Episode 404: 412. Liver Transplant - The One Referral I Doubt You Are Doing Correctly

Episode 404: 412. Liver Transplant - The One Referral I Doubt You Are Doing Correctly

Clinicians should refer patients for liver transplant evaluation after any decompensation event—such as ascites or variceal bleeding—regardless of MELD score.

  • After a first decompensation, 5-year mortality is 20–30%; after a second, it rises to 80–90%.

  • Refractory ascites carries a 50% 1-year mortality, and overt hepatic encephalopathy has a 25–40% 1-year mortality.

  • After an initial variceal bleed, the 1-year rebleeding risk is 60% without prophylaxis.

  • There are no strict BMI or age cutoffs, and frailty has minimal effect on post-transplant outcomes.

  • Substance use, including alcohol, is not a contraindication to referral—current guidelines no longer require a 6-month abstinence period.

  • Citations
    King LY et al. Guidance for timely referral to liver transplantation. Clin Gastroenterol Hepatol 2025 Aug 5; [e-pub]. (https://doi.org/10.1016/j.cgh.2025.07.032)

Episoder(388)

Episode 394: 402. Cardiovascular Risk Factors, Zilebesiran, Shared Decision Making

Episode 394: 402. Cardiovascular Risk Factors, Zilebesiran, Shared Decision Making

https://www.nejm.org/doi/10.1056/NEJMoa2415879?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Key Findings: Classic Risk Factors: The five risk factors examined were hype...

18 Jul 202515min

Episode 393: 404. 3 quick articles you might want to know about (oral semaglutide, tiktok, and GLP1 thyroid cancer)

Episode 393: 404. 3 quick articles you might want to know about (oral semaglutide, tiktok, and GLP1 thyroid cancer)

GLP1 might cause thyroid cancer in mice but the evidence is drastically lacking in humansOral semaglutide is expensive for an NNT of 50 at 4 yrsTiktok videos of skin care are a scam

25 Jun 202512min

Episode 392: 403. 3 Papers, 1 Podcast - One Guideline Changer

Episode 392: 403. 3 Papers, 1 Podcast - One Guideline Changer

https://jamanetwork.com/journals/jama/article-abstract/2834040amiloride is realistically equal to spironolactone for resistant HTNhttps://journals.lww.com/ajg/abstract/2025/05000/higher_rate_of_sponta...

16 Jun 202514min

Episode 391: 402. Functional disability after clinically significant extracranial bleeding: a secondary analysis of ASPREE

Episode 391: 402. Functional disability after clinically significant extracranial bleeding: a secondary analysis of ASPREE

https://www.jthjournal.org/article/S1538-7836(25)00109-6/fulltextAntithrombotic agents, like aspirin and anticoagulants, are essential for treating many cardiovascular conditions. However, a common si...

5 Jun 20257min

Episode 390: 401. Add-On Treatment With Zilebesiran for Inadequately Controlled Hypertension

Episode 390: 401. Add-On Treatment With Zilebesiran for Inadequately Controlled Hypertension

https://jamanetwork.com/journals/jama/article-abstract/2834632SummaryThe article examines the effectiveness and safety of zilebesiran, an RNA interference therapeutic agent, when used in combination w...

4 Jun 20258min

Episode 389: 400. CRP, Lipoprotein A, LDL for cardiac risk assessment

Episode 389: 400. CRP, Lipoprotein A, LDL for cardiac risk assessment

https://www.nejm.org/doi/full/10.1056/NEJMoa2405182?query=recirc_Semantic  Key Takeaways Extended Predictive Value of Biomarkers: High-sensitivity C-reactive protein (CRP), LDL cholesterol, and lipop...

29 Mai 20259min

Episode 388: 399. Use of albumin-adjusted calcium measurements in clinical practice

Episode 388: 399. Use of albumin-adjusted calcium measurements in clinical practice

Desgagnés N et al. Use of albumin-adjusted calcium measurements in clinical practice. JAMA Netw Open 2025 Jan 21; 8:e2455251. (https://doi.org/10.1001/jamanetworkopen.2024.55251)Overall, total calcium...

27 Mai 20257min

Episode 387: 398. Which is Better, Tirzepatide or Semaglutide?

Episode 387: 398. Which is Better, Tirzepatide or Semaglutide?

https://www.nejm.org/doi/10.1056/NEJMoa2416394At 72 weeks, the mean percentage decrease in weight was significantly greater with tirzepatide than with semaglutide (20% vs. 14%). Gastrointestinal side ...

21 Mai 20258min

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