Background: The burden of end-stage liver disease in older adults has increased; understanding trends in liver transplantation (LT) and outcomes for older recipients is imperative for evaluation, counseling, and appropriate referral of this vulnerable group of older adults. Study design and setting: We studied 8,627 older (age≥65) deceased donor liver-only transplant recipients using data from the Scientific Registry of Transplant Recipients (1/1/2003–12/31/2016). We evaluated temporal changes in recipient, donor, and transplant characteristics. We also evaluated post-LT length of stay (LOS), acute rejection, graft loss, and mortality using logistic regression and Cox proportional hazards. Results: LT in older adults increased almost 5-fold from 263 in 2003 (9.5% of total LT that year) to 1,144 in 2016 (20.7% of total LT). Recent recipients were more likely to be female, African American, and have a higher BMI and MELD score. Hepatitis C, non-alcoholic steatohepatitis, and hepatocellular carcinoma were the most common indications for LT in recent recipients. Comparing those in 2013–2016 to those in 2003–2006, odds of LOS>2 weeks decreased 34% (adjusted odds ratio [aOR]:0.66, 95%CI:0.57–0.76, P<.001), 1-year acute rejection decreased 30% (aOR:0.70, 95%CI:0.56–0.88, P=.002), all-cause graft loss decreased 54% (adjusted hazard ratio [aHR]:0.46, 95%CI:0.40–0.52, P<.001), and mortality decreased 57% (aHR:0.43, 95%CI:0.38–0.49, P<.001). Conclusion: Despite the substantial increase in number and severity of older adults undergoing LT, LOS, rejection, graft loss, and mortality have significantly decreased over time. These trends can help guide appropriate LT referral and counseling in older adults with end-stage liver disease.

In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leading cause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage III (node-positive) disease. For stage II and III colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluation-this is known as complete clinical response (cCR). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with cCR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.

Background: Arteriovenous fistulas (AVF) and grafts (AVG) have been associated with significant cardiac morbidity that often improves after ligation. However, AV access ligation after kidney transplant (KT) is controversial due to concern for potential long-term allograft failure. We investigated US trends in AV access ligation after KT and the association between ligation and allograft failure.Methods: All adult Medicare patients on pretransplant hemodialysis with a functioning AVF or AVG who underwent first-time KT were studied using the United States Renal Data Systems (January 2011 to December 2013). Post-transplant AV access ligation was determined using current procedural terminology codes. The incidence of post-transplant AV access ligation was described, and characteristics for patients undergoing ligation vs no ligation were compared. Kaplan-Meier curves and Cox proportional hazard models were then used to determine the association of AV access ligation with long-term allograft failure and all-cause mortality after accounting for patient characteristics, donor characteristics, and variation in transplant center practices.Results: A total of 16,845 patients with functioning AVF/AVG received a KT during the study period. Of these, 779 (4.6%) underwent post-transplant AV access ligation. The proportion of patients who underwent ligation varied From the