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There is increasing evidence that early liver transplantation (eLT), performed within standardized protocols can improve survival in severe alcoholic hepatitis (sAH). The aim of the study was to assess outcomes after eLT for sAH in four Italian LT centers and to compare them with non-responders to medical therapy excluded from eLT. Patients admitted for sAH (2013–2019), according to NIAAA criteria, were included. Patients not responding to medical therapy were placed on the waiting list for eLT after a strict selection. Histological features of explanted livers were evaluated. Posttransplant survival and alcohol relapse were evaluated. Ninety-three patients with severe AH were evaluated (65.6% male, median [IQR] age: 47 [42–56] years). Forty-five of 93 patients received corticosteroids, 52 of 93 were non-responders and among these, 20 patients were waitlisted. Sixteen patients underwent LT. Overall, 6-, 12-, and 24-month survival rates were 100% significantly higher compared with non-responders to medical therapy who were denied LT (45%, 45%, and 36%; p&nbsp

Background Recent innovations in the field of liver transplantation have led to a wealth of new treatment regimes, with potential impact on the onset of de novo malignancies (DNM). The aim of this multicenter cohort study was to provide contemporary figures for the cumulative incidences of solid and hematological DNM after liver transplantation. Methods We designed a retrospective cohort study including patients undergoing LT between 2000 and 2015 in three Italian transplant centers. Cumulative incidence was calculated by Kaplan–Meyer analysis. Results The study included 789 LT patients with a median follow-up of 81 months (IQR: 38–124). The cumulative incidence of non-cutaneous DNM was 6.2% at 5-years, 11.6% at 10-years and 16.3% at 15-years. Post-Transplant Lymphoproliferative Disorders (PTLD) were demonstrated to have a cumulative incidence of 1.0% at 5-years, 1.6% at 10-years and 2.2% at 15-years. Solid Organ Tumors (SOT) demonstrated higher cumulative incidences – 5.3% at 5-years, 10.3% at 10-years and 14.4% at 15-years. The most frequently observed classifications of SOT were lung (rate 1.0% at 5-years, 2.5% at 10-years) and head & neck tumors (rate 1.3% at 5-years, 1.9% at 10-years). Conclusions Lung tumors and head & neck tumors are the most frequently observed SOT after LT.

Background & Aims A causal relationship between infection, systemic inflammation, and hepatic encephalopathy (HE) has been suggested in cirrhosis. No study, however, has specifically examined, in cirrhotic patients with infection, the complete pattern of clinical and subclinical cognitive alterations and its reversibility after resolution. Our investigation was aimed at describing the characteristics of cognitive impairment in hospitalized cirrhotic patients, in comparison with patients without liver disease, with and without infection. Methods One hundred and fifty cirrhotic patients were prospectively enrolled. Eighty-one patients without liver disease constituted the control group. Bacterial infections and sepsis were actively searched in all patients independently of their clinical evidence at entry. Neurological and psychometric assessment was performed at admission and in case of nosocomial infection. The patients were re-evaluated after the resolution of the infection and 3months later. Results Cognitive impairment (overt or subclinical) was recorded in 42% of cirrhotics without infection, in 79% with infection without SIRS and in 90% with sepsis. The impairment was only subclinical in controls and occurred only in patients with sepsis (42%). Multivariate analysis selected infection as the only independent predictor of cognitive impairment (OR 9.5; 95% CI 3.5–26.2; p =0.00001) in cirrhosis. The subclinical alterations detected by psychometric tests were also strongly related to the infectious episode and reversible after its resolution. Conclusions Infections are associated with a worse cognitive impairment in cirrhotics compared to patients without liver disease. The search and treatment of infections are crucial to ameliorate both clinical and subclinical cognitive impairment of cirrhotic patients.

levels 30–60 minutes after ACTH stimulation; delta cortisol (Dc = Pc −Bc]. AI was defined as at least two of the following: Bc < 148nmol/L, Pc < 550nmol/L, Dc < 250nmol/L. All patients had Methylprednisolone intraand post-operatively. Parameters of graft and renal function were recorded 48 hours post-LT. Results: 18 patients (22.5%) had AI. Patients with AI had higher MELD score (19 vs. 15; p = 0.003), higher pre-LT INR, bilirubin and potassium, and lower sodium and haemoglobin levels. 48 hours post-LT patients with AI had higher creatinine (152 vs. 91umol/L; p = 0.038) compared to those with normal adrenal function. There was no difference in mechanical ventilation, vasopressor support, renal replacement therapy, length of ICU and hospital stay between the two groups. Parameters that correlated with 48-hour creatinine were age, Bc, Pc and pre-LT creatinine. In multivariate analysis only Pc and pre-LT creatinine were significant predictors of 48-hour creatinine. Conclusions: Pre-LT AI was associated with immediate post-LT renal dysfunction in our study. The full extent of AI implications may have been masked by the intaand post-operative use of steroids. These results should be confirmed in further studies.

Background and Aim: Malnutrition and infections are frequent burdens in patients with end-stage liver disease and both have been demonstrated to impair prognosis. Moreover, a poor nutritional status has been associated with an increased susceptibility to infections in cirrhotic patients. The aim of the present study was to investigate the role of malnutrition on the outcome of cirrhotic patients with infections. Patients and Methods: Cirrhotic patients consecutively admitted at our university hospital in the last 24 months were enrolled. Protein malnutrition was defined as Mid-Arm Muscle Circumference below 5th percentile. Bacterial infections were actively searched. The onset of portal hypertension related complications (hepatic encephalopathy, variceal bleeding, hepato-renal-syndrome and hyponatremia) and the modification in liver function (MELD and CHILD) were analyzed during the infection. In-hospital and short term (6 weeks) follow up was considered. Results: One-hundred-two cirrhotic patients with infection (70% males; median age 64 yrs; median Child score 9 and MELD score 14) were evaluated. Malnutrition was diagnosed in 40% of patients. Malnourished patients were more frequently males (90% vs 56%) with similar age and degree of liver function vs not malnourished patients. Episodes of sepsis (61% vs 57%) and multi-drug-resistant infections (27% vs 43%) were not different between malnourished and not malnourished patients. Moreover, sites and epidemiology (community acquired, nosocomial, healthcare associated) of infections were also similar. The occurrence of portal hypertension related complications and the deterioration of liver function (MELD and CHILD) caused by the infection were similar in malnourished and not malnourished patients. In-hospital and short term (6 weeks) mortality rates were comparable in patients with and without malnutrition [(24% vs 25%, (p = 0.9) and 14% vs 17% (p = 0.5)]. Conclusions: While malnutrition increases the susceptibility for infections, the present data suggest that the impact of malnutrition on the outcomes and short term survival of cirrhotic patients with a concomitant infection is less relevant.