Again, this may relate to allocation policy, as patients with T3 lesions are not given priority for deceased donation. It is also important

to note that the non-LDLT group did contain significantly more patients with HCV, fewer with cholestatic liver disease, and more racial diversity. Although these factors were adjusted for in the model, the power to detect differences is impacted as the numbers decrease. In addition, although this was a multicenter study the results of individual centers were not reported. A center effect has been reported to have a major impact on outcomes with liver transplantation.4 Although it is likely all centers within A2ALL are highly experienced at both living donor and deceased donor transplant, it is not known whether these results could be applied to all centers. In addition, there are marked geographic differences in MELD

threshold for access to deceased donor transplant, as C59 wnt order well as in the quality of deceased donor allografts.5, 6 These differences would likely augment or mitigate the survival benefit of living donor transplant, depending on the donor service area and region of the transplant center. Finally, and most essentially, this was not a randomized trial of all patients wait-listed for liver transplantation, but rather of a selected group of patients deemed appropriate candidates for LDLT by their transplant centers. Thus, centers must still consider what is best for each and every individual patient on their wait list based on factors that may impact outcome at their center. If there is a very short anticipated wait time to DDLT based on factors such as HCC MELD exception www.selleckchem.com/products/Vincristine-Sulfate.html MCE公司 or favorable blood type, then a survival benefit to LDLT compared to DDLT likely will not be present. For individual patients, other factors that impact the decision to proceed to LDLT beyond the

potential for a survival benefit, such as uncontrolled encephalopathy, refractory ascites, and intractable pruritus must also be carefully considered. In the future, information regarding validated quality of life outcomes following LDLT versus prolonged time on the wait list and/or DDLT would provide exceptionally helpful additional guidance to assist in discussion with patients and families regarding timing and donor options for liver transplantation. “
“In the most recent American Association for the Study of Liver Diseases hepatitis B virus (HBV) guidelines, Drs. Lok and McMahon recommend as “prudent” “to test all human immunodeficiency virus (HIV)-infected persons for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) and if either is positive, to test for HBV DNA”.1 I think that the recommendation of testing for HBV DNA in HIV-infected patients with isolated anti-HBc antibodies should be better supported by clinical evidence. HBV DNA testing is an expensive test, and unless there is a well-defined clinical benefit, it is difficult to justify it.