Severe alcoholic hepatitis is a serious form of alcoholic liver disease, presenting as acute-on-chronic liver failure (ACLF). A national survey on ACLF in Japan revealed that 37.2% of the cases were because of severe alcoholic hepatitis, and the 1-month mortality of severe alcoholic hepatitis can reach to 30%-50% without liver transplantation (LT). Anecdotally, a certain period of abstinence is required for listing, although recent studies have demonstrated the effectiveness of early LT for severe alcoholic hepatitis with comparable alcoholic relapse post-LT. Multidisciplinary evaluation of social and psychological aspects and family support contribute to alcoholic relapse post-LT. Therefore, further studies may be warranted to identify the LT eligibility criteria for patients with severe alcoholic hepatitis.

Despite the introduction of an electronic medical record alert-based system, some hepatitis virus carriers are still not referred to the hepatology department. Since June 2020, hepatology specialists reviewed the medical records of hepatitis C virus (HCV) antibody-positive patients with high-to-moderate titers who are not currently attending hepatology department or have not visited in the past through collaboration with hepatitis medical care coordinators (HMCCs) and individually recommended nonspecialists if necessary. In 2022, the percentage of patients requiring referrals decreased to approximately 10%, and the rate of intrahospital referrals increased by approximately 20% following individual recommendations. Although the number of HCV antibody-positive patients in non-hepatology departments has been decreasing, a certain number of patients continue to receive direct-acting antivirals (DAAs). The number of patients eligible for treatment has decreased because of the widespread use of DAAs; therefore, providing targeted individual recommendations by hepatology specialists through collaboration with HMCCs is important.

A 60-year-old male patient was admitted with Child- Pugh class C decompensated liver cirrhosis. Although he was on alcohol abstinence treatment since October 20XX-1 due to alcoholic liver cirrhosis, his alcohol consumption increased alcohol consumption from June 20XX, which resulted in decompensated liver cirrhosis. The patient in addition was administered rehabilitation therapy with one exercise/day (3 METs×20 minutes) to improve prefrailty. The patient exercised on 15 out of the 16 days of hospitalization (93.8%) and showed an improvement from 250 to 442 m in the 6-minute walk test. His liver frailty index also improved from 3.85 (prefrail) to 2.86 (robust). He did not exhibit liver reserve deterioration or falls during hospitalization. This case highlights that rehabilitation therapy should be considered depending on the patient's condition and physical function, even in patients with Child-Pugh class C decompensated cirrhosis.

A female patient in her 20s visited our department complaining of upper abdominal pain. She had been diagnosed with multiple intrahepatic stones and had a history of cholelithiasis. Her family medical history disclosed that her father had previously undergone hepatectomy for intrahepatic stone disease, and her aunt had undergone cholecystectomy. Genetic analysis identified a mutation in the ABCB4 gene, resulting in the diagnosis of low phospholipid-associated cholelithiasis (LPAC). Conservative treatment with oral ursodeoxycholic acid was selected due to the patient's young age, the presence of stones in both lobes of the liver, the absence of liver atrophy, and the risk of recurrence after hepatectomy. Although surgery was an option, it was not pursued. LPAC, a rare genetic disorder associated with recurrent cholelithiasis from an early age, underscores the importance of considering it as a potential differential diagnosis in cases of young-onset cholelithiasis with a family history.