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Background & Aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model's original thresholds. Methods: This multicenter cohort study included 2,444 adult patients who underwent LT for HCC in 47 centers from Europe and Latin America. A competing risk regression analysis estimating sub-distribution hazard ratios (SHRs) and 95% CIs for recurrence was used (Fine and Gray method). Harrell's adapted c-statistics were estimated. The net reclassification index for recurrence was compared based on each model's original thresholds. Results: During a median follow-up of 3.8 years, there were 310 recurrences and 496 competing events (20.3%). Both models predicted recurrence, HCC survival and survival better than Milan criteria (p

Introduction and objectives The liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center. Materials and methods Prospective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1). Results Of 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18–90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59–98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64–87) had confirmed HCC, 17% with microvascular invasion. Conclusions LI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.

Introduction: There is a lack of information regarding outcomes after liver transplant in Latin America. Objectives: This study sought to describe outcomes after liver transplant in adult patients from Argentina. Methods: We performed an ambispective cohort study of adult patients transplanted between June 2010 and October 2012 in 6 centers from Argentina. Only patients who survived after the first 48 hours postransplantation were included. Pretransplantation and posttransplantation data were collected. Results: A total of 200 patients were included in the study. Median age at time of transplant was 50 (interquartile range [IQR] 26 to 54) years. In total, 173 (86%) patients had cirrhosis, and the most frequent etiology in these patients was hepatitis C (32%). A total of 35 (17%) patients were transplanted with hepatocellular carcinoma. In patients with cirrhosis, the median Model for End-Stage Liver Disease (MELD) score at time of liver transplant was 25 (IQR 19 to 30). Median time on the waiting list for elective patients was 101 (IQR 27 to 295) days, and 3 (IQR 2 to 4) days for urgent patients. Almost 40% of the patients were readmitted during the first 6 months after liver transplant. Acute rejection occurred in 27% of the patients. Biliary and vascular complications were reported in 39 (19%) and 19 (9%) patients, respectively. Renal failure, diabetes, and dyslipidemia were present in 40 (26%), 87 (57%), and 77 (50%) at 2 years, respectively. Conclusions: We believe the information contained in this article might be of value for reviewing current practices and developing local policies. Fil: Haddad, L.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina Fil: Marciano, S.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina Fil: Cleres, M.. Fundación Favaloro; Argentina Fil: Zerega, A.. Sanatorio Allende; Argentina Fil: Piñero, F.. Hospital Universitario Austral; Argentina Fil: Orozco, F.. Hospital Aleman; Argentina Fil: Braslavsky, G.. Hospital General de Agudos Cosme Argerich; Argentina Fil: Mendizabal, M.. Hospital Universitario Austral; Argentina Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina Fil: Gil, O.. Sanatorio Allende; Argentina Fil: Silva, M.. Hospital Universitario Austral; Argentina Fil: Mastai, Ricardo. Hospital Aleman; Argentina Fil: Imvertaza, O.. Hospital General de Agudos Cosme Argerich; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina Fil: Descalzi, V.. Fundación Favaloro; Argentina Fil: Gadano, A.. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina

Background and aims. Background and aims. Heter Background and aims. ogeneous data has been reported regarding liver transplantation (LT) for hepatocellular carcinoma (HCC) in Latin America. We aimed to describe treatment during waiting list, survival and recurrence of HCC after LT in a multicenter study from Latin America. Material and methods. Material and methods. Patients with Material and methods. HCC diagnosed prior to transplant (cHCC) and incidentally found in the explanted liver (iHCC) were included. Imaging-explanted features were compared in cHCC (non-discordant if pre and post-LT were within Milan, discordant if pre-LT was within and post-LT exceeding Milan). Results. Overall, Results.Results. 435 patients with cHCC and 92 with iHCC were included. At listing, 81% and 91% of cHCC patients were within Milan and San Francisco criteria (UCSF), respectively. Five-year survival and recurrence rates for cHCC within Milan, exceeding Milan/within UCSF and beyond UCSF were 71% and 16%; 66% and 26%; 46% and 55%, respectively. Locoregional treatment prior to LT was performed in 39% of cHCC within Milan, in 53% beyond Milan/within UCSF and in 83% exceeding UCSF (p < 0.0001). This treatment difference was not observed according to AFP values (d100, 44%; 101-1,000, 39%, and > 1,000 ng/mL 64%; p = 0.12). Discordant imaging-explanted data was observed in 29% of cHCC, showing lower survival HR 2.02 (CI 1.29; 3.15) and higher recurrence rates HR 2.34 when compared to AFP 1,000 ng/mL at listing was independently associated with a higher 5-year recurrence rate and a HR of 3.24 when compared to AFP

