Program Details

General Details

Tuesday, September 14, 2021

5:00PM-7:00PM PT

Location

Virtual Event

A link will be sent to all registered attendees prior to the program. 

Topics

DEBATE #1:   HBV – Treat or do not treat in the immune tolerant patient.

Cedars Sinai Medical Center: Case to NOT treat patient
Loma Linda University Medicine: Case to treat patient

Case Study: 27-year-old man. PhD student in Los Angeles, born in Taiwan. Known to be HBsAg-positive for many years. His mother and younger sister are also  HBsAg-positive, not on antiviral therapy. No known family history of HCC. He is asymptomatic. No significant other medical issues, no EtOH use, no medications. Physical examination is completely normal. BMI is 22.

Labs: AST 17  ALT 22   AP 67   bilirubin 0.4   albumin 4.5  globulin 3.2

Hgb 14.5, WBC 7.5 MCV 87, platelets 256

HBeAg-positive

Anti-HBe-negative

Anti-HDV  IgG/IgM-negative

HBV DNA: 1,500,000 IU/ml

Ultrasound: Smooth liver surface, normal echogenicity, spleen 10 cm.

FibroScan: 3.5 kPa

Should this patient receive antiviral therapy for HBV infection?

 

DEBATE #2: Feasible or futile: Liver transplantation in a patient with severe ACLF

Kaiser Permanente: Transplantation is futile and patient should be offered conservative measures and consideration of comfort focused measures
University of California Irvine: Transplantation is feasible in this patient and the organ should be accepted

Case Study: A 66-year-old female with NASH cirrhosis is hospitalized for urinary tract infection, leading to leukocytosis. Her medical history is notable for diabetes and obesity with a BMI of 34. The patient is listed for transplant with a baseline MELD-Na score of 18, with decompensations of medication-controlled ascites and hepatic encephalopathy. A cardiac stress test as part of her updated OLT evaluation demonstrated no reversible ischemia and normal PA pressure. Prior to admission, she was ambulatory without assistant and able to perform her activities of daily living.

On admission, relevant blood tests indicate a white blood cell count of 18, creatinine of 1.5 (baseline = 0.9), bilirubin of 3.5, sodium of 134, and INR of 1.8. Her urine culture is positive for ESBL E. Coli. Despite treatment with meropenem, the patient becomes acutely hypotensive and requires transfer to the intensive care unit and initiation of norepinephrine for pressure support. Her liver decompensation worsens and she develops grade 4 hepatic encephalopathy, requiring intubation. She furthermore develops failure requiring hemodialysis. Ventilatory settings suggest no evidence of respiratory failure. Her antibiotic regimen is expanded to include vancomycin and micafungin.

On day 7 in the ICU, her labs are as follows: WBC=12.5, INR=3.1, Creatinine=1.0 on dialysis, Sodium=132, bilirubin=8.9, venous lactate=1.5, and platelets=45. Her MELD-Na score was 40. She remains intubated for airway protection but can open her eyes. She cannot follow commands.  She continues to require norepinephrine at a dosage of 0.05-0.10 mcg/kg/min to maintain her mean arterial pressure but attempts to wean her off of norepinephrine have been unsuccessful. Prior to her admission, advanced care planning was not performed but the consensus of the family is that they would like for the patient to receive full supportive care and not comfort care. A primary donor organ offer is received for the patient from a 24-year-old male who died from a motor vehicle accident.

Teams

Cedars Sinai Medical Center

Loma Linda University Health

Kaiser Permanente

University of California Irvine

Participants

Event Moderators

Jeffrey A. Kahn, MD

Dr.  Jeffrey Kahn completed his undergraduate training at the University at Albany, State University of New York, medical school training at the State University of New York, Upstate Medical University and internal medicine residency at Emory University. He then went on to fellowship training in gastroenterology at the University of Southern California and transplant hepatology training at Cedars Sinai-Sinai Medical Center. He has been the medical director of the Keck School of Medicine of USC Liver Transplant Program since 2011, with a special interest in living donor liver transplantation and transfusion-free liver transplantation. His research interests include liver transplant waitlist disparities, liver transplant outcomes and has ongoing translational research related to occult hepatitis C infection.

