Management of Alcoholic Liver Disease

324 Pages·2016·16.75 MB·English

Hepatology
Associates
Course
SUNDAY, NOVEMBER 13, 2016
8:00 AM–1:30 PM
Program Chairs:
Lisa M. Richards, MSN, FNP
Walid S. Ayoub, MD, FAASLD
Content
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Update to
Hepatitis C
Practice
Guidance
Recommendations for The section on patient monitoring
Testing, Managing, was updated in September 2016.
and Treating HCV
New recommendations include
testing all patients for HBV,
HBV vaccination for susceptible
individuals, starting HBV therapy in
patients who meet the criteria for
treatment, and monitoring patients
for HBV reactivation during HCV
DAA treatment.
Visit hcvguidelines.org for the latest
evidence-based clinical guidance in HCV care.
Fund your
future in
hepatology.
CALL FOR APPLICATIONS
NP/PA Clinical
Hepatology
Fellowship
$78,000, One Year*
T
he NP/PA Clinical Hepatology
Fellowship is designed to increase
the number of associate providers in
Above: Nicole Triggs, 2015 recipient;
clinical hepatology by providing $78,000 for
Patrick M. Horne, 2009 recipient;
Karie Robinson, 2015 recipient;
salary and benefit support to certified and
Rebekka Klemme, 2014 recipient
licensed Nurse Practitioners (NP) or Physician
Assistants (PA) pursuing one year of clinical IMPORTANT
hepatology training beginning July 1, 2017.
APPLICATION DEADLINE:
*Salary and benefit support only. Thursday, February 2, 2017
The AASLD Foundation provides equal opportunity for all award
applicants without regard to race, color, creed, religion, gender, sexual AWARD START DATE:
orientation, national origin, age, marital status, mental or physical
July 1, 2017
disability, pregnancy, military or veteran status, or any other basis
prohibited by state or federal law.
APPLICATIONS ARE AVAILABLE AT
www.aasldfnd.org/awards
Table of Contents
Continuing Education Information ......................................................................................... 1
Faculty, Planner and AASLD Staff Disclosures ......................................................................... 3
2016 Hepatology Associates Course Program and Agenda .................................................... 10
Speaker Presentations

Session I: Outpatient Management of ASH, NASH, Co-Infection and Cirrhosis Beyond Portal
Hypertension

Managing Alcoholic Hepatitis
Vijay Shah, MD……………………………………………………………………………………………………….……11
Management of Metabolic Syndrome and NASH
Rohit Loomba, MD…………………………………………………………..…………………………………….…….49
Cirrhosis – Beyond Portal Hypertension
Lucy Matthew, NP…………………………………………………………...…………………………………………111
Future Landscape With HCV Therapy
Fred Poordad, MD………….………………………………………….…...…………………………………………127

Session II: Beyond Cholestatic Liver Disease, Living Donor Liver Transplant Consideration, Iron
Overload and The Future of HCV Therapy

Complications of Cholestatic Liver Diseases
Cynthia Levy, MD ……………………………………………….………………………………………………………162
(Abstract) The Effect of a 12-month Weight Loss Program on Non-alcoholic Fatty Liver Disease
in Obese Patients
Anna Marie Hefner, RN, PhD, CPNP, MaEd…………………………………………………………………199
Adult Living Donor Liver Transplant: Donor and Recipient Considerations
Rebecca L. Duke, DNP, MSN, APN-CNP..……………………………………………………………………..201
Approach to the Patient with Iron Overload
Kris V. Kowdley, MD, FAASLD………………………………………………………………………………….….222
HIV, HBV, HCV Coinfections
Douglas T. Dieterich, MD, FAASLD ………………………………………….…………………………………266

The Use of AASLD Scientific Program Content
Information presented during the Hepatology Associates Course is the property of AASLD and the presenter.
Information may not be recorded, photographed, copied, photocopied, transferred to electronic format,
reproduced or distributed without the written permission of AASLD and the presenter. Any use of the program
content, which includes, but is not limited to, oral presentations, audiovisual materials used by speakers and
program handouts without the written consent of AASLD, is prohibited.
Hepatology Associates Course
Sunday, November 13, 2016
8:00 am – 1:30 pm

Program Chairs: Lisa M. Richards, MSN, FNP and Walid S. Ayoub, MD, FAASLD

Continuing Education:
Upon completion of this activity, participants will be able to:
• Identify risk factors for nonalcoholic fatty liver disease and initiate the appropriate
management according to the published guidelines.
• Manage complications of cholestatic liver disease.
Distinguish between primary and secondary iron overload and to select the appropriate
therapy based on the guidelines.

