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Introduction La prevalence de l’hepatite C reste elevee en milieu carceral avec pres de 5 % des detenus concernes. Une recommandation ministerielle recente invite a traiter tout les patients infectes par le virus de l’hepatite C (VHC) en detention. Nous rapportons ici l’experience de notre centre. Materiels et methodes Le depistage du VHC est systematique a l’arrivee en detention. Les patients ainsi depistes, sont orientes dans un parcours de soins diagnostic et therapeutique specialise. Ainsi, nous avons effectue une etude retrospective de l’ensemble des patients pris en charge pour une hepatite C chronique au sein de notre etablissement, entre le 1er juillet 2014 et 31 janvier 2017. Resultats Sur la periode etudiee, 219 patients ont ete pris en charge pour une hepatite C. L’âge moyen etait de 42,8 ans [24 ; 61] et le sex-ratio (H/F) de 11. Cent quatre vingt huit (85,8 %) patients avaient un antecedent de toxicomanie intraveineuse. Le score de fibrose hepatique se repartissait entre F0-F2 (n = 131-60 %), F3 (n = 42 – 19 %) et F4 (n = 46 – 21 %). Quatre patients presentaient des signes extra hepatique (1 lymphome indolent, 3 cryoglobulinemies). Les genotypes du VHC etaient 1 (115 – 53 %), 2 (20 – 9 %), 3 (53 – 24 %) et 4 (20 – 9 %). Un traitement a ete propose chez 114 patients (52 %), parmi lesquels 33 (28 %) n’ont pas ete traites car la duree de leur peine n’etait pas suffisamment longue et 2 patients ont refuse le traitement. Les traitements proposes etaient : sofosbuvir (SBV)/NS5A = 52 (64 %), SBV/NS5A + ribavirine (RBV) = 15 (19 %), SBV + RBV = 6 (7,5 %), SBV/NS3/4A = 4 (5 %), SBV + RBV + interferon pegyle = 2 (2,5 %). Soixante-dix-neuf patients ont ete traites, permettant 29 guerisons (37 %), 13 traitements termines etaient en attente de la PCR S12 (16 %), 23 traitements sont en cours (29 %). On note deux non-reponses et un suicide avant SVRS12. Aucun effet secondaire n’a ete rapporte. Depuis septembre 2016, 23 patients beneficient d’une prise en charge individuelle avec accompagnement social et medical dans le cadre du projet « Parcours de sante VHC en Ile de France ». Ainsi, ce dispositif permet d’augmenter le nombre de patient pouvant beneficier d’un traitement. Conclusion La prise en charge du VHC en detention est l’opportunite de toucher une population precaire souvent difficile a traiter dans les circuits classiques. Les nouvelles recommandations ministerielles facilitent ainsi la prescription des nouveaux anti-viraux d’action directe, permettant de traiter efficacement un nombre important de detenus. Certains patients n’ont pu etre traite a cause d’une impossibilite de suivi et de prise en charge a la liberation, justifiant la mise en place d’un dispositif dedie assurant la jonction lors de la sortie de detention.

Introduction La couverture vaccinale des malades atteints d’une hepatopathie chronique est reputee insuffisante, y compris quand les malades sont candidats a une transplantation hepatique (TH). Nous avons mis en place une cohorte prospective pour analyser la prevalence des immunisations vaccinales recommandees en pre-TH, proposer des vaccinations avant l’inscription sur liste et suivre les reponses vaccinales. Materiels et methodes Notre cohorte de candidats a une TH a ete vue pendant l’hospitalisation de semaine d’evaluation avant inscription sur liste. Une consultation avec un infectiologue avait pour but d’evaluer, a l’aide d’un carnet de vaccination ou de facon declarative, la couverture vaccinale contre diphterie-tetanos-poliomyelite (dTP) et les pneumocoques. Des serologies ont ete realisees pour evaluer l’immunite contre : hepatite A, hepatite B rougeole, oreillons, rubeole et varicelle. Les vaccins recommandes etaient mis a disposition par la pharmacie directement dans le centre de transplantation, constituant un « mini-centre de vaccinations ». Les vaccinations etaient systematiquement proposees si necessaire. Resultats Entre le 1er mai 2015 et le 31 decembre 2016, nous avons vu 76 malades (25 femmes et 51 hommes ; âge moyen 53 ans ; 70 % ne en France continentale) hospitalises pour une evaluation pre-TH. La plupart souffraient d’une cirrhose (83 %). Douze (16 %) avaient un document de vaccination disponible. Au total, 20 malades (26 %) etaient/declaraient etre a jour de leur vaccination dTP (≤ 10 ans) ; 10 (13 %) avaient recu une ou 2 doses de vaccin pneumococcique, mais seulement 2 (2,6 %) avaient recu 2 doses vaccinales ; 16 des 57 (28 %) malades evaluables etaient a jour du vaccin grippe. De nombreux malades avaient des serologies negatives contre : hepatite B (n = 39, 51 %), hepatite A (n = 27, 35 %), varicelle (n = 5, 7 %), rubeole (n = 4, 5,2 %), oreillons (n = 3, 4 %), rougeole (n = 1, 1,3 %). Seuls 2 (2,6 %) candidats etaient a jour de toutes les vaccinations recommandees. Nous avons ensuite realise 147 vaccins pendant l’hospitalisation : dTP ± coq (n = 48), pneumocoques (n = 63), hepatite B (n = 18), hepatite A (n = 17) et ROR (n = 1). Conclusion La couverture vaccinale des candidats a une TH est faible. Elle peut etre facilement augmentee en proposant une vaccination pendant l’evaluation pre-TH. Pour ameliorer la couverture vaccinale, nous avons mis au point un logiciel expert en vaccination des candidats a une transplantation hepatique qui nous permettra d’elargir encore la couverture vaccinale en permettant aux hepatologues non-experts en vaccination de prendre le relais.

