BACKGROUND:Data on the influence of donor gender on post-liver transplant outcomes is scarce and is lacking. AIMS:The aim of this study was to evaluate the prognostic factors of mortality in patients undergoing liver transplantation (LT) with a thorough evaluation of the influence of the donor variables. METHODS:All patients undergoing LT at a single center from December 2011 to December 2018 were included. The main outcome measure of the study was overall patient survival. The mortality predictors were evaluated using Cox regression. RESULTS:The study analyzed 202 patients, 118 (58.1%) being males, and the average age was 54.19±11.66 years. Post-LT survival for the entire cohort of 202 patients as assessed by the KaplanMeier method at 1, 3, 5, and 7 years was 81.6, 73.1, 67.6, and 63%, respectively. The only predictor of increased overall mortality was female donor gender [HR 1.918, 95%CI 1.150-3.201, p=0.013]. Weight and height differences between donor and recipient were not related to mortality (p=0.545 for weight and p=0.964 height). CONCLUSIONS:Female donor gender was associated with an increase in overall post-LT mortality, especially for male recipients, regardless of anthropometric parameters. For male patients receiving livers from female donors, infection was the most common cause of mortality, occurring in the first year following LT.

Background Data on the influence donor gender on post-liver transplant outcomes is scarce / is lacking. The aim of this study was to evaluate the prognostic factors of mortality in patients undergoing liver transplantation (LT) with a thorough evaluation of the influence of the donor variables. Methods Retrospective study of all patients undergoing LT at a single center from December 2011 to December 2018. The main outcome measure of the study was overall patient survival. The mortality predictors were evaluated using Cox regression. Results Overall, 202 patients analyzed in this study, 118 (58.1%) being males, and the average age was 54.19 ± 11.66 years. Post-LT survival for the entire cohort of 202 patients as assessed by the Kaplan-Meier method at 1-, 3-, 5-, and 7 years was 81.6%, 73.1%, 67.6%, and 63%. The only predictor of increased overall mortality was female donor gender [HR = 1.918, IC95%=1.150–3.201, (p = 0.013)]. Weight and height differences between donor and recipient were not related to mortality (p = 0.545 for weight and p = 0.964 height). Conclusion Female donor gender was associated with an increase in overall post-LT mortality, especially for male recipients, regardless of anthropometric parameters. For male patients receiving livers from female donors, infection was the most common cause of mortality occurring in the first year following LT.

BACKGROUND Hepatocellular carcinoma (HCC) is an aggressive malignant neoplasm that requires liver transplantation (LT). Despite patients with HCC being prioritized by most organ allocation systems worldwide, they still have to wait for long periods. Locoregional therapies (LRTs) are employed as bridging therapies in patients with HCC awaiting LT. Although largely used in the past, transarterial embolization (TAE) has been replaced by transarterial chemoembolization (TACE). However, the superiority of TACE over TAE has not been consistently shown in the literature. AIM To compare the outcomes of TACE and TAE in patients with HCC awaiting LT. METHODS All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included. All patients underwent LRT with either TACE or TAE. Some patients also underwent percutaneous ethanol injection (PEI), concomitantly or in different treatment sessions. The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus. The primary outcome was waitlist dropout due to tumor progression, and the secondary outcome was the occurrence of adverse events. In the subset of patients who underwent LT, complete pathological response and post-transplant recurrence-free survival were also assessed. RESULTS Twelve (18.5%) patients in the TACE group (only TACE and TACE + PEI; n = 65) and 3 (7.9%) patients in the TAE group (only TAE and TAE + PEI; n = 38) dropped out of the waitlist due to tumor progression (P log-rank test = 0.29). Adverse events occurred in 8 (12.3%) and 2 (5.3%) patients in the TACE and TAE groups, respectively (P = 0.316). Forty-eight (73.8%) of the 65 patients in the TACE group and 29 (76.3%) of the 38 patients in the TAE group underwent LT (P = 0.818). Among these patients, complete pathological response was detected in 7 (14.6%) and 9 (31%) patients in the TACE and TAE groups, respectively (P = 0.145). Post-LT, HCC recurred in 9 (18.8%) and 4 (13.8%) patients in the TACE and TAE groups, respectively (P = 0.756). Posttransplant recurrence-free survival was similar between the groups (P log-rank test = 0.71). CONCLUSION Dropout rates and posttransplant recurrence-free survival of TAE were similar to those of TACE in patients with HCC. Our study reinforces the hypothesis that TACE is not superior to TAE as a bridging therapy to LT in patients with HCC.

