Treatment Selection in a Patient with Decompensated Cirrhosis


Nancy Reau, MD
Professor of Medicine
Richard B. Capps Chair of Hepatology
Chief, Section of Hepatology
Associate Director, Solid Organ Transplantation, Rush University Medical Center, Chicago
Nancy Reau, MD

Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center in Chicago, IL. She received her medical degree from The Ohio State University College of Medicine in Columbus, where she completed a residency and fellowship in gastroenterology/hepatology followed by a second fellowship in advanced transplant hepatology at Johns Hopkins Hospital in Baltimore, MD. Her primary research interests focus on viral hepatitis – from both drug development and a clinical perspective – liver transplantation, and complications of chronic liver disease.

Prof. Reau has been an invited lecturer at numerous presentations focused on viral hepatitis, fatty liver disease, cirrhosis, and liver transplantation. Prof. Reau is a fellow of the American Gastroenterological Association and American Association for the Study of Liver Diseases (AASLD). Additionally, she is the current editor in chief of CLD (Clinical Liver Disease) and was an author of the AASLD/IDSA hepatitis C guidance document. She was the committee chair of the AASLD public policy committee and a member of the AASLD practice guideline committee for four years.

Prof. Reau has authored or coauthored more than 100 peer-reviewed articles that have been published in journals such as Hepatology, Hepatitis Research and Treatment, and Clinics in Liver Disease. She is Co-chair of the National ALF Medical Advisory Committee and sits on multiple advisory boards. She is currently a member of the steering committee for the hepatitis C special interest group (SIG) for the American Association for the Study of Liver Diseases (AASLD) and a member of the ACG training committee.

Paul Y. Kwo, MD
Professor of Medicine
Director of Hepatology, Stanford University School of Medicine, Stanford, CA
Paul Y. Kwo, MD
Professor of Medicine

Dr. Kwo is currently Professor of Medicine and Director of Hepatology at Stanford University where he joined the faculty in November 2016. Prior to joining the faculty at Stanford, he was at Indiana University for 21 years where he served as the Medical Director of Liver Transplantation. He received his MD from Wayne State University School of Medicine, his Internal Medicine training at University of Maryland, and his Gastroenterology/Hepatology training at Mayo Clinic Rochester. He is an Associate Editor for Clinical and Molecular Hepatology and serves on the editorial boards of multiple journals including Hepatology, Hepatology Communications, and Clinical and Molecular Hepatology. His service to the ACG has included membership of the Education Committee and International Relations Committee, and Chair of the Membership Committee.

In addition, Dr. Kwo is a co-director of the ACG Hepatology Circle, as well as the ACG Hepatology School and serves on the ACG Board of Trustees. Along with other ACG members, he recently authored the ACG Practice Guideline Evaluation of Abnormal Liver Chemistries. He has distinguished himself in the field of chronic Hepatitis C and has served as the principal investigator for multiple seminal trials in the treatment of hepatitis C that have been published in journals including the New England Journal of Medicine, Lancet, Gastroenterology, Hepatology, Journal of Hepatology and others. He has won multiple awards for his clinical care and teaching, and he believes in the importance of mentoring college students, medical students, residents, fellows and faculty in clinical research.

Joseph K. Lim, MD
Professor of Medicine
Director, Clinical Hepatology
Vice-Chief, Section of Digestive Diseases Yale University School of Medicine New Haven, CT
Joseph K. Lim, MD

Dr. Lim is a Professor of Medicine and Vice-Chief of the Section of Digestive Diseases at Yale University, where he serves as Director of Clinical Hepatology and Associate Chief of Yale-New Haven Health System (YNHHS) Digestive Health. He is a graduate of the Feinberg School of Medicine at Northwestern University (Chicago, Illinois, USA), and completed training in Internal Medicine at Yale University (New Haven, Connecticut, USA), and Gastroenterology and Hepatology at Stanford University (Palo Alto, California, USA). In his role at the Yale Liver Center, he conducts patient-oriented research evaluating clinical outcomes in chronic liver disease and runs an active clinical trials program examining novel investigational agents for viral hepatitis and NASH. He has held numerous leadership roles for the AASLD, AGA, and the ACG, and serves as Chair of the EPIC Gastroenterology Specialty Steering Board.