Drug-induced hepatotoxicity is an important cause of hepatocellular injury. Non-nucleoside retroviral transcriptase inhibitors are known to cause hepatotoxicity. We describe a detailed case of fulminant hepatitis induced by nevirapine (Viramune) and treated by liver transplantation.

The introduction of antiretroviral therapies (cART) has improved the survival of patients infected with human immunodeficiency virus (HIV). Because of shared ways of transmission, 30 % of HIV-infected patients have hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infection; so, till date, liver disease is a major cause of non-acquired immunodeficiency syndrome (AIDS)-related deaths. Survival of HIV-infected patients with end-stage liver disease is shorter than in the non-HIV-infected patients. For this reason, liver transplantation (LT) must be evaluated after the first episode of liver decompensation. The risk of opportunistic disease after LT is low, while HCV recurrence is the central problem and affects post-transplant patients’ survival. Standard anti-HCV therapy with pegylated interferon and ribavirin resulted in a low response rate. This should change with the advent of new anti-HCV drugs with better antiviral activity. This would allow viral control from the time of transplant and will improve the results of LT in HCV/HIV co-infected patients.

We report, for the first time, the outcome of anti-hepatitis C virus (HCV) triple therapy with telaprevir in an HIV/HCV co-infected transplanted patient. After liver transplantation, the patient experienced a severe HCV recurrence with fibrosing cholestatic hepatitis, and anti-HCV therapy with pegylated interferon alpha 2a, ribavirin and telaprevir was initiated. A sustained virological response was achieved after 48 weeks of anti-HCV therapy. Drug-drug interactions between antiretroviral therapy, immunosuppressive agents and anti-HCV therapy could be managed.

Domino liver transplantation (DLT) has become an accepted procedure designed to address problems with organ limited supply. However, cases of acquired amyloid neuropathy are increasingly being recognized following this procedure. Until now, only one patient had undergone liver retransplantation and follow-up findings were not reported. We describe the case of a 72-year-old patient with partial recovery from acquired amyloid neuropathy following retransplantation with a deceased donor 7 years after DLT performed for end-stage liver disease. His clinical and paraclinical improvement is described, and the impact of this case on the indication for a domino procedure and the challenges linked to retransplantation are discussed.

Hepatitis C virus (HCV) recurrence is the most important complication in HCV liver transplant patients. Boceprevir with pegylated interferon and ribavirin (PegIFN/RBV) enabled improvement in sustained virological response rates of patients with genotype 1 HCV. Boceprevir interacts with immunosuppressive therapy (IT) by inhibiting the cytochrome P450 3A enzyme. Our aim was to study interactions and assess the safety of boceprevir in the context of HCV recurrence. Boceprevir (800 mg three times a day) initiated after a 4-week lead-in phase was associated with cyclosporine (three patients), tacrolimus (two patients), and everolimus (one patient) in five liver transplant patients with genotype 1 HCV infection who experienced HCV recurrence. The mean follow-up period after HCV therapy was 14.8 ± 3.1 weeks. Estimated oral clearances of IT decreased on average by 50%, requiring reduced dosing regimens. Anemia occurred in all patients, with a mean fall in hemoglobin levels between baseline and week 12 of 3.12 ± 2.27 g/dl. All patients required administration of β-erythropoietin ( n = 5), three needed ribavirin dose reduction, and one needed a blood transfusion. A virological response was observed in all patients (mean HCV viral load [HVL] decrease at week 12, 6.64 ± 0.35 log 10 IU/ml). These preliminary results in liver transplant patients with HCV recurrence demonstrate the feasibility and safety of coadministration of boceprevir and IT.

