The natural history of clinically compensated hepatitis C virus (HCV) cirrhosis after liver transplantation is unknown. This information is relevant to transplant centers to improve the management of these patients and decide the optimal timing for retransplantation. The aims of the study were (1) to describe the natural history of patients with HCV-cirrhosis transplants in a center with annual liver biopsies, and (2) to determine predictors for clinical decompensation, retransplantation, and mortality rates. A total of 49 patients with HCV-graft cirrhosis, 39 clinically compensated at histologic diagnosis of cirrhosis (post-liver transplantation cirrhosis) were included and followed up for 1 year (15 days-3.5 years). All patients tested were infected with genotype 1b. Predictive variables included histologic activity index (HAI) at post-liver transplantation cirrhosis, liver function tests, age, sex, and maintenance immunosuppression. Eighteen of 39 patients developed at least 1 episode of decompensation after a median of 7.8 months (4 days-2.6 years; 93% ascites). The cumulative probability of decompensation was 8%, 17%, and 42% at 1, 6, and 12 months, respectively. Graft and patient survival rates were 100%, 85%, and 71% and 100%, 92%, and 74% at 1, 6, and 12 months, respectively. Patient survival rates dropped significantly once decompensation developed (93%, 61%, and 41% at 1, 6, and 12 months, respectively). Variables associated with decompensation, retransplantation, and mortality rate included a high Child-Pugh score (>A), low levels of albumin at post-liver transplantation cirrhosis, and a short interval between liver transplantation and post-liver transplantation cirrhosis. The natural history of clinically compensated HCV-graft cirrhosis is shortened when compared with immunocompetent patients. If retransplantation is considered, it should be performed promptly once decompensation develops. (HEPATOLOGY 2000;32:852-858.)

Transmission of hepatitis B virus (HBV) infection from T he acquisition of hepatitis B virus (HBV) infectionafter liver transplantation remains a significant problem in the liver transplant setting. Although de novo HBV infection may occur as a result of the reactivation of occult HBV infection in the recipient, 1,2 recent reports suggest that the vast majority of acquired HBV infections after liver transplantation are related to the donor liver. Liver grafts from donors who are hepatitis B surface antigen negative (HBsAg-) but positive for antibody to hepatitis B core antigen (anti-HBcϩ) have been shown to transmit HBV infection to HBsAg-liver transplant recipients at a rate that ranged from 33% to 78%. [3][4][5][6] However, these results were mostly derived from studies performed in geographic regions with a low prevalence (3% to 4%) of anti-HBc positivity in the liver donor population.The prevalence of HBsAg in the adult Spanish population ranges from 1.2% to 1.7%. 7,8 Accordingly, the prevalence of anti-HBc positivity in the general population is greater than that reported in areas of low prevalence of HBV infection. In a recent study, anti-HBc positivity was found in 10% of the Spanish adults aged 26 to 65 years. 7 In Spain, the current policy of the Organización Nacional de Trasplantes (ONT), the Spanish Organ Procurement Organization, is to test organ donors only for HBsAg. To a certain extent, the liver donor population is a reflection of the general population; therefore, it is reasonable to anticipate that the prevalence of anti-HBc positivity in Spanish liver donors and thus the incidence of de novo HBV infection after liver transplantation would be greater in our area than in areas of lower prevalence. In addition, inFrom the *HepatoGastroenterology, †Microbiology, and ‡Pathology Services, and the §Liver Transplantation and

ESHAP is an active regimen for relapsing Hodgkin's disease, with myelosuppression as its dose-limiting toxicity. An increased risk of treatment-related mortality when it is combined with high-dose chemotherapy can not be ruled out.

A new prognostic index is proposed allowing identification of three different PG. The feasibility of three known prognostic models was validated and demonstrated. Variables other than disease extent or PS (albumin or LDH) should be taken into account in designing future clinical trials.

Hepatocellular carcinoma (HCC) is still considered a controversial indication for liver transplantation (LT), mainly because of long waiting times and underlying viral cirrhosis. The goal was to evaluate the outcome of LT in 104 patients with HCC and cirrhosis, mainly hepatitis C virus (HCV)-related, in a center with a short waiting time (median, 105 days). Four groups were formed according to the HCC and HCV status: HCV positive with HCC (group 1, n ‫؍‬ 81), HCV negative with HCC (group 2, n ‫؍‬ 23), HCV positive without HCC (group 3, n ‫؍‬ 200), and HCV negative without HCC (group 4, n ‫؍‬ 207). Predictive factors of tumor recurrence were demographics, tumor related (size or number of nodules, capsule, bilobar involvement, vascular or lymphatic invasion, clinical and pathologic TNM staging, pre-LT percutaneous ultrasound-guided ethanol injection or transarterial chemoembolization, ␣-fetoprotein levels), donor and surgery related, and year of transplantation. The same variables and "tumor recurrence (yes/no)" were applied to evaluate the effect on survival. The median follow up was 29 months (range, 0 to 104 months). Patient survival was 70% at 1 year and 59% at 5 years for group 1, 87% at 1 year and 77% at 5 years for group 2, 81% at 1 year and 64% at 5 years for group 3, and 88% at 1 year and 77% at 5 years for group 4 (P ‫؍‬ .013). Survival was significantly lower in patients with HCC than in those without (74% and 63% versus 85% and 70%, at 1 and 5 years, respectively; P ‫؍‬ .05). The causes of death in those with and without HCC were tumor recurrence (24%) and recurrent HCV (8%) versus sepsis (34%) and recurrent HCV (14%). HCC recurrence occurred in 12 patients (11.5%) at a median of 14 months (range, 3 to 60 months) with a probability increasing from 8% at 1 year to 16% at 5 years. In patients with HCC, tumor recurrence was associated with vascular invasion (P ‫؍‬ .0004) by multivariate analysis; variables predictive of survival were donor old H epatocellular carcinoma (HCC) is the most frequent primary liver cancer worldwide, responsible for more than 1 million deaths yearly. 1 Without specific interventions, the mean survival time in patients with HCC in advanced stages is approximately 1 to 2 months, and that of patients with HCC in early stages only reaches 9 to 10 months. 2 Data from our country are slightly more optimistic, with survival rates of 3 and 15 months, respectively. 3 In a large recent prospective study based on cirrhotic patients with HCC, the median survival time was 17 months, ranging from 1 to 60 months, with a cumulative survival rate at 1, 3, and 5 years of 54%, 40%, and 28%, respectively. 4 Surgical resection is the only procedure capable of achieving a complete cure of this disease, and in that sense, it is likely that liver transplantation (LT) might be the best available oncologic option. 5 During the early years of transplantation activity, transplantation was only used in patients with large tumors. Unfortunately, results were highly disappointing because of the high rates of ...