Abstract
Thrombocytopenia in cirrhosis presents significant challenges in clinical practice. To help clinicians rapidly understand and standardize the diagnosis and treatment of this condition, the Liver Fibrosis, Cirrhosis, and Portal Hypertension Group under the Chinese Society of Hepatology, Chinese Medical Association, convened experts across relevant fields to formulate the Expert Consensus for the Management of Thrombocytopenia in Cirrhosis. This consensus aimed to provide evidence-based guidance for clinical diagnosis and treatment.
Keywords: Cirrhosis, Thrombocytopenia, Management, Diagnosis, Therapy, Prevention, Consensus
Cirrhosis is often accompanied by thrombocytopenia in clinical settings due to decreased platelet production, increased splenic sequestration, and increased platelet destruction. International studies have reported an incidence of approximately 64–76%,1,2 while studies conducted in China have reported an incidence of 57%.3 The increased risk of bleeding caused by thrombocytopenia imposes limitations on invasive procedures, anti-tumor drug therapy (systemic therapy), interventional therapy, and surgery, thereby negatively affecting the diagnosis and treatment of patients with cirrhosis and creating challenges in clinical practice.4,5 To assist clinicians in quickly and thoroughly understanding the key aspects of managing this condition and to standardize the diagnosis and treatment of thrombocytopenia in cirrhosis, the Chinese Society of Hepatology of the Chinese Medical Association convened a panel of experts from relevant fields—including hepatology, gastroenterology, infectious diseases, traditional Chinese medicine, surgery, interventional therapy, oncology, and clinical research methodology—to formulate the Expert Consensus for the Management of Thrombocytopenia in Cirrhosis. In developing this consensus, evidence-based medicine was applied where possible, and relevant literature on the definition, diagnosis, and treatment of the condition was reviewed with the aim of guiding clinical practice.
This expert consensus does not constitute mandatory standards and does not address or resolve all issues related to the diagnosis and treatment of thrombocytopenia in cirrhosis. Therefore, in managing individual patients, clinicians should adhere to the principles outlined in the consensus, fully assess the patient’s condition, consider the patient’s views and preferences, and factor in local healthcare resources and practical experience to formulate a comprehensive, rational, and individualized diagnostic and treatment plan.
The evidence and recommendations in this expert consensus are graded according to the Grading of Recommendations, Assessment, Development, and Evaluations system (Table 1).
Table 1. Quality of evidence and strength of recommendations.
| Level | Description |
|---|---|
| Quality of evidence | |
| High (A) | Further research is unlikely to change our confidence in this estimate of efficacy |
| Moderate (B) | Further research is likely to have an impact on our confidence in this estimate of efficacy and may change the estimate |
| Low or very low (C) | Further research is very likely to have an impact on our confidence in this estimate of efficacy and is very likely to change this estimate |
| Strength of recommendation | |
| Strong (1) | Clear evidence that the desirable effects of the intervention outweigh its undesirable effects or that the undesirable effects of the intervention outweigh its desirable effects |
| Weak (2) | Uncertainty about the balance between desirable and undesirable effects or both high and low quality indicating that the desirable and undesirable effects are comparable |
Issue 1: Diagnosis of thrombocytopenia in cirrhosis
Recommendation 1: Thrombocytopenia in cirrhosis is defined as a peripheral platelet count of <100 × 109/L attributable to cirrhosis. (A1)
Explanation: Thrombocytopenia in cirrhosis is primarily associated with three factors: decreased platelet production, increased splenic sequestration, and increased platelet destruction.