Domino transplantation using the liver (DLT) from patient with familial amyloid polyneuropathy (FAP) has been developed to alleviate the graft shortage. We herein studied 91 patients who ...

Background & Aims Most liver transplant centres have discontinued the practice of protocol liver biopsies (LB), mainly because of the perceived lack of therapeutic benefit. This study aimed to examine the usefulness of 20-year LBs. Methods Ten, 15, and 20-year protocol LBs from 147 patients surviving for >20years were reviewed. Twenty-year biopsy findings were correlated with clinical data. Results Twenty-year-biopsy patients (N=91) and 20-year-non-biopsy patients (N=56) were similar in terms of transplant data, adverse events, and liver function tests (LFTs). Twenty-year LBs revealed a 90% prevalence of abnormalities, among which viral chronic hepatitis (VCH) was the most common (46%). Between 15 and 20years, hepatic structural abnormalities were the only disorder to increase ( p =0.008). An individual progression of abnormalities occurred in 56% of patients. At 20years, the negative and positive predictive values (PV) of LFTs with respect to histological abnormalities were 95% and 18%, respectively; in VCH, Fibrotest and transient elastography displayed poor discriminative ability for fibrosis (80% and 81% discordance, respectively), but were satisfactory regarding significant fibrosis (negative PV of 77.7% and 80%, respectively). A decrease in immunosuppression was less frequent (14/91 vs . 20/56, p =0.008) while an increase was more common (15/91 vs . 2/56, p =0.017) in 20-year-biopsy patients than in non-biopsy patients. Antiviral therapy was administered in seven of the 20-year biopsy patients, but in none of the non-biopsy patients ( p =0.04). Conclusions Twenty-year LBs provided important histological information on graft function that was available to a limited degree from LFTs and non-invasive markers. They exerted an impact on immunosuppressive and antiviral therapies.

The standard antitubercular treatment (ATT), which consists of isoniazid (INH), rifampicin (RIF), ethambutol, and pyrazinamide (PZA), is the best available treatment for tuberculosis (TB). However, the hepatotoxicity of INH and PZA can be severe, and even after drug withdrawal, patients may require liver transplantation (LT). In these cases, the strategy for the treatment of TB is poorly defined. Between 1986 and 2008, 14 patients presented at our department with severe hepatitis secondary to INH and PZA treatment. Four of these patients were immunosuppressed: 2 after renal transplantation and 2 because of human immunodeficiency virus infection. In seven of the 14 patients an alternative ATT was begun on admission, which was well tolerated. Hepatitis improved spontaneously in 5 patients, and alternative ATT was continued for 9.3 ± 4.2 months; 1 patient deteriorated and underwent LT, and 1 patient died. ATT was stopped definitively in 2 patients. Six patients required urgent LT, and alternative ATT was started after transplantation and was successful. Five patients receiving RIF had an episode of acute rejection. In conclusion, hepatitis secondary to ATT can be successfully treated with alternative anti-TB regimens. The use of RIF in LT patients may lead to acute rejection. RIF should therefore be avoided in these patients.

ABO-incompatible (ABO-I) liver transplantation has been performed essentially in patients with acute liver failure awaiting an urgent liver transplantation. Early results with ABO-I liver transplantation were disappointing with a very low graft survival rate (20-50%). The main risk is the occurrence of severe humoral and cellular rejection, vascular thrombosis, and biliary complications. In order to avoid humoral rejection and improve graft survival, total plasma exchange in combination with an intense immunosuppressive regimen has been proposed to decrease hemagglutinin titers in ABO-I liver grafts. In some centers, this regimen was associated with splenectomy, phototherapy, and portal or arterial intrahepatic infusion therapy; however, as these patients are at high risk of sepsis, a selective approach using antigen-specific immunoadsorption with immunoadsorbent columns has been successfully proposed for ABO-I living donor kidney transplantation. Few cases have been reported following liver transplantation. We report our recent experience with three adult patients (two patients with acute liver failure, and one with severe cirrhosis and hepatic encephalopathy) transplanted in an emergency situation with an ABO-I liver graft and managed with the use of GlycoSorb ABO immunoadsorbent columns and a quadruple immunosuppressive regimen with preservation of the spleen. Eight sessions were performed in the three patients. Antigen-specific immunoadsorption greatly lowered the anti-A hemagglutinin titers. None of the three patients developed acute humoral or cellular rejection. Two patients are alive at 1.5 and 3 years follow-up with a normally functioning graft. The third patient died with a functioning graft, one month after the transplantation, from septic complications.