Vinay Sundaram, MD

Dr. Vinay Sundaram is currently the Director of Hepatology Outcomes Research and Assistant Medical Director of Liver Transplantation at Cedars-Sinai Medical Center, where he also serves as an Associate Professor of Medicine. He graduated from New York University School of Medicine, followed by residency at the University of Virginia, gastroenterology fellowship at the University of Pittsburgh, and a transplant hepatology fellowship at Beth Israel Deaconess Medical Center. His clinical interests include all aspects of hepatology, while his research interests are focused on outcomes related to end-stage liver disease and liver transplantation.

Judges

 

Danielle Brandman

Dr. Brandman earned a medical degree at the New Jersey Medical School of Rutgers University, and completed an internal medicine internship and residency at UCSF. She also completed fellowships in gastroenterology and transplant hepatology and earned a master’s of advanced studies in clinical research at UCSF. Dr. Brandman is the director of the UCSF Fatty Liver Clinic, serves as the hepatologist for the UCSF Polycystic Kidney Disease Center of Excellence, and is the inpatient chief of hepatology.  Dr. Brandman has a strong commitment to the education of trainees.  She is the program director of the transplant hepatology fellowship at UCSF and leads clinical hepatology education for trainees from the level of medical student to advanced fellow.  She was awarded the Excellence in Teaching Award by the UCSF Haile T. Debas Academy of Medical Educators.  Her research involves collaboration with primary care providers to identify patients with fatty liver at high risk of advanced fibrosis, as well as novel models for delivery of care to fatty liver patients. In her spare time, she loves staying active. She has fought fatty liver on the front lines in her role as a Zumba instructor, but more recently has focused her efforts on getting stronger through CrossFit. She loves her two elderly dogs, Atticus and Roxie (and most rescue dogs in general).

Christopher Bowlus, MD

Dr. Christopher Bowlus is the Chief of the Division of Gastroenterology and Hepatology at the University of California Davis School of MedicineHe is the Lena Valente Professor. Dr. Bowlus received his undergraduate education at the University of California San Diego and his medical degree from St. Louis University. He completed his Internal Medicine training at UC Davis and his fellowship training in Gastroenterology and Hepatology at Yale University. After completing his education, Chris returned to UC Davis as an Assistant Professor in 1998. He has an active research program that bridges the basic and clinical aspects of PBC and PSC. Dr. Bowlus has worked to improve testing and treatment of hepatitis B among Asian-Americans in the Sacramento region through implementation of electronic health record tools and community engagement. His research has been funded by the National Institutes of Health (NIH), Center for Disease Control and Prevention (CDC), and industry sponsors. He is a founding member and Steering Committee member of the International PSC Study Group (IPSCSG) and leads the US-based Consortium for Autoimmune Liver Disease (CALiD). Dr. Bowlus is the recipient of the Walter Trudeau Excellence in Teaching Award and the American Liver Foundation Postdoctoral Fellowship Award. He is also a Co-Chair of PSC Partners Seeking a Cure, a Fellow of the American College of Physicians, the American Gastroenterology Association, and the American Association for the Study of Liver Disease. 

Allison Kwong, MD

Allison Kwong, MD is a transplant hepatologist at Stanford University. She received her medical degree at Mount Sinai School of Medicine and completed fellowships in gastroenterology at Stanford University and advanced/transplant hepatology at University of California, San Francisco. She is an active member of the American Association for the Study of Liver Diseases (AASLD) and received the Clinical, Translational, and Outcomes Research Award from the AASLD Foundation. Her clinical and research interests include cirrhosis, portal hypertension, liver transplantation, and alcohol-associated liver disease.

