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Background & Aims Primary sclerosing cholangitis (PSC) is associated with an increased risk of gallbladder cancer (GBC). Gallbladder polyps potentially harbour malignancy and thus international guidelines recommend prophylactic cholecystectomy for gallbladder polyps of any size in patients with PSC. To best inform patient care we sought to quantify the malignant risk of gallbladder polyps in patients with PSC. Methods A retrospective cohort study of patients followed in secondary and tertiary care settings in two large PSC clinics in North America was performed. Results In total, 453 patients were included with a median (IQR) follow‐up time of 7.7 (4.1‐12) years. A gallbladder polyp was radiographically detected in 16% (n = 71) with median size (range) of 4 (2‐18) mm. In this group, post‐cholecystectomy histology (n = 17) reported benign or no polyp in 77% (n = 13), dysplasia in 5.9% (n = 1) and malignancy in 18% (n = 3). The GBC rate was 8.8 (95% CI 1.8‐25.7) per 1000 person‐years in patients with a radiographically detected gallbladder polyp. GBC was associated with polyps >10 mm, interval growth or mass‐like lesions on pre‐operative imaging. In patients who did not have cholecystectomy (n = 50), the polyp was only transiently seen in 80% (n = 40), remained stable or decreased in size in 10% (n = 5) and increased in size in 6% (n = 3). The majority of gallbladder polyps did not show significant growth over time (0.041 mm/year [95% CI −0.017 to 0.249]). Conclusions Most gallbladder polyps in patients with PSC are benign. Short‐term surveillance imaging may be considered prior to recommending immediate cholecystectomy in patients with PSC without high‐risk imaging features.

Background & Aims: Evidence for the benefit of scheduled imaging for early detection of hepatobiliary malignancies in primary sclerosing cholangitis (PSC) is limited.We aimed to compare different follow-up strategies in PSC with the hypothesis that regular imaging improves survival. Methods:We collected retrospective data from 2975 PSC patients from 27 centres. Patients were followed from the start of scheduled imaging or in case of clinical follow-up from 1 January 2000, until death or last clinical follow-up alive. The primary endpoint was all-cause mortality.Results: A broad variety of different follow-up strategies were reported. All except one centre used regular imaging, ultrasound (US) and/or magnetic resonance imaging (MRI).Two centres used scheduled endoscopic retrograde cholangiopancreatography (ERCP) in addition to imaging for surveillance purposes. The overall HR (CI95%) for death, adjusted for sex, age and start year of follow-up, was 0.61 (0.47-0.80) for scheduled imaging with and without ERCP; 0.64 (0.48-0.86) for US/MRI and 0.53 (0.37-0.75) for follow-up strategies including scheduled ERCP. The lower risk of death remained for scheduled imaging with and without ERCP after adjustment for cholangiocarcinoma (CCA) or high-grade dysplasia as a time-dependent covariate, HR 0.57 (0.44-0.75). Hepatobiliary malignancy was diagnosed in 175 (5.9%) of the patients at 7.9 years of follow-up. Asymptomatic patients (25%) with CCA had better survival if scheduled imaging had been performed.

The Executive Order launching the Advancing American Kidney Health Initiative in 2019 put a spotlight on the system of organ donation. The Center for Medicare and Medicaid Services (CMS) and the US Department of Health and Human Services (HHS) put forward proposals to change the metrics by which the 58 Organ Procurement Organizations (OPOs) are evaluated. One proposed change is that OPOs would be evaluated every 12 months, using objective, verifiable data from the Centers for Disease Control and Prevention (CDC) to define the denominator of potential donors. 1 Based on the proposal, CMS would require that if an OPO's donation rate (both based

Despite increases in the number of deceased donors in the United States, the donor supply fails to meet the ever-increasing demand. Centers have had to increase use of "marginal" liver grafts to increase the number of deceased donor liver transplantations (DDLTs). The term marginal has been used to describe donors with significant macrosteatosis, advanced age, donations after circulatory death, and split livers, for which a lot of data exist in the field of liver transplantation. (1) However, there are little data on use and outcomes of DDLTs from donors with fibrosis and none on a national level. A single-center study has shown the feasibility of transplanting livers with F1/F2 fibrosis per the Ishak scale, but there are knowledge gaps. In fact, some suggest that livers with greater than F2 fibrosis are unsuitable for transplantation. (2)(3)(4) Therefore, we sought to use national data to evaluate organ use and graft outcomes among donors with liver fibrosis. MethodsWe evaluated Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) data from December 24, 2014, to June 11, 2020. The Standard Transplant Analysis and Research file included data on donor biopsies, including hepatic fibrosis. Liver fibrosis was graded using the Ishak scale and categorized as none/minimal (0-1), mild/ moderate (2-3), and advanced/cirrhotic (4-6). STATISTICAL ANALYSISThe following 2 analyses were performed: (1) multivariable logistic regression models and (2) mixedeffects Cox regression models. We included donor covariates that could be related to an increased risk of fibrosis, use, and/or early graft outcomes. Liver UseWe fit multivariable logistic regression models with the primary exposure of liver fibrosis. We used a backward selection process to include variables with a P value <0.05. Graft OutcomesWe fit time-to-event models with donor fibrosis as the primary exposure. We fit 3 models, truncating follow-up at 3, 6, and 12 months to focus on short-term graft failure. To account for correlated graft outcomes within transplant centers, we fit mixed-effects Cox regression models with center as a random effect. We