Nagaraja Rao Padaki

Asian Institute of Gastroenterology | AIG · DEPARTMENT OF HEPATOLOGY

Acute liver failure (ALF) is a medical emergency and liver transplantation (LT) may be required as definitive therapy. The etiology varies across geographical locations and is mostly viral dominant in India. We aimed at evaluating the spectrum, impact of interventions (plasma exchange [PLEx], continuous renal replacement therapy [CRRT]) and outcome...

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in India. This review explores the epidemiological trends and the landscape of systemic therapy for HCC in the Indian context, acknowledging the recent shift in etiology from viral hepatitis to lifestyle-associated factors. A comprehensive review of the literature was con...

In this report, we present the case of vanishing bile duct syndrome in the setting of classical Hodgkin lymphoma. Vanishing bile duct syndrome was diagnosed retrospectively in this patient with Hodgkin lymphoma, who initially presented with a hepatic abnormality presumed to be drug induced. Vanishing bile duct syndrome is characterized by the disap...

Background/Purpose Genome‐wide association studies have reported the association of common variants with nonalcoholic fatty liver disease in genes, namely, PNPLA3/TM6SF2/MBOAT7/HSD17B13 , across ethnicities. However, the approach does not identify rarer variants with a higher effect size. We therefore sequenced the complete exonic regions of patien...

Background Post‐COVID‐19 cholangiopathy is an emerging cholestatic liver disease observed in patients recovering from severe COVID‐19 infection. Its prognosis is poor, necessitating liver transplantation in some cases. This study aimed to investigate the outcomes of liver transplantation for post‐COVID‐19 cholangiopathy. Methods Seven patients who...

Background Ascites is expected to resolve within 2 to 4 weeks following orthotopic liver transplantation. New-onset ascites after transplant is associated increased morbidity and affects quality of life. The risk of opportunistic infections is high in transplant recipients due to immunosuppressive drugs. Objective The objective was to assess the in...

Background: Atezolizumab-bevacizumab (atezo-bev) is recommended as first-line therapy for patients with unresectable hepatocellular carcinoma (uHCC). However, its effectiveness and safety in other populations, including those with Child-Turcotte-Pugh (CTP) class B cirrhosis, is unclear. Methods: For this systematic review and meta-analysis, elec...

Cirrhosis transcends various progressive stages from compensation to decompensation driven by the severity of portal hypertension. The downstream effect of increasing portal hypertension severity leads to various pathophysiological pathways, which result in the cardinal complications of cirrhosis, including ascites, variceal hemorrhage, and hepatic...

Background: Liver transplantation (LT) is associated with excellent survival in patients with acute-on-chronic liver failure (ACLF). There is a lack of data assessing the healthcare utilization and outcomes of patients with APASL-defined ACLF undergoing living donor liver transplantation (LDLT). Our aim was to assess pre-LT healthcare utilization...

Background and aims: Kayser-Fleischer (KF) rings are due to copper deposition in Descemet membrane of the cornea in Wilson disease. Pseudo-KF ring (PKF), seen in patients with high bilirubin, is often misinterpreted as KF rings. These are bilirubin deposits in posterior corneal stroma. The aim of the study was to prospectively evaluate the presenc...

Background and study aims Percutaneous liver biopsy is traditionally done on the right lobe of the liver. Endoscopic ultrasound-guided liver biopsy (EUS-LB) can be performed on either the left or right lobe or as a combined bi-lobar biopsy. Earlier studies did not compare the benefit of bi-lobar biopsies to single-lobe biopsy for reaching a tissue...

Background: Atezolizumab-bevacizumab (atezo/bev) combination is a recommended first-line systemic therapy for unresectable hepatocellular carcinoma (uHCC). There are no studies from India reporting the safety and efficacy of this drug in real-world settings where most patients present in an advanced stage. Methods: In this retrospective study fr...

Background: Alcohol is one of the most common causes of liver cirrhosis. Yet, the pattern of alcohol consumption in cirrhosis is rarely studied. This study aims to study the drinking patterns along with the educational, socioeconomic, and mental health in a cohort of patients with and without liver cirrhosis. Methods: This prospective observatio...

Worldwide, an estimated 2 billion individuals consume alcohol, which contributes to short-term or long-term consequences on health and social life. Alcohol is the cause of approximately 1.8 million deaths per year, representing 3.2% of all deaths worldwide. Of the 2 billion individuals who consume alcohol, more than 75 million are diagnosed with al...

