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This retrospective study suggests that in patients with HCC tumours of ≥ 3 cm, treatment with TACE + SBRT provides a survival advantage over treatment with only TACE. Confirmation of this observation requires that the concept be tested in a prospective, randomized clinical trial.

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Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis.

Background:  Orthotopic liver transplantation (LT) in non‐alcoholic steatohepatitis (NASH) is increasing in parallel with the obesity epidemic. Methods:  This study retrospectively reviewed the clinical outcomes of LTs in NASH (n= 129) and non‐NASH (n= 775) aetiologies carried out at a single centre between 1999 and 2009. Results:  Rates of 1‐, 3‐ and 5‐year overall survival in NASH (90%, 88% and 85%, respectively) were comparable with those in non‐NASH (92%, 86% and 80%, respectively) patients. Mortality within 4 months of LT was twice as high in NASH as in non‐NASH patients (8.5% vs. 4.2%; P= 0.04). Compared with non‐NASH patients, post‐LT mortality in NASH patients was more commonly caused by infectious (38% vs. 26%; P < 0.05) or cardiac (19% vs. 7%; P < 0.05) aetiologies. Five‐year survival was lower in NASH patients with a high‐risk phenotype (age >60 years, body mass index >30 kg/m2, with hypertension and diabetes) than in NASH patients without these characteristics (72% vs. 87%; P= 0.02). Subgroup analyses revealed that 5‐year overall survival in NASH was equivalent to that in Laennec's cirrhosis (85% vs. 80%; P= 0.87), but lower than that in cirrhosis of cryptogenic aetiology (85% vs. 96%; P= 0.04). Conclusions:  Orthotopic LT in NASH was associated with increased early postoperative mortality, but 1‐, 3‐ and 5‐year overall survival rates were equivalent to those in non‐NASH patients.

Background The number of Medicaid beneficiaries has increased under the Affordable Care Act (ACA), improving access to solid organ transplantation in this disadvantaged patient cohort. It is unclear what impact Medicaid expansion will have on transplant outcomes. We performed a retrospective cohort analysis to measure the frequency and variation in Medicaid transplantation, and post-transplant survival in Medicaid patients. Study Design Adult heart, lung, liver, and renal transplant recipients between 2002 and 2011 (n=169,194) reported to the Scientific Registry of Transplant Recipients were identified. Transplant recipients were classified based on insurance status (Private, Medicare or Medicaid). Outcome measures included five-year post-transplant survival, summarized using Kaplan-Meier curves and compared with log-rank tests. Organ-specific Cox proportional hazards models were used to adjust for donor and recipient factors. Results Medicaid patients comprised 8.6% of all organ transplant recipients. Fewer transplants were performed than expected among Medicaid beneficiaries for all organs but liver [Observed/Expected ratios (95% CI): liver=1.21 (0.68, 1.90); heart=0.89 (0.44, 1.49); lung=0.57 (0.22, 1.06); renal=0.32 (0.08, 0.72)]. Medicaid transplant recipients were listed with more severe organ failure and experienced shorter transplant wait times. Post-transplant survival was lower in Medicaid patients compared to Private insurance for all organs. Post-transplant survival in Medicaid patients was similar to Medicare patients for heart, liver and renal but lower in lung. Conclusions Medicaid organ transplant beneficiaries had significantly lower survival compared to Privately insured beneficiaries. The more severe organ failure among Medicaid beneficiaries at the time of listing suggested a pattern of late referral, which may account for worse outcomes. Implementation of the ACA affords the opportunity to develop the necessary infrastructure to ensure timely transplant referrals and improve long-term outcomes in this vulnerable population.

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