BackgroundAsymptomatic coronary artery disease (CAD) has been reported up to 25% among liver transplant (LT) candidates, however cardiovascular pre-LT work-up is not yet standardized. We aimed to assess the efficacy of the protocol used in a high-volume LT center.MethodsWe enrolled all adult cirrhotic patients who underwent first-LT between 01/2015-12/2021 in our Center. Follow-up was closed on 30/06/2023. Per protocol, 3 minor (age 60-64years, arterial hypertension, non-insulin diabetes, BMI≥30Kg/m2, CAD family history, active smoking) or 1 major cardiovascular-risk-factors (insulin-treated diabetes, age>64years, stroke, MAFLD) led to echostress test (EchoS). Coronary angiography (CATH) was performed in patients with CAD history/symptoms, positive/doubtful non-invasive tests or cardiology indication.Results803 patients were included: median age 58 years, 77% male, BMI 25.4 Kg/m2, 57.9% HCC.Cardiovascular-risk-factors: 15.6% CAD family history, 24.9% 60-64 years, 26.4% arterial hypertension, 23.3% diabetics, 10.5% BMI≥30Kg/m2, 25.9% active smokers, 1.6% previous CAD; 19.6%≥65 years, 1.9% previous stroke, 7.6% MAFLD.372/803(46.3%) underwent pre-LT EchoS (42% dobutamine), 7/372(1.9%) tested positive. Overall, CATH was performed in 41/803 patients (5.1%, 9/41 with revascularization) and echoS positivity was confirmed in 3/7(43%).Post-LT:After a median follow-up of 51 months[IQR 32-74], 88.5% patients survived.At 2 years, 12(1.5%) ischemic events were recorded (8 within 1 year, 4 within 2 years); all patients survived. 11/12(92%) underwent pre-LT EchoS, 11/11 tested negative. At univariate-analysis, ischemic event predictors were: MAFLD (p=0.022), age≥60 years(p=0.027), diabetes(p=0.026), previous CAD(p=0.043). At multivariate-analysis, MAFLD (p=0.026,HR=4.528) and previous CAD (p=0.049,HR=8.066) remained significant.ConclusionIn our Italian multiregional cohort of 803 patients, pre-LT EchoS was performed in almost half of them, and <2% tested positive (57% false positive). All patients with ischemic events within 2 years after LT who underwent pre-LT EchoS, tested negative. After multidisciplinary team discussion, starting from January 2022 we implemented in our pre-LT work-up coronary CT instead of EchoS in patients with at least 1 major CV-RF.

Background Liver transplant (LT) recipients are getting older resulting in increase of comorbidities, alongside with metabolic dysfunction-associated steatotic liver disease (MASLD) as etiology of cirrhosis. We aimed to analyze the pre-LT cardiovascular burden and the incidence of major post-LT events (MACE) in our Italian multiregional LT cohort. Methods We included all adult patients who underwent first LT from 01/2015 to 06/2022 in our LT center. Follow-up was closed on 30/06/2023. In the first era (A: 2015-2018) multivessel coronary-artery-disease (CAD) contraindicated LT. Post-LT MACE (heart ischemia, de-novo arrhythmia, heart failure) were recorded. Results 852 patients were enrolled, 429 in the first era (A) and 423 in the second one (B).Comparing B vs A era:Pre-LT: median age 59 [IQR 54-65] vs 58 years [53-62] (p<0.01); age≥65 years: 25.8% vs 13.9%(p<0.01); MASLD: 9.7% vs 5.8% (p=0.04); arterial hypertension: 30.9% vs 24.2% (p=0.03); previous CAD: 2.4% vs 0.7% (p=0.05); CAD stenting during pre-LT work-up: 2.8% vs 0% (p=0.001).Post-LT: MACE within 1 year: 5.2% vs 5.6%, (p=0.88) (most frequently arrhythmias: 77.3% vs 58.3% (p=0.22); during the second year 0.9% vs 0.5%, p=0.45 (most frequently ischemic heart disease: 75% vs 50%, p=0.99).At univariate analysis, MACE predictors were male sex (p=0.02), age >55 (p=0.01), diabetes (p=0.03), arterial hypertension (p<0.01) and previous CAD (p<0.01); LT era and CAD revascularization during LT-workup did not impact on MACE (p=0.94 and p=0.12). At multivariate analysis, male sex (p=0.045, HR=2.39), age>55 years (p=0.048, HR=2.01), arterial hypertension (p=0.043, HR=1.73) and CAD history (p=0.041, HR=3.01) remained significant.Post-LT survival at 1 and 2 years of era-B vs era-A was: 96% vs 95%% and 94% vs 93%, respectively (p=0.247). Discussion In our cohort, despite the increase of pre-transplant cardiac risk factors in recent years, post-LT MACE incidence and mortality remained stable, suggesting the efficacy and the strong necessity of careful pre-LT cardiac work-up.

