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Conflict of interest: No Introduction and Objectives: The term “recompensation” of cirrhosis was proposed in the latest BAVENO VII, underlying dynamic events and prognosis in cirrhosis. However, there is uncertainty regarding its prognosis in patients with advanced hepatocellular carcinoma (HCC) treated with first line systemic therapies (1L). We aimed to compare post-1L survival between compensated (CC), decompensated (DC), and recompensated (RC) cirrhosis. Patients / Materials and Methods: A multicenter prospective Latin-American cohort study including advanced HCC patients with cirrhosis who received any 1L was conducted from 2018 to 2024. Three groups were defined: CC (had never presented decompensation); DC (presenting any decompensated event associated with portal hypertension at time of 1L), and RC group (prior history of any decompensation event at HCC diagnosis who were compensated at time of 1L). Survival since date of 1L was compared using Cox proportional hazard analysis. Results and Discussion: Overall, 306 patients received 1L, including sorafenib 60.5%, atezolizumab + bevacizumab 29.7%, lenvatinib 9.1%, and nivo/pembrolizumab 0.6%. Of these, 83.3% presented cirrhosis. Median 1L treatment duration was 5.1 months with a median overall survival since 1L of 16.0 months (range 12.9-18.3). Significant differences were observed between CC (n=167), DC (n=31) and RC (n=42) groups (Table). In the RC group, median time from decompensation to recompensation was 12.0 months (range 1.9-25.9); being ascites the most frequent event (78.6%). DC group presented decreased post-1L survival [median 8.6 months vs 17.2 months in CC [adjusted HR 1.9 (95% CI 1.05-3.5); P=0.03], while no significant survival difference was observed between RC and CC [median survival 12.5 months; aHR 1.3 (95% CI 0.81-2.1); P=0.28] (Figure). Lower access to second line therapy was observed in DC group. Conclusions: Patients with cirrhosis and advanced HCC who achieve recompensation may benefit from systemic therapies. This demands an observation period of follow up before precluding 1L in decompensated cirrhosis.

Conflict of interest: No Introduction and Objectives: Stopping rules following transarterial chemoembolization (TACE), either tumor progression or “unTACEable” progression are needed. Avoiding liver decompensation after TACE may lead better access to systemic treatment and survival. These scenarios are unknown in our region. We aimed to evaluate accessibility to systemic therapy following TACE and its impact on survival. Patients / Materials and Methods: A multicenter prospective cohort study conducted in Latin America, included HCC patients receiving TACE from May 15, 2018 to March 15, 2024. We excluded patients on the liver transplant waiting list, or Child Pugh C. Survival since first TACE was compared between groups accessing (A) and not accessing (no-A) to systemic therapy after TACE through Cox proportional hazard survival analysis, and adjusted treatment effect was further evaluated using a propensity score (PS) and inverse probability treatment weighting (IPTW). Results and Discussion: rom 258 receiving TACE, 188 were included after excluding 33 patients on the waiting list and 37 Child C (Table). Access to any systemic therapy was 46.8% (95% CI 39.5-54.2%), within a median time from TACE to first line of 9 months (range 3.7-17.0). In group A (n=88) systemic treatments following TACE were sorafenib 62.5%, atezolizumab + bevacizumab 31.8%, and lenvatinib 4.5%. Paradoxically, while presenting better liver function reserve, liver decompensation after TACE was more frequent in group A (7% vs 0%; P=0.004), without significant differences regarding median number of TACEs, modality, or tumor burden. Median survival since first TACE between groups was A 37.4 months vs no-A 29.8 months [HR 0.69 (95% CI 0.44-1.10), adjusted for the HAP score (Figure), which was unchanged after PS and IPTW. Conclusions: In our region, less than half of HCC systemic treatment candidates acceded to sequential TACE-systemic therapy. Although not statistically significant, due to underpowered estimations, numerically higher survival was achieved with TACE-systemic therapies.

Conflict of interest: No Introduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) at intermediate stage of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are significant. The aim of this study was to evaluate pre and post-prognostic survival variables after transarterial chemoembolization (TACE). Patients / Materials and Methods: A multicenter prospective cohort study was conducted in Argentina, Chile, Brazil, and Colombia, including HCC patients at BCLC B or C stages who were treated with TACE from 2018 to 2024. The effect on survival since date of first TACE was evaluated through Cox proportional hazard survival analysis. Harrell´s c-statistic index for model discrimination was estimated through somers-d. Results and Discussion: Overall, 625 patients were included, of which 41.3% (n=258) received TACE (Table 1), and 4.6% (n=29) selective internal radiation therapy (SIRT). The median number of TACEs procedures was 2 (range 1-3); 54.5% conventional TACE, and 44.7% with drug-eluting beads. Median follow-up since first TACE was 17.7 months, with a median overall survival of 27.3 months (range 21.9-35.1). Radiological objective response rates (ORR) after first and last TACEs were 49.2% (95% CI 42.9-55.5%), and 29.0% (95% CI 22.6-36.1%), with significantly better post TACE survival [HR of 0.48 (95% CI 0.29-0.78); P=0.003]. The pre-TACE prognostic model showed liver decompensation was an independent variable associated with increased post TACE mortality was [HR 2.0 (CI 1.28-3.12)], adjusted for performance status, and the HAP score. Pre and post-TACE model showed that the effect of liver decompensation was adjusted [HR 1.7 (CI 0.98-2.8); P=0.06], when ORR after last TACE was achieved and included in this model [HR 0.48 (CI 0.29-0.79); P=0.004], with a c-statistic index of 0.66 (95% CI 0.60-0.72). Conclusions: Radiological response after sequential TACE might reduce the negative effect of liver decompensation on post-TACE survival. However, cautious TACE stopping rules should be considered.

