Good afternoon. I’m currently an assistant professor of medicine at Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University School of Medicine, and an investigator at the Cleveland Clinic Primary Care Institute Center for Value-Based Care research. My research focuses on applying disease science and health economics to support evidence-based medical decision making and inform public health policy.

With MASLD, prevalence expected to reach 41% by 2050, I think that primary care physicians really need to be more proactive in identifying at risk patients earlier. So right now, MASLD is often under diagnosed because routine levo function tests don’t always pick it up. A better approach should be to integrate simple non-invasive tools. For example, the fit for index or using elastography into regular checkups, especially for patients with metabolic risk factors. For example, obesity, type two diabetes or high cholesterol. Another important shift I think, is in awareness both among physicians and patients. Primary care provider can educate patients about MASLD as risk and the importance of lifestyle interventions. And at the same time, empowering patients with the knowledge to recognize risk factors and take a proactive steps such as taking regular checkups, eating healthier, or do more physical activity can play an important role in preventing disease prevention. So I think that with a lot of new treatments and being developed and also new treatment being approved for the condition, early detection will even be more important in identifying patients who might benefit from these therapies. That’s a really important issue because as MASLD case rise, we are going to see more patients progressing to advanced liver disease. And right now, one of the biggest challenges I think is timely referral. Many patients with significant fibrosis or cirrhosis aren’t being identified early enough for specialist care. To improve this, I think that we need a better coordination between primary care, gastroenterology, and hepatology. So for example, if a patient has metabolic risk factors in an elevated four score, that should automatically trigger further evaluation, whether it’s, it will be attention elastography, a direct referral to a specialist. We also need a clear referral guidelines and a better integration to electronic health record that will allow alerts or flag high risk patients. Another thing I think is important is the multidisciplinary care to have primary care, endocrinology and hepatology to work together, especially among patients with coexisting conditions like diabetes or cardiovascular disease.

First of all, one important thing to note about our studies that we projected the burden with our accounting for the potential impact of early screening and or treatment. So the actual increase in liver transplant may be less if patients are identified early and get treated timely. So regardless, the projected increase in liver transplant is a huge concern, and if liver transplant needs to quadruple by 2050, our current system won’t be able to keep up unless we started preparing. Now, I think one of the biggest challenges in the limited supply abdominal livers, so we can focus on both increasing organ availability and also reducing the number of patients who will progress to end-stage liver disease in the first place. For transplant center, this means that expanding liver living donor transplant programs and exploring strategies to improve organ preservation and utilizations will be important for the health system. They could invest in early interventions that include better screening, earlier specialist referral and wider access to new medications will be useful. Another big piece is equity. So right now not all patients have same access to transplant evaluation and care. So as demand grows, we must ensure that referral pathways are streamlined and that underserved populations are not left behind. So it’s really about a combinations of prevention, system level expansion and making sure that access to care is equitable.