About

Sonali Paul is an Associate Professor of Medicine at the University of Chicago and a transplant hepatologist. She is the director of the Metabolic and Fatty Liver clinic and has clinical interests in autoimmune diseases, autoimmune liver disorders, hepatitis, liver diseases, liver transplant, and viral hepatitis. Her research and scholarly interests include cirrhosis, liver health, fatty liver disease, hepatology, obesity, organ allocation, health disparities, and shared decision making between patients and providers. Dr. Paul completed her MD in Transplant Hepatology at Massachusetts General Hospital in 2016, her gastroenterology training at Tufts Medical Center in 2015, and her internal medicine residency at Massachusetts General Hospital in 2011. She earned her medical degree from Tufts University School of Medicine in 2008. Her work also encompasses advancing Asian American women in medical leadership and improving healthcare knowledge among gastrointestinal healthcare workers, with a focus on sexual and gender minority health, transgender health care, and liver transplantation considerations for gender-diverse patients.

Research topics

• Medicine
• Internal medicine
• Gastroenterology
• Surgery
• Microbiology
• Biology
• Bioinformatics
• Immunology
• Biochemistry
• Endocrinology
• Demography
• Environmental health

Selected publications

• An Education Intervention in Gastrointestinal Healthcare Workers Improves Knowledge of Sexual and Gender Minority Digestive Health

  Digestive Diseases and Sciences · 2025-02-20 · 1 citations

  article
  PublisherDOI

• S764 Effectiveness of Early vs Delayed GLP-1 Receptor Agonist Initiation Following Bariatric Procedures: A Meta-Analysis of Randomized Controlled Trials

  The American Journal of Gastroenterology · 2025-10-01

  articleSenior author

  Introduction: GLP-1 receptor agonists (GLP-1 RAs) and bariatric procedures (BPs) are key strategies in the treatment of obesity. While both are effective individually, the optimal timing for initiating GLP-1 RAs following BP remains unclear. This meta-analysis evaluates the efficacy of early (≤8 weeks) versus delayed (>8 weeks) initiation of GLP-1 RAs after BPs. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) comparing GLP-1 RAs to placebo or no intervention in patients who underwent BPs (surgical or non-surgical) and assessed whether early versus delayed treatment influenced outcomes. Primary outcomes included mean differences (MD) in total weight loss percentage (TWL%) and HbA1c% reduction. We used a random-effects model and I² statistic to assess pooled outcomes and heterogeneity. Results: Eight RCTs including 636 patients were analyzed: 350 received GLP-1 RAs, and 286 received placebo or no intervention. Among GLP-1 RA recipients, 173 started early treatment and 177 delayed treatment (mean time to treatment after BP in the delayed group was 57.4 months, SD = 29). Delayed GLP-1 RA use led to a greater TWL% (MD −7.24%, −11.05 to −3.42, P < 0.001), while early initiation was not beneficial (MD −2.46%, −6.73 to 1.80, P > 0.05). However, a pooled analysis of GLP-1 RA initiation irrespective of timing showed a significant benefit (MD −4.31%, −7.59 to −1.02, P = 0.01). HbA1c % reduction was also greater with delayed therapy (MD −0.31%, −0.47 to −0.16, P < 0.001) but not with early use (MD −0.01%, −0.17 to 0.15, P > 0.05). Leave-one-out sensitivity analysis revealed that excluding one study increased the TWL% benefit of early GLP-1 RA use (MD −4.33, −7.03 to −1.62; P < 0.01). In surgical BP patients, only delayed GLP-1 RAs led to a greater TWL% (MD –7.24%, –11.05 to –3.42); the delayed group also showed a significant reduction in HbA1c (MD –0.31%, –0.47 to –0.16; P < 0.001). Conclusion: Delayed initiation of GLP-1 RAs after BPs appears to yield greater benefits in TWL% and HbA1c% compared to early use. However, sensitivity analysis suggests a benefit from early therapy as well. The timing of GLP-1 RAs may influence metabolic outcomes and delayed initiation improved both TWL% and HbA1c% reduction. Further studies are needed to evaluate the efficacy of delayed GLP-1 RAs after non-surgical BPs.

