Ohio solid organ transplantation consortium criteria for liver transplantation in patients with alcoholic liver disease

AIM To evaluate risk of recidivism on a case-by-case basis.METHODS From our center's liver transplant program,we selected patients with alcoholic liver disease who were listed for transplant based on Ohio Solid Organ Transplantation Consortium(OSOTC) exception criteria.They were considered to have either a low or medium risk of recidivism,and had at least one or three or more months of abstinence,respectively.They were matched based on gender,age,and Model for End-Stage Liver Disease(MELD) score to controls with alcohol-induced cirrhosis from Organ Procurement and Transplant Network data.RESULTS Thirty six patients with alcoholic liver disease were approved for listing based on OSOTC exception criteria and were matched to 72 controls.Nineteen patients(53%) with a median [Inter-quartile range(IQR)] MELD score of 24(13) received transplant and were followed for a median of 3.4 years.They were matched to 38 controls with a median(IQR) MELD score of 25(9).At one and five years,cumulative survival rates(± standard error) were 90% ± 7% and 92% ± 5% and 73% ± 12% and 77% ± 8% in patients and controls,respectively(Log-rank test,P = 0.837).Four(21%) patients resumed drinking by last follow-up visit.CONCLUSION Compared to traditional criteria for assessment of risk of recidivism,a careful selection process with more flexibility to evaluate eligibility on a case-by-case basis can lead to similar survival rates after transplantation.

Risk factors and clinical implication of superimposed Campylobacter jejuni infection in patients with underlying ulcerative colitis

Background and aims:Superimposed Campylobacter jejuni infection(CJI)has been described in patients with ulcerative colitis(UC).Its risk factors and impact on the disease course of UC are not known.Our aims were to evaluate the risk factors for CJI in UC patients and the impact of the bacterial infection on outcomes of UC.Methods:Out of a total of 918 UC patients tested,21(2.3%)of patients were found to be positive for CJI(the study group).The control group comprised 84 age-matched UC patients who had tested negative for CJI.Risk factors for CJI and UC-related outcomes at 1 year after diagnosis of CJI were compared between the two groups.Results:Ten patients(47.6%)with CJI required hospital admission at the time of diagnosis,including eight for the management of“UC flare”.Treatment with antibiotics resulted in improvement in symptoms in 13 patients(61.9%).On multivariate analysis,hospital admission in the preceding year was found to be an independent risk factor for CJI[odds ratio(OR):3.9;95%confidence interval(CI):1.1–14.1]and there was a trend for chronic liver disease as a strong risk factor(OR:5.0;95%CI:0.9–28.3).At 1-year follow up,there was a trend for higher rates of UC-related colectomy(28.8% vs.14.3%;P=0.11),and mortality(9.5%vs.1.2%;P=0.096)in the study group.Conclusion:Recent hospitalization within 1 year was found to be associated with increased risk for CJI in UC patients.There was a trend for worse clinical outcomes of UC with in patients with superimposed CJI,which was frequently associated with UC flare requiring hospital admission.

Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases

Objective:Our aim was to assess the risk factors for non-surgery-related portal and mesenteric vein thrombosis(PMVT)and its impact on the outcomes of inflammatory bowel diseases(IBD).Methods:All patients with a concurrent diagnosis of IBD and PMVT between January 2004 and October 2013 were identified from the electronic medical record(study group;n=20).Patients were matched for age,sex,and IBD phenotype with control IBD patients who had no PMVT,with a ratio of 1:3(control group;n=60).Risk factors for PMVT and IBD-related outcomes at one year after diagnosis of PMVT were compared between the two groups.Results:Of the 20 patients in the Study group,6(30%)had UC,14(70%)had CD and 11(55%)were male.On multivariable analysis,inpatient status(odds ratio[OR]6.88;95%confidence interval[CI]1.88-25.12)and baseline corticosteroid use(OR 4.39;95%CI 1.27-15.19)were found to be independent risk factors for the development of PMVT.At one-year follow-up,PMVT patients were more likely to have an adverse outcome of IBD,including subsequent emergency room visit(26.3%vs.1.7%;P=0.003),hospitalization for medical management(60.0%vs.20.0%;P=0.001)or IBD-related surgery(65.0%vs.26.7%;P=0.003)than the non-PMVT controls.In multivariable analysis,PMVT(OR 5.19;95%CI 1.07-25.28)and inpatient status(OR 8.92;95%CI 1.33-59.84)were found to be independent risk factors for poor outcome,whereas baseline immunomodulator use(OR 0.07;95%CI 0.01-0.51)was found to be a protective factor.Conclusions:IBD patients who were inpatients or receiving corticosteroid therapy had an increased risk of the development of PMVT.The presence of PMVT was associated with poor clinical outcomes in IBD.

Biological therapy for ulcerative colitis

Ulcerative colitis(UC)is a major form of inflammatory bowel disease(IBD)worldwide.Better understanding of the pathogenesis of UC has led to the development of novel therapeutic agents that target specific mediators of the inflammatory cascade.A number of biological agents have been approved by the U.S.Food and Drug Administration(FDA)for the treatment of UC and several more are currently in various phases of drug development.The commonly used agents include TNFa antagonists(e.g.infliximab,adalimumab,and golimumab)and anti-integrin agents(vedolizumab).These biological agents have profoundly influenced the management of UC patients,especially those with refractory disease.This paper reviews the currently available knowledge and evidence for the use of various biological agents in the treatment of UC.