Statement of Need

Chronic hepatitis C virus (HCV) infection is associated with a 15- to 20-fold greater risk of hepatocellular carcinoma (HCC) compared to those without HCV. Individuals with HCV-related cirrhosis are at risk for HCC development, underscoring the importance of routine HCC surveillance in patients with HCV. Therefore, as a crucial component of HCV management, clinicians should integrate routine surveillance for HCC in patients with HCV, as recommended in current guidelines. Evidence shows that clinicians have misconceptions regarding appropriate tests to detect HCC and need to engage more in following HCC surveillance guidelines regarding screening intervals and imaging modality. To increase surveillance rates, it is crucial that all HCPs managing patients with HCV understand how to implement the most recent guidelines in practice.

This CMEO BriefCase will introduce a case involving the incorporation of routine surveillance for HCC in a patient with HCV. Join our faculty experts as they delve into the epidemiology and shared pathobiology of HCV and decompensated cirrhosis, identify compensated versus decompensated cirrhosis, and discuss surveillance strategies for HCC.

Learning Objectives

At the end of this CME/CE activity, participants should be able to integrate routine surveillance for HCC into clinical follow-up for patients with HCV.

Financial Support

Supported by an educational grant from Gilead Sciences, Inc.

Target Audience

U.S. and international physicians, PAs, nurse practitioners, nurses, and pharmacists specializing in primary care

Credit Information

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Physicians (ACCME)

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Nurses (CNE)

Provider approved by the California Board of Registered Nursing, Provider Number CEP 15510, for 1.0 contact hour(s).

Note to Nurse Practitioners

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Royal College MOC

Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

MIPS Improvement Activity

This activity counts towards MIPS Improvement Activity requirements under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website.

Disclosure Declaration

it is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Reau reports the following financial relationships: Consultant: AbbVie Inc.; Gilead Sciences, Inc.; Intercept Pharmaceuticals, Inc.; and Merck & Co., Inc. Grants/Research Support: GENFIT; Intercept Pharmaceuticals, Inc.; and Shire

Dr. Kwo reports the following financial relationships: Advisory Board: AbbVie Inc.; Aligos Therapeutics Inc.; Ambys Medicines; Antios Therapeutics, Inc.; CVS; Eisai Inc.; Enanta Pharmaceuticals, Inc.; Gilead Sciences, Inc.; HepQuant; Mallinckrodt Pharmaceuticals; and Surrozen. Consultant: Drug Farm; Durect Corporation; Generon; Inventiva; Mirum Pharmaceuticals; and Syneos Health. Grants: Altimmune; Arrowhead Pharmaceuticals, Inc.; Assembly Biosciences, Inc.; Bristol Myers Squibb; Eiger BioPharmaceuticals; Novo Nordisk; Target RWE Registries; and Ultragenyx Pharmaceutical. Stock (Directly Purchased): Durect Corporation

Dr. Lim (Reviewer/Advisor) reports the following financial relationships: Research Support: Allergan; Celgene Corporation; Eiger BioPharmaceuticals, Inc.; GENFIT; Gilead Sciences, Inc.; Pfizer Inc.; and Viking Therapeutics

Shirley Michelle Franks, MSN, APRN, FNP-BC (peer reviewer)

Kellie Busby, PharmD (planning committee)

Janan Sarwar, PharmD (planning committee)

Susan Perry (planning committee)

Susan H. Yarbrough, CHCP (planning committee)

Sharon Tordoff (planning committee)

Disclosures were obtained from the CME Outfitters, LLC staff: No disclosures to report.

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

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Treatment Selection in a Patient with Decompensated Cirrhosis
Event Date: 05/16/2022 at 12:00 pm