Although MELD score is a reliable tool for estimating mortality in the waiting list, criteria for preoperative prediction of survival after liver transplantation (LT) are lacking. ALBI score was validated as a prognostic marker for hepatocellular carcinoma patients undergoing transarterial chemoembolization, hepatic resection, and sorafenib treatment but not for LT outcomes yet. This study aimed to evaluate ALBI score as a prognostic factor in LT. This is a single-center analysis of patients undergoing LT between October 2001 and June 2017. Primary endpoint was overall post-LT mortality. Secondary endpoint was 90-day mortality. Of all 301 patients included in this study, 185 (61.5%) were males. The median age was 54.1 ± 11.3 years. Univariate and multivariate analysis revealed that ALBI grade 3 (HR 1.836, 95% CI 1.154–2.921, p = 0.010), low serum albumin (HR 0.628, 95% CI 0.441–0.893, p = 0.010), black race (HR 2.431, 95% CI 1.160–5.092, p = 0.019), and elevated body mass index (HR 1.061, 95% CI 1.022–1.102, p = 0.002) all were associated with decreased overall survival following LT. Patients with both ALBI grade 3 (n = 25) and calculated MELD score ≥ 25 had the lowest overall survival (p < 0.001). ALBI grade 3 was related to lower post-LT survival and can be utilized as a tool for risk stratification in LT.

Liver transplant (LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others. Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion. Intraoperative reinfusion of autologous blood is possible through previous self-donation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion (IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.

Background: Liver transplantation (LT) is a treatment for terminal chronic liver disease and in Brazil patients are listed based on Model End Liver Disease (MELD). However, when there is no significant increase in MELD, special situations (SS) were created, one of these is refractory ascites (RA). In these cases, patients receive additional score. RA is characterized when maximal doses of diuretics are used without ascites control or when creatinine increases when the dose of diuretics is increased, and the need for recurrent paracentesis. It is necessary to exclude the presence of hepatocellular carcinoma (HCC), and it is required to perform only abdominal ultrasonography (USG) up to 6 months before. Methods: The aim of this study was to evaluate explanted livers of patients submitted to LT in the Unit of Liver Transplantation of the University of Campinas, with RA to verify the presence of HCC, not diagnosed by the preoperative exams; and evaluate if would be useful to include the CT of Abdomen in the preoperative evaluation of these patients. Results: Of the 837 LT performed in this institution, 17 cases was due to SS by RA, with predominance of male (64.7%), mean age 59 years and the main etiology was virus C (47.0%).The mean survival was 238.64 days (0–1562), mean MELD of 15.23 (10–22), mean urinary sodium was 25.18 (1.25–120.4) and mean α-fetoprotein (AFP) of 10.23 (0.78–77.7).HCC was observed in 3 cases (17.6%), with 1, 3 and 6 nodules each of these patients and 8.14, 77.7 and 20.56 of AFP, respectively, with presence of angiolymphatic invasion in two of these cases. Conclusion: In conclusion, 17.6% of the cases of RA, no HCC was diagnosed with the currently required exams: abdominal USG and AFP. Thus, suggesting the need of preoperative abdominal CT in patients with chronic liver disease with RA for better selection to LT and, therefore, longer survival.

BACKGROUND:Factor V has never been compared to a validated early allograft dysfunction (EAD) definition. We aimed to assess factor V as a biomarker of EAD and a predictor of graft loss after liver transplantation (LT). METHODS:We retrospectively assessed the serum factor V levels on postoperative day 1 after LT. Patients were divided according to their factor V levels into the ≤36.1 U/mL and > 36.1 U/mL groups. The primary outcome was graft loss within 1, 3, and 6 months. The secondary outcome was EAD, as defined by Olthoff et al. Predictors of outcomes were identified by multivariable logistic regression. RESULTS:Two hundred twenty-seven patients were included in the study: 74 with factor V of 36.1 U/mL or less and 153 with factor V >36.1 U/mL. EAD was diagnosed in 41 (55.4%) of 74 patients with factor V of 36.1 U/mL or less and in 20/153 (13.1%) patients with factor V >36.1 U/mL (P < 0.001). According to the multivariable regression model, factor V was a continuous marker of EAD (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94-0.98 per U/mL). Among the study groups, the 1-, 3-, and 6-month graft survival rates were 82%, 74%, and 74%, respectively, for patients with factor V of 36.1 U/mL or less and 98%, 95%, and 95%, respectively, for patients with factor V >36.1 U/mL (P = 0.001). Factor V was a continuous predictor for 3- and 6-month graft losses (OR, 0.96; 95% CI, 0.94-0.99 and OR, 0.97; 95% CI, 0.94-0.99 per U/mL), whereas EAD was not significant when adjusted for factor V. CONCLUSION:Factor V is an early marker for EAD and is a continuous predictor of short-term graft loss after LT.

Background: Factor V is known to be a predictor of death in acute liver failure. However, it has never been tested as a predictor of death after LT. The aim of this study was to assess the role of plasmatic Factor V levels after LT as an predictor of mortality after LT.