Outcomes of Liver Transplantation Among Older Recipients With Nonalcoholic Steatohepatitis in a Large Multicenter US Cohort: the Re-Evaluating Age Limits in Transplantation Consortium.

The liver transplantation (LT) population is aging, with the need for transplant being driven by the growing prevalence of nonalcoholic steatohepatitis (NASH). Older LT recipients with NASH may be at an increased risk for adverse outcomes after LT. Our objective is to characterize outcomes in these recipients in a large multicenter cohort. All primary LT recipients ≥65 years from 2010 to 2016 at 13 centers in the Re-Evaluating Age Limits in Transplantation (REALT) consortium were included. Of 1023 LT recipients, 226 (22.1%) were over 70 years old, and 207 (20.2%) had NASH. Compared with other LT recipients, NASH recipients were older (68.0 versus 67.3 years), more likely to be female (47.3% versus 32.8%), White (78.3% versus 68.0%), Hispanic (12.1% versus 9.2%), and had higher Model for End-Stage Liver Disease-sodium (21 versus 18) at LT (P < 0.05 for all). Specific cardiac risk factors including diabetes with or without chronic complications (69.6%), hypertension (66.3%), hyperlipidemia (46.3%), coronary artery disease (36.7%), and moderate-to-severe renal disease (44.4%) were highly prevalent among NASH LT recipients. Graft survival among NASH patients was 90.3% at 1 year and 82.4% at 3 years compared with 88.9% at 1 year and 80.4% at 3 years for non-NASH patients (log-rank P = 0.58 and P = 0.59, respectively). Within 1 year after LT, the incidence of graft rejection (17.4%), biliary strictures (20.9%), and solid organ cancers (4.9%) were comparable. Rates of cardiovascular (CV) complications, renal failure, and infection were also similar in both groups. We observed similar posttransplant morbidity and mortality outcomes for NASH and non-NASH LT recipients. Certain CV risk factors were more prevalent in this population, although posttransplant outcomes within 1 year including CV events and renal failure were similar to non-NASH LT recipients.

Gastrointestinal Hemorrhage due to Large B-Cell Lymphoma Treated With Hemospray.

Gastrointestinal bleeding (GIB) is a common cause of hospitalization and is associated with significant morbidity and mortality. The most frequent causes of nonvariceal upper GIB are peptic ulcers, mucosal erosions, Mallory-Weiss tears, and malignancy. Current endoscopic hemostatic methods, including injections, thermal and mechanical modalities, have a 5%-10% chance of recurrent bleeding. Hemospray (Cook Medical, Winston-Salem, NC, USA) is a recently approved modality and can help treat tumor-related GIB. We present a case of a patient with diffuse large B-cell gastric lymphoma who presented with tumor-related GIB. His clinical course was complicated by gastric perforation and active bleeding which was treated with Hemospray and over-the-scope clips (OTSC, Ovesco, Tübingen, Germany).

Acute Pancreatitis Due to Clipping of the Ampulla With Over-The-Scope Clip as a Complication of Bleeding Duodenal Ulcer Treatment.

Over-the-scope clips (OTSC) (Ovesco, Tübingen, Germany) are commonly used for closure of bowel perforations, fistulas and to achieve hemostasis. This device is attached to the endoscope and delivers a variety of clips, based on diameter and depth, that works through tissue approximation. Complications including local inflammation, ulcers, or obstruction can occur. When the clip is misplaced or OTSC-associated complications occur, OTSC removal may be indicated. We present a case of a patient who presented to our hospital with upper gastrointestinal (GI) bleeding. OTSC was used to achieve hemostasis, however, the clip was misplaced over the ampulla of Vater. remOVE system (Ovesco, Tübingen, Germany) was used to remove the misplaced clip.

Gastric Ulcer and Perforation due to Mucormycosis in an Immunocompetent Patient.

Mucormycosis is a rare and life-threatening fungal infection that is associated with high mortality in immunocompromised individuals. Although it most commonly affects lungs and paranasal sinuses, cases of invasive mucormycosis of the gastrointestinal tract have also been reported. Gastrointestinal mucormycosis (GIM) is most commonly found in the stomach, colon, and ileum. Etiologies of GIM include ingestion of spores and penetrating abdominal trauma, causing mucocutaneous disruption. We present a case of an immunocompetent man who presented to our hospital after a gunshot wound to the abdomen. His hospital course was complicated with the development of invasive GIM in the form of a large gastric ulcer, which caused gastrointestinal bleeding and eventually perforation.