Background and Aims Recent studies have reported poor humoral immune response to mRNA vaccines in patients with chronic liver disease (CLD). However, the immunogenicity of ChAdOx1 (vector-based) and BBV152 (inactivated virus) vaccines in patients with CLD and liver transplant recipients (LTRs) is unknown. Therefore, we aimed to assess the immunogen...

Background Tinospora cordifolia (giloy) is a commonly used herbal supplement mentioned in Indian alternative medicine for its action as an immune booster. During the COVID 19 pandemic many commercial preparations of giloy became popular and gained widespread use among the public to prevent severe COVID 19 infections. Some of these patients develope...

Dengue fever is not an uncommon arboviral infection in lieu of tropical geography. The gravity of the disease ranges from an Outpatient Department (OPD) visits for febrile illness to haemorrhagic complications like shock. Hereby, authors report a case of a 33-year-old female patient with no prior morbidities. Initial fever episodes due to dengue re...

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Aim Nonselective beta‐blockers (NSBBs) can reduce the incidence of complications in patients with cirrhosis and prolong survival. The safety and efficacy of NSBBs in real‐world settings in patients with acute‐on‐chronic liver failure (ACLF) identified by the Asian Pacific Association for the Study of Liver criteria are unknown. This study aimed to...

Strategies to prevent infection and improve outcomes in patients with cirrhosis. HAV, hepatitis A virus; HBV, hepatitis B virus; COVID-19, novel coronavirus disease 2019; NSBB, nonselective β-blocker; PPI, proton pump inhibitors. Cirrhosis is a risk factor for infections. Majority of hospital admissions in patients with cirrhosis are due to infecti...

Background Non-alcoholic fatty liver disease (NAFLD) is now considered to precede the development of diabetes and metabolic syndrome (MetS) overriding the earlier notion of NAFLD being the hepatic manifestation of MetS. Studies identified variants conferring enhanced susceptibility to MetS predominantly in lipid metabolism related genes. A variant...

The COVID-19 pandemic has impacted transplantation worldwide in a major way with infections and post-COVID-19 complications contributing to increased mortality and morbidity. We present a case of a 42-year-old lady who developed rhino-orbital mucormycosis in a postliver transplantation period. The initial presentation of the patient was very subtle...

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Terlipressin with albumin, the recommended treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI), is associated with adverse events. Furthermore, the course of AKI in patients with acute-on-chronic liver failure (ACLF) is unknown. We aimed to analyze the safety and efficacy of terlipressin infusion and AKI course in patients with ACLF. W...

Background: Previous data from South Asia and India had shown that patients with nonalcoholic fatty liver disease (NAFLD) have mild liver disease severity. There are no data regarding long-term clinical outcomes in patients with NAFLD from South Asia. The aim of the study was to evaluate the clinicopathological profile, severity of NAFLD, and clini...

Introduction: This study aimed to evaluate the role of prophylactic norfloxacin in preventing bacterial infections and its effect on transplant-free survival (TFS) in patients with acute-on-chronic liver failure (ACLF) identified by the Asian Pacific Association for the Study of the Liver criteria. Methods: Patients with ACLF included in the stu...

Background: Terlipressin with albumin, the recommended treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI), is associated with adverse events. Furthermore, the course of AKI in patients with acute-on-chronic liver failure (ACLF) is unknown. We aimed to analyze the safety and efficacy of terlipressin infusion and AKI course in patients...

Background Immunosuppression and comorbidities increase the risk of severe coronavirus disease-2019 (COVID-19) in solid organ transplant (SOT) recipients. The outcomes of COVID-19 in liver transplant (LT) recipients remain unclear. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recip...

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Background and Aims Hematopoietic stem cell (HSC) infusion has demonstrated short term improvement in liver functions in chronic liver disease patients. Combination of HSC with mesenchymal stem cells (MSC), which have an immunomodulatory effect may augment the effects and enhance the duration of improvements on liver functions. The aim of the prese...

Background and aims: Currently, there is no pharmacotherapy for non-alcoholic steatohepatitis (NASH), a common liver disorder. In contrast, primary biliary cholangitis (PBC) is a chronic cholestatic liver disease for which ursodeoxycholic acid (UDCA) is the drug of choice. However, 50% of PBC patients may not respond to UDCA. Obeticholic acid (OCA...

