B. van Hoek

Similar liver transplantation survival with selected cardiac death donors and brain death donors

The outcome of orthotopic liver transplantation (OLT) with controlled graft donation after cardiac death (DCD) is usually inferior to that with graft donation after brain death (DBD). This study compared outcomes from OLT with DBD versus controlled DCD donors with predefined restrictive acceptance criteria.

The spectrum of liver disease in systemic lupus erythematosus.

Abstract Patients with systemic lupus erythematosus (SLE) have a 25–50% chance of developing abnormal liver tests in their lifetime. This percentage does not include unconjugated hyperbilirubinaemia due to haemolysis associated with SLE, or elevated aspartate-aminotransferase caused by SLE-associated myositis. The most common cause is drug-induced hepatitis, while mild, predominantly lobular—but sometimes also portal and periportal—hepatitis reflecting SLE activity is another possibility. Other liver disease in SLE can be related to thrombotic events, whether or not associated with the lupus anticoagulant, including Budd-Chiari syndrome and veno-occlusive disease. Other liver abnormalities have been more or less frequently associated with SLE, such as nodular regenerative hyperplasia, perihepatitis, and hepatic or splenic rupture. Also viral hepatitis, obstructive jaundice, autoimmune hepatitis, primary biliary cirrhosis, granulomatous hepatitis, cryptococcus infection of the liver, chronic hepatitis with IgA or IgD deficiency, porphyria or idiopathic portal hypertension co-existing with SLE have been described.

HLA-DRB1*03:01 and HLA-DRB1*04:01 modify the presentation and outcome in autoimmune hepatitis type-1

The classical human leukocyte antigen (HLA)-DRB1*03:01 and HLA-DRB1*04:01 alleles are established autoimmune hepatitis (AIH) risk alleles. To study the immune-modifying effect of these alleles, we imputed the genotypes from genome-wide association data in 649 Dutch AIH type-1 patients. We therefore compared the international AIH group (IAIHG) diagnostic scores as well as the underlying clinical characteristics between patients positive and negative for these HLA alleles. Seventy-five percent of the AIH patients were HLA-DRB1*03:01/HLA-DRB1*04:01 positive. HLA-DRB1*03:01/HLA-DRB1*04:01-positive patients had a higher median IAIHG score than HLA-DRB1*03:01/HLA-DRB1*04:01-negative patients (P<0.001). We did not observe associations between HLA alleles and alanine transaminase levels (HLA-DRB1*03:01: P=0.2; HLA-DRB1*04:01; P=0.5); however, HLA-DRB1*03:01 was independently associated with higher immunoglobulin G levels (P=0.04). The HLA-DRB1*04:01 allele was independently associated with presentation at older age (P=0.03) and a female predominance (P=0.04). HLA-DRB1*03:01-positive patients received immunosuppressive medication and liver transplantation. In conclusion, the HLA-DRB1*03:01 and HLA-DRB1*04:01 alleles are both independently associated with the aggregate diagnostic IAIHG score in type-1 AIH patients, but are not essential for AIH development. HLA-DRB1*03:01 is the strongest genetic modifier of disease severity in AIH.

Auxiliary or orthotopic liver transplantation for acute fatty liver of pregnancy: case series and review of the literature.

for acute fatty liver of pregnancy: case series and review of the literature J Ringers, KWM Bloemenkamp, N Francisco, JJ Blok, MS Arbous, B van Hoek a Department of Transplant Surgery, Leiden University Medical Centre, Leiden, the Netherlands b Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands c Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands d Department of Intensive Care, Leiden University Medical Centre, Leiden, the Netherlands Correspondence: Prof Dr B van Hoek, Department of Gastroenterology and Hepatology, C4-P, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands. Email b.van_hoek@lumc.nl

149 THE MANNAN-BINDING LECTIN-ASSOCIATED SERINE PROTEASE-2 D120G MUTATION IS A COMMON PATHOPHYSIOLOGICAL DENOMINATOR FOR NON-ANASTOMOTIC BILIARY STRICTURES AFTER ORTHOTOPIC LIVER TRANSPLANTATION AND THE BUDD–CHIARI SYNDROME