Background and Aims In the current era of pulmonary arterial hypertension (PAH) therapy (tx), patients (pts) affected by liver disease with mild portopulmonary hypertension (POPH) can experience significant improvement after liver transplant (LT). We described characteristics of POPH pts who underwent LT in our Center. Methods Among 1135 LT performed between 05/2013-05/2021 in our Center, we enrolled 10 cirrhotics with POPH. Diagnosis was made accordingto right heart catheterization (RHC) criteria: mean PA pressure(mPAP) >25 mmHg, PA wedge pressure(CAP)≤ 15 mmHg, pulmonary vascular resistance(PVR)>3WU. To achieve LT criteria (mPAP<35 mmHg, PVR<5 WU or mPAP 35-44 mmHg and PVR<3 WU) pts received phosphodiesterase-5-inhibitors(P-5i) and/or endothelin-receptor antagonists(ERA) and/or prostacyclin receptor-agonists. Follow-up was closed on 30/11/2022. Results Recipients (Table 1): median age 53 years, 80% male, BMI 26Kg/m2, 100% HCV cirrhosis, 20% HCC, 60% with large portosystemic-shunt, MELD 12. PAH-tx: pts#1-5 underwent ERA-tx; pts#6-8 ERA+P-5i; pt#9 and#10 prostacyclin+P-5i+ERA. Six pts (#1,#2,#4,#5,#9,#10) achieved POPH LT criteria after 4 mo of PAH-tx; 2 pts (#3,#6) after 8 mo, pt #8 after 12 mo.The 10 pts were transplanted after 0.3 y from registration on LT waiting list. Donors: median age 49 y, DRI 1.6. Post-LT: 3 pts developed early allograft dysfunction. All except pt #7 were extubated within day 2 post-LT; median hospital length of stay was 16 days. Pt#7 died after 18 days for cardiac failure.At a median follow-up of 2.9 y, 7 patients persistently discontinued PAH-tx. Conclusion In our high-volume LT center, in the last 8 y we transplanted 10 cirrhotic pts affected by POPH and responsive to targeted therapy. LT offered a POPH resolution in 78% of the pts who were weaned off all PAH-tx without RHC evidence of POPH recurrence. One pt died early post-LT for cardiac failure. Careful patient and donor selection and proper timing of LT remain pivotal to obtain good outcomes. In the current era of pulmonary arterial hypertension (PAH) therapy (tx), patients (pts) affected by liver disease with mild portopulmonary hypertension (POPH) can experience significant improvement after liver transplant (LT). We described characteristics of POPH pts who underwent LT in our Center. Among 1135 LT performed between 05/2013-05/2021 in our Center, we enrolled 10 cirrhotics with POPH. Diagnosis was made accordingto right heart catheterization (RHC) criteria: mean PA pressure(mPAP) >25 mmHg, PA wedge pressure(CAP)≤ 15 mmHg, pulmonary vascular resistance(PVR)>3WU. To achieve LT criteria (mPAP<35 mmHg, PVR<5 WU or mPAP 35-44 mmHg and PVR<3 WU) pts received phosphodiesterase-5-inhibitors(P-5i) and/or endothelin-receptor antagonists(ERA) and/or prostacyclin receptor-agonists. Follow-up was closed on 30/11/2022. Recipients (Table 1): median age 53 years, 80% male, BMI 26Kg/m2, 100% HCV cirrhosis, 20% HCC, 60% with large portosystemic-shunt, MELD 12. PAH-tx: pts#1-5 underwent ERA-tx; pts#6-8 ERA+P-5i; pt#9 and#10 prostacyclin+P-5i+ERA. Six pts (#1,#2,#4,#5,#9,#10) achieved POPH LT criteria after 4 mo of PAH-tx; 2 pts (#3,#6) after 8 mo, pt #8 after 12 mo.The 10 pts were transplanted after 0.3 y from registration on LT waiting list. Donors: median age 49 y, DRI 1.6. Post-LT: 3 pts developed early allograft dysfunction. All except pt #7 were extubated within day 2 post-LT; median hospital length of stay was 16 days. Pt#7 died after 18 days for cardiac failure.At a median follow-up of 2.9 y, 7 patients persistently discontinued PAH-tx. In our high-volume LT center, in the last 8 y we transplanted 10 cirrhotic pts affected by POPH and responsive to targeted therapy. LT offered a POPH resolution in 78% of the pts who were weaned off all PAH-tx without RHC evidence of POPH recurrence. One pt died early post-LT for cardiac failure. Careful patient and donor selection and proper timing of LT remain pivotal to obtain good outcomes.