The aim of this study was to evaluate the impact of an enfuvirtide-based antiretroviral (ARV) regimen on the management of immunosuppression and follow-up in hepatitis C virus (HCV)/hepatitis B virus (HBV)/human immunodeficiency virus (HIV)-coinfected liver transplant patients in comparison with a lopinavir/ritonavir-based ARV regimen. Tacrolimus and cyclosporine trough concentrations were determined at a steady state during 3 periods: after liver transplantation without ARV treatment (period 1), at the time of ARV reintroduction (period 2), and 2 to 3 months after liver transplantation (period 3). The findings for 22 HIV-coinfected patients were compared (18 with HCV and 4 with HBV); 11 patients were treated with enfuvirtide and were matched with 11 lopinavir/ritonavir-exposed patients. During period 1, tacrolimus and cyclosporine A doses were 8 and 600 mg/day, respectively, and the trough concentrations were within the therapeutic range in both groups. In period 2, the addition of lopinavir/ritonavir to the immunosuppressant regimen enabled a reduction in the dose of immunosuppressants required to maintain trough concentrations within the therapeutic range (to 0.3 mg/day for tacrolimus and 75 mg/day for cyclosporine). Immunosuppressant doses were not modified by the reintroduction of enfuvirtide, there being no change in the mean trough concentrations over the 3 periods. CD4 cell counts remained at about 200 cells/mm3. The HIV RNA viral load remained undetectable. Both groups displayed signs of mild cytolysis and cholestasis due to the recurrence of HCV, whereas no renal insufficiency was observed. Enfuvirtide is an attractive alternative to standard ARV therapy, facilitating the management of drug-drug interactions shortly after liver transplantation. Moreover, the lack of liver toxicity renders this drug valuable in the event of a severe HCV recurrence.

Antiviral therapy after liver transplantation (LT) using interferon (IFN) and ribavirin (RBV) can achieve a sustained virological response (SVR) rate ranging from 20% to 45%. The aims of our study were to assess efficacy and tolerability of therapy, effect on fibrosis progression and the importance of the initial fibrosis stage to outcome. A total of 113 hepatitis C virus (HCV)-infected LT patients received 133 courses of IFN (standard, n = 29, pegylated IFN [pegIFN], n = 104) and RBV (75% genotype 1). Early virological response (EVR), end-of-treatment (EOT), and SVR were obtained in 74%, 55%, and 38%, respectively. EVR, completion of treatment, viral load before therapy, genotype non-1, and use of pegIFN were predictive of SVR, but only EVR remained in the multivariate analysis. SVR was obtained in 45% patients who received a second course of therapy. Paired biopsies at baseline, at EOT and at long-term were available in 42 patients. The mean fibrosis stage remained stable in patients with SVR and increased in patients without response. Rejection episodes were observed in 6% of patients. Tolerability of therapy decrease in patients with fibrosis stageor =3 on baseline liver biopsy. A total of 20% of them died or were retransplanted due to liver failure as opposed to 1% of patients who had fibrosis stage3. In conclusion, IFN and RBV achieved SVR in 38% of patients. EVR is independently associated with SVR. Fibrosis stage remained stable in patients with SVR and increased in nonresponders. Fibrosis stageor =3 was associated with a high rate of liver failure, arguing for an early introduction of antiviral therapy.

