James O'Beirne

James O'Beirne
University of the Sunshine Coast | USC · Faculty of Science, Health, Education and Engineering

MBBS MD FRCP FRACP EDIC

About

249
Publications
16,667
Reads
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7,365
Citations
Additional affiliations
September 2009 - present
University of London
Position
  • Professor (Associate)
January 2009 - present
University College London
Position
  • Lecturer
July 2007 - present
Royal Free London NHS Foundation Trust
Position
  • consultant Hepatologist

Publications

Publications (249)
Article
Full-text available
Background and AimsWe aimed to validate newly proposed noninvasive criteria for diagnosing clinically significant portal hypertension (CSPH) using liver stiffness measurements (LSM) by transient elastography (TE) and platelet count.Methods Diagnostic performance of these new criteria for CSPH (LSM ≥ 25 kPa to rule in and Plt ≥ 150 × 109/L + LSM ≤ 1...
Article
Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct‐acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real‐world cohort. REACH‐C is an Australian observational study (n=10843) evaluating treatment outcomes of sequential DAA initiations across 3...
Article
Full-text available
Background Non-alcoholic fatty liver disease (NAFLD) is an emerging epidemic that affects approximately half of all people with type 2 diabetes. Those with type 2 diabetes are a high-risk NAFLD subgroup because of their increased risk of clinically significant liver-related outcomes from NAFLD which include hepatocellular carcinoma, cirrhosis-relat...
Article
Full-text available
Background The natural history and incidence of hepatocellular carcinoma (HCC) arising from indeterminate liver lesions are not well described. We aimed to define the incidence of HCC in a cohort of patients undergoing surveillance by magnetic resonance imaging (MRI) and estimate any associations with incident HCC. Methods We performed a retrospec...
Article
Full-text available
Background and study aims Refractory variceal bleeding is associated with high mortality in patients with chronic liver disease. A fully-covered self-expanding metal stent (SEMS) has been reported to have excellent rates of technical success and initial bleeding control; however, studies to date are small and limited to Europe and Asia. Our aim was...
Article
Full-text available
Aims: We explored barriers and facilitators to implementation of a nonalcoholic fatty liver disease (NAFLD) pathway for people with diabetes to identify determinants of behaviour surrounding the diagnosis, assessment, and management of NAFLD. Methods: Health practitioners (n=24) recruited from multidisciplinary diabetes clinics in primary care (...
Article
Background and aims To evaluate two-dimensional shear wave elastography (2DSWE) in parallel with transient elastography (TE) for diagnosing clinically significant portal hypertension (CSPH) and high-risk varices (HRV) in patients with chronic liver disease. Patients and methods Consecutive patients with suspicion of compensated advanced chronic li...
Article
Full-text available
Non-alcoholic fatty liver disease (NAFLD) is becoming the leading cause of liver morbidity worldwide and, as such, represents the pathogenic background for the increasing incidence of hepatocellular carcinoma (HCC). The annual incidence of NAFLD-related HCC is expected to increase by 45–130% by 2030. Diabetes mellitus is the most important risk fac...
Article
Full-text available
Australia was one of the first countries with unrestricted access to government subsidized direct‐acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real‐world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss t...
Preprint
Full-text available
Background The natural history and incidence of hepatocellular carcinoma (HCC) arising from indeterminate liver lesions is not well characterised. We aimed to define the incidence of HCC in a cohort of patients undergoing surveillance by magnetic resonance imaging (MRI) and estimate any associations with incident HCC.Methods We performed a retrospe...
Article
Background Direct acting antiviral (DAA) therapy is highly effective for hepatitis C virus (HCV) infection, but reinfection following treatment may compromise benefits of cure. This study assessed the real-world effectiveness of treatment for reinfection. Methods Real-world effectiveness of antiviral therapy in chronic hepatitis C (REACH-C) is an...
Article
Background/objective Methotrexate (MTX) is widely used in various medical specialties. However, hepatotoxicity is an ongoing concern and this is thought to be directly associated with cumulative dose. We sought to synthesise the published literature to evaluate the association between methotrexate hepatotoxicity and cumulative dose. Methods A syst...
Article
Background The endoscopic appearance of oesophageal varices determines the need for prophylaxis. However, as the point prevalence of varices is low (25%), the majority of surveillance endoscopies are unnecessary and costly. Narrow diameter,ultrathin (UT) endoscopes are more tolerable than conventional upper gastrointestinal (UGI) endoscopes and can...
Article