More specifically, these factors refer to: (1) decreased platelet production caused by reduced thrombopoietin (TPO) synthesis in the liver and bone marrow suppression from underlying liver diseases of cirrhosis (hepatitis virus, alcohol, etc.); (2) increased splenic sequestration of platelets due to splenomegaly associated with cirrhosis; and (3) increased platelet destruction from factors such as cirrhosis-induced hyperfibrinolysis or antiplatelet antibody production.6 Thrombocytopenia in cirrhosis may also involve varying degrees of impaired platelet function.7,8 Thrombocytopenia is associated not only with bleeding risk but also with hepatocyte regeneration. Furthermore, thrombocytopenia is a key predictor of decompensation events in cirrhotic patients.9 In general, thrombocytopenia is defined as a peripheral platelet count of <100 × 109/L.10 It is a hallmark of cirrhosis, and additional bone marrow aspiration or other tests are typically unnecessary in patients with relatively stable platelet levels under long-term follow-up. However, if a patient experiences a sharp decline in platelet count, a differential diagnosis should be conducted to rule out other causes, such as disseminated intravascular coagulation, infection, medications, or other contributing factors.11
Issue 2: Severity assessment of thrombocytopenia in cirrhosis
Recommendation 2: The Common Terminology Criteria for Adverse Events v5.0 is recommended for grading the severity of thrombocytopenia. A platelet count of <50 × 109/L is generally classified as severe thrombocytopenia, which serves as a criterion for thrombocytopenia requiring clinical intervention. (B1)
Explanation: Currently, there is no unified grading criterion for the severity of thrombocytopenia in cirrhosis either in China or internationally. The grading of thrombocytopenia severity should reflect the varying clinical levels of bleeding risk in patients. Some European and American countries recommend classifying thrombocytopenia in patients with liver disease as mild, moderate, or severe.12 Patients with cirrhosis are in a state of rebalanced hemostasis, with studies suggesting that the pro-coagulant function of platelets can be maintained at platelet counts ≥ 55 × 109/L. Generally, a platelet count of <55 × 109/L in cirrhotic patients serves as a criterion for severe thrombocytopenia or for thrombocytopenia requiring clinical intervention. Referring to the U.S. National Cancer Institute Common Terminology Criteria for Adverse Events v5.0, we recommend classifying thrombocytopenia in cirrhosis into four grades(Table 2).13
Table 2. Criteria for thrombocytopenia in the Common Terminology Criteria for Adverse Events v5.0.
| Grade | Platelet count (×109/L) |
|---|---|
| Grade 1 | ≥75–<100 |
| Grade 2 | ≥50–<75 |
| Grade 3 | ≥25–<50 |
| Grade 4 | <25 |
Issue 3: Platelet threshold for invasive procedures in patients with thrombocytopenia in cirrhosis
Recommendation 3: In patients with a platelet count of ≥50 × 109/L, invasive procedures can generally be performed after assessing the patient’s overall bleeding risk, without the need for additional platelet-boosting therapies. However, for patients with a platelet count between 50–100 × 109/L—especially in special cases (e.g., concomitant peptic ulcers, neurosurgical procedures, or cesarean delivery)—platelet-boosting drugs should be administered. For patients with a platelet count of 20–50 × 109/L, platelet-boosting drugs should be the main treatment during high-risk procedures, depending on the patient’s specific condition. In patients with a platelet count of <20 × 109/L, platelet-boosting drugs or platelet transfusion should be administered during invasive procedures. (C1)
Explanation: The bleeding risk for patients with thrombocytopenia due to cirrhosis undergoing invasive procedures is determined by multiple factors, including the type of procedure, baseline liver function, degree of portal hypertension, coagulation and fibrinolysis status, platelet count, concurrent medications, and infections.14 International and Chinese guidelines and consensus statements offer varying risk stratifications for invasive procedures in patients with cirrhosis and provide different recommendations for platelet thresholds.15–18 Generally, procedures classified as high bleeding risk are those with a bleeding risk ≥ 1.5%, or where even minor bleeding can cause permanent damage or death. Table 3 summarizes research data regarding the bleeding risk associated with different procedures and outlines the risk of common invasive procedures in patients with cirrhosis. We recommend individualized assessments to determine whether a patient is suitable for a given procedure and whether preoperative platelet-boosting therapy is necessary, based on the type of procedure, liver function, and overall coagulation status. In addition to the procedures listed in Table 3, certain neurological and vascular surgeries may require higher platelet counts,19 and individual judgment should be applied based on the risks associated with specialized surgeries and the patient’s condition.
