John Carl Hoefs MD

Dr. Hoefs has been actively involved in research as well as clinical care since 1979 when his first paper was published. These publications are listed in the enclosed CV and are referenced below. They include publications on ascites, hepatitis C (HCV), and scans to measure hepatic function.
Dr John Hoefs has been an important figure in the field of Hepatology since the description of hydraulic pressures between serum and ascites first published in 1983 when a series of publications (6, 8) led to an understanding that the serum to ascites albumin gradient (SAAG) is determined by portal pressure and ascites protein concentration by the combination of serum colloid osmotic pressure and portal pressure (13). There are many causes of ascites although chronic liver disease (CLD) is the most common. Prior to SAAG, the cause of ascites was thought to control the ascites protein concentration, but confusion occurred when this was strictly applied to assessment and management of the patient.
The understanding of the importance of the portal pressure in formation of the SAAG led to the proposal to use the SAAG as the means to determine the cause of ascites (12). The SAAG was further enhanced by a better understanding of colloid osmotic pressure resulting in a globulin correction of the SAAG and a new method of estimating serum colloid osmotic pressure from serum proteins (44). Consolidation of the information on ascites was summarized in an editorial in 1990 (39) and a chapter in "Ascites and Renal Dysfunction" in 1999. Assessment of ascites using the SAAG is presently accepted world-wide as the most efficient method to determine the cause of ascites.