Cyproterone acetate (CPA), a hydroxyprogesterone derivative, is used to treat advanced prostate cancer and infrequently in females for acne, breast cancer, and hirsutism. Transient mild liver enzymes' elevation is reported in 10% -30% of patients, and acute liver failure (ALF) is uncommon. Here we discuss the first case of CPA-induced ALF from Indi...

Background and Aims: Long-term data on cell-based therapies, including hematopoietic stem cell infusion in cirrhosis, are sparse and lacking. Methods: Patients with cirrhosis of non-viral etiology received either standard-of-care (n = 23) or autologous CD34+ cell infusion through the hepatic artery (n = 22). Study patients received granulocyte colo...

We read with interest the study by Wong et al. (1) We congratulate the authors for the commendable work. We would like to share our concerns regarding the study. There were a greater number of patients with hepatorenal syndrome (HRS) in the deceased donor liver transplantation (DDLT) group than living donor liver transplantation (LDLT) group. (1)...

Background Terlipressin with albumin is the recommended standard of care for hepatorenal syndrome. However, there is a paucity of Asian data on the use of terlipressin in acute-on-chronic liver failure (ACLF) patients. We aimed to evaluate the safety and efficacy of terlipressin infusion in ACLF patients with HRS-AKI (acute kidney injury). Methods...

Background: The only proven treatment for non-alcoholic steatohepatitis (NASH) and primary biliary cholangitis are lifestyle changes and ursodeoxycholic acid, respectively. Obeticholic acid (OCA), a farnesoid X receptor agonist, has shown promising results in NASH and PBC. We aimed to analyze the effect of OCA in liver disease. Methods: A comprehen...

A significant proportion of patients with non-alcoholic fatty liver disease (NAFLD) in Asian sub-continent are non-overweight and may have different underlying risk factors, lifestyles and metabolic profiles. Seven hundred fifty patients of NAFLD with raised alanine-amino-transferase (ALT) were divided into non-overweight and obese group based on t...

LINKED CONTENT This article is linked to Kulkarni et al and Elhence et al papers. To view these articles, visit https://doi.org/10.1111/apt.15916 and https://doi.org/10.1111/apt.16010

Background The incidence of elevated liver chemistries and the presence of the pre‐existing chronic liver disease (CLD) have been variably reported in COVID‐19. Aims To assess the prevalence of CLD, the incidence of elevated liver chemistries and the outcomes of patients with and without underlying CLD/elevated liver chemistries in COVID‐19. Meth...

Background Paracentesis induced circulatory dysfunction (PICD) is seen in up to 70% of patients undergoing large‐volume paracentesis (LVP). We performed comparative effectiveness of available pharmacological interventions for the prevention of PICD in cirrhotic patients undergoing LVP. Methods A comprehensive search of electronic databases from...

Annually, 10% of cirrhotic patients with ascites develop refractory ascites for which large-volume paracentesis (LVP) is a frequently used therapeutic procedure. LVP, although a safe method, is associated with circulatory dysfunction in a significant percentage of patients, which is termed paracentesis-induced circulatory dysfunction (PICD). PICD r...

Introduction: Development of ascites or encephalopathy is an ominous sign in a cirrhotic patient. Acute-on-chronic liver failure (ACLF) is a syndrome of acute portal hypertension, and both ascites and encephalopathy are part of the definition of APASL ACLF. We evaluated the impact of the development of ascites and hepatic encephalopathy (HE) at bas...

A 50-year-old man with cirrhosis presented with shortness of breath. Transthoracic echocardiography, shown in a video, revealed opacification of the chambers on the left side of the heart by microbubbles five heartbeats after the appearance of microbubbles in the right atrium, and a diagnosis of hepatopulmonary syndrome was made.

Background and Aims: Use of complementary and alternative medicine (CAM) is not well characterized among Indian patients with liver dis- eases. We did a hospital-based patient interview survey about CAM usage in patients with liver disease. Methods: We interviewed adult patients attending hepatology OPD at AIG hospitals using a specific CAM questio...

Background: Non-alcoholic fatty liver disease (NAFLD) is a condition where excess fat accumulates in the liver without alcohol consumption with no approved treatments. Lifestyle changes including dietary modifi- cations are recommended for treatment. Earlier studies identified that the ratio of n-6 to n-3 PUFAs interacted with the rs738409-GG-PNPLA...