Table 3. Classification of bleeding risk for common invasive procedures in patients with cirrhosis.
| Category | Low-risk procedures | High-risk procedures |
|---|---|---|
| Percutaneous invasive procedures | Abdominal paracentesis Thoracentesis Replacement of drainage catheter |
Biliary procedures (cholecystostomy or percutaneous biliary drainage) Tumor ablation Biopsy of liver and other solid organs Biopsy of thoracic organs Nephrostomy placement Central nervous system procedures Intraocular procedures or injections Intra-articular injection |
| Vascular invasive procedures | Peripherally inserted central venous catheters Replacement or placement of central venous catheters Placement of inferior vena cava filter Simple diagnostic venography Coronary angiography and right heart catheterization |
Transjugular intrahepatic portosystemic shunt Therapeutic arteriovenous angiography and related procedures Transjugular liver biopsy Transarterial chemoembolization or radioembolization Therapeutic coronary angiography |
| Endoscopic procedures | Esophagogastroduodenoscopy, colonoscopy, etc. (including mucosal biopsy) Endoscopic retrograde cholangiopancreatography (without sphincterotomy) Capsule endoscopy Endoscopic ultrasound without fine needle aspiration Transesophageal echocardiography Diagnostic bronchoscopy without biopsy |
Endoscopic treatment of esophageal varices Endoscopic gastrointestinal polypectomy Endoscopic gastrointestinal stricture dilation or mucosal resection Balloon-assisted endoscopy Percutaneous endoscopic gastrostomy Endoscopic retrograde pancreaticobiliary angiography with papillary incision Endoscopic ultrasound-guided fine needle aspiration Pancreatic cyst gastrostomy drainage Bronchoscopic biopsy or related treatments |
| Other procedures | Skin biopsy Teeth cleaning and other procedures without teeth retraction |
Tooth extraction |
Issue 4: Drug therapy for thrombocytopenia in cirrhosis
Recommendation 4: In patients with thrombocytopenia due to cirrhosis who are undergoing invasive procedures, surgery, or anti-tumor drug therapy, the bleeding risk can be reduced by administering recombinant human thrombopoietin (rhTPO) or thrombopoietin receptor agonists (TPO-RAs), depending on the required platelet threshold. (C1)
Explanation: Decreased platelet production due to inadequate TPO synthesis is a key pathogenic mechanism of thrombocytopenia in cirrhosis. rhTPO and TPO-RAs are the primary TPO-based agents used clinically to treat thrombocytopenia.
The pharmacological effects of rhTPO are similar to those of endogenous TPO. Continuous administration of rhTPO at the conventional dose (300 U/kg daily via subcutaneous injection) for five to seven days has been shown to effectively increase platelet counts in patients with cirrhosis, thereby reducing or eliminating the need for platelet transfusion.20,21 Approved TPO-RAs in China include avatrombopag, lusutrombopag, romiplostim, eltrombopag, and hetrombopag.
Among these, avatrombopag and lusutrombopag have been approved for the treatment of thrombocytopenia in adults with chronic liver disease undergoing elective invasive surgery. In cirrhotic patients undergoing elective invasive procedures with a platelet count of <50 × 109/L, oral avatrombopag at 40–60 mg/day for five days, or lusutrombopag at 3 mg/day for seven days, can effectively increase platelet count and reduce the bleeding risk.22–24 The clinical application of leucogen and traditional Chinese medicine has also been reported.
Issue 5: Extension of treatment course or increase of drug dose regimen in patients with poor response to platelet-boosting drug therapy
Recommendation 5: In patients with a poor response to platelet-boosting drug therapy, the treatment course can be extended as appropriate; treatment with rhTPO can be extended by one to six months. Further research is needed to determine the safety of increasing the dose of platelet-boosting drugs. (B2)
Explanation: The pharmacokinetic characteristics of rhTPO and TPO-RA drugs suggest that their effects are proportional to the total dose. Treatment of thrombocytopenia in cirrhosis with rhTPO for one month and six months increased platelet counts by two-fold compared to baseline (73.3% and 54.8%, respectively).20 Hence, for patients with multiple etiologies or whose platelet counts do not meet clinical requirements after conventional doses/treatment courses, extending the course of drug treatment may enhance efficacy. Increasing the drug dose may also enhance efficacy. However, it is necessary to consider the possible increase in thrombotic risk and the impact of some oral TPO-RA drugs on liver function. Thus, further clinical observation and research are needed.25,26
Issue 6: Platelet transfusion is generally not recommended for thrombocytopenia in cirrhosis. Under what circumstances can platelet transfusion be considered?