Background Significant coronary artery disease (CAD) should be treated with percutaneous revascularization in pre-liver transplant (LT) work-up. New-generation drug-eluting stents (DES) allow early discontinuation of dual antiplatelet therapy (DAPT). We aimed to describe pre-LT management and early post-LT outcome of our patients with CAD who underwent Percutaneous Coronary Intervention (PCI). Methods We enrolled all patients transplanted in our Centre from 01/2018 to 04/2022 who underwent pre-LT cardiac catheterization (CATH). Stenosis ≥50% in a major-vessel or stenosis ≥70% in a moderate-sized branch vessel indicated significant CAD. Results Among 638 adult patients who received LT, 33 underwent pre-LT CATH (5%) due to previous history of obstructive CAD (18%), positive noninvasive stress-test (61%), inconclusive noninvasive test (15%) or CAD symptoms (6%). CATH showed normal coronaries in 6/33 (18%), non-obstructive CAD in 15/33 (46%) and significant CAD in 12/33 (36%). These 12 patients were all male, median age 64 years, 75% diabetics, 83% smokers, median BMI 26kg/m2 and underwent PCI with single (6/12) or ≥ 2 coronary arteries stenting (6/12). Patients received 31 days (IQR 31-41) of DAPT (clopidogrel+cardioaspirin), followed by aspirin monotherapy; anemia was a concern, without pre-LT major bleeding. Registration on the LT waiting list and LT occurred after 14 days (7-87) and 77 days (12-172) respectively from DAPT discontinuation. The median number of red blood cell units transfused during LT was 5 (2-7). At the end of LT, median arterial lactate and noradrenaline requirement were 1.9 mmol/L and 0.13 γ/Kg/min (Table 1). After a median follow-up of 321 days from LT: patient #1 experienced acute heart failure at month 4th (EF 35%), following major gastrointestinal bleeding (hemoglobin 4.2 g/dL); CATH was unchanged; patient improved with blood transfusion (EF at discharge 45%). Conclusion Coronary DES revascularization and early clopidogrel discontinuation was safe in cirrhotic patients with significant CAD and allowed timely LT. Significant coronary artery disease (CAD) should be treated with percutaneous revascularization in pre-liver transplant (LT) work-up. New-generation drug-eluting stents (DES) allow early discontinuation of dual antiplatelet therapy (DAPT). We aimed to describe pre-LT management and early post-LT outcome of our patients with CAD who underwent Percutaneous Coronary Intervention (PCI). We enrolled all patients transplanted in our Centre from 01/2018 to 04/2022 who underwent pre-LT cardiac catheterization (CATH). Stenosis ≥50% in a major-vessel or stenosis ≥70% in a moderate-sized branch vessel indicated significant CAD. Among 638 adult patients who received LT, 33 underwent pre-LT CATH (5%) due to previous history of obstructive CAD (18%), positive noninvasive stress-test (61%), inconclusive noninvasive test (15%) or CAD symptoms (6%). CATH showed normal coronaries in 6/33 (18%), non-obstructive CAD in 15/33 (46%) and significant CAD in 12/33 (36%). These 12 patients were all male, median age 64 years, 75% diabetics, 83% smokers, median BMI 26kg/m2 and underwent PCI with single (6/12) or ≥ 2 coronary arteries stenting (6/12). Patients received 31 days (IQR 31-41) of DAPT (clopidogrel+cardioaspirin), followed by aspirin monotherapy; anemia was a concern, without pre-LT major bleeding. Registration on the LT waiting list and LT occurred after 14 days (7-87) and 77 days (12-172) respectively from DAPT discontinuation. The median number of red blood cell units transfused during LT was 5 (2-7). At the end of LT, median arterial lactate and noradrenaline requirement were 1.9 mmol/L and 0.13 γ/Kg/min (Table 1). After a median follow-up of 321 days from LT: patient #1 experienced acute heart failure at month 4th (EF 35%), following major gastrointestinal bleeding (hemoglobin 4.2 g/dL); CATH was unchanged; patient improved with blood transfusion (EF at discharge 45%). Coronary DES revascularization and early clopidogrel discontinuation was safe in cirrhotic patients with significant CAD and allowed timely LT.

