The present data suggest that recipients' malnutrition should be taken into account as a factor that increases complications and costs after LT.

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The natural history of portal hypertensive gastropathy is significantly influenced by the severity of liver disease and severity of portal hypertension. Acute bleeding from portal hypertensive gastropathy is infrequent but may be severe.

We hypothesized that antiviral efficacy [sustained virologic response (SVR)] has improved in recent years in the transplant setting. Our aim was to assess whether the efficacy of pegylated interferon (PegIFN)-ribavirin (Rbv) has improved over time. One hundred seven liver transplant patients [74% men, 55.5 years old (range: 37.5-69.5), 86% genotype 1a or 1b] were treated with PegIFN-Rbv for 355 (16-623) days at 20.1 (1.7-132.6) months after transplantation. Tacrolimus was used in 61%. Sixty-seven percent had baseline F3-F4 (cirrhosis: 20.5%). Donor age was 49 (12-78) Variables associated with SVR in the univariate analysis included donor age, baseline viremia and cirrhosis, bilirubin levels, rapid virologic response and early virologic response (EVR), premature discontinuation of PegIFN or Rbv, and accumulated Rbv dose. In the multivariate analysis, the variables in the model were EVR [odds ratio (OR): 0.08, 95% confidence interval (CI): 0.016-0.414, P ϭ 0.002] and donor age (OR: 1.039, 95% CI: 1.008-1.071, P ϭ 0.01). Variables that had changed over time included donor age, baseline viremia, disease severity (cirrhosis, baseline bilirubin, and leukocyte and platelet counts), interval between transplantation and therapy, and use of growth factors. In the multivariate analysis, variables independently changing were donor age (OR: 1.041, 95% CI: 1.013-1.071, P ϭ 0.004), duration from transplantation to antiviral therapy (OR: 1.001, 95% CI: 1.000-1.001, P ϭ 0.013), and baseline leukocyte count (OR: 1.000, 95% CI: 1.000-1.000, P ϭ 0.034). In conclusion, the efficacy of antiviral therapy with PegIFN-Rbv has worsened over time, at least in our center. The increase in donor age and greater proportion of patients treated at advanced stages of disease are potential causes. Liver Transpl 15:738-746, 2009.

Background & aims: Liver transplantation is a major procedure often undertaken in patients in poor nutritional status. Few studies have examined the modification of nutritional status after liver transplantation. We aimed at analyzing the modification of nutritional status occurring in liver recipients during the first year. Methods: Twenty-five consecutive patients submitted to liver transplantation were studied. A complete nutritional assessment, was performed before and at 3, 6 and 12 months after transplantation. Insulin and C-peptide plasma levels were determined and insulin sensitivity was estimated. Results: According to subjective global assessment 56% of patients were malnourished at transplant. In malnourished patients nutritional status further deteriorated at 3 months but improved 6 and 12 months after transplantation. Fat mass significantly increased from before to 12 months after transplant (median triceps skinfold: 10.8 vs 15.2 mm, p = 0.03) while parameters of muscle mass showed minor variations (median arm muscle circumference: 23.4 vs 24.0 cm, p = 0.3). The daily calorie intake also improved (27 vs 32 kcal/kg/die, p = 0.007) and protein intake increased (0.8 vs 1.3 g/kg, p = 0.02). In patients without malnutrition nutritional status and dietary intake showed minor variations after transplantation. Hyperinsulinemia was normalized and insulin sensitivity improved in all patients post-transplant. Conclusions: During the first 12 months after liver transplant a significant improvement in nutritional status is achieved in patients previously malnourished. Fat deposits show the more rapid improvement while the amelioration of muscle mass requires a longer period. The increased dietary intake and improved insulin sensitivity are associated to these changes. © 2011 European Society for Clinical Nutrition and Metabolism