148 LIVER TRANSPLANTATION IN CIRRHOTIC PATIENTS WITH MELD SCORE <18: A NEW PROGNOSTIC MODEL TO PREDICT DROP-OUT FROM THE WAITING LIST M. Dall’Agata, M. Biselli, A. Gramenzi, S. Gitto, C. Liberati, M. Ravaioli, M. Gambato, R. Montalti, P. Burra, U. Cillo, G.E. Gerunda, A.D. Pinna, P. Andreone, M. Bernardi. Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Dipartimento di Medicina Interna – Unita di Gastroenterologia, Azienda Ospedaliera-Universitaria Modena, Modena, Economics Department, University of Milano-Bicocca, Milan, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, University of Padova, Padova, Dipartimento di Chirurgia Generale e Specialita Chirurgiche, Unita Operativa di Chirurgia dei Trapianti, Azienda Ospedaliera-Universitaria Modena, Modena, Italy E-mail: mdallagata87@yahoo.it

496 LECTIN COMPLEMENT PATHWAY GENES OF DONOR AND RECIPIENT DETERMINE THE RISK OF CLINICALLY SIGNIFICANT INFECTIONS AFTER ORTHOTOPIC LIVER TRANSPLANTATION

for protease inhibitors (PI) (I13V, L33V, M36I, K43T, L63P, I64V, A71T, V77I). None harboured non-nucleoside reverse transcriptase inhibitors (NNRTI) mutations resistance. Virological failure under raltegravir (RAL) and enfuvirtide (ENF) was linked to the selection of the Q148R mutation and the N43D mutation. Three isolates had complete or possible resistance to NRTI (Stanford algorithm). Therapeutic trough levels of IS were maintained within the therapeutic target ranges. ARV adherence was suboptimal for one patient under ENF. HIV viral load became undetectable for all patients after changing ARV.

Similar liver transplantation survival with selected cardiac death donors and brain death donors (Br J Surg 2010; 97 : 744-753) Reply

Sir We read with interest the recent leading article in which the authors have indicated that the role of antireflux surgery for gastro-oesophageal reflux disease (GORD) is marginal and reserved only for patients who are either unwilling to take drugs or whose condition is refractory to such treatment. Although we agree with these two indications for surgery we believe that the role of surgery is not marginal. On the contrary, surgery offers a great deal more in a number of different clinical situations. Surgery should be considered in young patients who are completely dependent on high-dose proton-pump inhibitor (PPI) therapy and in whom lifelong PPIs are often required to control symptoms1. In addition to age, consideration should be given to general fitness and co-morbidity2. Patients on long-term acid suppression (10, 20 or even 30 years) are at risk of suffering intolerable side-effects and adverse drug interactions3,4, not least because of an absolute reduction in gastric acid. Theoretically, this can lead to an increase in the risk of gastric cancer. Furthermore, some patients still experience the unpleasant symptoms of regurgitation in the form of chronic cough and recurrent chest infections despite zealously following long-term PPI therapy. Lastly, the natural history of GORD is a gradual disease progression in many patients with or without acid suppression and it is prudent to counsel patients for surgery who are dependent on high-dose PPIs for more than 12 months. M. K. Zia and A. Hassn Department of Upper Gastrointestinal Tract Surgery, Princess of Wales Hospital, Bridgend, UK (e-mail: ahmed.Hassn@bromor-tr.Wales.nhs.uk) DOI: 10.1002/bjs.7205

Authors' reply: Similar liver transplantation survival with selected cardiac death donors and brain death donors (Br J Surg 2010; 97; 744–753)

Sir We read with interest the recent leading article in which the authors have indicated that the role of antireflux surgery for gastro-oesophageal reflux disease (GORD) is marginal and reserved only for patients who are either unwilling to take drugs or whose condition is refractory to such treatment. Although we agree with these two indications for surgery we believe that the role of surgery is not marginal. On the contrary, surgery offers a great deal more in a number of different clinical situations. Surgery should be considered in young patients who are completely dependent on high-dose proton-pump inhibitor (PPI) therapy and in whom lifelong PPIs are often required to control symptoms1. In addition to age, consideration should be given to general fitness and co-morbidity2. Patients on long-term acid suppression (10, 20 or even 30 years) are at risk of suffering intolerable side-effects and adverse drug interactions3,4, not least because of an absolute reduction in gastric acid. Theoretically, this can lead to an increase in the risk of gastric cancer. Furthermore, some patients still experience the unpleasant symptoms of regurgitation in the form of chronic cough and recurrent chest infections despite zealously following long-term PPI therapy. Lastly, the natural history of GORD is a gradual disease progression in many patients with or without acid suppression and it is prudent to counsel patients for surgery who are dependent on high-dose PPIs for more than 12 months. M. K. Zia and A. Hassn Department of Upper Gastrointestinal Tract Surgery, Princess of Wales Hospital, Bridgend, UK (e-mail: ahmed.Hassn@bromor-tr.Wales.nhs.uk) DOI: 10.1002/bjs.7205