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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.

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

Controversy exists whether NE after LT are more frequently observed in children or adults. We aimed to compare the incidence and outcomes for NE after LT in pediatric and adult recipients. A single-center cohort study, including all LT between 2001 and 2013, was performed. Definition of NE included impaired consciousness, delirium, seizures, focal neurologic deficit, visual impairment, or slurred speech. A cohort of 443 consecutive LT recipients was included: 307 adults and 136 children. Cumulative incidence of NE was similar between adults 15% (n = 41) and children 16% (n = 20; P = .73) with a complete neurological recovery in 62% and 95% of the patients, respectively (P < .0001). Adults with NE had significantly lower survival (70% vs 76%; P = .015) with a HR of 2.36; this was similarly observed in children (45% vs 66%; HR 2.05, CI 0.66; 6.34). Independent risk factors for NE in adults were pre-LT ascites, delta sodium, and post-LT hypomagnesemia, whereas in children pre-LT encephalopathy ≥II and serum albumin were associated with NE. Although a similar incidence of NE after LT was observed, children were more likely to achieve neurological recovery. Risk factors for the development of NE are difficult to assess in both populations.

Background & rationale. Limited information related to Liver Transplantation (LT) costs in South America exists. Additionally, costs analysis from developed countries may not provide comparable models for those in emerging economies. We sought to evaluate a predictive model of Early Discharge from Hospital after LT (ERDALT = length of hospital stay ≤ 8 days). A predictive model was assessed based on the odds ratios (OR) from a multivariate regression analysis in a cohort of consecutively transplanted adult patients in a single center from Argentina and internally validated with bootstrapping technique.Results. ERDALT was applicable in 34 of 289 patients (11.8%). Variables independently associated with ERDALT were MELD exception points OR 1.9 (P = 0.04), surgery time < 4 h OR 3.8 (P = 0.013), < 5 units of blood products consumption (BPC) OR 3.5 (P = 0.001) and early weaning from mechanical intubation OR 6.3 (P = 0.006). Points in the predictive scoring model were allocated as follows: MELD exception points (absence = 0 points, presence = 1 point), surgery time < 4 h (0-2 points), < 5 units of BPC (0-2 points), and early weaning (0-3 points). Final scores ranged from 0 to 8 points with a c-statistic of 0.83 (95% CI 0.77-0.90; P < 0.0001). Transplant costs were significantly lower in patients with ERDALT (median $23,078 vs. $28,986; P < 0.0001). Neither lower patient and graft survival, nor higher rates of short-term re-hospitalization and acute rejection events after discharge were observed in patients with ERDALT. In conclusion, the ERDALT score identifies patients suitable for early discharge with excellent outcomes after transplantation. This score may provide applicable models particularly for emerging economies.

Grafts from split livers (SLs) constitute an accepted approach to expand the donor pool. Over the last 5 years, most Argentinean centers have shown significant interest in increasing the use of this technique. The purpose of this article is to describe and analyze the outcomes of right-side grafts (RSGs) and left-side grafts (LSGs) from a multicenter study. The multicenter retrospective study included data from 111 recipients of SL grafts from between January 1, 2009 and December 31, 2013. Incidence of surgical complications, patient and graft survival, and factors that affected RSG and LSG survival were analyzed. Grafts types were 57 LSG and 54 RSG. Median follow-up times for LSG and RSG were 46 and 42 months, respectively. The 36-month patient and graft survivals for LSG were 83% and 79%, respectively, and for RSG were 78% and 69%, respectively. Retransplantation rates for LSG and RSG were 3.5% and 11%, respectively. Arterial complications were the most common cause of early retransplantation (less than 12 months). Cold ischemia time (CIT) longer than 10 hours and the use of high-risk donors (age ≥ 40 years or body mass index ≥ 30 kg/m2 or ≥ 5 days intensive care unit stay) were independent factors for diminished graft survival in RSG. None of the analyzed variables were associated with worse graft survival in LSG. Biliary complications were the most frequent complications in both groups (57% in LSG and 33% in RSG). Partial grafts obtained from liver splitting are an excellent option for patients in need of liver transplantation and have the potential to alleviate the organ shortage. Adequate donor selection and reducing CIT are crucial for optimizing results. Fil: Halac, Eduardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Dip, Marcelo. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Quiñones, Emilio. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Alvarez, Fernando. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Leiva Espinoza, Johana. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Romero, Pablo. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Nievas, Franco. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Maurette, Rafael. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Luque, Carlos. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Matus, Daniel. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Surraco, Paz. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Fauda, Martin. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Mc Cormarck, Lucas. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Mattera, Francisco J.. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina Fil: Gondolesi, Gabriel Eduardo. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Imventarza, Oscar. Capítulo Argentino de la International Hepato Pancreato Biliary Association; Argentina

