PD347 - PRACTICE PATTERNS IN ADULT IFALD: AN INTERNATIONAL SURVEY

PD347

PRACTICE PATTERNS IN ADULT IFALD: AN INTERNATIONAL SURVEY

O. Mohamed Elfadil^1,*, C. Cuerda^2,3, P. B. Jeppesen⁴, F. Joly⁵, S. Lal⁶, G. Lamprecht⁷, L. Pironi^8,9, K. Szczepanek¹⁰, A. Van Gossum¹¹, T. Vanuytsel¹², G. Wanten¹³, M. S. Mundi¹

¹Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic , Rochester, MN , United States, ²Department of Medicine, Universidad Complutense, ³Nutrition Unit. Endocrinology and Nutrition Service, Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Maranon, Madrid, Spain, ⁴Department of Intestinal Failure and Liver Diseases, Copenhagen University Hospital, Copenhagen, Denmark, ⁵Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, University of Paris, Paris, France, ⁶Intestinal Failure Unit, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom, ⁷Klinik und Poliklinik für Gastroenterologie, Hepatologie und Ernährungsmedizin, Department für Innere Medizin, Universitätsmedizin Rostock, Rostock, Germany, ⁸Department of Medical and Surgical Sciences, University of Bologna, ⁹Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy, ¹⁰Stanley Dudrick's Memorial Hospital, Skawina, Poland, ¹¹Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles (HUB), Free University of Brussels, Brussels, ¹²University Hospital Leuven, Leuven Intestinal Failure and Transplantation (LIFT), Leuven, Belgium, ¹³Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, Netherlands

Rationale: Adult intestinal failure-associated liver disease (IFALD) remains difficult to define, diagnose, and manage in chronic intestinal failure. We described international expert practice for IFALD monitoring, diagnosis, and treatment, and identified areas of agreement and uncertainty.

Methods: An anonymous electronic survey was distributed to clinicians involved in chronic intestinal failure and home parenteral nutrition (HPN) care. It collected demographics, monitoring practices at 0-3, 3-6, 6-12, and >12 months after HPN initiation, and responses to vignettes on cholestatic, hepatocellular/steatotic, and advanced fibrotic IFALD. Analyses were descriptive.

Results: Seventy-two clinicians from 29 countries across 5 continents responded. Routine laboratories and liver tests were obtained monthly or more often by 94.4% during the first 3 months of HPN, shifting mainly to quarterly surveillance beyond 12 months. Total bilirubin, AST, ALT, alkaline phosphatase, and platelet count were the most consistently monitored markers; direct bilirubin and GGT were less consistent (Table 1). The initial cholestatic vignette was diagnosed as IFALD by 43.1%, persistent cholestasis beyond 6 months by 84.7%, the hepatocellular/steatotic vignette by 37.1%, and the advanced/fibrotic vignette by 77.9%. Ultrasound and Fibroscan were the preferred adjunctive studies, but uncertainty about elastography and fat-based imaging thresholds was common. Management centered on parenteral nutrition modification, especially lipid emulsion changes; transplant referral was uncommon except in advanced disease.

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Conclusion: International expert practice was more consistent for surveillance intensity and lipid-focused management than for diagnostic thresholds and work-up, particularly in non-cholestatic phenotypes. These findings support phenotype-specific consensus definitions and validated adult diagnostic pathways for IFALD.

Disclosure of Interest: O. Mohamed Elfadil: None declared, C. Cuerda: None declared, P. Jeppesen Other: has received grants/research support/honoraria or consultation fees from Albumedix A/S, ArTara Therapeutics, Bainan Biotech, Baxter, Coloplast A/S, Ferring Pharmaceuticals, Fresenius Kabi, GlyPharma Therapeutic, Hanmi Pharmaceuticals, Ironwood, Naia Pharmaceuticals, NPS Pharmaceuticals, Protara Therapeutics, Shire, Takeda, The Novo Nordisk Foundation, Therachon, VectiveBio AG, Zealand Pharma A/S., F. Joly Other: has received grants/research support/honoraria or consultation fees from Agomab, Baxter, Fresenius Kabi, Nestlé Health Sciences, BBraun, Theradial, Mayoli, Biocodex, mobile3e Consulting, Carembouche, NPS Pharmaceuticals, NorthSea Therapeutics, Shire, Takeda, Therachon, VectivBio and Zealand Pharma., S. Lal Grant / Research Support from: Fresenius Kabi, Baxter and Takeda. , Consultant for: Northsea, Ironwood, receives honoraria from Takeda, Zealand, Fresenius Kabi, B Braun and Baxter., G. Lamprecht Consultant for: Zealand Pharma. , L. Pironi Other: Payment or honoraria for lectures for Baxter, B.Braun, Nestle, Lionhealth, Napo Therapeutics, Northsea Therapeutics; Participation on a Data Safety Monitoring for Takeda, Protrara., K. Szczepanek Other: received honoraria from B. Braun., A. Van Gossum Other: Lectures for Danone Nutricia, Fresenius and Medical Nutrition International Industry (MNI)., T. Vanuytsel Grant / Research Support from: Takeda, VectivBio, Ironwood., Consultant for: Baxter, Takeda, Zealand Pharma, VectivBio, Ironwood, NorthSea, Hanmi, Other: Payment or honoraria for lectures for Baxter, Takeda, Zealand Pharma, VectivBio; Support for attending meetings for Fresenius Kabi, Takeda; Participation on a Data Safety Monitoring for NorthSea Therapeutics., G. Wanten: None declared, M. Mundi Grant / Research Support from: Nestle Health Science, Northsea, Fresenius Kabi, and VectivBio. , Consultant for: Baxter Healthcare, Otsuka, and NutriShare.