Recently, several epidemiologic observations have suggested that obesity might be an independent risk factor for certain malignancies such as breast cancer, colon cancer, renal cell carcinoma, and esophageal adenocarcinoma. However, there are no studies examining the risk of hepatocellular carcinoma (HCC) in obesity. The aim of the present study was to determine whether obesity is an independent risk factor for HCC in patients with cirrhosis. Explanted liver specimens from a national database on patients undergoing liver transplantation were examined for HCC, and the incidence was compared among patients with varying body mass indices according to the etiology of cirrhosis. A multivariate analysis was used for controlling other potentially confounding variables such as age and sex. Among 19,271 evaluable patients, the overall incidence of HCC was 3.4% (n ‫؍‬ 659) with a slightly higher prevalence among obese patients compared with lean patients. Obesity was an independent predictor for HCC in patients with alcoholic cirrhosis (odds ratio [OR], 3.2; 95% CI, 1.5-6.6; P ‫؍‬ .002) and cryptogenic cirrhosis (OR, 11.1; 95% CI, 1.5-87.4; P ‫؍‬ .02). Obesity was not an independent predictor in patients with hepatitis C, hepatitis B, primary biliary cirrhosis, and autoimmune hepatitis. The higher risk of HCC in obese patients is confined to alcoholic liver disease and cryptogenic cirrhosis. In conclusion, more frequent surveillance for HCC may be warranted in obese patients with alcoholic and cryptogenic cirrhosis. However, as this study is based on patients with advanced cirrhosis, our findings need to be confirmed in a broader population of individuals with cirrhosis. (HEPATOLOGY 2002;36:150-155.)

Steroid-free liver transplantation using RATG and early tacrolimus monotherapy effectively reduces immunosuppression-related complications with excellent survival.

and 2 Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA Liver transplantation (LT) with donation after circulatory death (DCD) donors has been associated with a high rate of ischemic-type biliary strictures (ITBSs) and inferior graft survival. To investigate the impact of an intraoperative tissue plasminogen activator (tPA) on outcomes following DCD LT, we conducted a retrospective analysis of DCD LT at the Toronto General Hospital (TGH) and the Ochsner Medical Center (OMC). Between 2009 and 2013, 85 DCD LTs were performed with an intraoperative tPA injection (n 5 30 at TGH, n 5 55 at OMC), and they were compared with 33 DCD LTs without a tPA. Donor and recipient characteristics were similar in the 2 groups. There was no significant difference in the intraoperative packed red blood cell transfusion requirement (3.2 6 3.4 versus 3.1 6 2.3 U, P 5 0.74). Overall, biliary strictures occurred less commonly in the tPA-treated group (16.5% versus 33.3%, P 5 0.07) with a much lower rate of diffuse intrahepatic strictures (3.5% versus 21.2%, P 5 0.005). After 1 and 3 years, the tPA group versus the non-tPA group had superior patient survival (97.6% versus 87.0% and 92.7% versus 79.7%, P 5 0.016) and graft survival (96.4% versus 69.7% and 90.2% versus 63.6%, P < 0.001). In conclusion, a tPA injection into the hepatic artery during DCD LT reduces ITBSs and improves graft and patient survival without increasing the risk for bleeding. Liver Transpl 21:321-328, 2015. The use of liver transplantation (LT) as a lifesaving treatment for patients with end-stage liver disease continues to be primarily limited by donor organ availability. Donation after circulatory death (DCD) donors represent an important potential source to expand the donor pool for LT. However, posttransplant outcomes following DCD LT have to date been inferior in comparison with outcomes following LT with donation after brain death (DBD) donors. [1][2][3][4][5][6][7][8] Despite an increased use of DCD livers in the early part of the past decade, utilization has decreased in recent years as a result of inferior outcomes. 9 Biliary complications are the main contributor to inferior outcomes in DCD LT, with reported biliary stricture rates between 30% and 50% (more than double the rate for LT from DBD donors). The higher rate