 10 years. Age at LT ≤42 years (HR, 3.15; 95% CI, 1.22-8.16; p=0.02), use of mycophenolate mofetil post-LT (HR, 3.06; 95% CI, 1.39-6.73; p=0.005), donor and recipient sex mismatch (HR, 2.57; 95% CI, 1.39-4.76; p=0.003) and high IgG pre-LT (HR, 1.04; 95% CI, 1.01-1.06; p=0.004) were associated with higher risk of AIH recurrence after adjusting for other confounders. In multivariate Cox regression with time-dependent covariate, recurrent AIH significantly associated with graft loss (HR, 10.79, 95% CI 5.37-21.66, p<0.001) and death (HR, 2.53, 95% CI 1.48-4.33, p=0.001). CONCLUSION: Recurrence of AIH following transplant is frequent and is associated with younger age at LT, use of mycophenolate mofetil post-LT, sex mismatch and high IgG pre-LT. We demonstrate an association between disease recurrence and impaired graft and overall survival in patients with AIH, highlighting ongoing efforts to better characterize, prevent and treat recurrent AIH. LAY ABSTRACT: Recurrent autoimmune hepatitis following liver transplant is frequent and is associated with some recipient features and the type of antirejection medications. Recurrent autoimmune hepatitis negatively affects the outcome after liver transplant.

Elwir, S., C. Anugwom, E. K. Connor, N. H. Giama, A. Ndzengue, J. Menk, E. A. Mohamed, L. R. Roberts and M. Hassan (2018). “Barriers in Hepatitis C Treatment in Somali Patients in the Direct Acting Antiviral Therapy Era.” J Natl Med Assoc 110(6): 556-559.

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BACKGROUND AND AIMS: Hepatitis C virus (HCV) treatment has changed dramatically in the last few years. Our observations suggest that a minority of HCV infected Somalis are treated. In this study, we aimed to evaluate for treatment and health outcome disparities between Somali and non-Somali patients during the direct acting antiviral (DAA) era. METHODS: Patients with HCV seen in the gastroenterology clinic in 2015 were included in the study. Patients were identified using ICD9 and 10 codes. Electronic medical records were analyzed to evaluate for treatment candidacy, acceptance and reasons for refusal of treatment. RESULTS: Genotype 4 followed by 3 were the most common genotypes in the Somalis while genotype 1 was the most common in the non-Somalis. Majority of patients were offered treatment, active alcohol and substance abuse was a common reason for not offering treatment in non-Somalis while the presence of hepatocellular carcinoma was the most common reason in Somalis. Somalis had higher rates of declining treatment given the asymptomatic nature of their disease and the feeling that treatment is not needed. Sustained virologic response rates were comparable in both groups. CONCLUSIONS: Disparities in acceptance of HCV treatment persist in the DAA era. The asymptomatic nature of the infection and potential cultural mistrust makes patients hesitant to undergo treatment. Healthcare providers must find interventions aimed at reducing barriers to treatment and increasing acceptance of HCV treatment.

Elwir, S. and R. S. Rahimi (2017). “Hepatic encephalopathy: An update on the pathophysiology and therapeutic options.” J Clin Transl Hepatol 5(2): 142-151.

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Hepatic encephalopathy is a spectrum of reversible neuropsychiatric abnormalities, seen in patients with liver dysfunction and/or portosystemic shunting. One of the most debilitating complications of cirrhosis, encephalopathy affects 30-45% of cirrhotics. In addition to significantly affecting the lives of patients and their caregivers, it is also associated with increased morbidity and mortality as well as significant utilization of health care resources. In this paper, we provide an overview on the pathophysiology, diagnosis, management and newer therapies of hepatic encephalopathy.