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Liver disease due to hepatitis C virus (HCV) infection is an important health problem worldwide. HCV induced changes in microRNAs (miRNA) are shown to mediate inflammation leading to liver fibrosis. Gene expression analyses identified dysregulation of miRNA-449a in HCV patients but not in alcoholic and non-alcoholic liver diseases. By sequence analysis of the promoter for YKL40, an inflammatory marker upregulated in patients with chronic liver diseases with fibrosis, adjacent binding sites for nuclear factor of Kappa B/P65 and CCAAT/enhancer-binding protein alpha (CEBPα) were identified. P65 interacted with CEBPα to co-operatively activate YKL40 expression through sequence specific DNA binding. In vitro analysis demonstrated that tumor necrosis factor alpha (TNFα) mediated YKL40 expression is regulated by miRNA-449a and its target NOTCH1 in human hepatocytes.NOTCH1 facilitated nuclear localization of P65 in response to TNFα. Further, HCV patients demonstrated upregulation of NOTCH1 along with downregulation of miRNA-449a. Taken together it is demonstrated that miRNA-449a plays an important role in modulating expression of YKL40 through targeting the components of the NOTCH signaling pathway following HCV infection. Therefore, defining transcriptional regulatory mechanisms which control inflammatory responses and fibrosis will be important towards developing strategies to prevent hepatic fibrosis especially following HCV recurrence in liver transplant recipients.

Little information has been published about the suitability of candidates for living organ donation who have a past or current psychiatric diagnosis. A retrospective review of 445 living donor kidney transplants performed at Barnes-Jewish Hospital's transplant center from 1995 to 2005 disclosed 42 donor candidates with such a history, prompting detailed psychological evaluation. Although 41 candidates (10% of the donor pool) met criteria for 1 or more psychiatric diagnoses, none were considered psychologically unfit for donation. Of these, 22 candidates underwent kidney donation without medical or surgical complications and without development of subsequent active psychological problems. Several donors maintained long-term contact up to 12 years to report good health and a high degree of satisfaction with the decision to donate. This experience suggests that for donor candidates with a psychiatric diagnosis, formal psychiatric evaluation to evaluate current mental health stability is warranted. Stable individuals, on or off therapy, can be considered fit to donate with expected short- and long-term outcome prognoses similar to those for the general population.

The presence of hepatitis B surface and core antibodies (anti-HBs and anti-HBc) in a liver donor without hepatitis B surface antigen is taken to indicate resolution of hepatitis B and is not considered to contraindicate donation. We report a liver transplant recipient who developed hepatitis B after such a donation. It seems that hepatitis B virus can reside in the liver of a patient who has seemingly recovered from his disease. We recommend avoidance of liver transplants from donors who are positive for anti-HBs and anti-HBc.