Randomized Trial of Ciclosporin with 2-h Monitoring vs. Tacrolimus with Trough Monitoring in Liver Transplantation:DELTA Study

Background and Aims: Previous trials comparing cyclosporine and tacrolimus after liver transplantation (LT) showed conflicting results. Most used trough monitoring for cyclosporine (C0), leading to less accurate dosing than with 2-h monitoring (C2). Only one larger trial compared C2 with tacrolimus based on trough level (T0) after LT, with similar treated biopsy-proven acute rejection (tBPAR) and graft loss, while a smaller trial had less tBPAR with C2 compared to T0. Therefore, it is still unclear which calcineurin inhibitor is preferred after LT. We aimed to demonstrate superior efficacy (tBPAR), tolerability, and safety of C2 or T0 after first LT. Methods: Patients after first LT were randomized to C2 or T0. tBPAR, patient-and graft survival, safety and tolerability were the main endpoints, with analysis by Fisher test, Kaplan–Meier survival analysis and log-rank test. Results: In intention-to treat analysis 84 patients on C2 and 85 on T0 were included. Cumulative incidence of tBPAR C2 vs. T0 was 17.7% vs. 8.4% at 3 months (p=0.104), and 21.9% vs. 9.7% at 6 and 12 months (p=0.049). One-year cumulative mortality C2 vs. T0 was 15.5% vs. 5.9% (p=0.049) and graft loss 23.8% vs. 9.4% (p=0.015). Serum triglyceride and LDL-cholesterol was lower with T0 than with C2. Incidence of diarrhea in T0 vs, C2 was 64% vs. 31% (p≤0.001), with no other differences in safety and tolerability. Conclusions: In the first year after LT immunosuppression with T0 leads to less tBPAR and better patient-/re-transplant-free survival as compared to C2.</p

In Situ Study on Ni-Mo Stability in a Water-Splitting Device: Effect of Catalyst Substrate and Electric Potential

Nickel-molybdenum (Ni-Mo) alloys are well studied as highly effective electrocatalyst cathodes for water splitting. Understanding deactivation pathways is a key to improving the performance of these catalysts. In this study, in situ characterization by UV/Vis spectroscopy and AFM of the morphology and Mo leaching of an Ni-Mo electrocatalyst was performed with the goal of understanding the stability and related Mo leaching mechanism. Switching the potential towards higher overpotentials results in a nonlinear change in Mo leaching. Multiple processes are proposed to take place, such as a decrease in the extent of Mo oxidation at the cathode induced by more strongly reducing potentials, while simultaneously the increase in the local pH at the cathode due to the hydrogen evolution reaction causes more Mo leaching. The change in capacitance of these materials depends strongly on the change in surface composition and not only on the surface area. In situ UV/Vis spectroscopy showed that Mo leaching is a continuous process over the course of 4 h of operation. Finally, the material was deposited on different substrates and the effect on Ni-Mo stability was studied. The substrate has a significant, albeit complex, influence on the stability and activity of Ni-Mo cathodes. In terms of stability in 1 m KOH, Ni-Mo was found to be best deposited on stainless steel substrates operated at low overpotentials, on which it showed nearly no change in capacitance and exhibited low Mo leaching

In Situ Study on Ni–Mo Stability in a Water‐Splitting Device: Effect of Catalyst Substrate and Electric Potential

Nickel-molybdenum (Ni-Mo) alloys are well studied as highly effective electrocatalyst cathodes for water splitting. Understanding deactivation pathways is a key to improving the performance of these catalysts. In this study, in situ characterization by UV/Vis spectroscopy and AFM of the morphology and Mo leaching of an Ni-Mo electrocatalyst was performed with the goal of understanding the stability and related Mo leaching mechanism. Switching the potential towards higher overpotentials results in a nonlinear change in Mo leaching. Multiple processes are proposed to take place, such as a decrease in the extent of Mo oxidation at the cathode induced by more strongly reducing potentials, while simultaneously the increase in the local pH at the cathode due to the hydrogen evolution reaction causes more Mo leaching. The change in capacitance of these materials depends strongly on the change in surface composition and not only on the surface area. In situ UV/Vis spectroscopy showed that Mo leaching is a continuous process over the course of 4 h of operation. Finally, the material was deposited on different substrates and the effect on Ni-Mo stability was studied. The substrate has a significant, albeit complex, influence on the stability and activity of Ni-Mo cathodes. In terms of stability in 1 m KOH, Ni-Mo was found to be best deposited on stainless steel substrates operated at low overpotentials, on which it showed nearly no change in capacitance and exhibited low Mo leaching

In Situ Study on Ni-Mo Stability in a Water-Splitting Device: Effect of Catalyst Substrate and Electric Potential