Recommendation 6: Platelet transfusion is generally not recommended for cirrhotic patients with a low bleeding risk. Platelet transfusion can be performed in critically ill patients with a high bleeding risk or those requiring high-risk surgery or invasive procedures who are not suitable for platelet-boosting drug therapy. (B2)
Explanation: Thrombocytopenia in cirrhosis is often accompanied by coagulopathies, and the decision to perform a transfusion should be based on an analysis of the patient’s platelet count, platelet function in thromboelastometry, and the specifics of the risky procedure.27,28
Platelet transfusion can rapidly elevate platelet count and be used to treat thrombocytopenia caused by different etiologies and pathophysiological mechanisms.29 This method was once considered a routine preoperative measure to improve platelet counts in patients with thrombocytopenia. However, studies have shown that patients receiving multiple platelet transfusions produce more antiplatelet antibodies, resulting in increased platelet destruction and a higher risk of ineffective platelet transfusion.30 Therefore, platelet transfusion is recommended only for critically ill patients with a high bleeding risk or patients who require emergency surgery or invasive procedures but are not suitable for platelet-boosting drugs.31 Patients should be fully informed of the associated risks prior to transfusion.
Patients with thrombocytopenia in cirrhosis are prone to bleeding, especially gastrointestinal bleeding. Hence, the primary disease should be actively treated for the primary and secondary prevention of gastrointestinal bleeding in cirrhosis. Etiological treatment can alleviate liver fibrosis, reduce portal venous pressure, and block or reverse the progression of liver fibrosis and cirrhosis.32,33
Issue 7: Splenic artery embolization and/or splenectomy in patients with thrombocytopenia in cirrhosis
Recommendation 7: In patients with thrombocytopenia in cirrhosis associated with splenomegaly/hypersplenism who experience recurrent bleeding, splenic artery embolization or splenectomy are possible options that can be performed after fully assessing the risks and benefits and formulating an appropriate treatment plan based on the multidisciplinary team model. (C1)
Explanation: Splenic artery embolization and/or splenectomy are indicated for patients with thrombocytopenia in cirrhosis associated with splenomegaly/hypersplenism, allowing the long-term improvement and maintenance of platelet count. When determining which cases should undergo splenic artery embolization and/or splenectomy, it is necessary to assess the patient’s condition comprehensively, fully consider the patient’s liver function and surgical risks, incorporate multidisciplinary team consultation, and fully inform the patient of the benefits and possible complications to maximize treatment efficacy and quality of life.
Partial splenic embolization (PSE) can be used to treat hypersplenism-induced thrombocytopenia in cirrhosis and thrombocytopenia in advanced liver cancer.34–37 Hypersplenism is a manifestation of decompensated cirrhosis, and most patients exhibit varying degrees of impaired liver function. Child-Pugh Class C and excessive embolization can increase the risk of serious complications.38,39 Hence, phased PSE can be considered for these patients. PSE should be performed with caution in patients with splenomegaly, severe infection, severe jaundice, and large amounts of ascites.
Simple splenectomy is mainly used to treat severe splenomegaly and severe hypersplenism (white blood cell count <2.0 × 109/L, platelet count <30 × 109/L) and is often combined with shunt placement and devascularization. This procedure is invasive and has a high incidence of postoperative complications.40 In patients undergoing splenic embolization or splenectomy, care should be taken to prevent and treat postoperative complications, especially infection, embolism, and thrombosis.41,42 In patients scheduled for liver transplantation, splenectomy increases the susceptibility to portal vein thrombosis, which can complicate transplantation surgery.43
Issue 8: Anticoagulant therapy for thrombocytopenia in cirrhosis with thrombosis
Recommendation 8: In patients with grade 1–2 thrombocytopenia in cirrhosis combined with thrombotic disorders, direct oral anticoagulants, vitamin K antagonists, or low-molecular-weight heparin can be administered as anticoagulant therapy. In patients with grade 3 thrombocytopenia, half-dose low-molecular-weight heparin can be administered after balancing the risk of bleeding and thromboembolism. In patients with grade 4 thrombocytopenia, anticoagulant therapy is not recommended. (C2)
