Dr. Goel is a general and transplant hepatologist who specializes in caring for patients with chronic liver disease, viral hepatitis, fatty liver, autoimmune disorders, hepatocellular cancer and cirrhosis. She cares for patients before and after liver transplantation. Dr. Goel incorporates the most recent, evidence-based medicine in her practice and is passionate about ensuring the safest and highest quality of care for her patients. She engages her patients and their families in understanding the disease and in creating a comprehensive treatment plan. She is committed to teaching the next generation of hepatologists to do the same.

She has a particular clinical interest in the management of patients with autoimmune liver disease including autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and sarcoidosis. She is the leading institutional principal investigator for several clinical trials for these rare autoimmune liver conditions. Dr. Goel is also involved in several national and international collaborations to further our research and treatment of autoimmune hepatitis, PBC and PSC.

Clinical Focus

  • Transplant hepatology
  • Hepatology
  • Gastroenterology
  • Internal Medicine

Academic Appointments

Administrative Appointments

  • Clinical Associate Professor, SOM Gastroenterology and Hepatology (2022 - Present)
  • Associate Program Director, Gastroenterology Fellowship (2017 - Present)
  • Clinical Assistant Professor, Stanford School of Medicine Gastroenterology and Hepatology (2016 - 2022)

Honors & Awards

  • Annual Division Teaching Award, Stanford Department of Medicine (2020)
  • Summa Cum Laude, Jefferson Medical College (2009)
  • Alpha Omega Alpha Honor Society,, Jefferson Medical College (2008)

Boards, Advisory Committees, Professional Organizations

  • Member, American Association for the Study of Liver Diseases (2014 - Present)
  • Member, American Society of Transplantation (2016 - Present)
  • Member, American Gastroenterological Association (2013 - Present)
  • Member, American College of Gastroenterology (2013 - Present)

Professional Education

  • Residency: UCSF Dept of Internal Medicine (2013) CA
  • Board Certification: American Board of Internal Medicine, Transplant Hepatology (2018)
  • Medical Education: Sidney Kimmel Medical College Thomas Jefferson University (2009) PA
  • Fellowship: Icahn School of Medicine at Mount Sinai (2016) NY
  • Board Certification: American Board of Internal Medicine, Gastroenterology (2016)
  • B.S., Pennsylvania State University (2005)
  • M.D., Jefferson Medical College, Medicine (2009)
  • Resident, University of California San Francisco, Internal Medicine (2012)
  • Chief Resident, University of California San Francisco, Internal Medicine (2013)
  • Fellow, Icahn School of Medicine at Mount Sinai, New York, Gastroenterology (2016)
  • Chief Fellow, Icahn School of Medicine at Mount Sinai, Gastroenterology (2016)
  • Advanced Fellowship, Icahn School of Medicine at Mount Sinai, New York, Transplant Hepatology (2016)
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2012)
  • Board Certification, Gastroenterology, American Board of Internal Medicine (2016)

Community and International Work

  • PFC Volunteer


    Bay Area

    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

Dr. Goel is interested in studying the complications and management of patients with end-stage liver disease, including infections, bleeding and encephalopathy. As the waitlist for liver transplantation continues to grow, many patients develop consequences of decompensated liver disease. It is becoming increasingly important to improve our understanding and care of these complications in order to optimize the quality of life for this growing population of patients.

She is also particularly interested in the management of patients with autoimmune liver disease including autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis among others.

Clinical Trials

  • A Study of Zetomipzomib (KZR-616) in Patients With Autoimmune Hepatitis (PORTOLA) Recruiting

    This is a Phase 2a, multi-center, placebo-controlled study in which patients with autoimmune hepatitis will receive zetomipzomib or placebo in addition to standard-of-care for 24 weeks; an optional open-label extension period allows patients to receive zetomipzomib (KZR-616) for an additional 24 weeks of treatment.

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  • ALTA TIPS: A 5-year Longitudinal Observational Study of Patients Undergoing TIPS Placement Recruiting

    ALTA is a multicenter consortium focused on the management of portal hypertension. ALTA TIPS is a longitudinal observational study of patients who are undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement. ALTA will create a database that will provide clinical parameters and outcomes of patients undergoing TIPS as part of their standard of care in hopes of answering key clinical questions.

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  • Detection of Integrin avb6 in IPF, PSC, and COVID19 Using PET/CT Recruiting

    Detection of Integrin avb6 in Idiopathic Pulmonary Fibrosis, Primary Sclerosing Cholangitis, and Coronavirus Disease 2019 with \[18F\]FP-R01-MG-F2 with PET/CT

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  • Oral Hymecromone to Treat Adolescents and Adults With Primary Sclerosing Cholangitis. Recruiting

    Primary objective: To evaluate the efficacy of hymecromone plus standard of care compared with standard of care alone in the treatment of adolescents and adults with primary sclerosing cholangitis (PSC). Secondary objectives: To evaluate the change in Alkaline Phosphatase (ALP) from baseline to 6 months post-treatment following treatment with hymecromone plus standard of care compared with standard of care. To evaluate changes in biomarkers of PSC disease during hymecromone treatment, namely: (a) fibrotic effect (FibroScan); (b) inflammatory biomarkers (serum Hyaluronan (HA)); and, (c) T-cell count.

