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Long-term survival data on de novo malignancy are limited following orthotopic liver transplantation (OLT) when compared with controls without malignancies. Methods: Over a 23 yr period at our institution, 86 of 1300 patients (6.6%) who underwent OLT were identifi ed to have 86 de novo malignancies. The clinical characteristics and survival of these patients were retrospectively reviewed and compared with a control cohort of 86 OLT recipients without malignancy matched with the incidence cases by age, year of OLT, sex, and type of liver disease. Results: Chronic hepatitis C (49%) and B virus (20%), alcohol (18.4%) were the three leading causes of liver disease. Skin cancer was the most common malignancy (26%) including 5 cases of Kaposi disease, followed by gastrointestinal (24.6%) and hematological malignancies (PTLD) (17%), eye and rhynopharinx cancers (12.3%), lung cancers (7.6%), breast cancer (6.1%) and urinary cancers (4.6%). The cases and controls were not signifi cantly different in the immunosuppressive regimen (66% vs 74% Neoral and 34% vs 26% Prograf, p=0.42), the number of rejection episodes (15 vs 16,p=0.92), the gender (71% vs 69% male and 29% vs 31% female, p=0.67) the median recipient age (53 vs 51, p=0.63) and donor age (48.89 ± 20.3 vs 44.27 ± 17.3, p=0.52). The median time of the diagnosis of de novo tumor after OLT was 4.17 ± 3.77 years (0.4-16.2). The 5- and 10-year Kaplan–Meier survival rates for the cases were 84% and 62%, respectively, vs. 79% and 72%, respectively, for the controls (p=NS by log-rank test). Patients with skin cancers had 10- year survival similar to the controls (88% vs 72%,p=NS), but signifi cantly better than non-skin cancers (88% vs 56%, p=0.0001). The prognosis for patients with gastrointestinal tumors was poor, with a median survival of 8.6 months after the diagnosis. Conclusion: In this single institutional study, de novo malignancies after OLT were uncommon. Patients with non-skin cancer after OLT had diminished long-term survival compared with the controls. Following the poor prognosis of gastrointestinal cancers, it is mandatory an yearly surveillance after OLT to treat eventually this kind of tumors at an early stage.

Background Treatment of hepatitis C virus (HCV) recurrence after liver transplantation (LT) is difficult with low response rates. Aim To assess the safety and efficacy of pegylated-interferon (PEG-IFN) alfa-2b + ribavirin (RBV) in patients with post-LT recurrent genotype-1 HCV and to establish stopping rules according to response. Methods Fifty-three patients with post-LT HCV recurrence were enrolled. Patients received PEG-IFN alfa-2b 1.0 μ/kg/week plus RBV 8–10 mg/kg/day for 24 weeks. Those with ‘early virological response at week 24’ (EVR24) continued treatment for 24 weeks (group A). Patients without EVR24 were randomized to continue (group B) or to discontinue (group C). Results Overall sustained virological response (SVR) was 26% (14/53). Alanine aminotransferase, rapid virological response, EVR12, EVR24, undetectable serum HCV-RNA at weeks 12 (cEVR12) and 24 (cEVR24) were related to SVR. cEVR12 and cEVR24 (OR: 14.7; 95% CI: 2.02–106.4) were independent predictors of SVR. All patients with SVR, had cEVR12. No patient in groups B and C achieved end-of-treatment response. One patient in group B had SVR. Conclusions Pegylated-interferon alfa-2b was effective in one of four of patients with HCV genotype 1 after LT. Treatment should be discontinued in patients with no virological response at week 12. Further studies are needed to evaluate whether a longer treatment period may be beneficial in patients with ≥2 log10 drop in HCV-RNA at week 24

The aim of this study was to evaluate how the immunohistochemical detection of liver hepatitis C virus (HCV) antigens (HCV-Ag) could support the histologic diagnosis and influence the clinical management of post-liver transplantation (LT) liver disease. A total of 215 liver specimens from 152 HCV-positive patients with post-LT liver disease were studied. Histologic coding was: hepatitis (126), rejection (34), undefined (24; coexisting rejection grade I and hepatitis), or other (31). The percentage of HCV-Ag infected hepatocytes were evaluated, on frozen sections, by an immunoperoxidase technique. HCV-Ag were detectable early in 57% of cases within 30 days post-LT, 92% of cases between 31 and 180 days, and 74% of cases after more than 180 days. Overall, HCV-Ag were detected more frequently in histologic hepatitis as compared to rejection (P < 0.0001) with a higher percentage of positive hepatocytes (P < 0.00001). In 16 patients with a high number of HCV-Ag-positive hepatocytes (65%; range 40-90%) a clinical diagnosis of recurrent hepatitis (RHC) was made despite inconclusive histopathologic diagnosis. Multivariate analysis identified the percentage of HCV-Ag-positive hepatocytes and the time post-LT as independent predictors for RHC (P = 0.008 and P = 0.041, respectively) and the number of HCV-Ag-positive hepatocytes >/=50% as the only independent predictor for nonresponse (P < 0.001) in 26 patients treated with alpha-interferon plus ribavirin. In conclusion, HCV reinfection occurs early post-LT, reaching its peak within 6 months. Immunohistochemical detection of post-LT HCV reinfection support the diagnosis of hepatitis when the histologic features are not conclusive. A high number of infected cells, independently from the genotype, represents a negative predictive factor of response to antiviral treatment.

The incidence of invasive fungal infection is increasing especially in the field of transplantation, affecting as many as 50% of bone marrow transplant (BMT) patients with neutropenia and 5-20% of solid-organ transplant (SOT) recipients. Fusarium species are soil saprophytes and plant pathogens. They may cause superficial mycoses or important opportunistic infections in patients with bone marrow suppression and neutropenia, they have been rarely described in solid organ recipients, and up to now there have been no reports of such infection in isolated liver transplanted patients. We describe a case of disseminated Fusarium solani infection with hepatic localization in a liver transplanted patient that resolved with the administration of amphotericin B. Our observation confirms that Fusarium spp. are emerging pathogens that may most frequently affect not only BMT patients and patients with hematological malignancies, but also SOT patients. They may cause both localized and disseminated infection. In conclusion, Fusarium spp. etiology should be considered in the context of infectious diseases following liver transplantation.