- Email: [email protected]
[184] LIVER TRANSPLANTARION FOR FAMILIAL AMYLOID POLYNEUROPATHY. TEN YEARS EXPERIENCE OF HOSPITAL ARGERICH (ARGENTINA)
POSTERS
S78
Discussion: The LiMAx-test showed a high validity when compared to remnant liver volume after liver resection and allowed immediate measurement of actual maximal enzymatic liver function capacity. Risk stratification before and after liver resection seems to be possible.
11821 FASTING GLUCOSE IS NOT USEFUL FOR DETERMINATION OF IMPAIRED GLUCOSE TOLERANCE IN LIVING-DONOR LIVER TRANSPLANTATION M. Stockmann’, S. Nolting’ , T. Konrad2, D. Hiinerbein’, P. Neuhaus’ . Transplantution Surgery, Churit4, Berlin; ’Institute ,ft)r Mrtuholic Research, Germany E-mail: [email protected]
Introduction: Studies investigating impaired glucose tolerance or diabetes mellitus (DM) in transplantation mostly use fasting glucose for determination of DM. We prospectively analyzed the impact of fasting glucose in comparison to advanced methods in recipients and donors of livingdonor liver transplants (LD-LTX) for determination of impaired glucose tolerance. Methods: Recipients and donors without overt diabetes mellitus were investigated longitudinally before and on day 10, month 6 and month 12 after right lobectomy or liver transplantation of the right lobe. Insulin sensitivity (SI) was assessed by a computer-assisted analysis of a frequently sampled intravenous glucose tolerance test with 300 mg/kg BW glucose 50% (Konrad et al., 1999). (%cell responsiveness (first and second phase of pancreatic (i-cell secretion, Phi 1 and Phi 2) was determined by a c-peptide modeling analysis (SAAM 11 software). Conventional parameters (fasting glucose, insulin, c-peptide, HOMA-IR score) were correlated with modeling results. Results: Donors developed insulin resistance by day 10 (S1 2.65&0.41 10-4 min-1 pU ml-1 vs. 4.90&0.50 10-4 min-1 pU ml-1 in control, p < 0.01; Phi 2 increased which was normalized again by month 6 and 12. In contrast to healthy donors, recipients were insulin resistant prior to transplantation (SI 1.91+0.29 10-4 min-l pU ml-I, p i 0 . 0 I ) . There was no significant correlation between SI and fasting glucose, but significant 0.001). correlations to fasting insulin, c-peptide, and HOMA-IR (p i Discussion: Impaired glucose tolerance in cirrhosis was normalized by liver transplantation of the right lobe. Liver resection of the right lobe in donors leads to acute insulin resistance. Impaired glucose tolerance could not be predicted by fasting glucose. The reason for this is relative undernourishment of recipients before transplantation. Additional parameters such as fasting insulin, c-peptide, or HOMA-IR are necessary.
11831 AGE, CHOLINESTERASE AND PREOPERATIVE CREATININE PREDICT 6-MONTH SURVIVAL AFTER LIVER TRANSPLANTATION - PARAMETERS FOR PRE-OLT CLINICAL MANAGEMENT IN CONSIDERATION OF SHORTAGEOFORGANSANDRESOURCES T.J. Weismueller’, H. Barg-Hock2, M.P. Manns’, J. Klempnaue?, T. Becke?, C.P. Strassbure’ . Gastrornteroloy, Hr~iatologyand Endocrinology; ’Grnrral, Viscrrul und Trunsplunt Surgerji, Hannouer Medical School, Hannooel; Gernzany E-mail: [email protected];[email protected]
Background and Aims: Liver transplantation (OLT) is substantially burdened by a severe shortage of organs. In the Eurotransplant zone (ET) the severity of liver disease is grouped in medical urgency criteria (MUC) to ensure necessity-oriented OLT. The group of complicated T2-patients exhibiting 1 I Child-Pugh points or more with a reduced post OLT survival is increasing. Therefore a prediction of short term outcome is required to optimize preoperative management. Methods: All adult 104 consecutive OLT patients between May 2004 and April 2005 were analyzed retrospectively using the Mann-Whitney-test
and multiple logistic regression. They represent a homogeneous cohort without changes in graft allocation or transplant procedures. Results: I04 patients (6 I .5% men, mean age 46.3+- 12.1 years) underwent OLT: 25% viral Hepatitis (10.6% Hepatitis B, 14.4% Hepatitis C), 20.2% primary sclerosing cholangitis, 13.5‘% alcoholic liver disease, 10.6% metabolic liver disease (5.8‘X hemochromatosis), 6.7% primary biliary cirrhosis. 13.5% had developed hepatocellular carcinoma. 56.7% were on Eurotransplant T2 status, 33.7%) were T3, 9.6%) underwent high urgency OLT. Overall 6-month-survival was 84.6%. All deaths were because of multi organ failure. T2-patients showed a lower 6-month survival (T2: 81.4%, T3: 91.4%), longer pre-OLT hospitalization (26.W3.7 vs 1 1.3+-3.1 days, p = 0.002) and higher costs (€9015.69 vs. €4276.57, p = 0.005). 6-month mortality was associated with age (52.4+-2.5 vs. 45.2+-I .3 years, p = 0.041) and lower cholinesterase (2.3+-0.4 vs. 3.7+-0.2 kU/l, p = 0.004). Pre-OLT serum creatinine (p = 0.034), sodium (P = 0.048) and choline esterase (P = 0.01 9) but not pre-OLT MELD were independent parameters of 6-month survival. Conclusion: The allocation of organs to patients with severe liver failure has lead to an increase of OLT in patients with a reduced prognosis (ET T2). Age, pre-OLT creatinine and cholinesterase but not MELD predict short term post-OLT survival. In consideration of an increased utilization of resources, higher costs, lower survival rates, and a resulting increase of waiting time for less critically ill patients (T3) these parameters may be helpful for pre-OLT clinical management, outcome prediction and decision making.