This activity was planned in the context of the following ACGME/IOM/Interprofessional
Education Collaborative competencies: Patient-centered Care, Medical Knowledge, Systems-
Based Practice, Practice-Based Learning and Improvement, Evidence-Based Practice, Patient
Care and Procedural Skills, Professionalism, Teams and Teamwork

Accreditation Statement
The American Association for the Study of Liver Diseases (AASLD) is accredited by the
Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical
education for physicians.

Credit Designation
AASLD designates this live activity for a maximum of 5.25 AMA PRA Category 1 Credits™.
Physicians should claim only the credit commensurate with the extent of their participation in
the activity.

Continuing Education (CE)
Amedco is accredited as a provider of continuing nursing education by the American Nurses
credentialing Center’s Commission on Accreditation. These activities are co-provided by
Amedco and AASLD. This activity has been awarded 5.25 contact hours (*includes 1.75
pharmacology hours)

Claiming CME/CE Credits
A variety of continuing education evaluations are available to obtain CME/CE credits based on
your level of participation. Evaluations may be completed during or after the meeting.
Certificates of Attendance are also available for non-credit seeking attendees.

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The CME/CE* evaluations are online and can be completed in the following ways:

• During the Sessions. Download The Liver Meeting® app and evaluate the sessions in real time
– refer to the CME icon to access the evaluation.

• In your hotel room or at home. Access the evaluation website using your personal device of
choice. A link to the CME and CE* evaluation websites are available at
www.aasld.org/livermeeting.

• At Tech Connect. Visit Tech Connect to access the evaluation from any available kiosk.
DEADLINE: Be sure to complete the CME and/or CE evaluation for credit at
www.aasld.org/livermeeting before the following dates:

CME evaluation - March 31, 2017
CE* evaluation - December 31, 2016

Certificates of Attendance
Certificates of Attendance may be printed on-site in Tech Connect or after the meeting at
www.aasld.org/livermeeting by March 31, 2017.

Save your badge! Your email address and badge number will be needed to access the CME
evaluation, and to print a Certificate of Attendance.

2
Faculty, Planner and AASLD Staff Disclosures

This live educational activity has been planned in accordance with AASLD and ACCME Standards
of Commercial Support by members of the Postgraduate Course faculty and the following
planning committees: AASLD Hepatology Associates Committee, Education Committee,
Scientific Program Committee, and the Governing Board.

As an accredited provider, AASLD requires individuals involved in the planning of continuing
medical education (CME) activities to disclose all financial relationships, including those of their
spouse or partner, with a commercial interest within the past 12 months. A commercial
interest is defined as any entity producing, marketing, re-selling, or distributing health care
goods or services consumed by, or used on, patients. All conflicts of interest are resolved prior
to participation.

Statement on off-label and investigational use and Financial Disclosures: Speakers are asked
to identify any discussion of off-label or investigative use or application of a product or device;
including their financial disclosures. This information will appear after the title slide of each
speaker presentation.

Hepatology Associates Course Faculty Disclosures

Walid S. Ayoub, MD, FAASLD
Consulting: AbbVie, Bristol-Myers Squibb, Gilead, Grifols
Speaking and Teaching: Intercept

Rebecca Duke, DNP, MSN, APN-CNP
Speaking and Teaching: Alexion Pharmaceuticals, Gilead

Doug T. Dieterich, MD, FAASLD
Advisory Committees or Review Panels: AbbVie, Achillion, Bristol-Myers Squibb, Gilead, Janssen,
Merck

Anna Marie Hefner, RN, PhD, CPNP, MaEd
Nothing to Disclose

Kris V. Kowdley, MD, FAASLD
Advisory Committees or Review Panels: AbbVie, Enanta, Gilead, Intercept, Merck, Novartis, Trio
Health, Verylx
Grant/Research Support: AbbVie, Evidera, Galectin, Gilead, Immuron, Intercept, Merck, NGM
Biopharma, Novartis, Tobira, Trio Health
Speaking and Teaching: Gilead, Intercept