Background/aims: There are limited data about optimal strategy of cardiovascular (CV) risk assessment during liver transplant (LT) workup. We evaluated CV risk profile and its correlation with early post-LT cardiac events.

Invasive fungal infection (IFI) is a severe complication of liver transplantation burdened by high mortality. Guidelines recommend targeted rather than universal antifungal prophylaxis based on tiers of risk.

BACKGROUND:In recent years the incidence of invasive fungal infections (IFIs) in post liver transplant (LT) has reduced to about 5%, however the majority of IFIs develops early in the post-transplant course. Candida species are the most frequent causative pathogens followed by Aspergillus species. Mortality for invasive candidiasis is still 40-50%. For this reason universal prophylaxis is still considered useful and is adopted by different LT centers, although it is not justified by available data. The aim of study is to evaluate Candida infection incidence and mortality in low risk patients and therefore not subjected to antifungal prophylaxis in the immediate post-LT.METHODS:The patient is defined low risk if without any risk factor for IFIs as reported in literature and according to our center protocol described below. We analyzed retrospectively the records (with 90 days follow-up) of all adult patients underwent to LT at our center in 2011-2012.RESULTS:At our center between 2011 and 2012, 247 LT in 232 adult patients were performed: 137 patients (59%) received prophylaxis with Amphotericin B lipid complex or liposomal Amphotericin B, 95 patients (41%) didn't receive any prophylaxis. In these latter patients was observed only one case of Candida oesophagitis at the second month post-LT. The incidence of invasive candidiasis was 0%, and there wasn't mortality ascribed to Candida infection.CONCLUSIONS:It is possible to identify low risk patients for IFIs post-LT and the no prophylaxis policy in the early LT course appears safe and feasible.