Background: In clinical trials, HCV salvage treatment with Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX) achieved an SVR12 rate of >95% in NS5A-experienced participants. Lower SVR12 rates have been reported in real-world studies, particularly for genotype (GT)3 infection and cirrhosis. We determined the efficacy and safety of SOF/VEL/VOX in a...
Article
Full-text available
LINKED CONTENT This article is linked to Dunne et al paper. To view this article, visit https://doi.org/10.1111/apt.15797
Article
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The effects of hepatitis C virus (HCV), such as morbidity and mortality associated with cirrhosis and liver cancer, is a major public health issue in Australia. Highly effective treatment has recently been made available to all Australians living with HCV. A decision-analytic model was developed to evaluate the cost-effectiveness of the hepatology...
Article
Full-text available
Background: Non-alcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease in Australia and its recent increase mirrors the obesity and type 2 diabetes epidemics. Currently, many patients who present to primary care with abnormal liver function tests or steatosis on liver ultrasound are referred for assessment in second...
Article
Background: The rate of hospital admissions for cirrhosis increased 1.3-fold during 2008-2016 in Queensland. Alcohol misuse was a contributing factor for cirrhosis in 55% of admissions and 40% of patients had at least one comorbidity. Aim: This paper examines the temporal change in aetiology of liver disease and presence of comorbidity in patien...
Article
Background: Current guidelines suggest using transient elastography (TE) or APRI score <1 to exclude cirrhosis prior to commencing treatment for hepatitis C (HCV). Recently FIB-4 <0.93 has been shown to have a high negative predictive value (NPV) for the presence of cirrhosis. Aims: We aimed to assess FIB-4 and APRI in our cohort of HCV patients...
Article
Full-text available
Background: Anticoagulation alone in acute, extensive portomesenteric vein thrombosis (PVT) does not always result in spontaneous clot lysis, and leaves the patient at risk of complications including intestinal infarction and portal hypertension. Aim: To develop a new standard of care for patients with acute PVT and evidence of intestinal ischae...
Article
Full-text available
p>BACKGROUND: The identification of patients with advanced liver fibrosis secondary to non-alcoholic fatty liver disease (NAFLD) remains challenging. Using non-invasive liver fibrosis tests (NILT) in primary care may permit earlier detection of patients with clinically significant disease for specialist review, and reduce unnecessary referral of pa...
Article
Full-text available
Background: The primary purpose of educational interventions is to optimize the clinical management of patients. General practitioners (GPs) play a major role in the detection and management of diseases. This systematic literature review will describe the type and outcomes of educational interventions designed for general practitioners (GPs) in the...
Article
Background/aims: Post-liver transplant (LT) metabolic syndrome (PTMS) and cardiovascular (CVS) mortality are becoming increasingly prevalent following sustained improvements in post-LT survival. We investigated the prevalence and predictors of PTMS and CVS complications in a cohort of consecutive LT recipients. Methods: We reviewed prospectively...
Article
Full-text available
Background Haemorrhage from ruptured oesophageal varices is a common cause of death in people with cirrhosis. Guidelines recommend screening for varices at time of cirrhosis diagnosis and throughout the course of the disease. Conventional gastroscopy is the criterion standard for variceal screening; however, is invasive, costly, and carries risks r...
Article
Full-text available
Background: Limited information is available about hospitalization rates for cirrhosis in Australia. Methods: Using information on all hospital episodes of care for patients admitted to Queensland hospitals during 2008-2016, we report age-standardized hospitalization rates/10,000 person-years, in-hospital case-fatality rate among these admission...
Article
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Background: Tacrolimus minimization is usually restricted to patients with pre-transplant renal impairment and this strategy could result into worse renal outcomes after liver transplantation (LT). Methods: A consecutive cohort of 455 LT patients receiving tacrolimus-based immunosuppression was studied (2008-2013). Cumulative exposure to tacroli...
Article
Full-text available
Background and Aim Liver cirrhosis is associated with widespread microcirculatory dysfunction and hemodynamic derangement, which may play a role in the pathogenesis of multiple organ failure. Little is known, however, about the progression of microvascular alterations as the severity of liver disease worsens. Therefore, our aim is to quantify the p...
Article
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Background: Human cytomegalovirus (HCMV) can be managed by monitoring HCMV DNA in the blood and giving valganciclovir when viral load exceeds a defined value. We hypothesised that such pre-emptive therapy should occur earlier than the standard 3000 genomes/ml (2520 IU/ml) when a seropositive donor transmitted virus to a seronegative recipient (D+R...
