Renal function after liver transplantation : Real-world experience with basiliximab induction and delayed reduced-dose tacrolimus

Background: Routine use of delayed reduced-dose calcineurin-inhibitor treatment with induction immunosuppression in liver transplantation to minimize post-operative kidney injury is still scarce. im: To evaluate real-world experience of basiliximab induction with delayed reduced-dose tacrolimus. Methods: In a retrospective cohort study, kidney function was evaluated pre-and postoperatively by mea-sured glomerular filtration rate (mGFR). Adult patients undergoing liver transplantation between 20 0 0 and 2017 were divided into a conventional treatment group (immediate-introduction of tacrolimus, tar-get trough levels 10-15 ng/mL, and corticosteroids, n = 203) and a revised treatment group (basiliximab induction, reduced-dose tacrolimus, target through levels 5-8 ng/mL, delayed until day three, and my-cophenolate mofetil 20 0 0 mg/day, n = 343). Results: Mean mGFR was similar between groups at wait-listing (85.3 vs 84.1 ml/min/1.73m2, p = 0.60), but higher in the revised treatment group at 3 (56.8 vs 63.4 ml/min/1.73m2, p = 0.004) and 12 months post-transplant (60.9 vs 69.7 ml/min/1.73m2, p < 0.001); this difference remained after correcting for mul-tiple confounders and was independent of pre-transplant mGFR. In the revised treatment group, biopsy proven acute rejection rate was lower (38% vs. 21%, p < 0.001), and graft-survival better ( p = 0.01). Conclusion: Basiliximab induction with delayed reduced-dose tacrolimus is associated with less kidney injury when compared to standard-dose tacrolimus, without increased risk of rejection, graft loss or death. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.Peer reviewe

Risk and Protective Factors for the Occurrence of Sporadic Pancreatic Endocrine Neoplasms

Pancreatic neuroendocrine neoplasms (PNENs) represent 10% of all pancreatic tumors by prevalence. Their incidence has reportedly increased over recent decades in parallel with that of pancreatic adenocarcinoma. PNENs are relatively rare, and of the few institutions that have published potential risk factors, findings have been heterogeneous. Our objective was to investigate the association between potential risk and protective factors for the occurrence of sporadic PNENs across a European population from several institutions. A multinational European case-control study was conducted to examine the association of selected environmental, family and medical exposure factors using a standardized questionnaire in face-to-face interviews. A ratio of 1:3 cases to controls were sex and age matched at each study site. Adjusted univariate and multivariate logistic regression analysis were performed for statistically significant factors. The following results were obtained: In 201 cases and 603 controls, non-recent onset diabetes (OR 2.09, CI 1.27-3.46) was associated with an increased occurrence of PNENs. The prevalence of non-recent onset diabetes was higher both in cases with metastatic disease (TNM stage III-IV) or advanced grade (G3) at the time of diagnosis. The use of metformin in combination with insulin was also associated with a more aggressive phenotype. Drinking coffee was more frequent in cases with localized disease at diagnosis. Our study concluded that non-recent onset diabetes was associated with an increased occurrence of PNENs and the combination of metformin and insulin was consistent with a more aggressive PNEN phenotype. In contrast to previous studies, smoking, alcohol and first-degree family history of cancer were not associated with PNEN occurrence

PR3-ANCA:a promising biomarker in primary sclerosing cholangitis (PSC)

BACKGROUND AND AIMS:The only recognized biomarker for primary sclerosing cholangitis (PSC) is atypical anti-neutrophil cytoplasmic antibodies (aANCA), which, in addition to having low sensitivity and specificity, is an indirect immunofluorescence (IIF) test lacking the advantages of high throughput and objectivity. Recent reports have shown that antibodies to proteinase-3 (PR3-ANCA) might add diagnostic value in inflammatory bowel disease (IBD), specifically in ulcerative colitis (UC). As PSC is associated with IBD, the objective of this study was to evaluate the frequency and clinical significance of PR3-ANCA in a large cohort of patients. METHODS:A total of 244 PSC and 254 control [autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), hepatitis C viral infection (HCV), hepatitis B viral infection (HBV), and healthy controls] sera and their clinical correlations were retrospectively analyzed for PR3-ANCA determined by ELISA and a new chemiluminescence immunoassay (CIA). Testing was also performed for aANCA by IIF. RESULTS:When measured by CIA, PR3-ANCA was detected in 38.5% (94/244) of PSC patients compared to 10.6% (27/254) controls (p<0.0001). By ELISA, PR3-ANCA was detected in 23.4% (57/244) of PSC patients compared to 2.7% (6/254) controls (p<0.0001). PR3-ANCA in PSC patients was not associated with the presence or type of underlying IBD, and, in fact, it was more frequent in Crohn's disease (CD) patients with PSC than previously reported in CD alone. PR3-ANCA in PSC measured by CIA correlated with higher liver enzymes. CONCLUSION:PR3-ANCA is detected in a significant proportion of PSC patients compared to other liver diseases including PBC and AIH. PR3-ANCA is associated with higher liver enzyme levels in PSC, and is not solely related to underlying IBD

Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery

To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery

GAPS-EUS: a new and reliable tool for the assessment of basic skills and performance in EUS among endosonography trainees