Portopulmonary hypertension has been reported in 2% to 9% of candidates for liver transplantation (OLT). If it is moderate to severe, it represents a contraindication to the procedure until pulmonary vasodilatative therapy has been optimized. We report the case of a 43-year-old man, scheduled for OLT due to alcoholic cirrhosis with hemosiderosis. His Model for End-Stage Liver Disease was 25 at that time. The preoperative evaluation showed a severe alteration of diffusion (pO2 68 mm Hg), without hepatopulmonary syndrome or portopulmonary hypertension (PPH) upon basal and dobutamine stress echocardiography. At the beginning of the OLT the hemodynamic profile showed mean pulmonary artery pressure (mPAP) 38 mm Hg, wedge pressure (WP) 19 mm Hg, cardiac output (CO) 9.1 L/min, pulmonary vascular resistance (PVR) 166 dyne s/cm(5), transpulmonary gradient (TPG) 19 mm Hg, which lead us to promptly initiate inhaled nitric oxide (iNO) and intravenous epoprostenol 2 to 5 ng/kg/min. Upon graft reperfusion the hemodynamic profile was: mPAP 47 mm Hg, WP 23 mm Hg, CO 14.2 L/min, PVR 135 dyne s/cm(5), TPG 24 mm Hg, and at the end of surgery, mPAP 39 mm Hg, WP 20 mm Hg, CO 10.6 L/min, PVR 123 dyne s/cm(5), TPG 19 mm Hg. On postoperative day (POD) 3, we observed severe worsening of PPH: mPAP 60 mm Hg, WP 10 mm Hg, CO 9.8 L/min, PVR 395 dyne s/cm(5), TPG 50 mm Hg even with maximal pulmonary vasodilatatory therapy (ambrisentan 5 mg, intravenous sildenafil 20 mg × 3 and epoprostenol 22 ng/kg/min, iNO). Severe acute respiratory distress syndrome (ARDS) was presents. Therefore we decided to begin veno-venous extracorporeal membrane oxygenation (v-v ECMO) to correct the hypoxic vasoconstriction. Subsequent weaning from inotropic support with iNO and epoprostenol was possible on POD 7 due to mPAP 42 mm Hg, WP 15 mm Hg, CO 7.9 L/min, PVR 273 dyne s/cm(5), and TPG 27 mm Hg. On POD 11 he was weaned from ECMO due to: mPAP 40 mm Hg, WP 16 mm Hg, CO 6.5 L/min, PVR 295 dyne s/cm(5) and TPG 24 mm Hg. The patient was extubated on POD 17. The cardiac catheterization 1 month after OLT showed: mPAP 28 mm Hg, WP 13 mm Hg, CO 5.4 L/min, PVR 220 dyne s/cm(5) and TPG 15 mm Hg. ECMO rescue therapy in this "extreme" case allowed us to correct hypoxemia responsible for worsening of pulmonary hypertension allowing time to reach the goal of vasodilatatory therapy.

Neurological complications are common in cirrhotic patients with end-stage liver failure. They comprise a wide array of etiologies, which may originate before, during, or after liver transplantation. The objective of this study was to describe the nature of the main neurological complications in patients with end-stage liver failure. Several toxins including ammonia, manganese, benzodiazepine-like substances, gamma-aminobutyric acid-like substances, and impaired dopaminergic neurotransmission are at the top of the list of candidates for hepatic encephalopathy, subclinical encephalopathy, and extrapyramidal signs before liver transplantation. Central pontine myelinolysis, cerebrovascular autoregulation impairment, and paradoxical cerebral embolism are probably responsible for the neurological complications during liver transplantation. Neurological complications represented by alterations of mental status, seizures, and focal motor deficits have been described after liver transplantation. These complications have been attributed to several pathogenetic factors, such as a poorly functioning graft, an intracranial hemorrhage, a cerebral infarction, an infection, or the toxicity of immunosuppressants.