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  • A 5-year Longitudinal Observational Study of Patients With Primary Biliary Cholangitis Not Recruiting

    This is a 5-year, longitudinal, observational study of patients with PBC designed to specifically address important clinical questions that remain incompletely answered from registration trials. In addition to the study database, a bio specimen repository will also be included so that translational studies of genomics and biomarkers of response may be performed.

    Stanford is currently not accepting patients for this trial. For more information, please contact Jennifer Smart, 650-721-4288.

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  • A Phase 2b Study in Subjects With Alcoholic Hepatitis to Evaluate Safety and Efficacy of DUR-928 Treatment Not Recruiting

    This is a randomized, double-blind, placebo-controlled, phase 2b clinical Trial evaluating Safety and Efficacy of DUR-928 (an experimental medication) in Patients with Alcoholic Hepatitis (AH).

    Stanford is currently not accepting patients for this trial. For more information, please contact Thuy Nhi Huynh, (650)497-4070.

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  • ENHANCE: Seladelpar in Subjects With Primary Biliary Cholangitis (PBC) and an Inadequate Response to or an Intolerance to Ursodeoxycholic Acid (UDCA) Not Recruiting

    A 52-week, placebo-controlled, randomized, Phase 3 study to evaluate the safety and efficacy of seladelpar in subjects with primary biliary cholangitis (PBC) and an inadequate response to or intolerance to ursodeoxycholic acid (UDCA) The participants might enter the ongoing open-label safety study (NCT03301506) following this double-blind study.

    Stanford is currently not accepting patients for this trial. For more information, please contact Jennifer Smart, 650-721-4326.

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  • Phase 2a Evaluation of Safety, Tolerability, and Pharmacokinetics of PLN-74809 in Patients With Primary Sclerosing Cholangitis (PSC) Not Recruiting

    A Phase 2a, multicenter, randomized, double-blind, dose-ranging, placebo-controlled, study to evaluate the safety, tolerability, and PK of PLN-74809 in participants with primary sclerosing cholangitis and suspected liver fibrosis

    Stanford is currently not accepting patients for this trial. For more information, please contact Jennifer Smart, 650-721-8517.

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  • RESPONSE: Response to Seladelpar in Subjects With Primary Biliary Cholangitis (PBC) and an Inadequate Control to or an Intolerance to Ursodeoxycholic Acid (UDCA) Not Recruiting

    To evaluate the treatment effect of seladelpar on composite biochemical improvement in cholestasis markers based on ALP and total bilirubin and to evaluate the safety of seladelpar over 12 months of treatment compared to placebo

    Stanford is currently not accepting patients for this trial.

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  • Study of Cilofexor in Adults With Primary Sclerosing Cholangitis Not Recruiting

    The primary objective of this study is to evaluate whether cilofexor reduces the risk of fibrosis progression among non-cirrhotic adults with primary sclerosing cholangitis (PSC).

    Stanford is currently not accepting patients for this trial. For more information, please contact Tanvi Chitre, 650-723-9651.

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Graduate and Fellowship Programs

  • Gastroenterology & Hepatology (Fellowship Program)

All Publications

  • Outcomes of Liver Transplantation Among Older Recipients With Nonalcoholic Steatohepatitis in a Large Multicenter US Cohort: the Re-Evaluating Age Limits in Transplantation Consortium. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Kwong, A. J., Devuni, D., Wang, C., Boike, J., Jo, J., VanWagner, L., Serper, M., Jones, L., Sharma, R., Verna, E. C., Shor, J., German, M. N., Hristov, A., Lee, A., Spengler, E., Koteish, A. A., Sehmbey, G., Seetharam, A., John, N., Patel, Y., Kappus, M. R., Couri, T., Paul, S., Salgia, R. J., Nhu, Q., Frenette, C. T., Lai, J. C., Goel, A., Re-Evaluating Age Limits in Transplantation (REALT) Consortium 2020


    The liver transplantation (LT) population is aging, with the need for transplant being driven by the growing prevalence of nonalcoholic steatohepatitis (NASH). Older LT recipients with NASH may be at an increased risk for adverse outcomes after LT. Our objective is to characterize outcomes in these recipients in a large multicenter cohort. All primary LT recipients ≥65years from 2010 to 2016 at 13 centers in the Re-Evaluating Age Limits in Transplantation (REALT) consortium were included. Of 1023 LT recipients, 226 (22.1%) were over 70 years old, and 207 (20.2%) had NASH. Compared with other LT recipients, NASH recipients were older (68.0 versus 67.3years), more likely to be female (47.3% versus 32.8%), White (78.3% versus 68.0%), Hispanic (12.1% versus 9.2%), and had higher Model for End-Stage Liver Disease-sodium (21 versus 18) at LT (P<0.05 for all). Specific cardiac risk factors including diabetes with or without chronic complications (69.6%), hypertension (66.3%), hyperlipidemia (46.3%), coronary artery disease (36.7%), and moderate-to-severe renal disease (44.4%) were highly prevalent among NASH LT recipients. Graft survival among NASH patients was 90.3% at 1year and 82.4% at 3years compared with 88.9% at 1year and 80.4% at 3years for non-NASH patients (log-rank P=0.58 and P=0.59, respectively). Within 1 year after LT, the incidence of graft rejection (17.4%), biliary strictures (20.9%), and solid organ cancers (4.9%) were comparable. Rates of cardiovascular (CV) complications, renal failure, and infection were also similar in both groups. We observed similar posttransplant morbidity and mortality outcomes for NASH and non-NASH LT recipients. Certain CV risk factors were more prevalent in this population, although posttransplant outcomes within 1 year including CV events and renal failure were similar to non-NASH LT recipients.