Explanation: Thrombotic disorders mainly include venous thromboembolism (e.g., pulmonary thrombosis and deep vein thrombosis) and arterial thromboembolism (e.g., acute coronary syndrome, stroke). Grade 1–2 thrombocytopenia in cirrhosis does not significantly affect anticoagulant therapy for thrombotic disorders. Thus, anticoagulant therapy can be performed based on the specific type and risk stratification of the thrombotic disorder. Options include direct oral anticoagulants, vitamin K antagonists (warfarin), or low-molecular-weight heparin.44 In grade 3 thrombocytopenia, anticoagulant therapy increases the risk of bleeding. Therefore, after balancing the risk of bleeding and thromboembolism, half-dose low-molecular-weight heparin can be administered. Direct oral anticoagulants or vitamin K antagonists are not recommended. In grade 4 thrombocytopenia, anticoagulant therapy significantly increases the risk of bleeding, making it contraindicated.45
Issue 9: Antiplatelet therapy for thrombocytopenia in cirrhosis with thrombotic disorders
Recommendation 9: In patients with grade 1–2 thrombocytopenia in cirrhosis combined with thrombotic disorders, single or dual antiplatelet therapy can be administered based on the patient’s condition. In grade 3 thrombocytopenia, single antiplatelet therapy can be administered after balancing the risk of bleeding and thromboembolism. In grade 4 thrombocytopenia, antiplatelet therapy is generally not recommended. (C2)
Explanation: Grade 1–2 thrombocytopenia in cirrhosis does not significantly affect antiplatelet therapy for thrombotic disorders. Therefore, single or dual antiplatelet therapy can be administered according to the type and risk stratification of the thrombotic disorder. Options include drugs such as aspirin and clopidogrel.44 Clopidogrel is mainly metabolized by the liver and is contraindicated in cases of severe liver disease. In grade 3 thrombocytopenia, antiplatelet therapy increases the risk of bleeding. Thus, after balancing the risk of bleeding and thromboembolism, single antiplatelet therapy (e.g., aspirin) can be administered. In grade 4 thrombocytopenia, antiplatelet therapy significantly increases the risk of bleeding and is contraindicated. Single antiplatelet therapy (e.g., aspirin) can only be considered in extreme cases, such as acute coronary syndrome with cardiogenic shock.46
Issue 10: Follow-up of patients with thrombocytopenia in cirrhosis
Recommendation 10: Platelet count should be monitored once every six months in patients with compensated cirrhosis, once every three months in patients with decompensated cirrhosis, and as often as necessary in critically ill patients. (A1)
Explanation: The severity of thrombocytopenia in cirrhosis can vary among patients. In compensated cirrhosis, patients tend to have relatively high platelet levels, low bleeding risk, and a relatively stable condition with gradual changes. Therefore, platelet count can be tested once every six months. In decompensated cirrhosis, platelet levels gradually decrease, leading to an increase in bleeding risk. Hence, monitoring should occur every three months. In critically ill patients, such as those with gastrointestinal bleeding, sepsis, or liver failure, platelet counts are typically low, rapid changes may occur, and patients are at relatively high risk of bleeding. Consequently, platelet counts should be monitored daily or every few days, depending on the patient’s condition.
Issue 11: Management of thrombocytopenia in patients with cirrhosis and cancer undergoing anti-tumor therapy
Recommendation 11: Active treatment of the primary disease and/or precipitating factor is required. In cases with bleeding or those requiring emergency invasive procedures or surgery, platelet transfusion can be given. In non-emergency cases, rhTPO or TPO-RA should be administered to raise the platelet count to a safe threshold for invasive procedures or surgery. For patients scheduled to receive systemic treatment, invasive treatments such as PSE and splenectomy can be considered for those with hypersplenism/splenomegaly. (C1)
Explanation: Cirrhosis, tumors, and tumor-related treatments (radiotherapy, chemotherapy, etc.) can all lead to thrombocytopenia. The combination of multiple factors can result in more severe thrombocytopenia and significantly elevate the risk of cirrhosis-induced decompensation. Thrombocytopenia increases the risk of bleeding and limits the use of anti-tumor drugs, complicating tumor treatment and affecting surgical, radiotherapy, and chemotherapy outcomes. Radiotherapy or chemotherapy should be performed with caution in patients with thrombocytopenia in cirrhosis.46 In cases with bleeding or those requiring emergency invasive procedures or surgery, platelet transfusion can rapidly elevate platelet levels. Prior to non-emergency elective procedures or surgery, rhTPO or TPO-RA can be administered to raise platelet levels to the safe thresholds required for these procedures (Table 3). In patients scheduled to receive systemic treatment, PSE or splenectomy can be considered for those with severe hypersplenism/splenomegaly to raise platelet levels.
