Mortality was most closely associated with right ventricular hemodynamic function and can be characterized by means of an equation using three variables: mean pulmonary artery pressure, mean right atrial pressure, and cardiac index. Such an equation, once validated prospectively, could be used as an adjunct in planning treatment strategies and allocating medical resources.

End-stage liver disease secondary to hepatitis C virus (HCV) infection is the leading indication for liver transplantation in the UnitedSubsequent to the initial cloning of and the development of diagnostic tests for the hepatitis C virus (HCV) in 1989, 1,2 hepatitis C has emerged as a major cause of liver disease. It is estimated that there are approximately four million individuals infected with HCV in the United States, where HCV infection causes 20% of acute and 70% of chronic hepatitis. 3,4 While published data give conflicting estimates of the proportion of HCV-infected individuals who go on to develop cirrhosis, the number of patients with HCV infection requiring liver transplantation has grown steadily. In 1991, when screening for HCV infection first became widely available, 17.8% of liver transplantations were performed for end-stage liver disease associated with HCV infection. This proportion has increased every year following 1991 and is currently over 30%, making end-stage liver disease associated with HCV infection the leading indication for liver transplantation in the United States. 5 Recurrence of HCV infection in liver allograft recipients is nearly universal. 6,7 In the setting of an increasing donor organ shortage, these facts have raised pressing questions about liver transplantation for liver disease associated with HCV infection. In 1990, the Liver Transplantation Database (LTD) was established by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK). Three prominent liver transplantation centers prospectively contributed serum, tissue, clinical, and demographic information from patients being evaluated for liver transplantation, the purpose of which was to pool collective experience in liver transplantation to answer questions that could not readily be addressed by single centers. Transplantation for HCV-associated liver disease poses several important such questions. Although patients undergoing liver transplantation for HCV have been reported to have comparable overall patient and graft survival to most other indications, it is not known whether a subset of HCV-infected recipients exists who are at increased risk for poor patient or graft survival. To date, no viral, donor, recipient, or therapeutic variables identifying a cohort of HCV-infected recipients with poor patient and/or graft survival have been defined. We report the experience of the NIDDK LTD in the identification of risk factors for adverse outcomes following liver transplantation for HCV. PATIENTS AND METHODS Study PatientsThe LTD is a 7-year prospective study of patients who underwent liver transplantation at three medical centers. 8 The three participating centers were: Mayo Clinic and Foundation, Rochester, MN; the University of Nebraska, Omaha, NE; and the University of California, San Francisco, CA. The study was approved by the Institutional

Hepatic allograft rejection remains an important problem following liver transplantation, and, indeed, complications related to the administration of immunosuppressive therapy remain a predominant cause of posttransplantation morbidity and mortality. The Liver Transplantation Database (LTD) was used to study a cohort of 762 consecutive adult liver transplantation recipients and determined the incidence, timing, and risk factors for acute rejection. We also evaluated the impact of histological severity of rejection on the need for additional immunosuppressive therapy and on patient and graft survival. Four hundred ninety (64%) of the 762 adult liver transplantation recipients developed at least one episode of rejection during a median follow-up period of 1,042 days (range, 336-1,896 days), most of which occurred during the first 6 weeks after transplantation. Multivariate analysis revealed that recipient age, serum creatinine, aspartate transaminase (AST) level, presence of edema, donor/recipient HLA-DR mismatch, cold ischemic time, and donor age were independently associated with the time to acute rejection. An interesting observation was that the histological severity of rejection was an important prognosticator: the use of antilymphocyte preparations was higher, and the time to death or retransplantation was shorter, for patients with severe rejection. Findings from this study will assist in decision-making for the use of immunosuppressive regimens and call into question whether complete elimination of all rejection or alloreactivity is a desirable goal in liver transplantation. (HEPATOLOGY 1998;28: 638-645.)The results of liver transplantation have continued to improve, with 1-year patient survival now approaching 86% in some groups of patients. 1 However, hepatic allograft rejection remains an important problem following liver transplantation and is the major reason that immunosuppressive therapy must be administered. Indeed, complications related to the administration of immunosuppressive therapy are still the predominant causes of morbidity and mortality in the liver transplantation recipient. 2 While previous studies have shown that acute hepatic allograft rejection is common following liver transplantation, the use of multiple diagnostic schemes and the lack of uniform diagnostic criteria has made it difficult to assess the true incidence of rejection. [3][4][5][6][7] Furthermore, the identification of clinical risk factors for acute rejection, and the impact of rejection on subsequent patient outcome, remain poorly defined. In this study, we determined the incidence and timing of, and identified clinical risk factors for, acute rejection. In addition, we examined the association of histological severity of acute rejection using the Liver Transplantation Database (LTD) criteria 8,9 with the degree of biochemical liver dysfunction, the need for more aggressive immunosuppressive therapy, and overall patient outcome. PATIENTS AND METHODSThe LTD is a 7-year prospective study of patients undergoing liver tran...

The goal of the study was to compare cardiovascular heart disease risk factors in women with polycystic ovary syndrome (PCOS) and matched control subjects. Women with PCOS have risk factors, including anovulation, hyperandrogenism, and insulin resistance, that suggest a male coronary heart disease risk-factor profile. A total of 206 women with PCOS were recruited by using records from a large reproductive endocrinology practice. A clinical diagnosis of PCOS was made if there was a history of chronic anovulation in association with either clinical evidence of androgen excess (hirsutism) or if total testosterone level was > 2 nm/L or the luteinizing hormone/follicle-stimulating hormone ratio was greater than 2. The overall response rate for cases was 76%. A control population was obtained by using a combination of area voters' registration tapes and directories of households. A control subject was matched to each case subject by age +/- 5 years, race, and neighborhood. The response rate for recruitment of the first or second eligible control subject was 83.6%. The average age at initial interview was 35.9 +/- 7.4 years for case and 37.2 +/- 7.8 years for control subjects. Women with PCOS had significantly increased cardiovascular disease risk factors compared with control women. These included increases in body mass index, insulin, and triglyceride levels (P < .001), decreased total HDL and HDL2 levels (P < .01), and increased total cholesterol and fasting LDL levels, waist/hip ratio, and systolic blood pressure (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)