    View details for DOI 10.1002/lt.25863

    View details for PubMedID 33047893

  • Natural History of Primary Biliary Cholangitis in the Ursodeoxycholic Acid Era: Role of Scoring Systems. Clinics in liver disease Goel, A., Kim, W. R. 2018; 22 (3): 563-578


    Primary biliary cholangitis (PBC) is a chronic disease that progresses to end-stage liver disease. Ursodeoxycholic acid (UDCA), the standard treatment for PBC for several decades, is associated with improved survival without liver transplantation. Approximately 40% of patients do not respond to UDCA. Because of disease variability, several prognostic models exist that incorporate various factors including biochemical response to UDCA. Useful for patient care and counseling as well as risk stratification for research and clinical trials, the role of these models in the pre-UDCA and UDCA eras is discussed.

    View details for DOI 10.1016/j.cld.2018.03.007

    View details for PubMedID 30259853

  • Liver Simulated Allocation Modeling: Were the Predictions Accurate for Share 35? Transplantation Goel, A. n., Kim, W. R., Pyke, J. n., Schladt, D. P., Kasiske, B. L., Snyder, J. J., Lake, J. R., Israni, A. K. 2018


    The liver simulated allocation model (LSAM) can be used to study likely effects of liver transplant allocation policy changes on organ offers, acceptance, waitlist survival, and posttransplant survival. Implementation of Share 35 in June 2013 allowed for testing how well LSAM predicted actual changes.LSAM projections for 1 year of liver transplants before and after the Share 35 policy change were compared with observed data during the same period. Numbers of organs recovered, organ sharing, transplant rates, and waitlist mortality rates (per 100 waitlist years) were evaluated by LSAM and compared with observed data.Candidate, recipient, and donor characteristics in the LSAM cohorts were similar to those in the observed population before and after Share 35. LSAM correctly predicted more accepted organs and fewer discarded organs with Share 35. LSAM also predicted increased regional and national sharing, consistent with observed data, although the magnitude was overestimated. Transplant rates were correctly projected to increase and waitlist death rates to decrease.Although the absolute number of transplants was underestimated and waitlist deaths overestimated, the direction of change was consistent with observed data. LSAM correctly predicted change in discarded organs, regional and national sharing, waitlist mortality, and transplants after Share 35 implementation.

    View details for PubMedID 29309379

  • Systematic review with meta-analysis: rifaximin for the prophylaxis of spontaneous bacterial peritonitis. Alimentary pharmacology & therapeutics Goel, A. n., Rahim, U. n., Nguyen, L. H., Stave, C. n., Nguyen, M. H. 2017


    The primary and secondary prevention of spontaneous bacterial peritonitis (SBP) is recommended in high-risk patients with cirrhosis. Several studies evaluating the efficacy of rifaximin for SBP prophylaxis have yielded conflicting results. Rifaximin has the potential advantage of preventing bacterial overgrowth and translocation without the systemic side effects of broad-spectrum antibiotics.To evaluate the efficacy of rifaximin in the primary and secondary prevention of SBP.A literature search using five databases was performed to identify studies on the association between rifaximin and SBP. We performed two meta-analyses: (1) rifaximin compared to systemic antibiotics and (2) rifaximin compared to no antibiotics. Random-effect modelling was conducted to determine overall pooled estimates and 95% confidence intervals (CIs).Five studies with 555 patients (295 rifaximin, 260 systemic antibiotics) compared rifaximin with systemic antibiotics. The pooled odds ratio (OR) for SBP was 0.45 (95% CI 0.16-1.27; P = .13) in patients receiving rifaximin and strengthened on sensitivity analysis (OR 0.38, 95% CI 0.19-0.76, P = .01). In the analysis comparing rifaximin with no antibiotics, there were five studies with 784 patients (186 rifaximin, 598 no antibiotics). The OR for SBP was 0.34 (95% CI 0.11-0.99; P < .05) in patients receiving rifaximin. In subgroup analysis, rifaximin reduced the risk of SBP by 47% compared to no antibiotics for primary prophylaxis and by 74% compared to systemic antibiotics for secondary prophylaxis.Rifaximin may be effective in preventing SBP in patients with cirrhosis and ascites compared to systemically absorbed antibiotics and compared to placebo.

