Use of statins after liver transplantation is associated with improved survival: results of a nationwide study

BACKGROUND There is limited information on the effects of statins on the outcomes of liver transplantation (LT), regarding either their use by LT recipients or donors. AIM To analyse the association between statin exposure and recipient and graft survival. METHODS We included adult LT recipients with deceased donors in a nationwide prospective database study. Using a multistate modelling approach, we examined the effect of statins on the transition hazard between LT, biliary and vascular complications and death, allowing for recurring events. The observation time was 3 years. RESULTS We included 998 (696 male, 70%, mean age 54.46 ± 11.14 years) LT recipients. 14% of donors and 19% of recipients were exposed to statins during the study period. During follow-up, 141 patients died; there were 40 re-LT and 363 complications, with 66 patients having two or more complications. Treatment with statins in the recipient was modelled as a concurrent covariate and associated with lower mortality after LT (HR = 0.35; 95% CI 0.12-0.98; p = 0.047), as well as a significant reduction of re-LT (p = 0.004). However, it was not associated with lower incidence of complications (HR = 1.25; 95% CI = 0.85-1.83; p = 0.266). Moreover, in patients developing complications, statin use was significantly associated with decreased mortality (HR = 0.10; 95% CI = 0.01-0.81; p = 0.030), and reduced recurrence of complications (HR = 0.43; 95% CI = 0.20-0.93; p = 0.032). CONCLUSIONS Statin use by LT recipients may confer a survival advantage. Statin administration should be encouraged in LT recipients when clinically indicated

Use of statins after liver transplantation is associated with improved survival: results of a nationwide study.

BACKGROUND There is limited information on the effects of statins on the outcomes of liver transplantation (LT), regarding either their use by LT recipients or donors. AIM To analyse the association between statin exposure and recipient and graft survival. METHODS We included adult LT recipients with deceased donors in a nationwide prospective database study. Using a multistate modelling approach, we examined the effect of statins on the transition hazard between LT, biliary and vascular complications and death, allowing for recurring events. The observation time was 3 years. RESULTS We included 998 (696 male, 70%, mean age 54.46 ± 11.14 years) LT recipients. 14% of donors and 19% of recipients were exposed to statins during the study period. During follow-up, 141 patients died; there were 40 re-LT and 363 complications, with 66 patients having two or more complications. Treatment with statins in the recipient was modelled as a concurrent covariate and associated with lower mortality after LT (HR = 0.35; 95% CI 0.12-0.98; p = 0.047), as well as a significant reduction of re-LT (p = 0.004). However, it was not associated with lower incidence of complications (HR = 1.25; 95% CI = 0.85-1.83; p = 0.266). Moreover, in patients developing complications, statin use was significantly associated with decreased mortality (HR = 0.10; 95% CI = 0.01-0.81; p = 0.030), and reduced recurrence of complications (HR = 0.43; 95% CI = 0.20-0.93; p = 0.032). CONCLUSIONS Statin use by LT recipients may confer a survival advantage. Statin administration should be encouraged in LT recipients when clinically indicated

Die Moral Foundations Theory im Kontext politischer Online-Diskussionsforen : eine Untersuchung zu Gruppendifferenzen und Stabilität intuitiver moralischer Grundwerte

Auf Grundlage der Moral Foundations Theory, der Sozialen Netzwerkforschung, der Forschung zu Gruppenpolarisierung und zur Stabilität kognitiver moralischer Werte im Erwachsenenalter wurde anhand eines Datensatzes von N = 21,939,071 Kommentaren aus zwei politisch rechten, einem neutralen und zwei politisch linken Unterforen der Social-Media Seite Reddit untersucht, inwiefern (1) sich die Mitglieder politisch links ausgerichteter Subreddits von Mitgliedern politisch rechts ausgerichteter Subreddits anhand ihrer sprachlich ausgedrückten moralischen Grundwerte unterscheiden und (2) wie langanhaltende aktive Mitgliedschaft in politisch orientierten Diskussionsforen diese durch die Sprache ausgedrückten moralischen Grundwerte der Mitglieder beeinflusst. Dabei wurden anhand der Sprachverwendung die beiden Faktoren Individualizing Foundation (auf das Wohlergehen von Individuen ausgerichtete moralische Wertvorstellungen) und Binding Foundation (auf das Wohlergehen der Gruppe ausgerichtete moralische Wertvorstellungen) erhoben. Es zeigten sich in beiden moralischen Ausrichtungen signifikante Unterschiede zwischen allen fünf untersuchten Unterforen, die sich entgegen der Hypothese 1 nicht auf die politische Orientierung des jeweiligen Subreddits zurückführen ließen. Über die Dauer der Mitgliedschaft hinweg stiegen die Werte für beide erhobenen Faktoren der Moral in allen Gruppen, außer der neutralen Vergleichsgruppe, kurvilinear an und polarisierten entgegen der Vorhersagen der Hypothese 2 nicht gegenüber der politischen Outgroup. Die ermittelten Unterschiede deuten auf einen einzelnen zugrundeliegenden Faktor moralischer Sprachverwendung hin, der systematisch aufgrund unterschiedlicher Diskussionskulturen und soziokultureller Gruppenmerkmale variiert und nicht vordergründig mit der politischen Ausrichtung der Unterforen in Verbindung steht.eingereicht von Jonas Schropp, B. Sc.Universität Innsbruck, Masterarbeit, 2019(VLID)338481