Issue 12: Management of thrombocytopenia in cirrhosis with severe infection
Recommendation 12: Active management of infections is required. Anti-infective drugs should be applied based on the cause and site of infection, and local lesions should be drained. In case of septic shock, fluid replacement and additional vasoactive drugs should be promptly administered. Treatment of thrombocytopenia is similar to that of other cirrhotic patients. Platelet transfusion can be given in emergency cases, while the administration of rhTPO or TPO-RA can be considered in non-emergency cases. (C1)
Explanation: In cirrhosis complicated by severe infection, thrombocytopenia may be induced or exacerbated due to limited platelet production, increased consumption, and other factors. Infection-related therapeutic drugs (antibacterials, antifungals, and antivirals) may also induce or worsen thrombocytopenia. Conversely, thrombocytopenia may limit the options of therapeutic drugs for severe infection or hinder therapeutic measures such as abscess incision and drainage. Therefore, clinical management should involve the active treatment of infection using anti-infectives based on the cause and site of infection, promptly draining local lesions, and providing fluid replacement and vasoactive drugs in cases of septic shock. Clinical management should also address thrombocytopenia, with platelet transfusion given in emergency cases, while the administration of rhTPO or TPO-RA can be considered in non-emergency cases to elevate platelet levels.
Consensus expert group (listed alphabetically by pinyin of surname)
Jihong An (Department of Infectious Diseases, Inner Mongolia Autonomous Region People’s Hospital), Hongsong Chen (Hepatology Institute, Peking University People’s Hospital), Yu Chen (Fourth Department of Hepatology Center, Beijing You’an Hospital, Capital Medical University), Huiguo Ding (Hepatology and Gastroenterology Center, Beijing You’an Hospital, Capital Medical University), Xiaoguang Dou (Department of Infectious Diseases, Shengjing Hospital, China Medical University), Guohong Deng (Department of Infectious Diseases, First Affiliated Hospital of Army Medical University), Yun Dai (Department of Gastroenterology, Peking University First Hospital), Jiangao Fan (Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine), Yanhang Gao (Department of Hepatobiliary and Pancreatic Medicine, First Hospital of Jilin University), Tao Han (Department of Gastroenterology and Hepatology, Nankai University People’s Hospital), Ying Han (Department of Gastroenterology, Xijing University, Air Force Medical University), Ying Han (Hepatology and Gastroenterology Center, Beijing You’an Hospital, Capital Medical University), Peng Hu (The First Affiliated Hospital, Chongqing Medical University), Zhongjie Hu (Hepatology Center, Beijing You’an Hospital, Capital Medical University), Yan Huang (Department of Infectious Diseases, Xiangya Hospital, Central South University), Ying’an Jiang (Department of Infectious Diseases, Hubei Provincial People’s Hospital), Yuanyuan Kong (Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Friendship Hospital, Capital Medical University), Jie Li (Department of Pathogenic Biology, Peking University Health Science Center), Jun Li (Department of Infectious Diseases, First Affiliated Hospital of Nanjing Medical University), Jianping Li (Hepatology Center, The Eighth Affiliated Hospital of Guangzhou Medical University), Shuchen Li (Department of Infectious Diseases, The Second Affiliated Hospital of Harbin Medical University), Rongkuan Li (Department of Infectious Diseases, The Second Affiliated Hospital of Dalian Medical University), Wengang Li (Comprehensive Liver Cancer Department, Fifth Medical Center, PLA General Hospital), Yufang Li (Department of Infectious Diseases, The General Hospital of Ningxia Medical University), Chenghai Liu (Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine), Jianxiang Liu (Department of Gastroenterology, Peking University First Hospital), Jingfeng Liu (School of Clinical Oncology, Fujian Medical University), Xiaoqing Liu (Department of Infectious Diseases, Peking Union Medical College Hospital), Lungen Lu (Department of Gastroenterology, First People’s Hospital, Shanghai Jiao Tong University), Xiaobo Lu (Center for Infectious Diseases and Hepatology, The First Affiliated Hospital of Xinjiang Medical University), Mingqin Lu (Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University), Xinhua