Edward Mena, MD

California Liver Research Institute-Pasadena Liver Center

Arpan Patel, MD

Arpan Patel MD PhD is an Assistant Professor of Medicine the David Geffen School of Medicine and a staff hepatologist at the Greater Los Angeles VA Healthcare System.  He completed gastroenterology fellowship in the UCLA Division of Digestive Diseases and PhD in Health Policy and Management in the UCLA Fielding School of Public Health.  He also completed his Transplant Hepatology fellowship at the Icahn School of Medicine in Mount Sinai.  In addition to his clinical practice, Dr. Patel performs health services research with specific interests in patient-provider communication, palliative care, alcohol-associated liver disease, and quality improvement.  He has published in a number of high-impact journals, including JAMA Internal Medicine, Annals of Internal Medicine, Hepatology, and Clinical Gastroenterology and Hepatology. In his free time, Dr. Patel enjoys exploring plant-based restaurants in LA, running along Santa Monica Beach, spending time with his family in Orange County.

Norah Terrault, MD

Professor of Medicine and Chief of Gastroenterology at the Keck School of Medicine, University of Southern California, Los Angeles.  Dr. Norah Terrault is a transplant hepatologist and Professor of Medicine and Chief of Gastroenterology and Liver Diseases at the Keck School of Medicine at University of Southern California.  She has focused her clinical and research activities on viral hepatitis and non-alcoholic fatty liver disease, with specific focus on patients with cirrhosis and liver transplant recipients. In addition to multiple clinical trials related to preventing and treating chronic hepatitis viral hepatitis and fatty liver, Dr. Terrault has been PI on multiple NIH-funded studies, including the current NIH-supported HBV clinical research network (HBRN) and nonalcoholic steatohepatitis clinical research network (NASH CRN). She has authored over 400 peer-reviewed manuscripts, editorials, invited reviews as well as US national guidelines for treatment of chronic hepatitis B and C. Dr. Terrault was recently elected as Councilor to the AASLD governing board and will serve as president in 2023.

 

Cedars-Sinai Medical Center

Walid Ayoub, MD

Mentor

Walid Ayoub is a Professor of Medicine and the Associate Medical Director for the Liver Transplant Program at Cedars Sinai Medical Center, Los Angeles, USA.  He is a Clinical Professor of Medicine at Cedars Sinai Medical Center (CSMC) and the University of California, Los Angeles (UCLA). He achieved his MD at Creighton University School of Medicine in 1999 before taking up a residency at UCLA/West Los Angeles Veteran Administration Hospital. Between 2002–2006, Professor Ayoub conducted fellowships in Hepatology and Gastroenterology at Cedars Sinai Medical Center and UCLA, respectively. He then become Clinical Assistant Professor of Medicine at Stanford University until 2012, when he assumed his current position at Cedars Sinai Medical Center. Professor Ayoub is board certified in Internal Medicine, Gastroenterology, Transplant Hepatology, and has been involved in several clinical trials investigating pharmacological therapies for liver impairments, NAFLD, cholestatic liver disease, viral and cholestatic hepatitis. He is currently a primary investigator for clinical trials assessing the efficacy of novel agents in the treatment of chronic hepatitis B, primary biliary cholangitis and primary sclerosing cholangitis. He is a member of the PSC CALiD consortium- Clinical Outcomes Of Primary Sclerosing Cholangitis In North America.  He serves as an investigator on NIH/NCI sponsored trial addressing the chemoprevention role of statin on hepatocellular carcinoma. He has been an invited speaker at the Digestive Disease meeting discussing liver cancer and moderated sessions at American Association for the Study of Liver Disease and the American Transplant Congress addressing treatment of viral hepatitis and discussing quality of organs in the solid organ transplant recipient.   

He is an active member of the Liver and Intestinal Committee of Practice of the American Transplant Society. He serves at the Medical Advisory Committee of the American Liver Foundation and the Liver Wellness Foundation. He served as a member of the Hepatology Associate Committee of the American Association for the Study of Liver Diseases (AASLD).  He is also a Fellow at AASLD and a member of the American Gastroenterological Society, American College of Gastroenterology and American Society of Transplantation. Dr Ayoub has also held responsibilities as Editor of Journal of Pancreatic Disorders & Therapy and a reviewer for a variety of journals such as the American Journal of Transplantation, Gastroenterology, Liver Transplantation, Journal of Clinical Gastroenterology and Digestive Diseases and Sciences. He has written numerous reviews, book chapters and abstracts. His research has been published in peer-reviewed journals including Clinical Gastroenterology and Hepatology, American Journal of Transplantation, Alimentary Pharmacology & Therapeutics, and Journal of Viral Hepatitis.