  PublisherDOI

• A Case of Acute Respiratory Distress Syndrome After Hepatic Artery Embolization

  American Journal of Respiratory and Critical Care Medicine · 2025-05-01

  article

  Abstract Introduction: Acute Respiratory Distress Syndrome (ARDS) is a heterogeneous disease frequently encountered in intensive care units. Common triggers include pneumonia and sepsis; however, ARDS can arise from a variety of insults. Cases of ARDS have been described after embolization procedures including transarterial chemoembolization (TACE) for hepatic tumors, cerebral arteriovenous malformation (AVM) embolization and uterine artery embolization. Here, we present a novel case of ARDS following hepatic artery embolization. Case: A 65-year-old woman with past medical history of colon cancer in remission and chemotherapy vs. metabolic dysfunction-associated cirrhosis complicated by portal hypertension, esophageal varices and portal vein thrombosis presented for an outpatient transjugular intrahepatic portosystemic shunt (TIPS). TIPS was complicated by large right hepatic lobe hematoma, requiring embolization of segment 7/8 right hepatic artery branches. Day one post embolization, the patient developed hypotension, shock liver with peak aspartate aminotransferase (AST) of 1185 and alanine aminotransferase (ALT) of 701, and hypoxemic respiratory failure leading to intubation. A CT chest demonstrated new diffuse bilateral ground glass opacities with a P:F ratio &amp;lt; 200. Echocardiogram showed preserved cardiac function. Infectious work up, including bronchoalveolar lavage cultures, was negative. She was supported with diuresis, broad spectrum antibiotics, and low tidal volume ventilation. After nine days, she was extubated to high flow nasal cannula which was slowly weaned. Eight days post extubation, she developed worsening hypoxemia and was reintubated. Upon reintubation, she required maximum ventilatory support with P:F persistently &amp;lt;150. Ultimately, the patient's family made the decision to withdraw life sustaining treatments, and she passed away. Discussion: This is a novel presentation of ARDS not previously described in the literature. In cases of ARDS after TACE, it is hypothesized that lung injury is caused by embolization of lipoidal particles or chemotherapeutic agents through tumor-associated AVMs. In cerebral AVM embolization, the embolic agent utilized is known to cause direct lung toxicity. In uterine artery embolization, systemic cytokine response resulting from focal tissue ischemia leads to lung injury, though undetected arteriovenous shunting causing introduction of embolic agents to the lung has also been proposed. The trigger of ARDS in this case was likely the inflammatory cascade from acute hepatic necrosis following hepatic artery embolization. ARDS can develop after a variety of embolization procedures and this case suggests lung injury can develop after hepatic artery embolization. Future studies may help elucidate mechanisms to prevent and treat lung injury associated with embolization procedures.

  PublisherDOI

• Advancing Asian American Women in Medical Leadership—Breaking Another Glass Ceiling

  JAMA Network Open · 2025-05-27

  articleOpen accessSenior authorCorresponding
  PublisherDOI

• Considerations in gender-affirming hormone therapy in transgender and gender diverse patients undergoing liver transplantation

  American Journal of Transplantation · 2024-05-08 · 5 citations

  reviewSenior author
  PublisherDOI

• Geographic opportunities for growth in the transplant hepatology training workforce

  Liver Transplantation · 2024-04-22 · 2 citations

  letter

  Hutchison, Alan L.; Reddy, K. Gautham; Paul, Sonali; Pillai, Anjana A. Author Information

  PublisherDOI

• S1902 Alcohol-Related Liver Disease Among Sexual and Gender Minority Patients: Analysis From a Large Multicenter Database

  The American Journal of Gastroenterology · 2024-10-01

  article
  PublisherDOI

• Approaching Digestive Health Care in Transgender and Gender-Diverse Communities

  Clinical Gastroenterology and Hepatology · 2024-02-21 · 1 citations

  editorial
  PublisherDOI

• S1980 Assessing the Role of Donated Medications in Post-liver Transplant Patients

