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END-STAGE liver failure from primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH) are well recognized indications for liver transplantation (LT). Recurrence of autoimmune process in PBC, PSC, and AIH after LT is well recognized. Continuous small dose of steroids has been suggested to prevent the recurrence of disease. The longterm use of steroids obviously has disadvantages and it is generally accepted to avoid use of steroids as much as possible. The aims of the present study are to examine the long-term outcomes after LT for PBC, PSC, and AIH using tacrolimus and to review the requirements on when to use steroids.

To the editor: Graft-versus-host disease (GVHD) after transfusion of nonirradiated blood products or solid tumor transplantation is a rare but lethal complication associated with mortality of 80% to 90%[1][1][][2]–[3][3] and occurs when immunocompetent donor T cells from the graft recognize

Metabolic liver diseases result in accumulation or deposition of excessive amounts of metabolic products that lead to cirrhosis and subsequent liver failure. The defect may lie in the hepatocytes, as in Wilson disease and glycogen storage diseases, or the liver may be affected by deposition of substrates secondary to their increased concentration in plasma as a result of increased exogenous intestinal absorption (e.g., primary or hereditary hemochromatosis) or increased administration (e.g., secondary hemochromatosis). Whatever the cause, the accumulation of metabolic products in the liver may result in cirrhosis and the consequences thereof. These can result in chronic or acute liver failure. Most of these diseases also involve organs other than the liver, thus adding complexity to the management of such cases. Hereditary (primary) hemochromatosis (HH) and Wilson disease are the prototype metabolic liver diseases for which liver transplantation (LTx) is commonly indicated and shall form the basis of this review.

Background Since suitable recipients for hepatic allografts from donors with antibodies to hepatitis B virus (HBV) have not been determined, a review of our 7-year experience with donors positive for hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), or both was undertaken. Methods Recipients of hepatic allografts from donors with antibodies to HBV were identified by a retrospective review of procurement records and screened for HBV infection. Results From January 1, 1990, to January 1, 1997, 2578 liver transplants were performed and 140 (5.4%) recipients received an allograft from a donor with antibodies to HBV. Twenty-five of 48 recipients of a hepatic allograft from a donor positive only for anti-HBs were screened and none developed HBV infection. Twenty-five of 41 naive recipients of a hepatic allograft from an anti-HBc positive donor were screened and 18/25 (72%) developed HBV infection. Four of these 18 naive recipients with HBV infection received an allograft from a donor positive for both anti-HBc and anti-HBs. Seven of 13 anti-HBs-positive recipients of an allograft from an anti-HBc-positive donor were screened and none developed HBV infection. Fifteen of 16 recipients positive only for anti-HBc who received a hepatic allograft from an anti-HBc-positive donor were screened and 2/15 (13%) developed HBV infection. Conclusions Hepatic allografts from donors positive only for anti-HBs do not transmit HBV infection. Hepatic allografts from anti-HBc-positive donors frequently transmit HBV infection to naive recipients regardless of the donor anti-HBs status, and antiviral prophylaxis may be indicated. Anti-HBs-positive recipients appear resistant to HBV infection after orthotopic liver transplantation with an allograft from an anti-HBc-positive donor. Recipients positive only for anti-HBc infrequently develop HBV infection when transplanted with an allograft from an anti-HBc-positive donor; however, HBV prophylaxis may be justified.

4594 Background: The optimal treatment for hepatocellular carcinoma (HCC) for advanced cirrhosis is deceased donor liver transplantation (LT). However, tumor reoccurrence represents major limitatio...

BackgroundReconstruction of biliary drainage after liver transplantation (LTx) in patients with primary sclerosing cholangitis (PSC) has been a matter of controversy. Over recent years, the traditional method of Roux-en-Y hepaticojejunostomy (RY) has been challenged by duct-to-duct (DD) biliary reconstruction.MethodsThis study represents a retrospective review of biliary complications, patient and graft survival after LTx in PSC patients based on type of biliary reconstruction. Outcomes of DD reconstruction in this group of patients and non-PSC patients are compared.ResultsA total of 53 primary LTx procedures were performed for PSC between August 2005 and July 2010. Seven patients were excluded because unexpected cholangiocarcinoma was found in the explants (n= 3) or because they received partial livers (n= 4). Biliary reconstruction was performed as DD in 18 patients and RY in 28 patients. There were no bile leaks. Anastomotic stricture occurred in two (11%) patients in the DD group and one (4%) in the RY group. Two (7%) patients in the RY group developed non-PSC intrahepatic strictures and one had recurrence of PSC. Rates of 1- and 3-year patient and graft survival in the RY and DD groups were 96.7% and 96.7%, and 100% and 94.5%, respectively. In a group of 34 randomly selected patients transplanted for a non-PSC diagnosis with DD reconstruction during the same period, the anastomotic stricture rate was 9% and 1- and 3-year patient and graft survival rates were 97.0% and 88.5%; differences were not significant.ConclusionsDuct-to-duct biliary reconstruction at the time of LTx in selected PSC patients is both effective and safe, and shows outcomes comparable with those of RY reconstruction in these patients and those of DD reconstruction in non-PSC patients.