The first Italian liver transplant center to reach the goal of 1000 procedures was Turin. The paper reports this single-center experience, highlighting the main changes that have occurred over time. From 1990 to 2002, 1000 consecutive liver transplants were performed in 910 patients, mainly cirrhotics. Surgical technique was based on the preservation of the retrohepatic vena cava of the recipient. The veno-venous bypass was used in 30 cases only and abandoned since 1997. Operating time, warm ischemia time and length of hospital stay significantly decreased over the years, while operating room extubation became routine. Immunosuppression pivoted on cyclosporine A. Management of retransplantations, marginal grafts, and of HCV-positive, HBV-positive and hepatocellular carcinoma recipients were optimized. Median follow-up of the patients was 41 months. Overall survival rates at 1, 5 and 10 years were 87%, 78% and 72% respectively. Survival rates obtained in the second half of the cases (1999-2002 period) were significantly better than those obtained in the first half (1990-1998 period) (90% vs. 83% at 1 year and 81% vs. 76% at 5 years respectively). Increasing experience in liver transplant surgery and postoperative care allowed standardization of the procedure and expansion of the activity, with parallel improvement of the results.

ABSTRACT Hepatitis C virus (HCV) is a major cause of chronic hepatitis worldwide. The study of early steps during HCV infection has been hampered by the lack of suitable in vitro or in vivo models. Primary Tupaia hepatocytes (PTH) have been shown to be susceptible to HCV infection in vitro and in vivo. Human scavenger receptor class B type I (SR-BI) represents an HCV receptor candidate mediating the cellular binding of E2 glycoprotein to HepG2 hepatoma cells. However, the function of SR-BI for viral infection of hepatocytes is unknown. In this study, we used PTH to assess the functional role of SR-BI as a putative HCV receptor. Sequence analysis of cloned tupaia SR-BI revealed a high homology between tupaia and human SR-BI. Transfection of CHO cells with human or tupaia SR-BI but not mouse SR-BI cDNA resulted in cellular E2 binding, suggesting that E2-binding domains between human and tupaia SR-BI are highly conserved. Preincubation of PTH with anti-SR-BI antibodies resulted in marked inhibition of E2 or HCV-like particle binding. However, anti-SR-BI antibodies were not able to block HCV infection of PTH. In conclusion, our results demonstrate that SR-BI represents an important cell surface molecule for the binding of the HCV envelope to hepatocytes and suggest that other or additional cell surface molecules are required for the initiation of HCV infection. Furthermore, the structural and functional similarities between human and tupaia SR-BI indicate that PTH represent a useful model system to characterize the molecular interaction of the HCV envelope and SR-BI on primary hepatocytes.

O328 Aims: To evaluate if HCV-infected livers transplanted into HCV-infected recipients convey a worse outcome than HCV-negative grafts. Methods: We retrospectively analysed the outcome of 19 Liver Transplantations (LT) performed from july 1998 to december 2003 in HCV positive patients with livers from HCV positive donors. 428 patients with HCV cirrhosis who underwent LT in our center using livers from HCV negative donors were the control group.All HCV positive livers were submitted to heart-beating biopsy during retrieval to evaluate Ishak score. Other variables considered were: donor age, hepatic enzymes and ICU stay; total ischemia time; recipient age; HCV genotyping of donor and recipient (before LT and three months after LT). We considered outcome indexes patient and graft survival and hepatitis recurrence rate.Recurrent hepatitis was always biopsy-proven.Statistical analysis was performed using SPSS. Univariate survival was analysed by Kaplan-Meier method. Results: There were no significant differences between the two groups about donor age (median 59,7± 11,2 yrs in HCV+ donors vs 50,2±16,9 in control group), recipient age (53,7 ± 5,6 vs 51,7± 7,7), hepatic donor enzymes (median AST 75,9±78,4 vs 58,7±61,1, median ALT 38,7± 26 vs 47,8± 37,9), total ischemia time (median 688,9±192 min vs 585,4 ± 164,3 min), and ICU days (median 5,4 ± 5,1 vs 4,8 ± 4,2).The Ishak score grading was more than 2/18 in 3 cases, and only 1 graft presented a staging score more than 2/6.In only two cases we matched different HCV genotyping, and in these cases donor strain took over the recipient strain. In one patient donor genotyping 2a-2c took over recipient genotyping 1b; 9 months after LT we documented recurrent hepatitis, and antiviral therapy (interferon+ribavirin) cleared HCV. Sustained Virological Response (SVR) was confirmed 3 years after therapy discontinuation. In the second patient subtype 1b became the predominat strain over donor genotyping 4; a mild recurrent hepatitis (Ishak score 4/18,2/6) was documented 12 months after LT.In the group of HCV positive donor only one retransplantation was performed; portal hypertension developed two months after LT in the graft with Ishak score more than 2/6. Cumulative 1 year patient and graft survival rate didn’t significantly differ in the HCV negative donor group from HCV positive group (84% vs 80%, and 78% vs 73%, respectively). Hepatitis recurrence rate at one year was also similar in the two groups (70,3% vs 69,5%). Conclusions: Our study suggests that livers from HCV positive donors can safely be used in LT for HCV cirrhosis. Hepatic biopsy must always be performed before using such livers, because the outcome of LT seems to be influenced by histological features of donor liver. The takeover of one strain by another is possible, and it may really change the prognosis of the patient if the predominant strain is more sensitive to the antiviral therapy.