  The American Journal of Gastroenterology · 2024-10-01

  article

  Introduction: Significant financial toxicity is associated with chronic liver disease (CLD) and post-liver transplant (LT) care due to complex care needs including extensive medication regimens. This can pose a barrier to LT and even those with health insurance can suffer life-threatening gaps in coverage, with a patchwork of systems in place to mitigate the situation. However, given LT medication regimens are often dynamic based on a patient’s clinical situation, prescribed medications can go unused and be discarded. Illinois (IL) state law allows unopened and unexpired medications to be donated and reused. Donated medications have been used to fill gaps in insurance in other states and could be useful for patients with CLD. The aim of this study was to characterize the quantity and type of unused LT medications and determine whether they could be used for other patients. Methods: Patients were asked during routine scheduling calls to bring unused medications to their LT clinic appointment. Characteristics such as pill number, expiration, and tamper-evident seal were noted. Prices were sourced from UpToDate using the average of generic medication cost range. These pills were compared to a standard monthly regimen for a patient with cirrhosis and post-LT protocols. This project was formally determined to be quality improvement, not human subjects research, and was therefore not overseen by the Institutional Review Board, per institutional policy. Results: Nine post-LT patients provided unused medications and were included in this pilot study. A total of 49 bottles with 17 different medications (Figure 1A) were collected, worth $71,061.35 (Figure 1B). Seven bottles were sealed and unexpired, each with 60 tabs of rifaximin 550 mg, worth $27,443. Four other bottles (1 of sodium benzoate, 4 of rifaximin) were unused but did not have an internal seal and were therefore still not donatable. Comparing all unused medications to monthly regimens for patients with cirrhosis or post-LT patients, the volumes of donated medications were sufficient for months of dosing of several medications, with potential to save thousands of dollars in costs (Figures 1C, D, Table 1). Conclusion: This pilot study shows the potential for use of unused and donated medications to bridge care for patients who may have interrupted insurance coverage. Further work needs to understand how better to engage patients to donate unused medications, the scale of potential cost savings, and methods to broadly implement such practices.Figure 1.: A) Donated medications by dose, colors indicating patients who donated. B) Donated medications by cost per pill, on a log-10 scale. C) Comparison of donated medications to standard post-liver transplant immunosuppression and infection prophylaxis regimens as per the University of Chicago standard protocol and post-malignancy protocols. D) Comparison of donated medication to a standard monthly regimen for a patient with cirrhosis. Table 1. - Estimated oral medication prices for post-liver transplant immunosuppression protocols Immunosuppression Protocol Standard Standard Standard Cancer Cancer Cancer Notes CMV Risk High Medium Low High Medium Low - Month 1 $5,283.98 $5,283.98 $1,456.58 $6,105.38 $6,105.38 $2,277.98 Only noting outpatient pills Month 2 $5,295.60 $5,295.60 $1,468.20 $8,329.80 $8,329.80 $4,502.40 Start Everolimus for Cancer Protocol Month 3 $5,281.65 $5,281.65 $1,454.25 $10,528.65 $10,528.65 $6,701.25 - Month 4 $4,513.50 $518.10 $518.10 $10,514.70 $6,519.30 $6,519.30 Stop Valganciclovir/Valacyclovir for CMV Medium/Low Risk Month 5 $518.10 $518.10 $518.10 $6,519.30 $6,519.30 $6,519.30 Stop Valganciclovir for CMV High Risk Month 6 $518.10 $518.10 $518.10 $6,519.30 $6,519.30 $6,519.30 - Month 7 $518.10 $518.10 $518.10 $6,519.30 $6,519.30 $6,519.30 Stop TMP-SMX

  PublisherDOI

• Culmination of molecular genomic techniques in forensic crime investigation

  Forensic Science International · 2024-11-18 · 5 citations

  reviewSenior authorCorresponding
  PublisherDOI

Frequent coauthors

• Thomas Couri

  16 shared

• Catherine Frenette

  13 shared

• Aparna Goel

  Stanford University

  10 shared

• Thomas G. Cotter

  The University of Texas Southwestern Medical Center

  10 shared

• Archita P. Desai

  Indiana University – Purdue University Indianapolis

  10 shared

• Jessica Wisocky

  Gilead Sciences (France)

  9 shared

• Elizabeth C. Verna

  Cornell University

  9 shared

• Lisa B. VanWagner

  The University of Texas Southwestern Medical Center

  9 shared

Labs

• Sonali Paul LabPI

Education

• M.D.

  Tufts University School of Medicine

  2008

• M.D., Medicine

  Massachusetts General Hospital

• M.D., Internal Medicine

  Massachusetts General Hospital

  2011

• M.D., Gastroenterology

  Tufts Medical Center

  2015

• M.D., Transplant Hepatology

  Massachusetts General Hospital

  2016

Awards & honors

• University of Chicago Faculty Diversity Career Advancement G…
• Gastrointestinal Research Foundation Associates Board Grant…
• Lasagna Research Award in Clinical and Translational Science…
• Arnold P Gold Foundation Award for Humanism in Medicine (200…
• Alpha Omega Alpha Tufts University School of Medicine (2007)