Objective Endosonography (EUS) is a useful but complex diagnostic modality which requires advanced endoscopy training and guidance by a supervisor. Since learning curves vary among individuals, assessment of the actual competence among EUS trainees is important.Design/methods We designed a novel assessment tool entitled Global Assessment of Performance and Skills in EUS (GAPS-EUS) for assessing skills among EUS trainees. Five quality indicators were marked on a five-grade scale by the supervisor (Observer Score) and by the trainee (Trainee Score). Trainees were included in two high-volume centres (Gothenburg, Sweden, and Bologna, Italy). Outcomes were feasibility, patient safety, reliability, and validity of GAPS-EUS in trainee-performed EUS procedures.Results Twenty-two EUS-trainees were assessed in a total of 157 EUS procedures with a completion rate of 157/157 (100 %) and a patient adverse event rate of 2/157 (1.3 %; gastroenteritis n=1, fever n=1). GAPS-EUS showed a high measurement reliability (Cronbach’s alpha coefficient=0.87) and a high inter-rater reliability comparing the supervisor and the trainee (r=0.83, r2=0.69, p&lt;0.001). The construct of GAPS-EUS was verified by comparing low-level and high-level performance procedures and the content validity by recording that the EUS-FNA manoeuvre resulted in a lower score than other aspects of EUS 3.07 (95% CI 2.91 to 3.23) vs 3.51 (95% CI 3.37 to 3.65) (p&lt;0.001). External validity was confirmed via similar findings in both centres.Conclusion GAPS-EUS is an easy-to-use and reliable tool with a recorded high validity for the assessment of competence among trainees in EUS. It can be recommended to centres involved in the education of future endosonographers.Trial registration number NCT02455570

Aspectos regionales de las pesquerías de Galicia y Noruega

Los sistemas pesqueros gallego y noruego se asemejan en al importancia de sus pesquerías de altura y en la utilización de grandes palangreros; se diferencian, en cuanto a los efectos de las pesquerías en sus distritos pesqueros, ya que el sistema pesquero global en Galicia y España propicia un modelo descentralizado de asentamientos pesqueros más eficaz que el sistema noruego. Ello se debe a que en Galicia existe una clara separación del sistema pesquero en dos sub-sistemas diferentes: uno centralizado, que opera a escala global, y un sistema de bajura con base local. En los distritos noruegos, por el contrario, el proceso de centralización conduce progresivamente a una concentración geográfica de las actividades pesqueras en las regiones más vitales así como a un aumento gradual de las pesquerías en las ciudades más importante

A prospective cohort study on risk of acute pancreatitis related to serum triglycerides, cholesterol and fasting glucose

Background/objectives: To investigate risk for acute pancreatitis related to moderately elevated triglycerides, cholesterol and fasting glucose. Methods: This was a prospective cohort study in Malmo, Sweden of 33 346 subjects investigated 1974 - 1992 and followed until December 31, 2006. Baseline investigation included a self-administered questionnaire and analysis of serum triglycerides, cholesterol and fasting glucose. Cases of acute pancreatitis (n = 277, median time since baseline investigation 15.6 years) were identified in diagnosis registries and validated retrospectively. Attacks were classified as obstructive or non obstructive (alcohol or non alcohol related). Cox proportional hazards analysis was used to calculate hazard ratios (HR) for acute pancreatitis related to relevant risk factors, adjusting for age, sex, smoking habits and alcohol consumption. Results: Triglycerides were associated with overall, non obstructive and non obstructive non alcohol related acute pancreatitis with adjusted HRs of 1.21 (95% confidence interval (CI), 1.07-1.36), 1.23 (95% CI, 1.06-2.43) and 1.34 (95% Cl, 1.11-1.62) per 1 mmol/l increment, respectively. Corresponding HRs for forth versus first quartile of triglycerides were 1.55 (95% Cl, 1.09-2.21), 1.60 (95% Cl, 1.60-1.01-1.35) and 2.07 (95% Cl, 1.13-3.79). Triglycerides were not associated with obstructive acute pancreatitis and there were no associations between glucose or cholesterol and the risk of acute pancreatitis. Conclusions: We found an association between prediagnostic levels of triglycerides and risk for acute pancreatitis. This association was most pronounced in the non obstructive non alcohol related group. Our findings suggest that triglycerides may be a more important risk factor for acute pancreatitis than what has previously been estimated. Copyright (c) 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved

Incidence and Prevalence of Primary Sclerosing Cholangitis in a Defined Adult Population in Sweden

Population-based studies on the epidemiology of primary sclerosing cholangitis (PSC) are sparse. The aim of the present study was to investigate prevalence and temporal trends in the incidence of PSC 1992-2005 in an adult population in Vastra Gotaland, a region in southern Sweden with a defined population of about 1.5 million. Patients with PSC aged 18 years or above were identified through a computerized search for diagnostic codes. A total number of 199 incident cases fulfilling Mayo criteria for PSC were identified through retrospective validation of clinical records. Temporal trends in the incidence of PSC were investigated by Poisson regression and expressed as average annual percent change (AAPC) with a 95% confidence interval (CI). The point prevalence of PSC on December 31, 2005, was 16.2/100,000 in the total adult population (men, 23.7/100,000; women, 8.9/100,000). The annual incidence was 1.22/100,000 in the total adult population (men, 1.78/100,000; women, 0.69/100,000). The overall incidence rate of PSC increased significantly over the investigation period (AAPC 3.06, 95% CI 0.01-6.20). Stratified analysis revealed significantly increasing trends for inflammatory bowel disease (IBD) associated PSC (AAPC 7.01, 95% CI 0.24-14.24) and large duct PSC (AAPC 6.32, 95% CI 0.03-13.02) in women and for PSC without IBD (AAPC 9.69, 95% CI 0.82-19.33) and small duct PSC (AAPC 17.88, 95% CI 0.95-40.25) in men. Conclusion: This is the first study to report a significantly increasing trend in the incidence of PSC. The prevalence of PSC at the end of the study period is the highest reported to date. This implies that the medical burden of PSC may be higher than estimated previously. (HEPATOLOGY 2010;52:571-577