Jae Geun Lee

Background Statins have been reported to reduce overall death and hepatocellular carcinoma (HCC) recurrence in liver transplantation (LT) recipients. However, previous retrospective studies have significant flaws in immortal time bias. Methods Using data from 658 patients who received LT for HCC, we matched 140 statin users with statin nonusers in a 1:2 ratio at the time of the first statin administration after LT using the exposure density sampling (EDS). The propensity score, calculated using baseline variables (including explant pathology), was used for EDS to equilibrate both groups. HCC recurrence and overall death were compared after adjusting for information at the time of sampling. Results Among statin users, the median time to statin start was 219 (IQR 98–570) days, and intensity of statins was mainly moderate (87.1%). Statin users and nonusers sampled using EDS showed well‐balanced baseline characteristics, including detailed tumour pathology, and similar HCC recurrence with cumulative incidences of 11.3% and 11.8% at 5 years, respectively ( p = .861). In multivariate Cox models (HR 1.04, p = .918) and subgroup analyses, statins did not affect HCC recurrence. Conversely, statin users showed a significantly lower risk of overall death than nonusers (HR 0.28, p < .001). There was no difference in the type and intensity of statin usage between statin users who experienced HCC recurrence and those who did not. Conclusion Upon controlling immortal time bias by EDS, statins did not affect HCC recurrence but reduced mortality after LT. Statin usage is encouraged for survival benefits but not for preventing HCC recurrence in LT recipients.

Carbapenem‐resistant Acinetobacter baumannii bacteremia (CRAB‐B) is a fatal infectious complication of liver transplantation (LT). This study investigated the incidence, effects, and risk factors associated with CRAB‐B during the early post‐LT period. Among 1051 eligible LT recipients, 29 patients experienced CRAB‐B within 30 days of LT with a cumulative incidence of 2.7%. In the patients with CRAB‐B ( n = 29) and matched controls ( n = 145) by nested‐case control design, the cumulative incidence of death on days 5, 10, and 30 from the index date was 58.6%, 65.5%, and 65.5%, and 2.1%, 2.8%, and 4.2%, respectively ( p < .001). Pre‐transplant MELD (OR 1.11, 95% confidence interval [CI] 1.04–1.19, p = .002), severe encephalopathy (OR 4.62, 95% CI 1.24–18.61, p = .025), donor body mass index (OR .57, 95% CI .41–.75, p < .001), and reoperation (OR 6.40, 95% CI 1.19–36.82, p = .032) were independent risk factors for 30‐day CRAB‐B. CRAB‐B showed extremely high mortality within 30 days after LT, especially within 5 days after its occurrence. Therefore, assessment of risk factors and early detection of CRAB, followed by proper treatment, are necessary to control CRAB‐B after LT.