Conflict of interest: No Introduction and Objectives: Clinical trials evaluating the efficacy of first line systemic immune therapies for patients with advanced hepatocellular carcinoma (HCC) have recruited a lower proportion of patients with cirrhosis. In this group of patients, immune related adverse events (irAEs) may lead to decreased prognostic outcomes. The aim of this study was describe the incidence rate of irAEs and its impact on survival. Patients / Materials and Methods: A multicenter prospective Latin-American cohort study was conducted including HCC patients who received A+B since its regional approval, either as first or sub-sequent systemic lines, to March 15, 2024. Overall survival since A+B, and survival since date of irAE was compared between patients developing and not developing irAEs (date since A+B), through Cox proportional hazard analysis (Harrell's c-index). Results and Discussion: Overall, 99 patients treated with A+B were included (n=8 received it as second line post sorafenib), 82.3% presented cirrhosis. The median treatment duration was 6 months [number of cycles 5 (range 3-11.5)], with a median overall survival of 17.0 months (range 12.6-19.8). Over a median follow-up of 7.7 months (range 4.5-17.2), the irAE incidence rate was 2.1 cases per 100 persons-months [cumulative incidence 18.1% (95% CI 11.1-27.2%); n=18]. Median time to irAE was 2.3 months (range 1.4-4.8), most frequently hepatitis (n=6), thyroiditis (n=5), and 8/18 required steroids (Table). Follow-up and treatment duration times were similar regardless irAEs occurrence. On multivariable Cox regression model, AFP values before A+B >400ng/ml [HR 2.9 (95% CI 1.1-7.6)], adjusted for HCC diffuse intrahepatic pattern was associated with irAE development (c-statistic 0.66). Patients developing irAEs presented decreased overall and post-irAE survival [median 2.9 months vs 18.5 months; HR 6.2 (95% CI 2.7-14.2); P

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 and Objectives: there is insufficient data regarding bacterial infections in patients with cirrhosis to support recommendations for empiric antibiotic treatments, particularly in Latin America. This study aimed to evaluate bacterial infection's clinical impact and microbiological characteristics, intending to serve as a platform to revise current practices. Materials and Methods: multicenter prospective cohort study of patients with cirrhosis and bacterial infections from Argentina and Uruguay. Patient and infection-related information were collected, focusing on microbiology, antibiotic susceptibility patterns, and outcomes. Results: 472 patients were included. Spontaneous bacterial infections and urinary tract infections (UTIs) were registered in 187 (39.6%) and 116 (24.6%) patients, respectively, representing the most common infections. Of the 256 culture-positive infections, 103 (40.2%) were caused by multidrug-resistant organisms (reaching 50% for UTI), and 181 (70.7%) received adequate initial antibiotic treatment. The coverage of cefepime and ceftriaxone was over 70% for the empirical treatment of community-acquired spontaneous infections, but ceftazidime´s coverage was only 40%. For all UTI cases and for healthcare-associated or nosocomial spontaneous bacterial infections, the lower-spectrum antibiotics that covered at least 70% of the isolations were imipenem and meropenem. During hospitalization, a second bacterial infection was diagnosed in 9.8% of patients, 23.9% required at least one organ support, and 19.5% died. Conclusions: short-term mortality of bacterial infections in patients with cirrhosis is very high, and a high percentage were caused by multidrug-resistant organisms, particularly in UTIs. The information provided might serve to adapt recommendations, particularly related to empirical antibiotic treatment in Argentina and Uruguay. The study was registered in Clinical Trials (NCT03919032).

Introduction and Objectives: Selecting an empiric antibiotic treatment in patients with cirrhosis and spontaneous bacterial infections is challenging. It is of paramount importance to have local epidemiological data to maximize pathogen coverage while minimizing the unnecessary use of broad-spectrum antibiotics. This study aimed to describe the patterns of antibiotic resistance of spontaneous bacterial infections according to the site of acquisition. Materials and Methods: Analysis of the multicenter prospective cohort study of cirrhotic patients with bacterial infections in Argentina and Uruguay (NCT03919032). Only culture-positive spontaneous infections were included in this study: spontaneous bacterial peritonitis (SBP), spontaneous bacterial empyema (SBE), and spontaneous bacteremia (SB). We estimated the proportion of infections that were sensitive to various antibiotics according to where the infection was acquired: community-acquired (CA), healthcare-associated (HCA), or nosocomial (NOS). Approximately 80% coverage is advisable for empiric treatments in stable patients and 90% for critically-ill patients. Results: The main cohort included 472 patients, of whom 97 presented culture-positive spontaneous infections and were included: with 57 (59%) SBP, 34 (35%) SB, and 4 (6%) SBE. Regarding the site of acquisition, 43% were CA, 36% NOS, and 21% HCA. Gram-positive and negative bacteria were found in 53% and 47% of the infections. The most frequent isolations were Streptococcus spp (26%), E coli (20), K pneumonia (15%), S Aureus (10%), E. faecium (6%) and E. faecalis (4%). Multidrug-resistant organisms (MDROs) were isolated in 35% of the patients. As shown in the table, cefepime and ceftriaxone offer the most rational coverage for CA and HCA infections, and imipenem or meropenem for NOS infections. However, in critically-ill patients, broader-spectrum antibiotics are needed to achieve a coverage closer to 90% (table). Conclusions: We present, for the first time in our region, evidence-based recommendations for the empirical treatment of spontaneous bacterial infections. Prior colonization and/or infections by MDROs might refine even more the antibiotic selection and should be explored.