    View details for PubMedID 28994123

  • Timing of Hepatitis C Virus Treatment in Liver Transplant Candidates in the Era of Direct-acting Antiviral Agents. Journal of clinical and translational hepatology Cholankeril, G. n., Joseph-Talreja, M. n., Perumpail, B. J., Liu, A. n., Yoo, E. R., Ahmed, A. n., Goel, A. n. 2017; 5 (4): 363–67


    Chronic hepatitis C virus (HCV) infection remains the leading indication for liver transplantation (LT) in the United States. While most patients with chronic HCV infection remain asymptomatic, up to one-third develop progressive liver disease resulting in cirrhosis. LT is often the only curative treatment once significant hepatic decompensation develops. However, antiviral therapy for HCV infection has advanced markedly in the past 5 years with the discovery and approval of direct-acting antiviral agents. These new regimens are well tolerated, of short duration and highly effective, unlike the traditional treatment with pegylated-interferon and ribavirin. As achieving sustained virological response becomes increasingly attainable for a majority of HCV-infected patients, concerns have been raised regarding the optimal timing of treatment for HCV infection in the setting of end-stage liver disease and during the peri-transplant period. On one hand, HCV treatment may improve hepatic function and negate the need for LT in some, which is crucial given the scarcity of donor organs and mortality on the waiting list in certain regions. On the other hand, HCV treatment may result in lowering the priority for LT without improving quality of life, thereby delaying potentially curative LT surgery. This review evaluates the evidence supporting the use of direct-acting antiviral agents in the period before and following LT.

    View details for PubMedID 29226102

  • A systematic model improves hepatitis C virus birth cohort screening in hospital-based primary care. Journal of viral hepatitis Goel, A., Sanchez, J., Paulino, L., Feuille, C., Arend, J., Shah, B., Dieterich, D., Perumalswami, P. V. 2016


    Despite national and local governing board recommendations in the United States of America to perform an HCV screening test in baby boomers, screening rates remain low. Our goal was to study the impact of an HCV screening and link to care program with patient navigation in two New York City primary care practices. This was a two-year prospective study of patients born between 1945-1965 ("baby boomers") with encounters at two primary care practices at the Mount Sinai Hospital between November 1, 2013 and November 30, 2015. Baseline HCV screening rates were collected for four months. A multifaceted intervention was sequentially implemented involving electronic alerts, housestaff education, data feedback and patient navigation. HCV screening rates and link to care, defined as attending an appointment with a viral hepatitis specialist, were compared before and after these interventions. There were 14,642 primary care baby boomer patients of which 4,419 (30.2%) were newly screened during the study. There was a significant increase in HCV screening rates from 55% to 75% (p<0.01) and the HCV seropositive rate was 3.3%. Factors associated with being HCV seropositive included older age (p<0.01), male sex (p<0.01), African American race (p<0.01) and receiving care in the housestaff practice (p<0.01). With patient navigation, 78 of 84 (93%) newly diagnosed HCV infected persons were referred to a specialist and 60 (77%) attended their first appointment. A structured, multifaceted HCV screening program using well-studied principles identifies a large number of undiagnosed baby boomers within hospital-based primary care and improves access to specialty providers in a timely manner. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/jvh.12669

    View details for PubMedID 28039935

  • A Real-World Evaluation of Repeat Paracentesis-guided Management of Spontaneous Bacterial Peritonitis. Journal of clinical gastroenterology Goel, A., Biewald, M., Huprikar, S., Schiano, T., Im, G. Y. 2016


    Spontaneous bacterial peritonitis (SBP) is a common infection in cirrhosis associated with high mortality. More than 20% of patients with SBP do not respond to initial antibiotics. Guidelines differ in recommendations to repeat paracentesis (retap) to confirm antibiotic efficacy. We aim to evaluate the effect of retap-guided management of SBP on antibiotic escalation and 30-day transplant-free survival.Retrospective cohort study of cirrhotic patients with SBP admitted to a single transplant center from 2010 to 2014. Patients were divided into 2 groups: retap-guided management versus no retap. Prevalence of initial antibiotic treatment failure, defined as <25% decrease in ascitic polymorphonuclear cells, and factors associated with treatment failure, antibiotic escalation and 30-day transplant-free survival were evaluated.Out of 210 patients, 146 (age 58, 74% male, mean model for end-stage liver disease score, 25) had retap and treatment failure was noted in 28 (22%). Gram-positive bacteria accounted for 44% of all positive cultures and third-generation cepahalosporin resistance was noted in 23%. Thirty-day transplant-free survival was 72% and 62% in retap and control groups, respectively (P=0.07). Treatment failure independently doubled the 30-day mortality rate (hazard ratio: 2.15, 1.03 to 4.50, P=0.04). After adjusting for age, model for end-stage liver disease and nosocomial infection, retap-guided management was not associated with improved survival (P=0.34).The prevalence of initial treatment failure is high (22%) in patients with SBP and doubles the 30-day mortality risk, supporting recommendations to retap all patients with SBP.

