Kinghicks8958

PURPOSE OF REVIEW Alcoholic liver disease continues to be a major public health concern in the United States and around the world. Alcoholic liver disease remains the third most common indication for liver transplantation in the United States. Mortality has been reported in up to 30-50% of patients with severe alcoholic hepatitis. Liver transplantation can be lifesaving for patients with alcoholic hepatitis. Liver transplantation for alcoholic liver disease was traditionally only considered in patients who have achieved 6 months of abstinence. The majority of patients with severe alcoholic hepatitis who fail medical therapy will not live long enough to meet this requirement. The purpose of this review is to provide an update from the most recent peer reviewed articles regarding early liver transplantation of alcoholic hepatitis. RECENT FINDINGS This review shows that liver transplantation offers the best survival benefit to patients with alcoholic hepatitis. Selection criteria is a key component for a successful transplant. No change in 1-year graft survival between patients who have 6 months sobriety vs. those transplanted prior to 6 months abstinence. Liver transplantation is limited by very narrow selection criteria and limited long-term data. SUMMARY Liver transplantation offers the best survival benefit to patients with alcoholic hepatitis. Selection criteria of patients has evolved and have become more permissive and the period of sobriety has become less important in the evaluation of process. However, long-term outcomes continue to lack in the literature. On the basis of previous studies, patients with longer pretransplant abstinence, disease process insight, older age at the time of transplant, the presence of social support that lives with the patient in the same dwelling place were noted to have lower rates of return to alcohol use after liver transplantation.PURPOSE OF REVIEW Despite major therapeutic improvements in most cancer entities, hepatocellular carcinoma (HCC) has remained a dismal disease. In fact, incidence and mortality are increasing in many parts of the world, including the United States. Given that a number of systemic agents has recently been tested positive in phase 3 clinical trials, the objective of this review is to summarize the current treatment landscape for advanced HCC. RECENT FINDINGS Following the positive SHARP trial in 2008, sorafenib has been the only systemic agent for advanced HCC for almost a decade. However, in first line, lenvatinib was tested noninferior to sorafenib, and most recently, the combination of atezolizumab with bevacizumab was tested superior to sorafenib. In second line, regorafenib, cabozantinib, and ramucirumab (the latter for patients with AFP ≥400 ng/ml) have shown prolonged overall survival compared with placebo. SUMMARY Systemic treatment options for advanced HCC have substantially increased over the past years. see more The combination of atezolizumab and bevacizumab will likely become the new standard of care as it is the first treatment to report improved overall survival compared with sorafenib and the first, and so far only, positive phase 3 clinical trial for an immune-checkpoint inhibitor-containing regimen in advanced HCC.BACKGROUND Most transplantation centers recognize a small patient population that unsuccessfully participates in all available, both living and deceased donor, transplantation programs for many years the difficult-to-match patients. This population consists of highly immunized and/or AB0 bloodgroup 0 or B patients. METHODS To improve their chances, CIAT (Computerized Integration of Alternative Transplantation programs) was developed to integrate kidney paired donation, altruistic/unspecified donation and AB0 and HLA-desensitization. To compare CIAT with reality, a simulation was carried out, including all patients, donors and pairs that participated in our programs in 2015-2016. Criteria for inclusion as difficult-to-match, selected-Highly immunized patient (sHI) were vPRA>85% and participating for 2 years in Eurotransplant Acceptable-mismatch program. sHI-patients were given priority and AB0i- and/or HLAi-matching with DSA-MFI less then 8000 were allowed. For long-waiting bloodgroup 0 or B patients AB0i matches were allowed. RESULTS In reality, 90 alternative program transplantations were carried out 73 compatible, 16 AB0i and 1 both AB0i-and-HLAi combination. Simulation with CIAT, resulted in 95 hypothetical transplantations 83 compatible (including 1 sHI) and 5 AB0i combinations. Eight sHI patients were matched 1 compatible, 6 HLAi with DSA-MFI less then 8000(1 also AB0i), and 1 AB0i match. Six/eight combinations for sHI-patients were CDC-XM negative. CONCLUSIONS CIAT led to 8 times more matches for difficult-to-match sHI-patients. This offers them better chances because of a more favorable MFI profile against the new donor. Besides, more AB0 compatible matches were found for AB0i couples, while total number of transplantations was not hampered. Prioritizing difficult-to-match patients improves their chances without affecting the chances of regular patients.BACKGROUND Angiotensin II type-1 receptor (AT1R) antibodies have been associated with rejection and allograft loss in solid organ transplantation and may act synergistically with HLA donor-specific antibodies (DSA). Our aims were to assess the prevalence of AT1R antibodies and determine if they were associated with allograft dysfunction in pediatric liver transplant recipients. METHODS We performed a retrospective, cross-sectional study of HLA DSA and AT1R antibodies in 2 cohorts of pediatric liver transplant recipients a stable control cohort with normal allograft function (n=70) who consented to have serum samples collected for research purposes during a routine clinic visit and a cohort with active allograft dysfunction (n=9) whose serum samples were collected as part of clinical care. RESULTS AT1R antibodies >17 U/mL were detected in 29% of stable control patients and 89% of patients with active allograft dysfunction (p=0.001). In stable control patients, AT1R antibodies were associated with younger age at transplant (p=0.