Data
Spreadsheet containing the data used for the analyses described in this paper. (XLSX)
Article
Full-text available
The incidence of hepatocellular carcinoma (HCC) is increasing. Notably, the majority of these patients have two potentially life-threatening conditions (cirrhosis and HCC), and management requires close working between several specialties. Treatment of HCC is also an active area of research, and the last decade has seen an increase in the number of...
Article
Background Australia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; how...
Article
Background: despite a 450% increase in UK alcohol-related liver disease mortality over the past 30 years, little evidence-based guidance exists regarding preventing recidivism post-liver transplant for alcohol-related liver disease. Method: a systematic literature review was conducted to identify demographic variables predictive of alcohol relapse...
Article
Objectives: 'Hub-and-spoke' networks may be one solution to reduce the geographical inequality in access to liver transplantation (LT) and the growing demands on, and saturation of, LT centres. It is not clear if such networks improve equity of access, deliver comparable patient outcomes or effect patient satisfaction. Study design: Retrospectiv...
Chapter
A 65-year-old man with non-alcoholic steatohepatitis cirrhosis presented to the outpatient clinic. He had portal vein thrombosis and chronic hepatic encephalopathy with 3 admissions in the previous year despite lactulose and rifaximin. Laboratory workup was remarkable for INR 1.1, creatinine 105 μmol/L, bilirubin 22.3 μmol/L, sodium 141 and albumin...
Article
Full-text available
Background: Intrahepatic microvascular derangements and microcirculatory dysfunction are key in the development of liver cirrhosis and its associated complications. While much has been documented relating to cirrhosis and the dysfunction of the microcirculation in the liver parenchyma, far less is known about the state of the extrahepatic microcir...
Article
Full-text available
Background & aims: Infections are life threatening to patients with acute decompensation and acute-on-chronic liver failure (AD/ACLF). Patients with AD/ACLF have prostaglandin E2-mediated immune suppression, which can be reversed by administration of albumin; infusion of 20% human albumin solution (HAS) might improve outcomes of infections. We per...
Conference Paper
Introduction Hepatitis C virus (HCV) affects approximately 230000 Australians and leads to cirrhosis, progressive liver failure and hepatocellular carcinoma (HCC). The introduction of directly-acting antiviral (DAA) therapies has revolutionised management due to improved tolerability and efficacy. Unlike other health systems funding for unrestricte...
Conference Paper
Introduction The Albumin-Bilirubin (ALBI) grade, has been recently proposed for assessing liver function in patients with hepatocellular carcinoma (HCC) showing good performance in predicting survival after liver resection (LR) and loco-regional therapy. We aimed to evaluate the impact of post operative change in ALBI to predict decompensation and...
Article
Background & aims: Controversy exists on the impact of non-selective beta-blockers (NSBBs) on survival in patients with ascites. We assessed whether NSBB treatment affects survival in a cohort of 316 consecutive patients with ascites undergoing evaluation for liver transplantation. Methods: Consecutive patients with cirrhosis and ascites assesse...
Article
Objectives: We assessed the prognostic significance of infections in relation to current prognostic scores and explored if infection could be considered per se a distinct clinical stage in the natural history of cirrhosis. Methods: We included consecutive patients with cirrhosis admitted to a tertiary referral liver unit for at least 48 h over a...
Article
Full-text available
AIM To identify significant liver disease [including nodular regenerative hyperplasia (NRH)] in asymptomatic Didanosine (DDI) exposed human immunodeficiency virus (HIV) positive patients. METHODS Patients without known liver disease and with > 6 mo previous DDI use had liver stiffness assessed by transient elastography (TE). Those with alanine tra...
Article
AIM: To identify significant liver disease [including nodular regenerative hyperplasia (NRH)] in asymptomatic Didanosine (DDI) exposed human immunodeficiency virus (HIV) positive patients. METHODS: Patients without known liver disease and with > 6 mo previous DDI use had liver stiffness assessed by transient elastography (TE). Those with alanine tr...
Article
Conclusion: We developed and validated a new accurate model for GFR assessment in cirrhosis, the Royal Free Hospital cirrhosis GFR, using readily available variables; this remains to be tested and incorporated in prognostic scores in patients with cirrhosis. (Hepatology 2017;65:582-591).
Article
Full-text available
We are not aware of a report detailing the complex obstetrical and medical management of twin pregnancy in the context of HIV infection and early post-liver transplantation period. Here we describe the successful outcome of a twin pregnancy in a 28-year-old HIV-positive female receiving antiretroviral therapy and immunosuppressive therapy who was t...