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Background & Aims Data from Europe and North America have been published regarding the risk of developing hepatocellular carcinoma (HCC) after treatment with direct antiviral agents (DAA). We proposed to evaluate cumulative incidence and associated risk factors for de novo HCC. Methods This was a prospective multicentre cohort study from Latin America including 1400 F1‐F4‐treated patients with DAAs (F3‐F4 n = 1017). Cox proportional regression models (hazard ratios, HR and 95% CI) were used to evaluate independent associated variables with HCC. Further adjustment with competing risk regression and propensity score matching was carried out. Results During a median follow‐up of 16 months (IQR 8.9‐23.4 months) since DAAs initiation, overall cumulative incidence of HCC was 0.02 (CI 0.01; 0.03) at 12 months and 0.04 (CI 0.03; 0.06) at 24 months. Cumulative incidence of HCC in cirrhotic patients (n = 784) was 0.03 (CI 0.02‐0.05) at 12 months and 0.06 (CI 0.04‐0.08) at 24 months of follow‐up. Failure to achieve SVR was independently associated with de novo HCC with a HR of 4.9 (CI 1.44; 17.32), after adjusting for diabetes mellitus, previous interferon non‐responder, Child‐Pugh and clinically significant portal hypertension. SVR presented an overall relative risk reduction for de novo HCC of 73% (CI 15%‐91%), 17 patients were needed to be treated to prevent one case of de novo HCC in this cohort. Conclusions Achieving SVR with DAA regimens was associated with a significant risk reduction in HCC. However, this risk remained high in patients with advanced fibrosis, thus demanding continuous surveillance strategies in this population.

Pulmonary complications after orthotopic liver transplant (OLT) are frequent, involving high morbidity and mortality. We have determined the pulmonary complication incidence in 187 patients submitted to OLT at the General University Hospital "Gregorio Maraiion" in the last 4 years, analyzing the type of infection, evolution, diagnostic and therapeutic measures and their influence on OLT niortality. A total of 120 patients had pulmonary complications, the most frequent being pleural effusion (61.94 YO), pneumonia (43.36 YO), and pneumothorax (11.5 YO). Serious pulmonary hypertension was diagnosed by invasive methods in two patients at the time of surgery (unidentified before OLT); both died at early post postoperative times. Pleural effusion was noted in 70 patients. 31.42% of them requiring thoracic tube drainage, complications developing in 22.72 %. Thirteen patients were diagnosed of pneumothorax, the most frequent etiologies being percutaneous liver biopsy, thoracic tube drainage for pleural effusion. and postoperative complications in 41.6, 33.3, and 23.3 YO, respectively. Pneumonia was diagnosed in the 1st month after OLT in 45 patients. Tests to diagnose and identify the etiological agent were made in 71.1 % of diagnosed pneumonia patients, identification being obtained in 62.5 YO. Telescope catheter culture identified the agent in 48 Yo, fiber optic bronchoscopy in 50 Yo, and lung or pleural biopsy in 100 YO. Respiratory insufficiency was noted in 64 patients (34.22 YO of transplanted patients). Factors involved in their development were pneumonia (42.1 8 YO), graft dysfunction (39.06 %, pleura1 effusion (34.37 %), sepsis (28.18 Y ) , and poor nutritional status (7.81 "/o). Fifty patients (41.66 %) died, pulmonary pathology being the determinant factor in 28.8 Yo. Patient mortality with respiratory insufficiency was greater, especially in those with three factors involved the development of respiratory insufficiency.

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A trend toward a higher incidence of hepatocelullar carcinoma (HCC) in patients with cirrhosis treated with bare-stent transjugular intrahepatic portosystemic shunt (TIPS) has been observed in previous studies. To assess the influence of TIPS as a risk factor for developing HCC, we have compared the incidence of HCC in two retrospective cohorts of patients. The TIPS cohort (n ‫؍‬ 138) included patients with cirrhosis who underwent TIPS placement for the treatment of portal hypertension-related complications; the non-TIPS cohort was composed of patients admitted at the hospital at the same time of TIPS insertion who were individually H epatocellular carcinoma (HCC) is a wellknown complication of cirrhosis. The incidence of this neoplasm has increased worldwide in the last few decades, 1-4 and it currently represents one of the major causes of death in patients with end-stage liver disease. 5 Cirrhosis is considered the major risk factor for developing HCC. 6 Male sex, older age, advanced ChildTurcotte-Pugh class, and viral and alcoholic causes of cirrhosis have been consistently associated with HCC in different studies. 5,7 Other risk factors for developing HCC, however, are not as well defined, due in part to the difficulty of performing epidemiological studies on this condition.Transjugular intrahepatic portosystemic shunt (TIPS) is an invasive procedure in which a side-to-side portacaval shunt is created by placing a stent between the portal vein and a hepatic vein or the cava vein. Because this procedure effectively reduces portal pressure, it is widely used to treat portal hypertensionrelated complications. [8][9][10] A potential association between surgical portosystemic shunting and the development of HCC has been suggested in a retrospective study of autopsies performed on patients who had cirrhosis, 11 but this association has not been confirmed by other studies. 12 Although TIPS is not a surgical shunt, it generates similar circulatory, hemodynamic, and functional changes. As in surgical shunts, two recent preliminary studies have observed higher 13 and unchanged 14 incidence of HCC in patients with noncovered TIPS. Clearly more controlled observations with longer follow-up are needed to better assess the influence of TIPS on the development of HCC. Therefore, we designed a clinical retrospective cohort study to evaluate TIPS as a risk factor for developing HCC. From the