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Hepatic allograft rejection remains an important problem following liver transplantation, and, indeed, complications related to the administration of immunosuppressive therapy remain a predominant cause of posttransplantation morbidity and mortality. The Liver Transplantation Database (LTD) was used to study a cohort of 762 consecutive adult liver transplantation recipients and determined the incidence, timing, and risk factors for acute rejection. We also evaluated the impact of histological severity of rejection on the need for additional immunosuppressive therapy and on patient and graft survival. Four hundred ninety (64%) of the 762 adult liver transplantation recipients developed at least one episode of rejection during a median follow-up period of 1,042 days (range, 336-1,896 days), most of which occurred during the first 6 weeks after transplantation. Multivariate analysis revealed that recipient age, serum creatinine, aspartate transaminase (AST) level, presence of edema, donor/recipient HLA-DR mismatch, cold ischemic time, and donor age were independently associated with the time to acute rejection. An interesting observation was that the histological severity of rejection was an important prognosticator: the use of antilymphocyte preparations was higher, and the time to death or retransplantation was shorter, for patients with severe rejection. Findings from this study will assist in decision-making for the use of immunosuppressive regimens and call into question whether complete elimination of all rejection or alloreactivity is a desirable goal in liver transplantation. (HEPATOLOGY 1998;28: 638-645.)The results of liver transplantation have continued to improve, with 1-year patient survival now approaching 86% in some groups of patients. 1 However, hepatic allograft rejection remains an important problem following liver transplantation and is the major reason that immunosuppressive therapy must be administered. Indeed, complications related to the administration of immunosuppressive therapy are still the predominant causes of morbidity and mortality in the liver transplantation recipient. 2 While previous studies have shown that acute hepatic allograft rejection is common following liver transplantation, the use of multiple diagnostic schemes and the lack of uniform diagnostic criteria has made it difficult to assess the true incidence of rejection. [3][4][5][6][7] Furthermore, the identification of clinical risk factors for acute rejection, and the impact of rejection on subsequent patient outcome, remain poorly defined. In this study, we determined the incidence and timing of, and identified clinical risk factors for, acute rejection. In addition, we examined the association of histological severity of acute rejection using the Liver Transplantation Database (LTD) criteria 8,9 with the degree of biochemical liver dysfunction, the need for more aggressive immunosuppressive therapy, and overall patient outcome. PATIENTS AND METHODSThe LTD is a 7-year prospective study of patients undergoing liver tran...

SUMMARYThe Indo-US Cross-National Dementia Epidemiology Study seeks to compare two rural populations, in the US and India: the Monongahela Valley, a rural community of relatively low socioeconomic status in southwestern Pennsylvania (USA), and Ballabgarh, a rural community near New Delhi in North India. Of particular interest is the fact that the Ballabgarh elderly population is exclusively Hindi-speaking, has little or no education and is largely illiterate, rendering its cognitive screening a particular challenge. In this article we report methods and preliminary data on the development of a Hindi cognitive screening instrument suitable for the Ballabgarh elderly population. We use as an example our Hindi adaptation of the Mini-Mental State Examination (MMSE), a widely used global cognitive screening scale. Systematic, item-by-item, empirically based test development has shown that effective modifications can be made to existing tests that require reading and writing; and that culturally sensitive modifications can be made to render the test meaningful and relevant while still tapping the appropriate cognitive domains. Certain cognitive functions, particularly orientation to time, remain difficult to test adequately in this type of population. In Ballabgarh, as in the Monongahela Valley, educated individuals obtain higher test scores. Implications for dementia screening are discussed, including those relevant to the hypothesis that low education predisposes to dementia.KEY WORDS-dementia epidemiology; ageing; neuropsychology; cross-cultural research Cognitive impairment, characteristic of dementia, is measured objectively by standard neuropsychological (cognitive) tests. Screening for dementia is usually accomplished by means of a global cognitive

Objective: To evaluate the frequency of HIV-associated neurocognitive disorder (HAND) in HIV1 individuals and determine whether the frequency of HAND changed over 4 years of follow-up. Methods:The Multicenter AIDS Cohort Study (MACS) is a prospective study of gay/bisexual men.Beginning in 2007, all MACS participants received a full neuropsychological test battery and functional assessments every 2 years to allow for HAND classification.