The problem

• Cirrhosis and its complications
• Hepatocellular carcinoma
• ACLF

The approach 

Early diagnosis of hepatocellular carcinoma.

Prevalence, epidemiology, characterization and mechanisms of acute-on-chronic liver failure in the Latin American population.

Main discoveries and innovations

• Hepatocellular carcinoma
  Most HCCs are diagnosed in advanced stages (>80%), associated with cirrhosis in more than 95% of cases, etiologically due to HCV, ethanol, HBV, NAFLD, and other causes, respectively. Among amerindians, the etiology of HBV predominates, in a non-cirrhotic liver. The association with NAFLD is an emerging situation in Latin America. In our institution, screening patients with cirrhosis for HCC using US and transient elastography, we detected HCC at an early stage in about 40% of patients with stiffness > 22 kPa.

• Acute-on-chronic liver failure
  ACLARA is a prospective observational study in1274 patients with acute decompenstion of cirrhosis in 46 centers across 7 Latin American countries with the aim to assess the prevalence of ACLF at enrollment and short-term death (i.e., death within 28 days after enrollment). Clinical, laboratory and demographic data was recorded at enrollment and one-year clinical course data was also collected. Results from this study suggest the existence of genetic ancestry and race differences in the prevalence and clinical course of ACLF.