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Children who undergo liver transplantation and subsequently develop BSI are at risk for adverse outcomes. Research from high‐income settings contrasts the dearth of information from transplant centers in low‐ and middle‐income countries, such as South Africa. Therefore, this study from Johannesburg aimed to describe the clinical and demographic profile of children undergoing liver transplantation, and determine the incidence and pattern of BSI and associated risk factors for BSI during the first year after liver transplant. Pediatric liver transplants performed from 2005 to 2014 were reviewed. Descriptive analyses summarized donor, recipient, and post‐transplant infection characteristics. Association between BSI and sex, cause of liver failure, age, nutritional status, PELD/MELD score, graft type, biliary complications, and acute rejection was determined by Fisher's exact test; and association with length of stay by Cox proportional hazards regression analysis. Survival estimates were determined by the Kaplan‐Meier method. Sixty‐five children received one transplant and four had repeat transplants, totaling 69 procedures. Twenty‐nine BSI occurred in 19/69 (28%) procedures, mostly due to gram‐negative organisms, namely Klebsiella species. Risk for BSI was independently associated with biliary atresia (44% BSI in BA compared to 17% in non‐BA transplants; P = .014) and post‐operative biliary complications (55% BSI in transplants with biliary complications compared to 15% in those without; P = .0013). One‐year recipient and graft survival was 78% (CI 67%‐86%) and 77% (CI 65%‐85%), respectively. In Johannesburg, incident BSI, mostly from gram‐negative bacteria, were associated with biliary atresia and post‐operative biliary complications in children undergoing liver transplantation.

Colonoscopy is regularly used for investigation of bowel pathology and has become the gold standard for screening and diagnosis of colorectal cancer (CRC). [1] The procedure has diagnostic and therapeutic benefits, such as direct visualisation of the entire colon and removal of precancerous polyps, which is associated with a lowered risk of CRC. [2] Colonoscopy is a skill-intensive procedure and poses a risk to the patient, even if performed by a trained endoscopist in an appropriate setting. [1] Therefore, there is a need for standardised practice and regular audit of endoscopists to ensure consistent, high-quality care. [3] Based on the 'adenoma-carcinoma sequence' hypothesis for developing CRC, screening and surveillance colonoscopy aim to detect and remove polyps, particularly adenomatous polyps, with the intention of reducing the incidence of CRC. [4] Therefore, the polyp detection rate (PDR) and adenoma detection rate (ADR) are two key indicators of the quality of endoscopy. Other measurable This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

According to GLOBOCAN, colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancerrelated death, with 1.85 million new cases diagnosed worldwide in 2018. [1,2] The incidence of CRC appears to be increasing in emerging low-and middle-income countries (LMICs) owing to socioepidemiological transitions, including dietary changes, with countries in sub-Saharan Africa (SSA) reporting a notable increase in colorectal, breast and prostate cancer. [3,4] South Africa (SA) is no exception-the incidence of CRC is increasing steadily, and it was the sixth leading cause of cancer-related death in 2018. [1] It is noteworthy that apart from increasing incidence, the average age of CRC patients at the time of diagnosis in SSA is ~10 years younger than that observed in high-income countries (HICs). [5,6] In addition, other non-communicable diseases (NCDs), including diabetes and respiratory and cardiovascular disease, are on the rise, with the prevalence in SA being reported as two to three times higher than in HICs. [7] While there are no published data on comorbidity with CRC from SSA, many CRC cohorts from HICs describe a considerable comorbidity burden that adversely affects short-(30-day) and long-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Pediatric ALF is rare but life-threatening and may require urgent transplantation. In low and middle-income countries, access to transplantation is limited, deceased organ donation rates are low, and data on outcomes scarce. The Wits Donald Gordon Medical Centre, in Johannesburg, is one of only two centers in South Africa that perform pediatric liver transplant. We describe the etiology, clinical presentation, and outcomes of children undergoing liver transplant for ALF at our center over the past 14 years. We performed a retrospective chart review of all children undergoing liver transplantation for ALF from November 2005 to September 2019. Recipient data included demographics, clinical and biochemical characteristics pretransplant, post-operative complications, and survival. We conducted descriptive data analysis and used the Kaplan-Meier method for survival analysis. We performed 182 primary pediatric liver transplants. Of these, 27 (15%) were for ALF, mostly from acute hepatitis A infection (11/27;41%). Just over half of the grafts were from living donors (15/27;56%), and five grafts (5/27;19%) were ABO-incompatible. The most frequent post-transplant complications were biliary leaks (9/27;33%). There were two cases of hepatic artery thrombosis (2/27;7%), one of whom required re-transplantation. Unadjusted patient and graft survival at one and 3 years were the same, at 81% (95% CI 61%-92%) and 78% (95% CI 57%-89%), respectively. At WDGMC, our outcomes for children who undergo liver transplantation for ALF are excellent. We found workable solutions that effectively addressed our pervasive organ shortages without compromising patient outcomes.

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Background: For those with unresectable hepatocellular carcinoma, liver transplantation is considered the treatment of choice. Since 2006, the transplant programme at Wits Donald Gordon Medical Centre (WDGMC) has offered liver transplantation for selected patients with hepatocellular carcinoma. While the number of patients transplanted was small, we are unaware of any published data from Southern Africa describing outcomes in this group of liver transplant recipients. The aim of this study was to describe our experience as a case series. Methods: The records of all patients with HCC who underwent deceased donor liver transplantation between April 2006 and March 2018 were reviewed retrospectively. Data were extracted from transplant clinic patient files, histopathology and pathology laboratory reports and an existing database of all liver transplant recipients at WDGMC. Patient survival was calculated from the time of transplant and survival estimates were determined by the Kaplan-Meier method. Results: Thirty-one liver transplants were reviewed. The most common causes of underlying liver disease were infectious, mostly hepatitis B virus, and diseases of lifestyle including alcoholic/non-alcoholic steatohepatitis. Median age at transplant, 57 years (IQR 44-65 years), was younger than observed internationally, but consistent with reports from Africa. Male recipients predominated, in keeping with published trends. Overall, outcomes were worse than expected but for recipients who were within the University of California at San Francisco (UCSF) criteria for transplantation; survival was comparable to previously published data. Conclusions: Despite limitations, this is the first documented series of patients undergoing liver transplantation for HCC in South Africa and demonstrates that good results can be achieved in appropriately selected patients.