ABSTRACT BACKGROUND: Liver transplantation (LT) is the only treatment that can provide long-term survival for patients with acute-on-chronic liver failure (ACLF). Although several studies identify prognostic factors for patients in ACLF who do not undergo LT, there is scarce literature about prognostic factors after LT in this population. AIM: Evaluate outcomes of ACLF patients undergoing LT, studying prognostic factors related to 1-year and 90 days post-LT. METHODS: Patients with ACLF undergoing LT between January 2005 and April 2021 were included. Variables such as chronic liver failure consortium (CLIF-C) ACLF values and ACLF grades were compared with the outcomes. RESULTS: The ACLF survival of patients (n=25) post-LT at 90 days, 1, 3, 5 and 7 years, was 80, 76, 59.5, 54.1 and 54.1% versus 86.3, 79.4, 72.6, 66.5 and 61.2% for patients undergoing LT for other indications (n=344), (p=0.525). There was no statistical difference for mortality at 01 year and 90 days among patients with the three ACLF grades (ACLF-1 vs. ACLF-2 vs. ACLF-3) undergoing LT, as well as when compared to non-ACLF patients. CLIF-C ACLF score was not related to death outcomes. None of the other studied variables proved to be independent predictors of mortality at 90 days, 1 year, or overall. CONCLUSIONS: LT conferred long-term survival to most transplant patients. None of the studied variables proved to be a prognostic factor associated with post-LT survival outcomes for patients with ACLF. Additional studies are recommended to clarify the prognostic factors of post-LT survival in patients with ACLF.

PURPOSE:Locoregional therapies (LRT) are employed for bridging patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT). Although the main LRT options include transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) is an alternative with considerably lower costs. This study is a pioneering evaluation of the natural history of PEI bridging to OLT as compared to TACE.METHODS:All consecutive cirrhotic patients with HCC enlisted for OLT (2011-2020) at a single center were analyzed. Patients were divided into three LRT modality groups: PEI, TACE, and PEI+TACE. The primary study outcome was waitlist dropout due to tumor progression beyond Milan criteria. A comparison of post-transplant outcomes of patients as stratified by LRT modality also was performed.RESULTS:One hundred twenty-nine patients were included (PEI=56, TACE=43, PEI+TACE=30). The dropout rate due to tumor progression was not different among the three groups: PEI=8.9%, TACE=14%, PEI+TACE=16.7% (p=0.54). Thirteen (76.4%) patients underwent OLT after successful downstaging (3 [75%] in the PEI group, 5 [83.3%] in the TACE group, and 5 [71.4%] in the PEI+TACE group). For the 96 patients undergoing OLT, 5-year post-transplant recurrence-free survival was PEI=55.6% vs. TACE=55.1% vs. PEI+TACE=71.4% (p=0.42). Complete/near-complete pathological response rate was similar among groups (p=0.82).CONCLUSION:Dropout rates and post-transplant recurrence-free survivals related to PEI were comparable to those of TACE. This study supports the use of PEI alone or in combination with TACE for HCC patients awaiting OLT whenever RFA is not an option.

Abstract Purpose Although liver transplantation (LT) outcomes have improved significantly over the last decades, early post-transplant vascular complications are still associated with an elevated risk of graft failure. Doppler ultrasound (DUS) enables detection of vascular complications and provides hepatic artery Resistive Index (RI). The aim of our study was to evaluate the association of the RI parameters of DUS performed in the first post-transplant week with post-transplant outcomes. Methods All consecutive patients undergoing a first LT between 2001 and 2019 at a single center were included. P were divided into three groups: RI < 0.55, RI 0.55–0.85 and RI > 0.85. Patients were also divided according to the presence or absence of hepatic artery thrombosis (HAT). Graft survival was compared among groups. Results Three hundred and forty-four patients were included. HAT occurred in 23 patients (6.7%), of which 7 were partial and 16 were complete. Biliary complications were more common in patients with HAT (11 [47.8%]) vs. 44 [13.4%] [p < 0.001]). There was no statistically significant difference in graft survival between patients with and without HAT. Patients with RI < 0.55 on post-operative day 1 had worse graft survival compared to patients with RI 0.55–0.85 and RI > 0.85. RI on post-operative day 3 and 5 was not predictive of graft survival. Conclusions The use of DUS on liver transplant recipients in the early post-transplant period offers the possibility of early diagnosis of vascular complications. Additionally, according to our data, low RI (< 0.55) on the first postoperative day also provides prognostic information regarding graft-survival.

PURPOSE:Although liver transplantation (LT) outcomes have improved significantly over the last decades, early vascular complications are still associated with elevated risks of graft failure. Doppler ultrasound (DUS) enables detection of vascular complications, provides hepatic artery Resistive Index (RI). The aim of our study was to evaluate the association of the RI parameters of DUS performed in the first post-transplant week with post-transplant outcomes. METHODS:All consecutive patients undergoing a first LT between 2001 and 2019 at a single center were included. Patients were divided into two groups: RI < 0.55 and RI ≥ 0.55. Patients were also divided according to the presence or absence of hepatic artery thrombosis (HAT). Graft survival was compared between groups. RESULTS:Overall, 338 patients were included. HAT occurred in 23 patients (6.8%), of which 7 were partial and 16, complete. Biliary complications were more common in patients with HAT (10 [43.5%]) vs. 38 [12.1%] [p < 0.001]). Graft survival was lower for patients with HAT (p = 0.047). Also, RI < 0.55 was associated with increased incidence of HAT (p < 0.001). Additionally, patients with RI < 0.55 on post-operative day 1 had decreased graft survival as compared to patients with RI > 0.55 (p = 0.041). RI on post-operative day 3 and 5 was not predictive of inferior graft outcomes. CONCLUSIONS:Intensive use of DUS in the early post-LT period offers the possibility of early diagnosis of vascular complications, guiding medical and surgical management of HAT. Additionally, according to our data, low RI (< 0.55) on the first postoperative day also is a predictor of HAT and decreased graft-survival.

