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The futility of liver transplantation in elderly recipients remains under debate in the HCV eradication era.The aim was to assess the effect of older age on outcome after liver transplantation. We used the ELTR to study the relationship between recipient age and post-transplant outcome. Young and elderly recipients were compared using a PSM method.A total of 10,172 cases were analysed. Recipient age65 years was identified as an independent risk factor associated with reduced patient survival (HR:1.42 95%CI:1.23-1.65,p 0.001). After PSM, 2124 patients were matched, and the same association was found between elderly recipients and patient survival and graft survival (p 0.001). As hepatocellular carcinoma and alcoholic cirrhosis were independent prognostic factors for patient and graft survival a propensity score-matching was performed for each. Patient and graft survival were significantly worse (p 0.05) in the alcoholic cirrhosis elderly group. However, patient and graft survival in the hepatocellular carcinoma cohort were similar (p 0.05) between groups.Liver transplantation is an acceptable and safe curative option for elderly transplant candidates, with worse long-term outcomes compare to young candidates. The underlying liver disease for liver transplantation has a significant impact on the selection of elderly patients.

This study was a retrospective analysis of the European Liver Transplant Registry (ELTR) performed to compare long-term outcomes with prolonged-release tacrolimus versus tacrolimus BD in liver transplantation (January 2008-December 2012). Clinical efficacy measures included univariate and multivariate analyses of risk factors influencing graft and patient survival at 3 years posttransplant. Efficacy measures were repeated using propensity score-matching for baseline demographics. Patients with

This study aims to compare the results of living donor (LDLT), cadaveric split (SLT) and domino (DO) liver transplantation which are currently available alternatives to the conventional cadaveric full-size liver transplantation (CAD).Immunologic, vascular and biliary complications (BC) were evaluated in 38 LDLT, 20 SLT, 17 DO and 38 CAD recipients.The incidence of acute rejection (AR) was similar between groups, and between blood-related and blood-unrelated patients. AR was more severe in the SLT group according to the Banff scores (P=0.03, P0.001, P0.001). The evolution of AR was similar between the groups, in terms of development of chronic rejection. No venous complications occurred in the overall population. The rate of arterial thrombosis (10.5, 10, 0 and 3%, respectively) was statistically similar between groups. The rate of BC (26, 40, 12, and 8%, respectively) was higher in the partial grafts than in the whole grafts (P=0.006), but was not significantly different within each group. There was an association between the severity of preservation injury and occurrence of AR (P=0.01) and arterial thrombosis (P=0.016), but not BC. One- and 2-year graft and patient survival rates were similar between groups.None of the graft types seemed to confer immunological advantage. BC remained problematic in the partial grafts, independently from ischemia time.

revascularization on early hepatic artery thrombosis after pediatric liver transplantation. Arch Surg 2002;137:1279–1283. [36] Hasegawa T, Sasaki T, Kimura T, Okada A, Nakatsuchi Y, Sugiara T, et al. Successful percutaneous transluminal angioplasty for hepatic artery stenosis in an infant undergoing living-related liver transplantation. Pediatr Transplant 2002;6:244–249. [37] Campos AC, Matias JE, Coelho JC. Nutritional spects of liver transplantation. Curr Opin Clin Nutr Matab Care 2002;5:297–307. [38] Djurberg H, Pothmann W, Joseph D, Tjan D, Zuleika M, Ferns S, et al. Anesthesia Care for living-related liver transplantation for infants and children with end-stage liver disease: report of our initial experience. J Clin Anesth 2002;14:564–570. [39] Holmes RD, Orban-Eller K, Karrer FR, Rowe DT, Narkewicz MR, Sokol RJ. Response of elevated Epstein-Barr virus DNA levels to

A recent ELTR study clearly showed that liver graft preservation with HTK is an independent risk factor for graft loss after liver transplantation (1). Naturally this result is highly relevant to all the transplant teams that use this solution. However, as suggested by a recent letter to the Editor (2) it may be questioned as it comes from a registry and therefore subject to possible bias. However, not only were the results of the original analysis confirmed by multivariate analysis but additional analyses excluding German centers and living donor liver transplants, also conveyed the same message (3). This article is protected by copyright. All rights reserved.

Background No model exists for liver transplantation to estimate the mortality risk in a given patient, and no standard by which to assess performance in different centres. We investigated the intrinsic mortality risk in the absence of known mortality risk factors, Methods We identified mortality risk factors and risk ratios quantified in data from the European Liver Transplant Registry (22 089 patients at 102 centres in 18 countries) registered from 1988 to 1997. To develop a model of the intrinsic risk and the risk ratios for specific factors, univariate and multivariate analyses were done separately for the overall population, for adults, and for children younger than 15 years, and the number of deaths were estimated, We validated the model by comparing mortality in patients without risk factors with the model-adjusted mortality in patients with risk factors. Findings Overall 5-year and 8-year actuarial survival was 66% (95% CI 65-66) and 61% (60-62). 65% of deaths occurred within 6 months, Retransplantation, transplantation for cancer, acute liver failure, fewer than 20 split-liver grafts per year, and a centre workload of fewer than 25 transplants per year were the main risk factors of 12 identified factors, 1-year and 5-year death rates among adults with no risk factors were similar to model estimates (15 [13-16] vs 14% [13-15], and 22 (20-24) vs 23% [21-24]). Corresponding data for paediatric transplants were 9% (7-12) compared with 11% (9-12) and 13% (10-17) compared with 14% (11-16). The reduction of mortality risk in high-volume centres was even greater in patients without risk factors (48 vs 23%, p

