Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of the vascular invasion by loco‐regional therapies, and define sub‐groups with better outcomes. Medical records of 45 patients were retrospectively reviewed and imaging was centrally assessed by an expert liver radiologist. In the 30 patients with validated diagnosis of macrovascular invasion, overall survival was 60% at 5 years. Pre‐transplant alpha fetoprotein (AFP) value was significantly different between patients with and without recurrence (p=0.019) and the optimal AFP cut‐off was 10ng/ml (area under curve= 0.78). Recurrence rate was 11% in patients with pre‐transplant AFP <10ng/ml. The number of viable nodules (p=0.008), the presence of residual HCC (p=0.036) and satellite nodules (p=0.001) on the explant were also significantly different between patients with and without recurrence. Selected HCC patients with radiological signs of vascular invasion could be considered for transplantation, provided that they previously underwent successful treatment of the macrovascular invasion resulting in a pre‐transplant AFP <10ng/ml. Their expected risk of post‐transplant HCC recurrence is 11%, and further prospective validation is needed.

Brustia, Raffaele, Giulia Enrione, Bruna Catuzzo, Luca Cavoretto, Massimo Pesenti Compagnoni, Enrico Visetti, Emmanuel Cauchy, Stefanie Ziegler, and Guido Giardini. Results of a prospective observational study on mountaineering emergencies in Western Alps: mind your head. High Alt Med Biol. 17:116–121, 2016.— Background: In the northern Italian district Valle d'Aosta district during winter and summer season the population can increase up to 170% of the resident population. A prospective monocentric observational registry was held to obtain a precise picture of seasonal mountain-related medical and traumatic major events. Methods: From 1st January 2012 to 31st December 2013 all patients admitted to the Aosta Regional Hospital Emergency Room for any event occurred above 2500 m were screened: all those affected by High Altitude Illness , Acute Illness in High Altitude , Trauma , or Cold disease were prospectively included. Activity incidence rate is expressed as the occurrence of mountain-related events per 1000 hours of mountain activity. Event Incidence rate is expressed as the occurrence of new cases per 1000 hours of mountain activity. Results: Two hundred two patients were included during the study period. Trauma (65.1% vs. 24.6%, p < 0.001) and head commotive injury (48.1% vs. 15.1%, p < 0.001) were more frequent during winter compared to the summer season. High altitude illness (36.9% vs. 9.3%, p < 0.001) and cold pathologies (15.1% vs. 0.1%, p < 0.001) occurred more frequently in summer than in winter. Patients (51.4%) were immediately discharged from emergency room, 8.4% after a 24-hour observation period, and 30.6% required hospitalization. During summer, the event risk is 0.013 per person and 1000 hours of mountain activity, while in winter, event risk amounts to 0.005 per person and 1000 hours of mountain activity. Comments: High altitude medical events or trauma represent <1% of pathologies observed in the emergency room department of a mountain district in the western Alps. Head commotive injury is the most observed mountain-related event in high altitude, in winter and during ski practice. High altitude illness and cold injuries are observed more frequently in summer, during trekking or climbing activities.