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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.

Background: Predicting short-term mortality in patients with cirrhosis and bacterial infections is challenging. Aims: To compare the performance of various scores in predicting in-hospital mortality in this population. Methods: We performed an analysis of the multicenter prospective cohort study of patients with cirrhosis with bacterial infections throughout Argentina and Uruguay (clinicatrials.gov.NCT03919032). Patients were classified according to the CLIF criteria as having ACLF or mere acute decompensation (AD). We evaluated the performance of scores of liver disease and infection severity in predicting in-hospital mortality. MELD, MELD-Na, and Quick SOFA (qSOFA) were computed in all patients. CLIF-AD was only computed in patients without ACLF, and CLIF-ACLF only in patients with ACLF. We plotted ROC curves and estimated their area under the curve (AUROC). Results: We included 472 patients: 66% male, mean age 57 ± 12 years. Most frequent infections: SBP (30%) and urinary tract infection (25%). Overall, 332 (70%) patients had acute decompensation, and 140 (30%) ACLF. In-hospital mortality rate was 19%: 41% in patients with ACLF vs 10% in patients with AD (p

Background: Antibiotic de-escalation is considered a safe strategy that reduces costs and the risk of multi-drug resistant infections. However, its prevalence and associated factors in real-life practice were not reported in patients with cirrhosis in Latin-America. Aims: To estimate the prevalence of antibiotic de-escalation in patients with cirrhosis in real life-practice, and to explore its associated factors. Methods: We performed an analysis of the multicenter prospective cohort study of cirrhotic patients with bacterial infections throughout Argentina and Uruguay (clinicatrials.gov NCT03919032). Patients who died in the first 72 hs from the diagnosis of the infection were excluded. In accordance with guidelines, de-escalation was defined as changing the initially antimicrobials to a narrower spectrum regimen, or suspending one or more of the empirical antibiotics, according to culture results or to other clinical reasons, either in patients with culture-positive or culture-negative bacterial infections. We used inverse probability weighting (IPW) of having a culture-positive infection to estimate its causal effect on de-escalation. Results: We included 450 patients. Most frequent infections were SBP (30.4%), and urinary tract infection (12.9%). Overall, 243 (54%) infections were culture-positive, and 207 (46%) culture-negative. De-escalation was reported in 85 patients (18.9%: 95% CI 15%-22%) at a mean of 3.3 ± 2.4 days from treatment initiation and was more frequent in culture-positive than culture-negative infections (28.4% vs 7.7%, p< 0.001). The table shows the crude analyses of variables associated with de-escalation. Culture-positive infection was strongly and independently associated with de-escalation (ORIPW 6.08; 95% CI: 2.90-12.70; p < 0.001). Conclusions: Antibiotic de-escalation was reported in one-fifth of in-patients with cirrhosis. Given that having a culture-positive infection had a strong effect on de-escalation, efforts should be made to increase the likelihood of obtaining adequate culture samples in a timely manner.