Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease:A nationwide analysis

BACKGROUND Recent studies have revealed the endocannabinoid system as a potential therapeutic target in the management of nonalcoholic fatty liver disease(NAFLD).Cannabis use is associated with reduced risk for NAFLD,we hypothesized that cannabis use would be associated with less liver-related clinical complications in patients with NAFLD.AIM To assess the effects of cannabis use on liver-related clinical outcomes in hospitalized patients with NAFLD.METHODS We performed a retrospective matched cohort study based on querying the 2014 National Inpatient Sample(NIS)for hospitalizations of adults with a diagnosis of NAFLD.The NIS database is publicly available and the largest all-payer inpatient database in the United States.The patients with cannabis use were selected as cases and those without cannabis were selected as controls.Case-control matching at a ratio of one case to two controls was performed based on sex,age,race,and comorbidities.The liver-related outcomes such as portal hypertension,ascites,varices and variceal bleeding,and cirrhosis were compared between the groups.RESULTS A total of 49911 weighed hospitalizations with a diagnosis of NAFLD were identified.Of these,3820 cases were selected as the cannabis group,and 7625 noncannabis cases were matched as controls.Patients with cannabis use had a higher prevalence of ascites(4.5%vs 3.6%),with and without cannabis use,P=0.03.The prevalence of portal hypertension(2.1%vs 2.2%),varices and variceal bleeding(1.3%vs 1.7%),and cirrhosis(3.7%vs 3.6%)was not different between the groups,with and without cannabis use,all P>0.05.Hyperlipidemia,race/ethnicity other than White,Black,Asian,Pacific Islander or Native American,and higher comorbidity score were independent risk factors for ascites in the cannabis group.Among non-cannabis users,obesity and hyperlipidemia were independent protective factors against ascites while older age,Native American and higher comorbidity index were independent risk factors for ascites.CONCLUSION Cannabis was associated with higher rates of ascites,but there was no statistical difference in the prevalence of portal hypertension,varices and variceal bleeding,and cirrhosis.

De novo and recurrence of metabolic dysfunction-associated fatty liver disease after liver transplantation

Metabolic dysfunction-associated fatty liver disease(MAFLD)is a new acronym adopted from the consensus of international experts.Given the increasing prevalence of MAFLD in pre-transplant settings,de novo and recurrent graft steatosis/MAFLD are common in post-transplant settings.The impact of graft steatosis on long-term outcomes is unclear.The current knowledge of incidence rate,risk factors,diagnosis,long-term outcomes,and management of graft steatosis(both de novo and recurrent)is discussed in this review.