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Laura M. Kulik, MD
Consulting: Blueprint, Gilead

Cynthia Levy, MD
Advisory Committees or Review Panels: Target Pharmasolutions
Board Membership: Liver Transplantation
Consulting: Intercept, Novartis
Grant/Research Support: CymaBay, Gilead, Intercept, NGM, Novartis, Shire, Tobira
Speaking and Teaching: Medscape

Josep M. Llovet, MD, FAASLD
Consulting: Bayer Pharmaceuticals, Biocompatibles, Blueprint Medicines, Boehringer-Ingelheim,
Bristol-Myer Squibb, Celsion, Eli Lilly Pharmaceuticals, GlaxoSmithKline, Novartis
Grant/Research Support: Bayer Pharmaceuticals, Boehringer-Ingelheim, Bristol-Myers Squibb

Rohit Loomba, MD
Advisory Committees or Review Panels: Arrowhead Research Inc, Galmed Inc, Tobira Inc
Consulting: Alnylam Inc, Celgene Inc, Corgenix Inc, Deutrx Inc, Gilead Inc, Inanta Inc, Janssen
and Janssen Inc, Zafgen Inc
Grant/Research Support: Adheron Inc, AGA, Daiichi Sankyo Inc, Immuron Inc, Kinemed Inc,
Merck Inc, Promedior Inc

Lucy Matthew, NP
Speaking and Teaching: AbbVie, Gilead, Merck

Fred Poordad, MD
Advisory Committees or Review Panels: Abbott, AbbVie, Achillion, Bristol-Myers Squibb,
Boeheringer Ingelheim, Genentech, Gilead, Idenix, Inhibitex, Janssen, Merck, Novartis, Pfizer,
Salix, Vertex
Grant/Research Support: AbbVie, Achillion, Anadys, Bristol-Myers Squibb, Boehringer
Ingelheim, Genentech, Gilead, Idenix, Merck, Novartis, Pharmassett, Salix, Tibotec/Janssen,
Vertex

Lisa M. Richards, MSN, FNP
Advisory Committees or Review Panels: Merck
Consulting: Valeant
Speaking and Teaching: AbbVie, Bristol-Myers Squibb, Gilead

Vijay Shah, MD
Nothing to Disclose

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Planner Disclosures
Walid S. Ayoub, MD, FAASLD (Hepatology Associates Committee)
Consulting: AbbVie, Bristol-Myers Squibb, Gilead, Grifols
Speaking and Teaching: Intercept

Gavin E. Arteel, PhD, FAASLD (Scientific Program Committee)
Nothing to Disclose

Jasmohan Bajaj, MD, FAASLD (Education Committee)
Consulting: Abbott, Intercept, Norgine, and Valeant
Grant/Research Support: Grifols ,Salix,

Jorge A. Bezerra, MD, FAASLD (Governing Board and Hepatology Associates Committee)
Grant/Research Support: CHMC, Gilead, Molecular Genetics Laboratory

Carla W. Brady, MD, MHS (Scientific Program Committee)
Nothing to Disclose

Kimberly A. Brown, MD, FAASLD (Scientific Program Committee and Governing Board)
Advisory Committees or Review Panels: AbbVie, Bristol Myers Squibb, CLDF, Gilead Janssen,
Merck
Grant/Research Support: AbbVie, Duke Medical Research, Gilead, Janssen, Merck
Speaking and Teaching: CLDF

Kyle E. Brown, MD, FAASLD (Education Committee)
Nothing to Disclose

Elizabeth M. Brunt, MD, FAASLD (Education Committee)
Consulting: AXS Consulting, Olson Research Group

Kenneth D. Chavin, MD, PhD (Scientific Program Committee)
Grant/Research Support: Bridge to Life, Gilead, Novartis, Sanofi

Yogesh K. Chawla, MD, DM (Education Committee)
Nothing to Disclose

Amanda J. Chaney, MSN, ARNP, FNP-BC (Education Committee)
Nothing to Disclose

Mark J. Czaja, MD, FAASLD (Governing Board)
Advisory Committees/Review Panels: Verlyx Pharma Inc.
Grant/Research Support: Verlyx Pharma Inc.

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