Sofosbuvir and daclatasvir are direct-acting antiviral drugs used to treat chronic hepatitis C virus infection. In 2015, the Food and Drug Administration and European Medical Agency warned that bradycardia could occur when amiodarone was administered in combination with sofosbuvir, but no case reports had been published. We report extreme bradycardia within 2 hrs after intake of sofosbuvir and daclatasvir by 2 patients receiving amiodarone. The first patient had a cardiac asystole 30 min after receiving sofosbuvir and daclatasvir. Amiodarone, sofosbuvir, and daclatasvir treatment were stopped; after 10 days, the cardiac evaluation was normal and patient was discharged. The second patient was taking amiodarone and propranolol; 2 hrs after receiving sofosbuvir and daclatasvir, he had an extreme sinus node dysfunction (heart rate of 27beats/min). Amiodarone and propranolol were stopped, but the patient continued receiving sofosbuvir and daclatasvir for 3 days and sinus bradycardia was recorded each day, 2 hrs after intake of these drugs. When he stopped taking the drugs, no bradycardia was observed. Administration of sofosbuvir and daclatasvir on day 13 induced bradycardia 2 hrs after intake. However, no bradycardia occurred following a rechallenge 8 weeks after the patient stopped taking amiodarone. These observations indicate that patients treated with amiodarone should be continuously monitored within the first 48 hrs following the initiation of sofosbuvir and daclatasvir.

Background The French National Reference centre for Transthyretinrelated amyloidosis (ATTR) was accredited in 2005. One of its 10 lines of action is to inform and educate patients about their disease to improve their care and reduce morbidities. We thus decided to elaborate a therapeutic patient education (TPE) programme, starting with patients’ needs assessment. We will describe our needs assessment and discuss our experience in TPE for ATTR patients.

Methods Seventy seven consecutive patients with multimodality imaging evaluation (echocardiography, 1.5T MRI and 99mTc-DPD scintigraphy) to diagnose cardiac amyloidosis were identified from the database of the French National Reference Center for Amyloidosis. Patients with pacemaker or severe renal failure did not undergo cardiac MRI and were analyzed on the basis of the echocardiography and scintigraphy (n=17). Three groups were compared: patients with positive agreement to diagnose cardiac ATTR (PA-ATTR group), patients with positive agreement to exclude cardiac ATTR (PA-normal) and patients with negative agreement (NA).

I/R injury remained more prominent in DBD grafts as compared to their DCD counterparts. Further, there was greater upregulation of pro-inflammatory ceramides in post-transfusion biopsies in DBD as compared to DCD allografts. Despite decreased inflammation, DCD allografts had significantly higher levels of cell death than DBD grafts, which correlated with the duration of warm ischemia time as well as significantly higher levels of aspartate aminotransferase (AST) in the serum of recipients of DCD livers in the acute posttransplant period. Conclusions: These data suggest that ischemia/reperfusion injury causes a non-inflammatory necrosis in DCD allografts with an appreciable effect on early graft function. The long-term consequences of increased inflammation in DBD allografts and cell death in DCD allografts are unknown and warrant further investigation.

Background and Aims: The association of liver steatosis with a number of common metabolic conditions has been suggested. The aim of the present study was to evaluate the clinical features of subjects with different severities of steatosis. Methods: The present study was performed in 282 consecutive patients with ‘bright liver’ at ultrasonography and in 58 subjects without steatosis. They had no history of alcohol abuse and negative tests for the presence of hepatitis B and C virus. Patients underwent clinical examination, anthropometry, laboratory tests and routine liver ultrasonography. Steatosis was graded as absent, mild, moderate and severe. Results: A progressive increase in the prevalence of obesity (P

Introduction Les neuropathies amyloides Familiales (NAF) sont des neuropathies de transmission autosomique dominante survenant chez l’adulte et liees a une mutation amyloidogene du gene de la transthyretine (TTR). Il s’agit de polyneuropathies sensitivomotrices progressives invalidantes avec dysautonomie letales en 10 ans en moyenne. La Transplantation Hepatique (TH), qui permet de supprimer la principale source de TTR mutee est actuellement le principal traitement propose.Objectifs : Rapporter l’evolution a long terme de la neuropathie et la survie apres TH et en determiner les facteurs pronostiques independants. Methodes Etude prospective monocentrique avec evaluation periodique clinique (dont scores PND de marche et vegetatif) et electrophysiologique. Entre 1993 et 2010, 200 patients avec une NAF- TTR symptomatique ont eu une TH, 138 (69 %) ayant un variant Met30TTR, 62 un variant non Met30 (15 varietes). L’âge moyen etait de 45,5 ans avec un debut tardif (≥ 50ans) chez 37,5 % des patients. Nous avons utilise la methode de Kaplan Meier avec le test de Log- rank et le modele de Cox multivarie pour etudier la survie et ses facteurs pronostiques. Resultats La majorite des patients (63 %) a conserve la meme autonomie de marche mais 21,3 % ont eu recours a une aide a la marche (PND3) apres TH dont un quart sont devenus grabataires. Les facteurs de risque d’atteinte du score PND 3 etaient un amaigrissement > 20 %, l’âge tardif de debut, une duree de maladie avant TH ≥ 3 ans. 76/200 patients sont decedes dont 37 % la premiere annee, le plus souvent de causes cardiaques (39 %), d’infection (24 %), ou de progression de la neuropathie (7 %). La mediane de survie post TH est de 11,4 ans ; les facteurs de risque de deces sont une hypotension orthostatique ; une incontinence urinaire, l’âge tardif de debut (≥ 50 ans), un variant non Met30. La mediane de survie globale depuis le debut de maladie est de 14,7 ans, egale a 21,3 ans pour les Met30TTR jeunes ( vs 8,9 ans pour les non Met30TTR âgees, ≥ 50 ans). Pour 20 % des patients, l’implantation de Pace Maker s’est revelee necessaire au decours de la TH. Conclusions L’evolution apres TH semble meilleure dans les formes precoces de NAF- TTR Met30 jeunes en terme de survie et d’arret de progression de la neuropathie ; elle est moins favorable dans les formes tardives majoritaires actuellement ; ceci souligne l’interet des nouvelles biotherapies telles que SiRNA, Oligonucleotides AntiSens capables de supprimer le variant TTR ainsi que le sauvage, egalement fortement pathogene.