    View details for DOI 10.1097/MCG.0000000000000704

    View details for PubMedID 27661968

  • Hepatic Artery and Biliary Complications in Liver Transplant Recipients Undergoing Pretransplant Transarterial Chemoembolization LIVER TRANSPLANTATION Goel, A., Mehta, N., Guy, J., Fidelman, N., Yao, F., Roberts, J., Terrault, N. 2014; 20 (10): 1221-1228


    Liver transplantation (LT) is the treatment of choice for patients with cirrhosis and hepatocellular carcinoma (HCC) not amenable to resection. Locoregional therapies for HCC are often used to reduce tumor burden, bridge patients to LT, and down-stage HCC so that patients are eligible for LT. We hypothesized that prior endovascular antitumor therapy may increase the risk of hepatic artery (HA) and biliary complications after LT. The aim of this study was to compare HA and biliary complications in LT recipients with HCC who received transarterial chemoembolization (TACE) before LT with complications in LT recipients with HCC who did not receive TACE before LT. This was a retrospective cohort study of HCC patients at two transplant centers. The prevalence of HA complications (HA thrombosis, stenosis, or pseudoaneurysm) and biliary complications (nonanastomotic stricture, bile leak, and diffuse injury) were compared between patients treated with or without TACE. There were 456 HCC patients with a median age of 61 years (77% were male, and 63% had hepatitis C virus), and 328 (72%) received TACE before LT. The overall prevalence of HA complications was 4.7% in the no-TACE group and 7.9% in the TACE group (P = 0.22). All HA stenosis complications (n = 14) occurred in the TACE group (P = 0.018 versus the no-TACE group). An older donor age and a lower albumin level significantly increased the odds of HA complications. There was a nonstatistically significant increased odds of HA complications in the TACE group versus the no-TACE group according to an adjusted analysis (odds ratio = 2.02, 95% confidence interval = 0.79-5.16, P = 0.14). The overall prevalence of biliary complications was 16.4% in the no-TACE group and 19.8% in the TACE group (P = 0.40). In conclusion, a lower pre-LT albumin level and an older donor age were significantly associated with higher odds of HA complications after LT. TACE was not associated with higher odds of overall HA complications but was associated with a higher prevalence of HA stenosis. Further studies are warranted to confirm the HA stenosis findings and elucidate the pathogenesis.

    View details for DOI 10.1002/lt.23945

    View details for Web of Science ID 000343012000010

    View details for PubMedID 25045002

  • Provider Attitudes and Practices for Alcohol Screening, Treatment and Education in Patients with Liver Disease: a Survey from the AASLD ALD SIG. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Im, G. Y., Mellinger, J. L., Winters, A., Aby, E. S., Lominadze, Z., Rice, J., Lucey, M. R., Arab, J. P., Goel, A., Jophlin, L. L., Sherman, C. B., Parker, R., Chen, P., Devuni, D., Sidhu, S., Dunn, W., Szabo, G., Singal, A. K., Shah, V. H. 2020


    BACKGROUND & AIMS: While abstinence-promoting behavioral and pharmaco-therapies are part of the therapeutic foundation for alcohol use disorder (AUD) and alcohol-associated liver disease (ALD), these therapies, along with alcohol screening and education, are often underutilized. Our aim was to examine provider attitudes and practices for alcohol screening, treatment and education in patients with liver disease.METHODS: We conducted a survey of primarily (89%) hepatology and gastroenterology providers within (80%) and outside the US (20%). Surveys were sent to 921 providers with 408 complete responses (44%), of whom 343 (80%) work in a tertiary liver transplant center.RESULTS: While alcohol screening rates in liver disease patients was nearly universal, less than half of providers reported practicing with integrated addiction providers, using alcohol biomarkers and screening tools. Safe alcohol use by liver disease patients was felt to exist by 40% of providers. While 60% of providers reported referring AUD patients for behavioral therapy, 71% never prescribed AUD pharmacotherapy due to low comfort (84%). Most providers (77%) reported low addiction education and 90% desired more during GI/hepatology fellowship training. Amongst prescribers, baclofen was preferred, but with gaps in pharmacotherapy knowledge. Overall, there was low adherence to the 2019 AASLD practice guidance for ALD, although higher in hepatologists and experienced providers.CONCLUSIONS: While our survey of hepatology and gastroenterology providers demonstrated higher rates of alcohol screening and referrals for behavioral therapy, we found low rates of prescribing AUD pharmacotherapy due to knowledge gaps from insufficient education. Further studies are needed to assess interventions to improve provider alignment with best practices for treating patients with AUD and ALD.

    View details for DOI 10.1016/j.cgh.2020.10.026

    View details for PubMedID 33069880

  • Tenofovir Alafenamide Attenuates Effects of Diabetes and Body Mass on Serum Alanine Aminotransferase Activities in Patients with Chronic Hepatitis B. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Sripongpun, P. n., Kim, W. R., Mannalithara, A. n., Kwong, A. n., Daugherty, T. n., Goel, A. n., Kwo, P. Y. 2020

    View details for DOI 10.1016/j.cgh.2020.11.047

    View details for PubMedID 33285291

  • NAFLD and Diabetes are Associated with Post-TIPS Renal Dysfunction: An ALTA Group Study. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Ge, J. n., Lai, J. C., Boike, J. R., German, M. n., Jest, N. n., Morelli, G. n., Spengler, E. n., Said, A. n., Lee, A. n., Hristov, A. n., Desai, A. P., Junna, S. n., Pokhrel, B. n., Couri, T. n., Paul, S. n., Frenette, C. n., Christian-Miller, N. n., Laurito, M. n., Verna, E. C., Rahim, U. n., Goel, A. n., Das, A. n., Pine, S. n., Gregory, D. n., VanWagner, L. B., Kolli, K. P. 2020


    Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications, but its effect on renal function is not well-characterized. Here, we describe renal function and characteristics associated with renal dysfunction at 30-days post-TIPS.Adults with cirrhosis who underwent TIPS at nine hospitals in the US 2010-2015 were included. We defined "post-TIPS renal dysfunction" as a change in estimated glomerular filtration rate (ΔeGFR) ≤ -15ml/min/1.73m2 and eGFR ≤ 60ml/min/1.73m2 , or new renal replacement therapy (RRT) at day 30. We identified the characteristics associated with post-TIPS renal dysfunction by logistic regression and evaluated survival using adjusted competing risk regressions.Of 673 patients: median age 57 years, 38% female, 26% had diabetes, median MELDNa 17. Thirty days post-TIPS, 66 (10%) had renal dysfunction, of which 23 (35%) required new RRT. Patients with post-TIPS renal dysfunction, compared to those with stable renal function, were more likely to have NAFLD (33% versus 17%, p = 0.01) and comorbid diabetes (42% versus 24%, p < 0.01). Multivariate logistic regressions showed NAFLD (OR 2.04, 95%CI 1.00 to 4.17, p = 0.05), serum sodium (OR 1.06 per mEq/L, 95%CI 1.01 to 1.12, p = 0.03), and diabetes (OR 2.04, 95%CI 1.16 to 3.61, p = 0.01) were associated with post-TIPS renal dysfunction. Competing risk regressions showed those with post-TIPS renal dysfunction were at higher sub-hazard of death (sHR 1.74, 95%CI 1.18 to 2.56, p = 0.01).In this large multi-center cohort, we found NAFLD, diabetes, and baseline serum sodium associated with post-TIPS renal dysfunction. This study suggests that patients with NAFLD and diabetes undergoing TIPS evaluation may require additional attention to cardiac and renal comorbidities prior to proceeding with the procedure.

    View details for DOI 10.1002/lt.25949

    View details for PubMedID 33217178

  • Dead Meat: Glecaprevir/Pibrentasvir-Induced Statin Myonecrosis. Digestive diseases and sciences Wong, K., Podboy, A., Lavezo, J., Goel, A. 2020

    View details for DOI 10.1007/s10620-019-05993-w

    View details for PubMedID 31894484

  • Practical strategies for pruritus management in the obeticholic acid-treated patient with PBC: proceedings from the 2018 expert panel. BMJ open gastroenterology Pate, J., Gutierrez, J. A., Frenette, C. T., Goel, A., Kumar, S., Manch, R. A., Mena, E. A., Pockros, P. J., Satapathy, S. K., Yimam, K. K., Gish, R. G. 2019; 6 (1): e000256


    Background and aims: This article provides expert guidance on the management of pruritus symptoms in patients receiving obeticholic acid (OCA) as treatment for primary biliary cholangitis (PBC). PBC is a chronic, autoimmune cholestatic liver disease that affects intrahepatic bile ducts. If not adequately treated, PBC can lead to cholestasis and end-stage liver disease, which may require transplant. Timely treatment is therefore vital to patient health. Pruritus is a common symptom in patients with PBC. Additionally, the use of OCA to treat PBC can contribute to increased pruritus severity in some patients, adding to patient discomfort, decreasing patient quality of life (QoL), and potentially affecting patient adherence to OCA treatment.Methods: In May 2018, a group of physician experts from the fields of gastroenterology, hepatology, and psychiatry met to discuss the management of pruritus in OCA-treated patients with PBC. Recognizing the importance of optimizing treatment for PBC, these experts developed recommendations for managing pruritus symptoms in the OCA-treated PBC patient based on their experience in clinical practice.Results: These recommendations include a comprehensive list of management strategies (including over-the-counter, prescription, and alternative therapies), guidance on titration of OCA to minimize pruritus severity, and an algorithm that outlines a practical approach to follow up with patients receiving OCA, to better assess and manage pruritus symptoms.Conclusions: Pruritus associated with OCA therapy is dose dependent and often manageable, and with the proper education and tools, most pruritus cases can be effectively managed to minimize treatment discontinuation.

    View details for PubMedID 30815273

  • Early Liver Transplantation is a Viable Treatment Option in Severe Acute Alcoholic Hepatitis ALCOHOL AND ALCOHOLISM Puri, P., Cholankeril, G., Myint, T. Y., Goel, A., Sarin, S., Harper, A. M., Ahmed, A. 2018; 53 (6): 716–18


    Liver transplantation is lifesaving for patients with severe acute alcoholic hepatitis (SAH) with preliminary data demonstrating favorable early post-transplant outcomes. Using the United Network for Organ Sharing database, we demonstrate that liver transplantation for SAH in the USA has steadily increased and is associated with similar 1- and 3-year post-transplant survival as well as comparable 30-day waitlist mortality to acute liver failure due to drug-induced liver injury.

