Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery datasets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5×10−8) and used pathway analysis to identify JAK-STAT/IL12/IL27 signaling and cytokine-cytokine pathways, for which relevant therapies exist.

We genotyped 2,861 cases from the UK PBC consortium and 8,514 UK population controls across 196,524 variants within 186 known autoimmune risk loci. We identified three loci newly associated with primary biliary cirrhosis (PBC) (with P<5×10−8), increasing the number of known susceptibility loci to 25. The most associated variant at 19p12 is a low-frequency non-synonymous SNP in TYK2, further implicating JAK/STAT and cytokine signalling in disease pathogenesis. A further five loci contained non-synonymous variants in high linkage disequilibrium (LD) (r2>0.8) with the most associated variant at the locus. We found multiple independent common, low-frequency and rare variant association signals at five loci. Of the 26 independent non-HLA signals tagged on Immunochip, 15 have SNPs in B-lymphoblastoid open-chromatin regions in high LD (r2>0.8) with the most associated variant. This study demonstrates how dense fine-mapping arrays coupled with functional genomic data can be utilized to identify candidate causal variants for functional follow-up.

The proposed system, to be introduced into the UK compares with some other systems, where different models for selection and allocation have been introduced.

Double-contrast MR imaging significantly improves the diagnosis of HCC compared with SPIO-enhanced and nonenhanced imaging (P <.01).

Grafts from donation after cardiac death (DCD) donors are used to increase the number of organs available for liver transplantation. There is concern that warm ischemia may impair graft function. We compared our DCD recipients with a case-matched group of donation after brain death (DBD) recipients. Between January 2002 and April 2008, 39 DCD grafts were transplanted. These were matched with 39 DBD recipients on the basis of identified variables that had a significant impact on mortality. These were used to individually match DCD and DBD patients with similar predictive mortality. We compared patient/graft survival, primary non-function (PNF), and rates of complications. Of all liver transplants, 6.1% were DCD grafts. PNF occurred twice in the DCD group. The incidence of nonanastomotic biliary strictures (NABS; 20.5% versus 0%, P ϭ 0.005) and hepatic artery stenosis (HAS; 12.8% versus 0%, P ϭ 0.027) in the DCD group was higher. One-year (79.5% versus 97.4%, P ϭ 0.029) and 3-year (63.6% versus 97.4%, P ϭ 0.001) graft survival was lower in the DCD group. Three-year patient survival was also lower (68.2% versus 100%, P Ͻ 0.0001). Our study is the first to use case-matched patients and compare groups with similar predictive mortality. There was a higher incidence of NABS and HAS in the DCD group. NABS were likely a result of warm ischemia. HAS may have been due to ischemia or arterial injury during retrieval. The DCD group had significantly poorer outcomes, but DCD grafts remain a valuable resource. With careful donor/recipient selection, minimization of ischemia, and good postoperative care, acceptable results can be achieved.