ABSTRACT BACKGROUND: Liver transplantation is a complex and valuable therapy. However, complications that burden postoperative quality of life, such as incisional hernia, are to be better elucidated, such as risk factors and prophylactic measures. AIM: This study aimed to define the rate of incisional hernia in patients who underwent liver transplantation in a population in southern Brazil and to assess the related risk factors in order to establish measures for prior optimization and specific prophylactic care in the future. METHODS: Patients undergoing adult Liver transplantation from January 2004 to November 2020 were retrospectively analyzed, assessing demographic features, surgical outcomes, and predisposing factors. RESULTS: Among 261 liver transplantation patients included, incisional hernia was diagnosed in 71 (27.2%). Of the 71 incisional hernia patients, 28 (39.4%) developed IH during the first post-transplant. Majority of the patients were male (52/71, 73.2%); of the 71 patients, 52 had hepatitis C virus (HCV) and 33 (46.5%) had hepatocellular carcinoma (HCC). Male gender (p=0.044), diabetes mellitus (p=0.008), and acute cellular rejection (p<0.001) were risk factors for IH. In all, 28 (39.4%) patients were submitted for hernia repair with mesh, with a recurrence rate of 17.8%. CONCLUSION: Incisional hernia after liver transplantation is a relatively common problem associated with male gender, diabetes, and acute cellular rejection. This is a problem that should not be trivialized in view of the complexity of liver transplantation, as it can lead to a reduction in quality of life as well as jeopardize late liver transplantation results and lead to incarceration and strangulation.

Abstract:Introduction: Patients with acute-on-chronic liver failure(ACLF) have different characteristics from those presented by non-ACLF patients with liver diseases. The degree of ACLF impacts the outcome with or without transplantation, with divergences in the literature, especially regarding post-transplant prognosis. Objectives: To review the different aspects of patients with ACLF, including the concepts of the syndrome adopted by various institutions, the treatment of complications, and to describe the knowledge about the outcomes with or without transplantation of patients with the syndrome reported in the literature. Methods: Twenty-two articles were included in the PubMed, MEDLINE and the Scientific Electronic Library Online (SciELO) databases with the descriptors “ACLF definitions” and “Liver transplantation ACLF.” The concepts and data from the selected texts were compared and used as a basis for writing this article. Results: There are some differences in the definition of the syndrome, varying especially between Western and Eastern countries. ACLF patients awaiting liver transplantation have characteristics distinct from those presented by non-ACLF patients. The degree of ACLF also impacts the outcome with or without transplantation, with divergences in the literature especially regarding the post-transplant prognosis of ACLF-3 patients, with an increasing trend in the indication of transplantation even for these patients. Conclusions: Outcomes vary among ACLF patients according to the degree of the disease. Liver transplantation has been more frequently indicated in ACLF-3, with waiting time impacting outcomes. Further studies are needed to define which subgroups of patients benefit most from liver transplantation.

Introdução: Pacientes em acute on chronic liver failure (ACLF) apresentam características distintas daquelas apresentadas por pacientes hepatopatas não ACLF. O grau de ACLF impacta no desfecho com ou sem o transplante, havendo divergências na literatura principalmente no que tange ao prognóstico pós-transplante. Objetivos: Revisar os diferentes aspectos dos pacientes em ACLF, abrangendo os conceitos da síndrome adotados por diversas instituições, o tratamento das complicações, e descrever o conhecimento acerca dos desfechos com ou sem transplante dos portadores da síndrome reportados na literatura. Métodos: Foram incluídos 22 artigos encontrados na busca de bases de dados PubMed, Medline e Biblioteca Eletrônica Científica Online (SciELO) com os descritores “ACLF definitions” e “Liver transplantation ACLF”. Os conceitos e dados apontados nos textos selecionados foram comparados e utilizados como base para redigir este artigo. Resultados: Existem algumas diferenças na definição da síndrome, variando especialmente entre os países do Ocidente e os do Oriente. Pacientes aguardando transplante hepático em ACLF apresentam características distintas daquelas apresentadas por pacientes não ACLF. O grau de ACLF também impacta no desfecho com ou sem o transplante, havendo divergências na literatura principalmente no que tange ao prognóstico pós-transplante dos pacientes em ACLF 3, com tendência cada vez maior na indicação do transplante mesmo para esses pacientes. Conclusões: Os desfechos variam entre pacientes em ACLF de acordo com o grau da doença. O transplante hepático tem sido mais frequentemente indicado em ACLF 3, tendo o tempo de espera impactado os resultados. São necessários mais estudos para definir quais subgrupos de pacientes se beneficiam mais do transplante hepático.