BACKGROUND/AIMS:Interferon (IFN) with ribavirin combination therapy (CT) was proposed for the treatment of hepatitis C recurring in liver transplants. We assessed the efficacy of two protocols of CT in transplanted patients with recurrent severe hepatitis C virus (HCV) hepatitis. METHODS:Fifty-seven patients (68% genotype 1b) were treated with IFN alfa-2b 3 million units three times weekly and oral ribavirin 800mg/die for 6 or 12 months. Study end-points were the end of treatment (ETVR) and the 12-month post-therapy sustained virologic response (SVR; negative HCV-RNA). RESULTS:ETVR was induced in 9/27 (33%) and in 7/30 patients (23%) treated, respectively, for 6 and 12 months (P=0.4); a SVR was induced in six (22%) of the former and five (17%) of the latter (P=0.4). HCV genotype non-1 patients responded better than genotype 1 (SVR: 43% in genotype non-1 versus 12% in genotype 1, P: 0.02). In ETV responders the hepatitis activity index improved by >2 points in biopsies taken after therapy compared to pre-therapy biopsies. Anemia and leukopenia required reduction of therapy in 51% of the patients. CONCLUSIONS:CT is efficacious in controlling HCV disease in about 20% of transplants with recurrent hepatitis C. Six months of therapy are as efficacious as 12 months.

The aim of this study is to evaluate the role of spectral electroencephalogram (EEG) analysis ((S)EEG) in quantitating brain dysfunction in cirrhotic patients, showing conditions of minimal hepatic encephalopathy (HE), and determining the impact of orthotopic liver transplantation (OLT) on its correction. (S)EEG was compared with visual EEG ((V)EEG) in 44 cirrhotic patients waiting for OLT and 44 healthy controls. Eighteen patients had overt HE, and 26 patients had no apparent HE. Twenty-one transplant recipients were reexamined 6 months after OLT. Computerized (S)EEG was performed by mean dominant frequency (MDF) and the occipital alpha-theta ratio, expressed as its logarithmic transformation (LogR). All patients underwent psychometric assessment. MDF and LogR correlated significantly with Child-Pugh score (P <.05) and the presence of HE (P <.0001). (S)EEG and (V)EEG determined minimal HE in 8 (31%) and 6 (23%) of 26 patients without overt HE, respectively. (S)EEG did not correlate with age, sex, cause of liver disease, portal hypertension, or psychometric test results. MDF and LogR improved in many transplant recipients. LogR was significantly lower in OLT candidates who died before OLT compared with OLT survivors. In conclusion, (S)EEG provides reliable quantitative information to evaluate the degree of HE and appears more sensitive than (V)EEG to discriminate a subclinical stage of HE. The improvement in (S)EEG results observed in transplant recipients confirms the reversibility of bioelectric brain dysfunction with restoration of liver functions.