SummaryThe aim of this study was to identify potential risk factors linked to neurologicevents (NE) occurring after liver transplantation (LT) and use them to constructa model to predict such events. From odds ratios (OR) of risk factors, a scoringsystem was assessed using multivariate regression analysis. Forty-one of 307 LTpatients presented NE (13.3%), with prolonged hospital stay and decreased post-LT survival. On multivariate analysis, factors associated with NE included: severepre-LT ascites OR 3.9 (1.80–8.41; P = 0.001), delta sodium ≥12 mEq/l OR 3.5(1.36–8.67; P = 0.01), and post-LT hypomagnesemia OR 2.9 (1.37–5.98;P = 0.005). Points were assigned depending on ORs as follows: ascites 4 points,and hypomagnesemia and delta sodium ≥12 mEq/l, 3 points each (scorerange = 0–10 points). ROC curve analysis suggested good discriminative powerfor the model, with a c-statistic of 0.72 (CI 0.62–0.81; P 3 points (71% sensitivity, 60% specificity). NE riskincreased progressively from 6.4%, to 10.3%, 12.8%, 31.5% and 71.0% as scoresrose from 0 to 3, 4, 6–7 and 10 cumulative points, respectively. The scoredescribed helps to identify patients potentially at risk for neurologic events, andits prevention would decrease morbidity and mortality after LT.IntroductionRisk of neurological events (NE) occurring after liver trans-plantation (LT) is relatively high [1]. These events maypresent as seizures, delirium, impaired consciousness, orfocal neurologic signs, at rates reported between 9 and 42%[1,2], higher than for other solid organ transplants. Thereason for this increase remains unexplained; possiblecauses include surgical procedure complexity, structuralcentral nervous system (CNS) changes resulting from hepa-tic encephalopathy (HE) [3,4], metabolic disturbances[3,5,6] and drugs used following LT [1]. Neurotoxicity sec-ondary to calcineurin inhibitors (CNI) has been studied inthe past [7]. However, controversy persists over whichpatients are at greater risk for developing NEs followingtransplantation.Increased mortality and morbidity, in the form of greaterincidence of acute cellular rejection (ACR) [3–6], pro-longed hospital stay [1–3], higher rates of in-hospital infec-tions [3–5] and poorer quality of life [1,3] have all beenassociated with NEs. Ultimately, LT costs are probablyhigher in these patients, making early identification ofthose potentially at risk for developing NE important, inorder to implement measures attempting to reduce NEsincidence.We recently reviewed our clinical care algorithms used atour institution following LT. We aimed to identify risk fac-tors associated with NEs, develop a predictive-prognostic

We report a unique case of orthotopic domino livertransplantation for a patient with ALF: a noncirrhoticliver graft with HCC was used as bridge therapy untila permanent deceased donor graft became available.A 42-year-old Hispanic woman presenting with ALFwas admitted to the emergency department and waspromptly listed for emergency liver transplantation.However, her clinical deterioration progressed rapidly,the patient required mechanical ventilatory support,and an epidural intracranial pressure monitor wasplaced. The patient developed intracranial hyperten-sion (25-30 mm Hg), which was successfully con-trolled with medical therapy. Synchronously,scheduled living donor liver transplantation (LDLT)was being performed for a 60-year-old female patientwith a history of recurrent HCC in a noncirrhotic liver.This patient had previously undergone a series of sur-gical and ablative treatments. The actual tumor bur-den was 2 HCC lesions (each 20 mm in diameter), theserum alpha-fetoprotein level was 2.4 ng/mL, and novascular or extrahepatic metastasis was found at thetime of LDLT.Progressive worsening of an already critical clinicalcondition in the first patient, the absence of either adeceased donor or a living donor after 5 days on thewaiting list, and no access to liver support systems orbioartificial devices at that time led the transplantteam to consider a domino liver transplant using theexplanted noncirrhotic liver with HCC from the secondpatient undergoing synchronous LDLT as bridge ther-apy. Consent was obtained from both the recipientand donor families, the institutional ethics committee,and the Instituto Nacional Central Unico Coordinadorde Ablacion e Implante. A sequential triple-procedureschedule was followed: left lobe LDLT; back-tableresection of the two 2-cm HCC lesions in segments VIand IV; and, finally, domino implantation of the HCCliver graft with the piggyback technique. The coldischemia time lasted 4 hours, and the warm ischemiatime was 40 minutes. Shortly after transplantation,vasopressor infusion was discontinued, and the intra-cranial pressure parameters improved to 15 to 17 mmHg (Fig. 1). Twelve hours after the domino procedure,a deceased donor graft from a 49-year-old female,located 600 km from the hospital, was made availablefor this patient. The deceased donor liver transplanta-tion procedure began 11 hours after the completion ofthe bridge domino liver transplant with the resectedHCC graft, and it lasted a total of 165 minutes with acold ischemia time of 6 hours.A pathological examination of the explanted dominoHCC liver graft confirmed 2 small HCC nodules: one

Introduction. Abdominal wall closure management has become an important challenge during recipient candidate selection, at the time of donor to recipient matching and during the planning of the surgical procedure for intestinal or multiorgan transplantation. Different strategies have been proposed to overcome the lack of abdominal domain: to reduce the graft size or to increase the abdominal domain. Based on the recent concept of using an acellular dermis matrix (Alloderm) and the availability of abdominal wall tissues from the same organ donor, we conceived the idea of using the fascia of the rectus muscle (FoRM) as a nonvascularized tissue allograft. Materials and Methods. This is a retrospective report of a series of 16 recipients of FoRM as part of a liver, intestinal, or multiorgan transplant procedure performed between October 2004 and May 2008 at three different transplant centers. Results. Of the 16 recipients of FoRM, all but one case was performed during their transplantation (four multivisceral, two modified multivisceral, three isolated intestine, and two livers). Five patients underwent a retransplant surgery (two livers, two multivisceral, and one isolated intestine). Abdominal wall infection was present in 7 of 16 cases. Nine patients are still alive. No deaths were related to wound infection. Long-term survival showed complete wound healing and only one ventral hernia. Discussion. The use of a nonvascularized FoRM is a novel and simple surgical option to resolve complex abdominal wall defects in liver/intestinal/multivisceral transplant recipients when it can be covered with the recipient skin.