Keywords: clinical research/practice; liver transplantation/hepatology; liver transplantation: living donor; liver transplantation: split; liver transplantation: auxiliary; liver allograft function/dysfunction

s / Digestive and Liver Disease 48S (2016) e1–e17 e7 36 Fondazione IRCCS Ospedale Maggiore Policlinico, Milano, Italy 37 Policlinico Giaccone, Palermo, Italy 38 Universita di Modena, Modena, Italy 39 AO San Gerardo, Monza, Italy Theaimof this studywas toevaluate theprevalenceand theclinical profile of mixed crioglobulinemia (MC) in consecutive patients enrolled in PITER. A specific questionnaire regarding the presence of crioglobulinemia and related symptoms was applied. Of 7496 patients enrolled, the MC was never tested in 6019 (80%). The remaining 1477 HCV (+) patients were classified as follows: in 22% as symptomatic MC (MCS-HCV: mean age 64±11 years), in 29% as asymptomaticMC (MC-HCV:meanage61±12years), and in49%as HCV infectedpatientswithoutMC(meanage60±13years). Among the 328 patients, declared to be “symptomatic”, detailed data that confirmed MCS were available for 252 (33% of patients with MC). MC symptoms included purpura, weakness, and arthralgia (MC triad), as well as peripheral neuropathy, siccasyndrome, myalgias, cutaneous ulcers and renal involvement. Nocturnal sweet, fever and pruritis was also rarely reported. In patientswithMCS the liver fibrosis stage, was F0-F1 in 40%; F2 in 12%; F3 in 13% and F4 in 35% of patients, with no significant differences among the different groups. Previous IFN-based therapy was reported in 54% of MCSHCV, in 45% of MC-HCV and in 50% of HCV patients. 162 (65%) of MCS-HCV patients have been treated or are on DAA treatment. Preliminary results are available showing high rate of virological and clinical response with rare (1%: 3 patients) treatment interruption due to adverse events/intolerance. In Conclusion: This nation-wide, in progress study showed that, in spite of the clinical and therapeutic importance of HCV related MC, the presence of this condition is not considered in the large majority of cases. Among patients with MC, a symptomatic form was observed in more than 30% of cases. Treated patients will be prospectively followed up to better characterize the long term outcome of this important consequence of chronic HCV infection. http://dx.doi.org/10.1016/j.dld.2015.12.027

Introduction Les neuropathies amyloides Familiales (NAF) sont des neuropathies de transmission autosomique dominante survenant chez l’adulte et liees a une mutation amyloidogene du gene de la transthyretine (TTR). Il s’agit de polyneuropathies sensitivomotrices progressives invalidantes avec dysautonomie letales en 10 ans en moyenne. La Transplantation Hepatique (TH), qui permet de supprimer la principale source de TTR mutee est actuellement le principal traitement propose.Objectifs : Rapporter l’evolution a long terme de la neuropathie et la survie apres TH et en determiner les facteurs pronostiques independants. Methodes Etude prospective monocentrique avec evaluation periodique clinique (dont scores PND de marche et vegetatif) et electrophysiologique. Entre 1993 et 2010, 200 patients avec une NAF- TTR symptomatique ont eu une TH, 138 (69 %) ayant un variant Met30TTR, 62 un variant non Met30 (15 varietes). L’âge moyen etait de 45,5 ans avec un debut tardif (≥ 50ans) chez 37,5 % des patients. Nous avons utilise la methode de Kaplan Meier avec le test de Log- rank et le modele de Cox multivarie pour etudier la survie et ses facteurs pronostiques. Resultats La majorite des patients (63 %) a conserve la meme autonomie de marche mais 21,3 % ont eu recours a une aide a la marche (PND3) apres TH dont un quart sont devenus grabataires. Les facteurs de risque d’atteinte du score PND 3 etaient un amaigrissement > 20 %, l’âge tardif de debut, une duree de maladie avant TH ≥ 3 ans. 76/200 patients sont decedes dont 37 % la premiere annee, le plus souvent de causes cardiaques (39 %), d’infection (24 %), ou de progression de la neuropathie (7 %). La mediane de survie post TH est de 11,4 ans ; les facteurs de risque de deces sont une hypotension orthostatique ; une incontinence urinaire, l’âge tardif de debut (≥ 50 ans), un variant non Met30. La mediane de survie globale depuis le debut de maladie est de 14,7 ans, egale a 21,3 ans pour les Met30TTR jeunes ( vs 8,9 ans pour les non Met30TTR âgees, ≥ 50 ans). Pour 20 % des patients, l’implantation de Pace Maker s’est revelee necessaire au decours de la TH. Conclusions L’evolution apres TH semble meilleure dans les formes precoces de NAF- TTR Met30 jeunes en terme de survie et d’arret de progression de la neuropathie ; elle est moins favorable dans les formes tardives majoritaires actuellement ; ceci souligne l’interet des nouvelles biotherapies telles que SiRNA, Oligonucleotides AntiSens capables de supprimer le variant TTR ainsi que le sauvage, egalement fortement pathogene.