The protective capacity and duration of humoral immunity after SARS‐CoV‐2 infection is not yet understood in solid organ transplant recipients. A prospective multicenter study was performed to evaluate the persistence of anti‐nucleocapsid IgG antibodies in liver transplant recipients 6 months after coronavirus disease 2019 (COVID‐19) resolution. A total of 71 liver transplant recipients were matched with 71 immunocompetent controls by a propensity score including variables with a well‐known prognostic impact in COVID‐19. Paired case‐control serological data was also available in 62 liver transplant patients and 62 controls at month 3 after COVID‐19. Liver transplant recipients showed a lower incidence of anti‐nucleocapsid IgG antibodies at 3 months (77.4% vs. 100%, p<0.001) and at 6 months (63.4% vs. 90.1%, p<0.001). Lower levels of antibodies were also observed in liver transplant patients at 3 (p=0.001) and 6 months (p<0.001) after COVID‐19. In transplant patients, female gender (OR=13.49, 95%CI 2.17‐83.8), a longer interval since transplantation (OR=1.19, 95%CI 1.03‐1.36), and therapy with renin–angiotensin–aldosterone system inhibitors (OR=7.11, 95%CI 1.47‐34.50) were independently associated with persistence of antibodies beyond 6 months after COVID‐19. Therefore, as compared with immunocompetent patients, liver transplant recipients show a lower prevalence of anti‐SARS‐CoV‐2 antibodies and more pronounced antibody levels decline.

Background: Delayed cholecystectomy in patients with symptomatic gallstone disease is associated with recurrence. Limited data on the recurrence patterns and the factors that determine them are available.Objective: We aimed to determine the pattern of relapse in each symptomatic gallstone disease (acute pancreatitis, cholecystitis, cholangitis, symptomatic choledocholithiasis, and biliary colic) and determine the associated factors.Methods: RELAPSTONE was an international multicenter retrospective cohort study. Patients (n = 3016) from 18 tertiary centers who suffered a first episode of symptomatic gallstone disease from 2018 to 2020 and had not undergone cholecystectomy during admission were included. The main outcome was relapse‐free survival. Kaplan–Meier curves were used in the bivariate analysis. Multivariable Cox regression models were used to identify prognostic factors associated with relapses.Results: Mean age was 76.6 [IQR: 59.7–84.1], and 51% were male. The median follow‐up was 5.3 months [IQR 2.1–12.4]. Relapse‐free survival was 0.79 (95% CI: 0.77–0.80) at 3 months, 0.71 (95% CI: 0.69–0.73) at 6 months, and 0.63 (95% CI: 0.61–0.65) at 12 months. In multivariable analysis, older age (HR = 0.57; 95% CI: 0.49–0.66), sphincterotomy (HR = 0.58, 95% CI: 0.49–0.68) and higher leukocyte count (HR = 0.79; 95% CI: 0.70–0.90) were independently associated with lower risk of relapse, whereas higher levels of alanine aminotransferase (HR = 1.22; 95% CI: 1.02–1.46) and multiple cholelithiasis (HR = 1.19, 95% CI: 1.05–1.34) were associated with higher relapse rates.Conclusion: The relapse rate is high and different in each symptomatic gallstone disease. Our independent predictors could be useful for prioritizing patients on the waiting list for cholecystectomies.

INTRODUCTION: Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality. METHODS: This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022. RESULTS: We included 102 patients: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01–1.05, P = 0.005). EVT failure (OR 24.5, 95% CI 4.5–133, P = 0.001) and development of pneumonia after EVT (OR 246.97, 95% CI 11.15–5,472.58, P = 0.0001) were independent predictors of in-hospital mortality. DISCUSSION: EVT is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.

Background and aims: Obesity is considered a risk factor for perioperative complications, but its effect on patients undergoing liver transplantation (LT) remains unclear. This study was conducted to analyze the impact of obesity on early morbidity and mortality risk following LT. Methods: A multicenter study of outcomes in patients submitted to LT between 2009 and 2019 was conducted. Recipients were stratified into obese (BMI ≥ 30 kg/m²) and nonobese patients (BMI < 30 kg/m²). Early postoperative complications were compared and 30-day and 1-year patient and graft survival were assessed by Kaplan–Meier method. Primary graft nonfunction (PGNF) was defined as the presence of total bilirubin > 10 mg/dl, INR > 1.6 or ALT > 2000 U/l within the first week after LT. Results: A total of 1608 patients were included after applying exclusion criteria, nonobese (1149, 71.46%) and obese patients (459, 28.54%). There were no significant differences in age, sex, Model for End-stage Liver Disease, Charlson comorbidity score, ethnicity, waiting list time and ischemia time. There were significantly higher rates of vascular (17.58% vs 23.53%, P = 0.021) and biliary complications (27.68% vs 35.73%, P = 0.006) and PGNF (11.40% vs 12.20%, P = 0.021) in obese patients. There was a significantly increased risk for long-term graft failure; however, there was no significant difference in patient survival after LT. Conclusion: Obese patients have significantly increased morbidity in terms of vascular and biliary complications and PGNF after LT. They have a higher risk for worse 1-year graft survival in comparison to controls.

Background and aims: Nonalcoholic fatty liver disease (NAFLD) is a long-term complication after liver transplantation. Our aims were to determine de-novo-NAFLD at 5-year post-liver transplantation and identify predictive risk factors. Methods: This was a retrospective analysis of de-novo-NAFLD at 5-year post-liver transplantation. NAFLD was defined as the radiological evidence of steatosis. Data from transplanted patients between November 2001 and May 2014 were collected. Noninvasive fibrosis scores were calculated. Predictors of de-novo NAFLD and survival were assessed by multivariate analyses and Kaplan–Meier method. Results: A total of 252 liver transplantations were evaluated after applying exclusion criteria, (78.6% men) with 54.9 years old (SD ± 9.5). Prevalence of de-novo NAFLD at 5-year post-liver transplantation was 36.1%. Cardiovascular events were presented in 19.88% and 23.08% of non-NAFLD and NAFLD patients, (P = 0.58). On multivariate analysis, male sex (OR, 5.40; P = 0.001), obesity (OR, 3.72; P = 0.017), metabolic syndrome (OR, 4.69; P < 0.001) and de-novo diabetes (OR, 2.79; P = 0.018), were predictive. Significant fibrosis (≥F2) was presented in 58–86%. The mean survival in NAFLD and control group was 166.3 and 173.6 months, respectively (P = 0 0.50). Conclusion: De-novo NAFLD at fifth-year post-liver transplantation is frequently and associated with cardiovascular comorbidity. Male sex, obesity, de-novo diabetes and metabolic syndrome were factors associated with de-novo NAFLD. A significant proportion of patients had advanced fibrosis. This group trends toward worse patients’ survival.