Background: Mesenchymal and hematopoetic stem cells(HSC) have been individually used in multiple studies with varied success. Immunomodulatory effect of MSC may augment the effect of HSC. We present this safety study to see the in vivo stability of co culture of HSC and MSC and also the safety of the combination infusion of MSC and HSC in humans. M...

Background: Paracentesis induced circulatory dysfunction (PICD) is seen in up to 70% of patients undergoing large volume paracentesis (LVP). Several drugs, like albumin (8g/L of ascites tapped,4g/L), terlipressin, midodrine, noradrenaline, etc have been used to prevent PICD . Till date, albumin is considered as a safe and effective drug for the pre...

INTRODUCTION The paucity of organs for liver transplant coupled with rising cost have paved the way for research in alternative cell based therapies as a bridge to liver transplantation. Our initial published work with 6 months follow up have now been followed up for 3 years and the data is presented below METHODS Cirrhotic patients of non-viral e...

INTRODUCTION NCPH is the presence of portal hypertension (PH) in the absence of cirrhosis. While Schistosomiasis is the commonest cause in West, myeloproliferative diseases (MPD) characterized by cellular proliferation of one or more hematologic cell lines resulting in extra-medullary hematopoiesis predominantly in the spleen and occasionally in li...

Background: Idiosyncratic drug‐induced liver injury (DILI) is a common cause of acute liver failure (ALF) worldwide. The causes and outcome vary geographically. We conducted a nationwide prospective DILI study from 2013 to 2018. This report summarizes the causes, clinical features, outcomes and predictors of mortality amongst those patients who dev...

Background: Idiosyncratic drug‐induced liver injury (DILI) is a common cause of acute liver failure (ALF) worldwide. The causes and outcome vary geographically. We conducted a nationwide prospective DILI study from 2013 to 2018. This report summarizes the causes, clinical features, outcomes and predictors of mortality amongst those patients who dev...

Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality and healthcare expenditure in patients with chronic liver disease in India. The Indian National Association for Study of the Liver (INASL) had published its first guidelines on diagnosis and management of HCC (The Puri Recommendations) in 2014, and these guidelines we...

Liver diseases occurring during pregnancy can be serious and can progress rapidly, affecting outcomes for both the mother and fetus. They are a common cause of concern to an obstetrician and an important reason for referral to a hepatologist, gastroenterologist, or physician. Liver diseases during pregnancy can be divided into disorders unique to p...

Introduction Hepatitis C virus (HCV) displays high genetic diversity, characterized by regional variations in the prevalence of genotype posing challenges to the development of vaccines and definitive treatment. Very few reports exist on the distribution and frequency change of HCV genotypes in India. In the present retrospective study, we aimed to...

Abstract Background and Aim: Nonalcoholic fatty Liver disease (NAFLD) is a spectrum of liver diseases with simple steatosis on one end and Hepatocellular carcinoma on the other. Although obesity is a known risk factor for NAFLD, individuals with normal body mass index also have hepatic fatty infiltration now termed “Lean-NAFLD”. It represents a dis...

Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids is emerging to be an important cause of morbidity and mortality in patients with current or prior exposure to HBV infection. These patients suffer a dual onslaught of illness: one from the primary disease for which they are re...

Background/objectives Individuals with Gilbert's syndrome (GS) harbor mutations in the UGT1A1 gene and are known to have elevated levels of bilirubin, which enhances the risk for gall stone formation. The aim of this study is to screen Indian patients with GS for the incidence of gall stone disease. Methods Individuals with persistently elevated s...

Aims We studied in-hospital predictors of mortality of acute on chronic liver failure (ACLF) in Indian patients. Methods Patients admitted to the intensive care unit of our institute fulfilling the definition of ACLF based on the Asia-Pacific Association for Study of Liver Disease (APASL) consensus were included. Complete history and medical evalu...

AIM: To validate the association of variants in PNPLA3 (rs2281135) and TM6SF2 (rs58542926) genes with ultrasound detected Non-alcoholic fatty liver disease. METHODS: A total of 503 individuals with and without fatty infiltration were recruited. Fatty infiltration was confirmed based on ultrasound findings. Anthropometric data and blood samples were...