The Baveno meeting is a consensus meeting led by the European Association for the Study of the Liver about various topics related to portal hypertension. This meeting has been held every 5 years since 1990. Recent Baveno VII consensus meeting was held online in October 2021. Several clinical studies worldwide are based on the Baveno criteria, which have become the global standard for portal hypertension. Representing Japan for the first time, the Japanese Society of Hepatology officially joined the meeting as a faculty member for the Baveno VII meeting. This paper reviews the background of the Baveno meeting and the presentations at Baveno VII, including the differences in the treatment of liver cirrhosis in Japan.

A woman in her 30s with no history of liver diseases was diagnosed with COVID-19 and subsequently suffered from chronic fatigue. Five months later, liver dysfunction was incidentally detected on follow-up check-up. The patient was hospitalized due to suspected acute liver failure. Laboratory data showed a high titer of antibody against anti-nuclear antigen. A needle aspiration biopsy revealed massive lymphoid cell infiltration and hepatocyte rosette formation around the central veins, which are consistent with acute autoimmune hepatitis (AIH). Based on the International Autoimmune Hepatitis Group revised scoring system for diagnosis of AIH, the patient scored 12 points, indicating probable AIH. On receiving glycyrrhizic acid and corticosteroid therapy, liver enzyme levels immediately returned to normal, and her symptoms disappeared. This is a case of AIH possibly triggered by COVID-19. Liver function must be examined in patients with long-lasting fatigue after COVID-19.

We encountered a case of primary sclerosing cholangitis that was diagnosed by liver biopsy and monitored for progression by magnetic resonance cholangiopancreatography. Three years after the initial biopsy, the patient developed cirrhosis and needed to undergo living donor liver transplant within 6 months because of significant deterioration in the liver reserve capacity and general condition. After more than 20 years of liver transplantation, there had been no recurrence, and the patient had been in excellent health.

A woman in her 90's was admitted for the treatment of lumbar oppression fracture. At the time of admission, her liver function was normal, and she was negative for hepatitis B surface antigen, hepatitis C virus antibody, antinuclear antibody, and anti-mitochondrial antibody-M2. On day 26 of acetaminophen administration for pain relief, the patient showed increased liver enzyme levels (AST 251 U/l, ALT 197 U/l, ALP 327 U/l, γ-GTP 256 U/l, T-Bil 0.4 mg/dl), a blood eosinophil count of 16.1%, and tested negative for IgM-hepatitis B core, IgA-hepatitis E, IgM-hepatitis A, IgM-Epstein-Barr virus, or IgM-cytomegalovirus antibodies, indicating hepatic disorder. Acetaminophen-induced injury was suspected, and liver biopsy was conducted. Histological examination of the liver revealed atypical findings, including moderate lymphocytic infiltration, mild eosinophil infiltration, and neutrophil infiltration with cholangitis in the portal area; however, no central zone necrosis was observed. Hepatobiliary enzyme levels normalized immediately after acetaminophen was discontinued.

In September 20XX, a 50-year-old male was admitted to our hospital with leg and scrotal edema. He was later diagnosed with hepatocellular carcinoma (HCC), portal vein tumor thrombus (PVTT), and inferior vena cava thrombosis. The PVTT shrank after lenvatinib and hepatic arterial infusion chemotherapy, and a cavernous transformation was found. It was challenging to continue chemotherapy because of the refractory hepatic encephalopathy caused by a mesocaval shunt. Therefore, a coil-assisted retrograde transvenous obliteration II was performed, which improved the hepatic encephalopathy and enabled the resumption of multimodal HCC therapy. We are reporting this case as it is rare and interesting, and also examine related literature.

A 30-year-old woman without prior abnormal liver function had an increased alanine transaminase level of 30 U/L 5 days after delivering a baby and continued to deteriorate, requiring referral to our department in October. Laboratory findings at first visit were as follows: aspartate transaminase, 96 U/L; alanine transaminase, 137 U/L; immunoglobulin G, 1517 mg/dL; antinuclear antibody, 1: 40; and smooth muscle actin, 1: 160. Liver biopsy revealed mild lymphocytic infiltration in portal areas, minimal interface hepatitis, scattered focal necrosis with plasma cell infiltration, and absence of fibrosis and centrilobular necrosis. Elevated immunoglobulin G level of 2124 mg/dL 2 weeks after the biopsy led to the diagnosis of acute-onset autoimmune hepatitis (AIH). She was started on corticosteroids with gradual tapering in addition to ursodeoxycholic acid and azathioprine, which ultimately preserved normal liver function. Although numerous studies reported AIH resolving during pregnancy with flare-up after delivery, few studies reported new-onset AIH in the postpartum period.