Toxoplasma gondii Monitoring in Liver Transplantation Patients: A Single Center Cross-Sectional Study in an Italian Hospital.

Toxoplasma gondii (TG) is one of the most widespread intracellular parasites in the world, despite the slight declining trend in industrialized countries. Whilst the infection is often asymptomatic in immunocompetent hosts, in immunocompromised patients such as organ transplant recipients it can have important clinical sequels with even fatal consequences. We retrospectively reviewed 568 primary liver transplants (LT) from deceased donors from 2012 to 2017. Data were analyzed adjusting for year, gender, and age. The study objective was to assess the incidence of post-transplant TG infection and adherence to international guidelines for primary chemoprophylaxis. Prior to transplantation, 42.4% of recipients tested seronegative and 56.5% seropositive, while 36.6% of donors were seropositive and 40.4% showed undetermined serology. Anti-TG antibody titer was higher in patients born abroad (71.4%) versus Italy (54.8%). Among recipients at high risk of post-transplant TG infection, 82.7% of them received chemoprophylaxis, while in 17.3% of cases no prophylaxis was administered. At a mean (SD) follow-up of 21.2 (12.4) months no case of TG infection has been observed. Despite the low rate of adherence to recommendations, prophylaxis of high-risk LT recipients provides control of post-transplant TG infection risk. Review of current guidelines is warranted for low-risk populations

Early switching to intramuscular anti-HBs Immunoglobulins (Igantibe™) after liver transplantation: feasibility, efficacy, and safety

We present the results of a single-center trial on early switching from i.v to i.m.anti HBs immunoglobulins (HBG) after liver transplantation

Screening for alcohol-induced liver injury by patient self-report after liver transplantation

Despite widespread concern about the magnitude of alcohol consumption and/or recidivism after liver transplantation (LT), no universal agreement exists regarding the tools to assess problem alcohol drinking. We performed a single-center, cross-sectional study to assess the performance of the CAGE questionnaire in discriminating between LT recipients with and without post-transplant alcohol-induced liver injury. A total of 316 adult, consenting, maintenance patients between 6 months and 5 years after LT received the CAGE (Cut down, Annoyed, Guilty, Eye-opener) screening questionnaire. Calculation of the sensitivity, specifi city, receiver operating characteristic (ROC) curve, and likelihood ratio for CAGE scores of 0 to 4 was performed using as gold standard the biopsy-proven evidence of alcohol-induced liver injury (BPAI). One-hundred-ninety-fi ve patients responded to the questionnaire, and among them 45 (23%) had a CAGE score ≥1 (mean 2.13 ± 0.9). Among patients with a CAGE score = 0 there were 11 (7.3%) cases of BPAI, as compared with 24 (53.3%) among patients with a CAGE score of ≥1 (p<0.0001). A CAGE score ≥1 was associated with a sensitivity and a specifi city of 68.5% and 86.8%, and an area under ROC curve of 0.79 (95% CI 0.70-0.87). The likelihood ratios for scores of 0 to 4 were 0.3, 5.2, 7.8, 9.9, and 100, respectively. These ratios were associated with posterior probabilities for BPAI of 7.3%, 53.3%, 63.3%, 87.5%, and 100%, respectively. Based on these data, transplant physicians can improve their ability to predict the probability for alcohol-related liver injury using likelihood ratios for CAGE scores, in the setting of either recurrent or de novo post-transplant alcohol disorder

The impact of hepatitis C virus direct acting agents in liver transplant using very old donor grafts: a real-world single-center analysis

The correct timing of use of direct acting agents (DAAs) among transplanted patients remains unknown. The aim of this paperwork is to evaluate the impact of DAAs treatment in pre- or peri-operative period in liver transplantation when grafts ≥ 70 years are used. This is a retrospective analysis comparing adult liver transplant performed for HCV-related cirrhosis and/or hepatocarcinoma using a graft ≥ 70 in the period 2015-2018 (Group DAA-HCV-OLD, study group) to three different groups: (a) anti-HCV-Ab-negative patients receiving graft ≥ 70 (no-HCV-OLD), (b) anti-HCV-Ab-negative patients receiving a graft aged 18-69 years (no-HCV-YOUNG), and (c) anti-HCV-Ab-positive patients receiving a donor graft ≥ 70 in the period 2007-2011 (no-DAA-HCV-OLD). Totally, 528 liver transplants were considered: 164 in DAA-HCV-OLD, 143 in no-HCV-OLD, 120 in no-HCV-YOUNG and 101 in no-DAA-HCV-OLD Group. Graft survival rates at 1 and 3 years were 88% and 81% in DAA-HCV-OLD Group, 82% and 68% in no-DAA-HCV-OLD (p = 0.007), 89% and 84% in no-HCV-OLD (p = 0.76), and 94% and 92% in no-HCV-YOUNG (p = 0.02). No differences were observed among groups in the incidence of primary non-function, primary dysfunction, vascular or biliary complications. DAAs were able to zero HCV-related graft loss, with a 3-year graft survival &gt; 80%. The outcomes of older graft recipients became equal irrespectively of their HCV serological status

Quality assurance, efficacy indicators and cost-utility of the liver pre-transplant patient evaluation algorithm

Background: efficacy of pre-transplant algorithms is crucial to improve standards of care and optimize resource allocation. Aim of the study is to report on a retrospective review of the pre-LT algorithm adopted at our center, illustrate the efficacy indicators and highlight strategies to improve cost-utility. Materials and methods: a retrospective review of the pre-LT evaluation algorithm used at our center. Pre-LT eligibility evaluation is performed on an outpatient basis at a cost per patient (CPP) of 2770 Euros. Objective measures were: overall and per-procedure patients inflow and outflow; referral efficacy rate (RER), as the ratio of patients admitted to pre-LT evaluation to the total of referred patients; evaluation efficacy rate (EER), as the ratio of patients waitlisted for LT to patients admitted to pre-LT evaluation; process efficacy rate (PER), as the ratio of patients waitlisted for LT to the total of referred patients, and the cost per waitlisted patient (CPWP), as CPP/EER. Results: from January 1996 to October 2004, 1837 patients were referred on an outpatient basis for evaluation for LT. Based on evaluation of transmitted clinical data, 412 patients (22.4%) were excluded, while 1425 (77.6%) were admitted to preliminary outpatient clinic consultation. After consultation, 603 patients (42.3%) were excluded from pre-LT eligibility evaluation, in 356 (59%) because of comorbidities contraindicating LT and in 247 (41%) because of early referral. 822 patients (57.7%) were admitted to LT eligibility evaluation and RER was 47.7% (822/1837). Out of the 822 patients evaluated, 338 (41.1%) were excluded from LT waitlisting, in 244 cases (72.2%) because of comorbidities, while in 94 (27.8%) because of early referral, with a cost-utility and EER of 58.8% each (484/822). Thus, of the 1837 patients who were originally addressed for LT eligibility evaluation, 484 were waitlisted, yielding a PER of 26.3% (484/1837) and a CPWP of 4710.8 Euros. Conclusions: the PER of the pre-LT algorithm is low. However, use of RER, EER, and PER allows to monitor the efficacy of the whole process. Strategies to increase PER are reduction of futile referrals; diffusion of eligibility criteria among physicians, and pre-emptive patient charts evaluation. Such a policy might reduce referrals by 42.3% to 60.3%, increase PER to 66.5% and reduce CPWP to 4165.4 Euros