Introduction: Early preventive strict quarantine due to COVID-19 pandemic was implemented in Argentina since March 20th, 2020. Transplant societies and organ procurement organizations were challenged to face this complex scenario and sustain organ donation and transplantation activity. Objectives: We evaluated the impact of complete and preventive lockdown in organ procurement and transplantation before the COVID-19 peak onset. Materials and Methods: We analyzed prospectively collected data from the National Report Agency (INCUCAI). By constructing time series, we compared donation and transplant rates from the years 2010 to 2020, during a same monthly-period between March 3rd and July 20th. We evaluated the effect of preventive lockdown before the peak of COVID-19 curve. Donation rates per million population in these months were also registered for each year. Transplant accessibility was calculated, dividing the total number of transplants and the total number of listed patients. Results: The preventive lockdown was associated with a 34.5% relative reduction (95% CI 26.9-43.2) in organ procurement when compared to 2010-2019 and significantly reduced comparing 2019 [53.3% (CI 44.6-61.6)]. This scenario was even worse in Buenos Aires city and its surroundings, the region most affected by COVID-19. During this period, donation per million population rates decreased from 7.8 in 2019 to 3.3 in 2020. This reduction was even higher in the number of deceased and living donor transplants performed comparing 2019 vs. 2020, with a relative reduction of 62.0% (CI 30.8-89.1) and 68.8% (CI 65.7-71.7), respectively. Conclusions: During this short observation period of 120 days of preventive quarantine, not yet having reached the ''peak'' incidence of COVID-19, a marked reduction in procurement and transplantation rates were observed. Although waiting list mortality was not significantly modified, transplant access has been significantly reduced, showing a future negative trend on waitlist mortality.

Introduction & objectives: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. Materials & methods: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. Results: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7–47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4–16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9–21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1–14.6); P < .0001). After excluding patients with history of chronic liver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI 1.1–2.0); P = 0.01], and severe COVID-19 (2.6 [2.0–3.3], P < .0001), both adjusted by age, gender, diabetes, pneumonia and body mass index >30. Conclusions: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. Fil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Anders, Margarita. Hospital Aleman; Argentina Fil: Silveyra, María Dolores. Sanatorio Anchorena; Argentina Fil: Torre, Aldo. Centro Médico ABC; México Fil: Montes, Pedro. Hospital Nacional Daniel A. Carrión; Perú Fil: Urzúa, Alvaro. Hospital Clínico de la Universidad de Chile; Chile Fil: Pages, Josefina. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Toro, Luis G.. Hospitales de San Vicente Fundación de Medellín y Rionegro; Colombia Fil: Díaz, Javier. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Gonzalez Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina Fil: Miranda Zazueta, Godolfino. Instituto Nacional de Ciencias Médicas y Nutrición; México Fil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Gutiérrez, Isabel. Centro Médico ABC; México Fil: Michelato, Douglas. Hospital Especializado en Enfermedades Infecciosas Instituto Couto Maia; Brasil Fil: Venturelli, Maria Grazia. Hospital Nacional Guillermo Almenara Irigoyen; Perú Fil: Varón, Adriana. Fundación Cardio-Infantil; Colombia Fil: Vera Pozo, Emilia. Hospital Regional Dr. Teodoro Maldonado Carbo; Ecuador Fil: Tagle, Martín. Clínica Anglo-Americana; Perú Fil: García, Matías. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Tassara, Alfredo. Hospital Aleman; Argentina Fil: Brutti, Julia. Sanatorio Anchorena; Argentina Fil: Ruiz García, Sandro. Hospital de Víctor Lazarte Echegaray; Perú Fil: Bustios, Carla. Clínica Delgado; Perú Fil: Escajadillo, Nataly. Hospital Nacional Almanzor Aguinaga Asenjo; Perú Fil: Macias, Yuridia. No especifíca; Fil: Higuera de la Tijera, Fátima. Hospital General de México “Dr. Eduardo Liceaga"; México Fil: Gómez, Andrés J.. Hospital Universitario Fundación Santa Fé de Bogotá; Colombia Fil: Dominguez, Alejandra. Hospital Padre Hurtado; Chile Fil: Castillo Barradas, Mauricio. Hospital de Especialidades del Centro Médico Nacional La Raza; México Fil: Contreras, Fernando. No especifíca; Fil: Scarpin, Aldana. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Schinoni, Maria Isabel. Hospital Alianza; Brasil Fil: Toledo, Claudio. Universidad Austral de Chile; Chile Fil: Girala, Marcos. Universidad Nacional de Asunción; Paraguay Fil: Mainardi, Victoria. Hospital Central De las Fuerzas Armadas; Uruguay Fil: Sanchez, Abel. Hospital Roosevelt; Guatemala Fil: Bessone, Fernando. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina Fil: Rubinstein, Fernando Adrian. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Silva, Marcelo Oscar. Universidad Austral. Hospital Universitario Austral; Argentina

Background. Bacterial infections are frequent complications in patients with cirrhosis. Since they are associated with poor outcomes, antibiotics are frequently over-prescribed. Surrogate markers of bacterial infections, like procalcitonin, are needed to better discriminate between infected and not infected patients. Aims. To evaluated the diagnostic accuracy of an ultra-sensitive procalcitonin assay for the diagnosis of bacterial infections in patients with cirrhosis. Material and methods. In a single-center prospective study, we determined the basal levels of procalcitonin in 106 episodes of admissions to the emergency department in 84 cirrhotic patients. Patients were classified as infected or not infected by two independent hepatologists blinded to the procalcitonin result. Results. The prevalence of bacterial infection was 28% (29 episodes). The median procalcitonin was significantly higher in the infected group than in the not infected group (0.45 vs. 0.061 ng/mL, p < 0.001). The diagnostic accuracy of procalcitonin for bacterial infection estimated by the ROC curve was 0.95 (CI: 95%, 0.91-0.99). When selecting a cutoff value of 0.098 ng/mL a sensitivity of 97% and a negative predictive value 98% were found. Conclusions. The use of an ultra-sensitive procalcitonin assay identifies patients with cirrhosis at very low risk of bacterial infections.