    View details for PubMedID 30099535

    View details for PubMedCentralID PMC6203122

  • Clinical utility of ledipasvir/sofosbuvir in the treatment of adolescents and children with hepatitis C Adolescent Health, Medicine and Therapeutics Yang, C. H., Goel, A., Ahmed, A. 2018; 9: 103—110


    Chronic infection with hepatitis C virus (HCV) affects an estimated 0.1%-2% of the pediatric population in the United States. While the clinical course in young children is indolent, adolescents who contract HCV have a disease course similar to adults, with a 26-fold increased risk of chronic liver disease-associated mortality, hepatocellular carcinoma, and need for curative liver transplantation. Furthermore, adolescent patients are entering childbearing age and carry a risk of passing HCV to their offspring via vertical transmission. Pegylated-interferon (PEG-IFN) with ribavirin was previously the only treatment option for pediatric patients with chronic hepatitis C (CHC), but the high likelihood of adverse reactions and subcutaneous route of administration limited its use and efficacy. Recently, the direct-acting antivirals (DAAs) ledipasvir (LDV) and sofosbuvir (SOF) were approved for adolescents with CHC. This review discusses the natural history of CHC in pediatric patients, data supporting LDV/SOF in adolescents, and ongoing studies evaluating DAAs in pediatric patients.

    View details for DOI 10.2147/AHMT.S147896

    View details for PubMedCentralID PMC6071628

  • Improved Post-Transplant Mortality After Share 35 for Liver Transplantation. Hepatology (Baltimore, Md.) Kwong, A. J., Goel, A., Mannalithara, A., Kim, W. R. 2017


    The Share 35 policy was implemented in June 2013 to improve equity in access to liver transplantation (LT) between patients with fulminant liver failure and those with cirrhosis and severe hepatic decompensation. The aim of this study was to assess post-LT outcomes after Share 35.Relevant donor, procurement, and recipient data were extracted from the OPTN/UNOS database. All adult deceased donor LT from January 1, 2010 to March 31, 2016 were included in the analysis. One-year patient survival before and after Share 35 was assessed by multivariable Cox proportional hazards analysis, with adjustment for variables known to affect graft survival.Of 34,975 adult LT recipients, 16,472 (47.1%) were transplanted after the implementation of Share 35, of whom 4,599 (27.9%) had a Model for End-Stage Liver Disease (MELD) ≥35. One-year patient survival improved from 83.9% to 88.4% after Share 35 (p<0.01) for patients with MELD ≥35. There was no significant impact on survival of patients with MELD <35 (p=0.69). Quality of donor organs, as measured by Donor Risk Index without the regional share component, improved for patients with MELD ≥35 (p<0.01) and worsened for patients with lower MELD (p<0.01). In multivariable Cox regression analysis, Share 35 was associated with improved one-year patient survival (hazard ratio 0.69, 95% confidence interval 0.60-0.80) in recipients with MELD ≥35.Share 35 has had a positive impact on survival after transplantation in patients with MELD ≥35, without a reciprocal detriment in patients with lower acuity. This was in part a result of a more favorable donor-recipient matching. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/hep.29301

    View details for PubMedID 28586179

  • An Atypical Cause of a Typical Symptom. Gastroenterology Menezes, A., Goel, A., Sam, G. 2016

    View details for DOI 10.1053/j.gastro.2016.06.019

    View details for PubMedID 27591422

  • The features of mucosa-associated microbiota in primary sclerosing cholangitis ALIMENTARY PHARMACOLOGY & THERAPEUTICS Torres, J., Bao, X., Goel, A., Colombel, J., Pekow, J., Jabri, B., Williams, K. M., Castillo, A., Odin, J. A., Meckel, K., Fasihuddin, F., Peter, I., Itzkowitz, S., Hu, J. 2016; 43 (7): 790-801


    Little is known about the role of the microbiome in primary sclerosing cholangitis.To explore the mucosa-associated microbiota in primary sclerosing cholangitis (PSC) patients across different locations in the gut, and to compare it with inflammatory bowel disease (IBD)-only patients and healthy controls.Biopsies from the terminal ileum, right colon, and left colon were collected from patients and healthy controls undergoing colonoscopy. Microbiota profiling using bacterial 16S rRNA sequencing was performed on all biopsies.Forty-four patients were recruited: 20 with PSC (19 with PSC-IBD and one with PSC-only), 15 with IBD-only and nine healthy controls. The overall microbiome profile was similar throughout different locations in the gut. No differences in the global microbiome profile were found. However, we observed significant PSC-associated enrichment in Barnesiellaceae at the family level, and in Blautia and an unidentified Barnesiellaceae at the genus level. At the operational taxa unit level, most shifts in PSC were observed in Clostridiales and Bacteroidales orders, with approximately 86% of shifts occurring within the former order.The overall microbiota profile was similar across multiple locations in the gut from the same individual regardless of disease status. In this study, the mucosa associated-microbiota of patients with primary sclerosing cholangitis was characterised by enrichment of Blautia and Barnesiellaceae and by major shifts in operational taxa units within Clostridiales order.