Luo (Department of Infectious Diseases, Guizhou Provincial People’s Hospital), Xiong Ma (Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine), Yimin Mao (Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine), Xiaorong Mao (Department of Infectious Diseases, The First Affiliated Hospital of Lanzhou University), Junqi Niu (Department of Hepatobiliary and Pancreatic Medicine, First Hospital of Jilin University), Yunxong Qian (Department of Liver Cirrhosis, Ningbo Second Hospital), Huiying Rao (Hepatology Institute, Peking University People’s Hospital), Hong Ren (Department of Infectious Diseases, Second Affiliated Hospital of Chongqing Medical University), Wanhua Ren (Department of Infectious Diseases, Shandong Provincial Hospital), Jia Shang (Department of Infectious Diseases, Henan Provincial People’s Hospital), Minghua Su (Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University), Yu Tian (Department of Gastroenterology, Peking University First Hospital), Xianbo Wang (Center of Integrated Traditional Chinese and Western Medicine, Beijing Ditan Hospital, Capital Medical University), Rongqi Wang (Department of Integrated Traditional Chinese and Western Medicine for Hepatology, The Third Hospital of Hebei Medical University), Weihong Wang (Department of Gastroenterology, Peking University First Hospital), Zhili Wen (Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University), Biao Wu (Department of Infectious Diseases, Hainan Provincial People’s Hospital), Chao Wu (Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School), Wen Xie (Hepatology Center, Beijing Ditan Hospital, Capital Medical University), Yao Xie (Hepatology Center, Beijing Ditan Hospital, Capital Medical University), Shaojie Xin (Department of Hepatology, Fifth Medical Center, PLA General Hospital), Yongning Xin (Department of Infectious Diseases, Qingdao Municipal Hospital), Huichun Xing (Hepatology Center, Beijing Ditan Hospital, Capital Medical University), Youqing Xu (Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University), Changqing Yang (Department of Gastroenterology, Tongji Hospital, Tongji University), Dongliang Yang (Department of Infectious Diseases, Wuhan Tongji Hospital), Jiming Yang (Department of Infectious Diseases, Tianjin Second People’s Hospital), Li Yang (Department of Gastroenterology, West China Hospital, Sichuan University), Jinhui Yang (Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University), Yongfeng Yang (Department of Hepatology, The Second Hospital of Nanjing), Zhiyun Yang (Beijing Ditan Hospital, Capital Medical University), Hong You (Department of Hepatology, Beijing Friendship Hospital, Capital Medical University), Yanyan Yu (Department of Infectious Diseases, Peking University First Hospital), Yongyi Zeng (Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University), Chunqing Zhang (Department of Gastroenterology, Shandong Provincial Hospital), Dazhi Zhang (Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University), Liaoyun Zhang (Department of Infectious Diseases, First Hospital of Shanxi Medical University), Lingyi Zhang (Department of Hepatology, Lanzhou University Second Hospital), Liting Zhang (Department of Infectious Diseases, The First Affiliated Hospital of Lanzhou University), Xinxin Zhang (Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine), Yuexin Zhang (Center for Infectious Diseases and Hepatology, The First Affiliated Hospital of Xinjiang Medical University), Xin Zheng (Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology), Jingmin Zhao (Department of Pathology, Fifth Medical Center, PLA General Hospital), Shousong Zhao (Department of Infectious Diseases, Affiliated Hospital of Bengbu Medical College), Weifeng Zhao (Department of Infectious Diseases, The First Affiliated Hospital of Soochow University), Yongjian Zhao (Department of Gastroenterology, Guangzhou First People’s Hospital), Hongmei Zu (Department of Gastroenterology, Fourth People’s Hospital of Qinghai Province), Weize Zuo (Department of Infectious Diseases, The First Affiliated Hospital of Shihezi University Medical College).
Secretary group
Yaping Wang (Hepatology Center, Eighth Affiliated Hospital of Guangzhou Medical University), Hang Sun (Hepatology Center, Eighth Affiliated Hospital of Guangzhou Medical University), Zhan Zeng (Department of Infectious Diseases, Peking University First Hospital).
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