Aarshi Vipani, MD

Fellow

Aarshi Vipani, MD is a second-year clinical gastroenterology fellow at Cedars-Sinai Medical Center in the Karsh Division of Gastroenterology and Hepatology. She completed her residency in Internal Medicine and served as a Chief Resident in the Department of Medicine prior to her gastroenterology fellowship. Her accolades include the Leo Rigler Awards for Outstanding Academic Achievement as intern and resident of the year respectively. Her research interests include non-alcoholic fatty liver disease, specifically, gender-related variances. She several first author publications in Gastroenterology, Clinical Gastroenterology and Hepatology, and Journal of Clinical Gastroenterology. Outside of her clinical training and research endeavors, Dr. Vipani enjoys hiking, cooking, and exploring all that LA has to offer with her husband.

Hui Yee Yeo, MD

Fellow

Yee Hui Yeo, MD, MSc is a resident doctor at Cedars-Sinai Medical Center. He is an active investigator on viral hepatitis related epidemiological and health outcomes research. He is currently a trainee member of the Hepatitis B SIG Steering Committee, AASLD. He has published more than 50 peer-reviewed publications, including first or co-first authorship of original articles published in Gastroenterology, Journal of Hepatology, HEPATOLOGY and Gut. Dr. Yeo has served as an associate editor for BMC Gastroenterology. He is interested in harnessing health data analytic tools, modeling, and meta-analysis to determine the epidemiology, cascade of care, natural history, and outcomes of chronic liver disease. He uses large databases, multicenter cohorts and EHR data from Cedars-Sinai Medical Center. He has been participating in international consortia of natural history of hepatitis B infection. His works were selected as “Best of the Liver Meeting” in AASLD annual meeting 2018. Yeo is the recipient of “Emerging Liver Scholar Award” in 2019. He was the co-chair for an AASLD HBV SIG webinar in 2020. He enjoys his leisure time with his family (wife, daughter and labradoodle) and exploring Asian food in LA.

 

Kaiser Permanente

Amandeep Sahota, MD

Mentor

Dr. Amandeep Sahota is a compassionate and result driven physician with a triple board-certification in internal medicine, gastroenterology, and transplant hepatology. She started her medical career as a resident at USC. While she finished her residency, she completed her Master of Science in Clinical Investigation. This sparked her passion in elevate patient centered care within transplant. As Assistant Medical Director of Transplant Services in Kaiser Permanente Southern California and Hawaii, Dr. Sahota has dedicated her medical career to challenging the current quality of care for transplant and liver patients. She developed, promoted, and deployed several patient care programs and educational opportunities to improve the quality of life or quality of care of transplant and liver patients. Dr. Sahota has spearheaded several collaborations to improve patient care such as improving relationships with internal departments and out of state transplant partners. Dr. Sahota is constantly thinking of new ways to improve transplant care and the patient experience. When Dr. Sahota is not making an impact in the medical world, she is a mother of two sons. She challenges her sons to find a passion that will help them get out of bed everyday and to be authentic. During her free time, Dr. Sahota enjoys taking dance lessons and performing.

Angeline Luong, MD

Fellow

Dr. Angie Luong was born and raised in sunny Southern California. She left her life of perfect weather and headed east to North Carolina to complete her biomedical engineering degree at Duke University. Following a year of working in the field, she decided to pivot to medicine, and earned her medical degree from Virginia Commonwealth University. She completed her Internal Medicine residency at Kaiser Permanente Los Angeles and is now fortunate to continue her education as a second-year GI fellow at Kaiser. Dr. Luong’s clinical interest is in the field of inflammatory bowel disease. When she away from the hospital, she usually catching up on the latest episodes of various reality TV shows, watching movies with her fiancé, or trying to figure out how to take care of their goldendoodle puppy. Angie loves to travel and hopes to be able to visit Europe again in the next year.