quartile of LDLR mRNA expression in the PI biopsy survived with a significantly (Log-Rank test P < 0.05) better survival than those in the three lowest quartiles. Surviving graft (n = 34, median followup 44.8 months, range 8.6–72.3) had significantly higher LDLR (P < 0.01) and NPC1L1 (P < 0.05) mRNA expression in the PI biopsy and HMGCR (P < 0.05) mRNA expression in the PR biopsy than lost grafts (n = 13, median follow-up 6.0 months, range 0.03–43.7). Conclusions: In the settings of human liver transplantation: 1. hepatic LDLR mRNA is overexpressed immediately after graft reperfusion, suggesting an increased hepatocyte cholesterol uptake from blood; 2. hepatic upregulation of genes involved in cholesterol recruitment and synthesis is inversely related to the severity of IRI and is associated with better graft survival.

219 PROSPECTIVE ASSESSMENT OF LIVER FIBROSIS AFTER LIVER TRANSPLANTATION IN HIV/HCV COINFECTED PATIENTS: A USEFUL TOOL ASSESSING SEVERE FIBROSIS ON THE LIVER GRAFT B. Roche, M. Belnard, P. Pham, L. Allain, A.-M. Roque-Afonso, A. Coilly, T.M. Antonini, R. Sobesky, D. Samuel, J.-C. Duclos-Vallee. Centre Hepato-Biliaire, AP-HP – Hopital Paul Brousse, Unit 785, INSERM, Villejuif, Faculte de Medecine, Univ Paris-Sud, Le Kremlin-Bicetre, Laboratoire de Biochimie, AP-HP – Hopital Paul Brousse, Laboratoire Roche, Laboratoire de Virologie, AP-HP – Hopital Paul Brousse, Villejuif, France E-mail: bruno.roche@pbr.aphp.fr

W72 for the three renal groups were 1.1, 1.2 and 1.4mg/dL and median change from baseline was −0.10, 0, and −0.20, respectively. Four patients with mild renal impairment at baseline had a confirmed creatinine clearance

quartile of LDLR mRNA expression in the PI biopsy survived with a significantly (Log-Rank test P < 0.05) better survival than those in the three lowest quartiles. Surviving graft (n = 34, median followup 44.8 months, range 8.6–72.3) had significantly higher LDLR (P < 0.01) and NPC1L1 (P < 0.05) mRNA expression in the PI biopsy and HMGCR (P < 0.05) mRNA expression in the PR biopsy than lost grafts (n = 13, median follow-up 6.0 months, range 0.03–43.7). Conclusions: In the settings of human liver transplantation: 1. hepatic LDLR mRNA is overexpressed immediately after graft reperfusion, suggesting an increased hepatocyte cholesterol uptake from blood; 2. hepatic upregulation of genes involved in cholesterol recruitment and synthesis is inversely related to the severity of IRI and is associated with better graft survival.

(p = 0.006), inotropic support (p = 0.006) and the absence of transplantation (p = 0.002) were significantly predictive of mortality. In the multivariate analysis, MELD score and need for inotropic support were major significant predictors of death while transplant free survival was significantly related to a MELD score

Background In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. Results 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7–51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24–0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08–0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15–0.54, p Conclusion Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis. Trial registration: ClinicalTrials.gov registry number: NCT01953458.