Nickel-molybdenum (Ni-Mo) alloys are well studied as highly effective electrocatalyst cathodes for water splitting. Understanding deactivation pathways is a key to improving the performance of these catalysts. In this study, in situ characterization by UV/Vis spectroscopy and AFM of the morphology and Mo leaching of an Ni-Mo electrocatalyst was performed with the goal of understanding the stability and related Mo leaching mechanism. Switching the potential towards higher overpotentials results in a nonlinear change in Mo leaching. Multiple processes are proposed to take place, such as a decrease in the extent of Mo oxidation at the cathode induced by more strongly reducing potentials, while simultaneously the increase in the local pH at the cathode due to the hydrogen evolution reaction causes more Mo leaching. The change in capacitance of these materials depends strongly on the change in surface composition and not only on the surface area. In situ UV/Vis spectroscopy showed that Mo leaching is a continuous process over the course of 4 h of operation. Finally, the material was deposited on different substrates and the effect on Ni-Mo stability was studied. The substrate has a significant, albeit complex, influence on the stability and activity of Ni-Mo cathodes. In terms of stability in 1 m KOH, Ni-Mo was found to be best deposited on stainless steel substrates operated at low overpotentials, on which it showed nearly no change in capacitance and exhibited low Mo leaching

High peak alanine aminotransferase determines extra risk for nonanastomotic biliary strictures after liver transplantation with donation after circulatory death

Orthotopic liver transplantation (OLT) with donation after circulatory death (DCD) often leads to a higher first week peak alanine aminotransferase (ALT) and a higher rate of biliary nonanastomotic strictures (NAS) as compared to donation after brain death (DBD). This retrospective study was to evaluate whether an association exists between peak ALT and the development of NAS in OLT with livers from DBD (n=399) or DCD (n=97) from two transplantation centers. Optimal cutoff value of peak ALT for risk of development of NAS post-DCD-OLT was 1300IU/l. The 4-year cumulative incidence of NAS after DCD-OLT was 49.5% in patients with a high ALT peak post-OLT, compared with 11.3% in patients with a low ALT peak. (

Epstein-Barr Viral Load Monitoring Strategy and the Risk for Posttransplant Lymphoproliferative Disease in Adult Liver Transplantation A Cohort Study

Background: Primary infection with or reactivation of Epstein-Barr virus (EBV) can occur after liver transplant (LT) and can lead to posttransplant lymphoproliferative disease (PTLD). In pediatric LT, an EBV-DNA viral load (EBV VL) monitoring strategy, including the reduction of immunosuppression, has led to a lower incidence of PTLD. For adult LT recipients with less primary infection and more EBV reactivation, it is unknown whether this strategy is effective. Objective: To examine the effect of an EBV VL monitoring strategy on the incidence of PTLD after LT in adults. Design: Cohort study. Setting: Two university medical centers in the Netherlands. Patients: Adult recipients of first LT in Leiden between September 2003 and January 2017 with an EBV VL monitoring strategy formed the monitoring group (M1), recipients of first LT in Rotterdam between January 2003 and January 2017 without such a strategy formed the contemporary control group (C1), and those who had transplants in Leiden between September 1992 and September 2003 or Rotterdam between 1986 and January 2003 formed the historical control groups (M0 and C0, respectively). Measurements: Influence of EBV VL monitoring on incidence of PTLD. Results: After inverse probability of treatment weighting of the 4 groups to achieve a balance among the groups for important patient characteristics, differences within hospitals between the historical and recent era in cumulative incidences-expressed as the number of events per 1000 patients measured at 5-, 10-, and 15-year follow-up-showed fewer events in the contemporary era in both centers. This difference was considerably larger in the monitoring center, whereas the 95% CI included the null value of 0 for point estimates. Limitation: Retrospective, low statistical power, and incompletely balanced groups, and non-EBV PTLD cannot be prevented. Conclusion: Monitoring EBV VL may reduce PTLD incidence after LT in adults; larger studies are warranted

Characteristics associated with outcome after liver transplantation and validation of the donor risk index in Eurotransplant

Development and application of statistical models for medical scientific researc

Current policy for allocation of donor livers in the Netherlands advantages primary sclerosing cholangitis patients on the liver transplantation waiting list-a retrospective study

Studies from the USA and Nordic countries indicate primary sclerosing cholangitis (PSC) patients have low mortality on the liver transplantation (LTx) waiting list. However, this may vary among geographical areas. Therefore, we compared waiting list mortality and post-transplant survival between laboratory model for end-stage liver disease (LM) and MELD exception (ME)-prioritized PSC and non-PSC candidates in a nationwide study in the Netherlands. A retrospective analysis of patients waitlisted from 2006 to 2013 was conducted. A total of 852 candidates (146 PSC) were waitlisted of whom 609 (71.5%) underwent LTx and 159 (18.7%) died before transplantation. None of the ME PSC patients died, and they had a higher probability of LTx than LM PSC [HR obtained by considering ME as a time-dependent covariate (HRME 9.86; 95% CI 6.14-15.85)] and ME non-PSC patients (HRME 4.60; 95% CI 3.78-5.61). After liver transplantation, PSC patients alive at 3 years of follow-uyp had a higher probability of relisting than non-PSC patients (HR 7.94; 95% CI 1.98-31.85) but a significantly lower mortality (HR 0.51; 95% CI 0.27-0.95). In conclusion, current LTx prioritization advantages PSC patients on the LTx waiting list. Receiving ME points is strongly associated with timel LTx