Timnit Tekeste, MD

Fellow

 

Loma Linda University Medical Center

Michael Volk, MD, MSc, AGAF

Mentor

Michael L. Volk, MD, MSc, AGAF is a transplant hepatologist who serves as the Medical Director of Liver Transplantation and Division Chief of Gastroenterology at Loma Linda University.  He attended medical school at the University of Rochester, residency at the University of Virginia, and then fellowship at the University of Michigan where he stayed for 11 years and served as the Medical Director of the Liver Tumor Program before joining Loma Linda in 2015.  A former Robert Wood Johnson Clinical Scholar, Dr. Volk is an expert in health care delivery who has published over 80 papers and received grant funding from the NIH, AASLD, AGA and Greenwall Foundation.  He remains a busy clinician and is rated among the Best Doctors in hepatology nationwide.

Joy Lee, MD

Fellow

Dr. Joy Lee was born and raised in southern California. She obtained her undergraduate degree from the University of California, Los Angeles where she majored in Molecular, Cell, and Developmental Biology and minored in Statistics. She completed her medical education at the University of Maryland, School of Medicine and then moved to La Jolla, CA where she trained at Scripps Green Clinic/Hospital for her internal medicine training. She is currently a 2nd year Gastroenterology/Hepatology fellow at Loma Linda University. Her current career interests include esophageal disorders and motility. Outside of fellowship training, Dr. Lee enjoys traveling and exploring southern California. She is an avid runner, hiker, and enjoys tasting new local restaurants/eateries/ethnic cuisines. 

Prachi Rana, MD

Fellow

Dr. Prachi Rana completed her internal medicine residency and LAC+USC in Los Angeles and she is a 2nd year GI fellow at Loma Linda University.  She hopes to be a transplant hepatologist in the near future and is excited to be applying for the upcoming cycle. In her free time, she enjoys biking, listening to true crime podcasts, and playing with her 9 nieces and nephews.  She loves everything chocolate and sushi.  She hopes to travel to Japan one day. Prachi and her husband are expecting their first child this December.

 

University of California, Irvine

Lydia Aye, DO

Mentor

Dr. Aye is an Associate Clinical Professor in the Department of Medicine as well as the Program Director for the Gastroenterology Fellowship at University of California, Irvine (UCI). Dr. Aye holds BS in Psychobiology and BA in Anthropology from University of California, Los Angeles. She received her DO from Western University of Health Sciences, College Osteopathic Medicine of the Pacific. She completed her Internal Medicine residency and Gastroenterology fellowship at Banner University Medical Center in Phoenix, AZ. She completed an additional fellowship in Transplant Hepatology at University of Miami. She was a faculty member at Loma Linda University for seven years, where she held various leadership positions. Dr. Aye transitioned to UCI in July of 2020 and assumed the position of Gastroenterology Program Director in September 2020.

Ke-Qin Hu, MD, FAASLD

Mentor

James Han, MD

Fellow

Dr. James Hans attended Duke University for his B.S. degree and continued onto medical school at the University of Virginia. He trained at UC Irvine for Internal Medicine and is currently a third year GI fellow there. He is interested in general GI and IBD and plans to join a private practice on after training. In his free time, James enjoys going to concerts, playing tennis, and keeping up with the latest tech. In the future, he hopes to be able to travel the word and create his own electronic music.

Jaehyun Kim, MD

Fellow

Dr. Jeahyun “Jae” Kim is currently a second year fellow at the gastroenterology fellowship Program in UC Irvine. He completed his undergraduate studies at Baylor University in Waco, TX, and attended medical school in UT Southwestern Medical Center in Dallas, TX, where he also completed his internal medicine residency. His clinical interests include general gastroenterology and inflammatory bowel disease. Dr. Kim lives with his wife and they are soon expecting their first child. They also raise two Welsh Corgis. His hobbies include going on walks with his dogs, traveling and playing video games.