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Abnormal body composition such as severe skeletal muscle depletion or sarcopenia has emerged as an independent predictor of clinical outcomes in a variety of clinical conditions. This study is the first study to report the frequency and prognostic significance of sarcopenia as a marker of nutritional status in patients with hepatocellular carcinoma (HCC).

Simultaneous liver and kidney transplantation is a life saving procedure for patients with combined liver and kidney failure; however, it remains controversial because of the need to balance individual patient need versus resource allocation. As waiting lists for transplantation become longer and patients become increasingly ill, there will be greater numbers of patients referred for liver and kidney transplantation. Acute kidney injury even requiring dialysis may potentially be reversible making combined transplant decisions difficult. Similarly, selected compensated cirrhotic patients with renal failure may be managed with renal transplant alone. Shared multicenter experience or clinical trials or both will be required to refine our ability to optimally manage these patients with combined liver and kidney dysfunction.

Orthotopic liver transplantation (OLT) stresses the cardiovascular system, and cardiac complications after OLT are common.

We report long-term outcomes and side effects after transplantation for hepatocellular carcinoma (HCC) using de novo, sirolimus-based immunosuppression (IS).

AbstractOgilvie's syndrome, or acute colonic pseudo‐obstruction, is a rare complication following liver transplantation. We describe two cases in which the onset of Ogilvie's syndrome is strongly temporally associated with acute cytomegaloviral (CMV) infection in immunosuppressed liver transplant recipients. The pseudo‐obstruction resolved rapidly in both cases following treatment with intravenous ganciclovir. Acute CMV infection therefore appeared to be causally linked to pathogenesis of Ogilvie's syndrome in these two cases. This association has not been described previously to our knowledge, and should be considered in any transplant patient presenting with Ogilvie's syndrome.

We report biliary lithiasis secondary to infestation with Ascaris lumbricoides in a young man. We review the pathogenesis and clinical features of this condition and discuss the differential diagnosis.

The expression of hepatitis B viral antigens was quantified in liver tissue from four transplant recipients with fibrosing cholestatic hepatitis (FCH) and compared with five other transplant recipients who did not develop this syndrome and 30 patients with chronic hepatitis B virus (HBV) infection. As measured by radioimmunoassays, the liver tissue from patients with FCH had significantly greater amounts of both hepatitis B surface antigen (HBsAg) and nucleocapsid antigens than to transplant patients without this syndrome (P< 0.01) or patients with chronic HBV infection (P< 0.001). Intrahepatic expression of pre-S1/pre-S2in FCH was also extensive with a distribution parallel to that of HBsAg. High-level expression of intrahepatic HBsAg and hepatitis B core antigen in the explanted liver was associated with subsequent development of FCH in the liver graft, suggesting that viral/host factors may also be important. This pattern of intrahepatic hepatitis viral antigen expression, by analogy with Chisari's transgenic mice model and Roingeard's HBV-transfected HepG2 cell model, may be the cause of direct hepatocytopathic injury in this condition.

In one pattern of hepatitis B virus (HBV) recurrence following orthotopic liver transplantation—namely, fibrosing cholestatic hepatitis (FCH), the intrahepatic expression of HBV antigens was found to be markedly increased, suggesting that HBV may be directly cytopathic to the liver cells. Understanding how immuno-suppressive drugs influence HBV may be of considerable clinical relevance in the treatment of patients with chronic HBV infection after liver transplantation. To determine how these drugs influence intrahepatic HBV antigen expression, hepatocytes isolated from patients with chronic HBV infection were incubated in the absence or presence of prednisolone (10-6–10-10M), methylprednisolone (10-8–10-10M), azathioprine (0.1–10 μg/ ml), or cyclosporine (50–1000 ng/ml) and the amount of intracellular/secreted antigen was measured by radio-immunoassay.

Postshunt myelopathy is a rare, severely debilitating syndrome complicating portosystemic shunts that is characterized by spastic paraparesis. In this report we describe a 39-year-old woman with alcoholic liver disease and postshunt myelopathy resulting in an inability to walk. The syndrome did not become manifest until eight years after construction of a side-to-side portacaval shunt. This case is compared with reported literature on the subject.