Improved Survival in Liver Transplant Patients Receiving Prolonged-Release Tacrolimus (Advagraf): The European Liver Transplant Registry (ELTR)

WOS:000368626500642International audience21st Annual International Congress of the International-Liver-Transplant-Society (ILTS) - Chicago, IL 201

3-month and 12-month mortality after first liver transplant in adults in Europe: predictive models for outcome

Background Mortality after liver transplantation depends on heterogeneous recipient and donor factors. Our aim was to assess risk of death and to develop models to help predict mortality after liver transplantation. Methods We analysed data from 34 664 first adult liver transplants from the European Liver Transplant Registry to identify factors associated with mortality at 3-months (n=21 605 in training dataset) and 12-months (n=18 852 in training dataset) after transplantation. We used multivariable logistic regression models to generate mortality scores for each individual, and assessed model discrimination and calibration on an independent validation dataset (n=9489 for 3-month model and n=8313 for 12-month model). Findings 2540 of 21 605 (12%) individuals in the 3-month training sample had died by 3 months. Compared with those transplanted in 2000-03, those transplanted earlier had a higher risk of death. increased mortality at 3-months post- transplantation was associated with acute liver failure (adjusted odds ratio 1.61), donor age older than 60 years (1.16), compatible (1.22) or incompatible (2.07) donor-recipient blood group, older recipient age (1.12 per 5 years), split or reduced graft (1.96), total ischaemia time of longer than 13 h (1.38), and low United Network for Organ Sharing score (score 1: 2.43; score 2: 1.67). However, cirrhosis with hepatocellular carcinoma, alcohol cirrhosis, hepatitis C or primary biliary cirrhosis, donor age 40 years or younger, or less, hepatitis B, and larger size of transplant Centre (>= 70 transplants per year) were associated with improved early outcomes. The 3-month mortality score discriminated well between those who did and did not die in the validation sample (C statistic=0.688). We noted similar findings for 12-month mortality, although deaths were generally underestimated at this timepoint. Interpretation The 3-month and 12-month mortality models can be effectively used to assess outcomes both within and between centres. Furthermore, the models provide a means of assessing the risk of post-transplantation mortality, giving clinicians important data on which to base strategic decisions about transplant policy in particular individuals or groups

Fusion Energy-Production from a Deuterium-Tritium Plasma in the Jet Tokamak

The paper describes a series of experiments in the Joint European Torus (JET), culminating in the first tokamak discharges in deuterium-tritium fuelled mixtures. The experiments were undertaken within limits imposed by restrictions on vessel activation and tritium usage. The objectives were: (i) to produce more than one megawatt of fusion power in a controlled way; (ii) to validate transport codes and provide a basis for accurately predicting the performance of deuterium-tritium plasma from measurements made in deuterium plasmas; (iii) to determine tritium retention in the torus systems and to establish the effectiveness of discharge cleaning techniques for tritium removal; (iv) to demonstrate the technology related to tritium usage; and (v) to establish safe procedures for handling tritium in compliance with the regulatory requirements. A single-null X-point magnetic configuration, diverted onto the upper carbon target, with reversed toroidal magnetic field was chosen. Deuterium plasmas were heated by high power, long duration deuterium neutral beams from fourteen sources and fuelled also by up to two neutral beam sources injecting tritium. The results from three of these high performance hot ion H-mode discharges are described: a high performance pure deuterium discharge; a deuterium-tritium discharge with a 1% mixture of tritium fed to one neutral beam source; and a deuterium-tritium discharge with 100% tritium fed to two neutral beam sources. The TRANSP code was used to check the internal consistency of the measured data and to determine the origin of the measured neutron fluxes. In the best deuterium-tritium discharge, the tritium concentration was about 11% at the time of peak performance, when the total neutron emission rate was 6.0 x 10(17) neutrons/s. The integrated total neutron yield over the high power phase, which lasted about 2 s, was 7.2 x 10(17) neutrons, with an accuracy of +/- 7%. The actual fusion amplification factor, Q(DT), was about 0.15. With an optimum tritium concentration, this pulse would have produced a fusion power of almost-equal-to 5 MW and a nominal Q(DT) almost-equal-to 0.46. The same extrapolation for the pure deuterium discharge would have given almost-equal-to 11 MW and a nominal Q(DT) = 1.14, so that the total fusion power (neutrons and alpha-particles) would have exceeded the total losses in the equivalent deuterium-tritium discharge in these transient conditions. Techniques for introducing, tracking, monitoring and recovering tritium were demonstrated to be highly effective: essentially all of the tritium introduced into the neutral beam system and, so far, about two thirds of that introduced into the torus have been recovered