Inflammatory activity affects the accuracy of liver stiffness measurement by transient elastography but not by two-dimensional shear wave elastography in non-alcoholic fatty liver disease.

BACKGROUND In patients with non-alcoholic fatty liver disease (NAFLD), the impact of the severity of steatosis and inflammatory activity on the accuracy of liver stiffness measurement (LSM) by transient elastography (TE) and by two-dimensional shear wave elastography (2D-SWE) in staging liver fibrosis is still debated and scarce. We aimed to focus on this aspect. METHODS We prospectively studied 104 patients requiring biopsy for the assessment of NAFLD. We used ordinary least squares regression to test for differences in the association between fibrosis and LSM by TE and 2D-SWE when other factors (steatosis and inflammatory activity) are considered. RESULTS Among 104 patients, 102 had reliable LSM by TE, and 88 had valid LSM by 2D-SWE. The association between fibrosis based on histology and LSM was significantly stronger when 2D-SWE assessed LSM compared to TE (Spearman's correlation coefficient of .71; P < .001 vs .51, P < .001; Z = 2.21, P = .027). Inflammatory activity was an independent predictor of LSM by TE but not of LSM by 2D-SWE. After controlling for fibrosis, age, sex and body mass index, the inflammatory activity and the interaction between inflammatory activity and fibrosis independently explained 11% and 13% of variance in LSM by TE respectively. Steatosis did not affect the association of fibrosis and LSM by either method. CONCLUSION Inflammatory activity on histology significantly affects LSM by TE, but not LSM by 2D-SWE in NAFLD. LSM by 2D-SWE reflects liver fibrosis more accurately than LSM by TE. Furthermore, the severity of steatosis on histology did not influence the association of LSM and fibrosis by either elastography method

The MELD upgrade exception: a successful strategy to optimize access to liver transplantation for patients with high waiting list mortality.

BACKGROUND MELD exceptions are designed to equipoise liver transplant waiting list survival. We aimed to analyze the impact of the MELD Upgrade rule and all other MELD exceptions on the liver transplant waiting list outcomes during 2012-2017 in Switzerland. METHODS We conducted a nationwide cohort study including all adult patients registered on the Swiss liver transplant waiting list between 2012 and 2017. Waiting list mortality and access to transplantation were analyzed, considering MELD exceptions as time-dependent covariates. RESULTS 730 patients were included. Patients with MELD Upgrade exceptions had a higher risk of dying while on the waiting list (OR 2.13; CI 95% 1.30-3.47) and also an increased likelihood of receiving a liver transplantation, when compared to patients without MELD exceptions. Patients with any type of MELD exceptions were more likely to be transplanted when compared to patients without MELD exceptions. The proportion of patients with MELD exceptions increased from 2012 to 2017 (44% vs 88%). Allocation MELD at the time of transplantation showed an annual increase (23 ± 8 points vs 32 ± 5 points, p < 0.001). CONCLUSION Only patients with MELD Upgrade exceptions had the expected combination of higher waiting list mortality and quicker access to liver transplantation

Essays on Random Choice

Chapter 1 introduces and axiomatizes a new class of representations for incomplete preferences called confidence models, which describe decision makers who behave as if they have probabilistic uncertainty over their true preferences, and are only willing to express a binary preference if it is sufficiently likely to hold. Confidence models provide a natural way to connect incomplete preferences with stochastic choice; this connection is characterized by a simple condition that serves to identify the behavioral content of incomplete preferences. Chapter 2 studies random choice rules over finite sets that obey regularity but potentially fail to satisfy all of the Block-Marschak inequalities. Such random choice rules can be represented by capacities on the space of preferences. The higher-order Block-Marschak inequalities are shown to be related to the degree of monotonicity that can be achieved by a capacity representation. Finally, Chapter 3 shows that failures of uniqueness for random utility representations are widespread. Uniqueness can be restored by introducing a finite state space and considering random choice over Savage acts. A representation is characterized in which acts are chosen according to the probability that they are optimal in every state.Economic