    View details for DOI 10.1111/apt.13552

    View details for Web of Science ID 000371742300004

    View details for PubMedID 26857969

  • Early Liver Transplantation for Severe Alcoholic Hepatitis in the United StatesA Single-Center Experience AMERICAN JOURNAL OF TRANSPLANTATION Im, G. Y., Kim-Schluger, L., Shenoy, A., Schubert, E., Goel, A., Friedman, S. L., Florman, S., Schiano, T. D. 2016; 16 (3): 841-849


    Early liver transplantation (LT) in European centers reportedly improved survival in patients with severe alcoholic hepatitis (AH) not responding to medical therapy. Our aim was to determine if a strategy of early LT for severe AH could be applied successfully in the United States. We reviewed 111 patients with severe AH at our center from January 2012 to January 2015. The primary end point was mortality at 6 months or early LT, with a secondary end point of alcohol relapse after LT. Survival was compared between those receiving early LT and matched patients who did not. Using a process similar to the European trial, 94 patients with severe AH not responding to medical therapy were evaluated for early LT. Overall, 9 (9.6%) candidates with favorable psychosocial profiles underwent early LT, comprising 3% of all adult LT during the study period. The 6-month survival rate was higher among those receiving early LT compared with matched controls (89% vs 11%, p<0.001). Eight recipients are alive at a median of 735 days with 1 alcohol relapse. Early LT for severe AH can achieve excellent clinical outcomes with low impact on the donor pool and low rates of alcohol relapse in highly selected patients in the United States.

    View details for DOI 10.1111/ajt.13586

    View details for Web of Science ID 000371240500016

    View details for PubMedID 26710309

  • Reply: To PMID 25045002. Liver transplantation Goel, A., Terrault, N. 2015; 21 (3): 416-?

    View details for DOI 10.1002/lt.24066

    View details for PubMedID 25530165

  • Identification of Liver Transplant Candidates With Hepatocellular Carcinoma and a Very Low Dropout Risk: Implications for the Current Organ Allocation Policy LIVER TRANSPLANTATION Mehta, N., Dodge, J. L., Goel, A., Roberts, J. P., Hirose, R., Yao, F. Y. 2013; 19 (12): 1343-1353


    It has been shown that patients with hepatocellular carcinoma (HCC) meeting the United Network for Organ Sharing T2 (Milan) criteria have an advantage in comparison with patients without HCC under the current organ allocation system for liver transplantation (LT). We hypothesized that within the T2 HCC group, there is a subgroup with a low risk of wait-list dropout that should not receive the same listing priority. This study evaluated 398 consecutive patients with T2 HCC listed for LT with a Model for End-Stage Liver Disease exception from March 2005 to January 2011 at our center. Competing risk (CR) regression was used to determine predictors of dropout. The probabilities of dropout due to tumor progression or death without LT according to the CR analysis were 9.4% at 6 months and 19.6% at 12 months. The median time from listing to LT was 8.8 months, and the median time from listing to dropout or death without LT was 7.2 months. Significant predictors of dropout or death without LT according to a multivariate CR regression included 1 tumor of 3.1 to 5 cm (versus 1 tumor of 3 cm or less), 2 or 3 tumors, a lack of a complete response to the first locoregional therapy (LRT), and a high alpha-fetoprotein (AFP) level after the first LRT. A subgroup (19.9%) that met certain criteria (1 tumor of 2 to 3 cm, a complete response after the first LRT, and an AFP level ≤ 20 ng/mL after the first LRT) had 1- and 2-year probabilities of dropout of 1.3% and 1.6%, respectively, whereas the probabilities were 21.6% and 26.5% for all other patients (P = 0.004). In conclusion, a combination of tumor characteristics and a complete response to the first LRT define a subgroup of patients with a very low risk of wait-list dropout who do not require the same listing priority. Our results may have important implications for the organ allocation policy for HCC.

    View details for DOI 10.1002/lt.23753

    View details for Web of Science ID 000327431600009

    View details for PubMedID 24285611

  • The Housestaff Incentive Program improving the timeliness and quality of discharge summaries by engaging residents in quality improvement BMJ QUALITY & SAFETY Bischoff, K., Goel, A., Hollander, H., Ranji, S. R., Mourad, M. 2013; 22 (9): 768-774


    Quality improvement has become increasingly important in the practice of medicine; however, engaging residents in meaningful projects within the demanding training environment remains challenging.We conducted a year-long quality improvement project involving internal medicine residents at an academic medical centre. Resident champions designed and implemented a discharge summary improvement bundle, which employed an educational curriculum, an electronic discharge summary template, regular data feedback and a financial incentive. The timeliness and quality of discharge summaries were measured before and after the intervention. Residents and faculty were surveyed about their perceptions of the project; primary care providers were surveyed about their satisfaction with hospital provider communication.With implementation of the bundle, the average time from patient discharge to completion of the discharge summary fell from 3.5 to 0.61 days (p<0.001). The percentage of summaries completed on the day of discharge rose from 38% to 83% (p<0.001) and this improvement was sustained for 6 months following the end of the project. The percentage of summaries that included all recommended elements increased from 5% to 88% (p<0.001). Primary care providers reported a lower likelihood of discharge summaries being unavailable at the time of outpatient follow-up (38% to 4%, p<0.001). Residents reported that the systems changes, more than the financial incentive, accounted for their behaviour change.Our discharge summary improvement project provides an instructive example of how residents can lead clinically meaningful quality improvement projects.

    View details for DOI 10.1136/bmjqs-2012-001671

    View details for Web of Science ID 000329777400009

    View details for PubMedID 23704085