11841 LIVER TRANSPLANTARION FOR FAMILIAL AMYLOID POLYNEUROPATHY. TEN YEARS EXPERIENCE OF HOSPITAL ARGERICH (ARGENTINA) P. Trigo, E. Varela, G. Aballay, G. Braslasky, N. Cejas, R Barros Schelotto, C. Romero, A. Oks, G. Cueto, D. Rodriguez, J. Lendoire, 0. Imventarza. Liurr Tr-LEnsIilant Unit, Hospitul Argrrich, Ciudud de Burnos Airrs, Argentinu E-mail: [email protected]
Introduction: Familial amiloidotic polyneuropathy (FAP) is a rare disease, but is an important cause of morbidity and mortality in certain locations of the world. The disease is characterized mainly by progressive peripheral and autonomic neuropathy secondary to deposition of a mutant transthyretin. Transthyretin is predominantly expressed in the hepatocytes and orthotopic liver transplantation stabilized or improve many aspects of the disease. Recently we describe a new focus of this disease in Argentina. The Argerich Hospital has the mayor experience of liver transplantation for familial amyloidotic polyneuropathy in Argentine. Aims: Describe the Argerich Hospital experience in ten years of liver transplantation for FAP. Patients and Methods: From July 1995 to July 2005, 296 patients were transplanted in our center. Fourteen (4.73%) by FAR All had the MET 30 mutation variant. Twelve male, median age 39 years (28-63 y). The duration of symptoms prior to transplantation ranged from 3 to 13 years. The polyneuropathy Disability Score were: 5 patients score 1, 6 patients score 11, 3 patients score 111. Median follow up were 83 month. Results: 1 and 8 years patient’s survival were 86‘X and 77% respectively, the acute rejection rate was 38.5‘%, the acute renal dysfunction was 69%, the incidence of biliary complication was 30.7% 23% experience progression of the disease after transplantation. Discussion: Overall patient’s survival is according to FAP World Registry. Liver transplantation for FAP has high morbidity and should probably be performed only in specialized centers
S78
Discussion: The LiMAx-test showed a high validity when compared to remnant liver volume after liver resection and allowed immediate measurement of actual maximal enzymatic liver function capacity. Risk stratification before and after liver resection seems to be possible.
11821 FASTING GLUCOSE IS NOT USEFUL FOR DETERMINATION OF IMPAIRED GLUCOSE TOLERANCE IN LIVING-DONOR LIVER TRANSPLANTATION M. Stockmann’, S. Nolting’ , T. Konrad2, D. Hiinerbein’, P. Neuhaus’ . Transplantution Surgery, Churit4, Berlin; ’Institute ,ft)r Mrtuholic Research, Germany E-mail: [email protected]
Introduction: Studies investigating impaired glucose tolerance or diabetes mellitus (DM) in transplantation mostly use fasting glucose for determination of DM. We prospectively analyzed the impact of fasting glucose in comparison to advanced methods in recipients and donors of livingdonor liver transplants (LD-LTX) for determination of impaired glucose tolerance. Methods: Recipients and donors without overt diabetes mellitus were investigated longitudinally before and on day 10, month 6 and month 12 after right lobectomy or liver transplantation of the right lobe. Insulin sensitivity (SI) was assessed by a computer-assisted analysis of a frequently sampled intravenous glucose tolerance test with 300 mg/kg BW glucose 50% (Konrad et al., 1999). (%cell responsiveness (first and second phase of pancreatic (i-cell secretion, Phi 1 and Phi 2) was determined by a c-peptide modeling analysis (SAAM 11 software). Conventional parameters (fasting glucose, insulin, c-peptide, HOMA-IR score) were correlated with modeling results. Results: Donors developed insulin resistance by day 10 (S1 2.65&0.41 10-4 min-1 pU ml-1 vs. 4.90&0.50 10-4 min-1 pU ml-1 in control, p < 0.01; Phi 2 increased which was normalized again by month 6 and 12. In contrast to healthy donors, recipients were insulin resistant prior to transplantation (SI 1.91+0.29 10-4 min-l pU ml-I, p i 0 . 0 I ) . There was no significant correlation between SI and fasting glucose, but significant 0.001). correlations to fasting insulin, c-peptide, and HOMA-IR (p i Discussion: Impaired glucose tolerance in cirrhosis was normalized by liver transplantation of the right lobe. Liver resection of the right lobe in donors leads to acute insulin resistance. Impaired glucose tolerance could not be predicted by fasting glucose. The reason for this is relative undernourishment of recipients before transplantation. Additional parameters such as fasting insulin, c-peptide, or HOMA-IR are necessary.
11831 AGE, CHOLINESTERASE AND PREOPERATIVE CREATININE PREDICT 6-MONTH SURVIVAL AFTER LIVER TRANSPLANTATION - PARAMETERS FOR PRE-OLT CLINICAL MANAGEMENT IN CONSIDERATION OF SHORTAGEOFORGANSANDRESOURCES T.J. Weismueller’, H. Barg-Hock2, M.P. Manns’, J. Klempnaue?, T. Becke?, C.P. Strassbure’ . Gastrornteroloy, Hr~iatologyand Endocrinology; ’Grnrral, Viscrrul und Trunsplunt Surgerji, Hannouer Medical School, Hannooel; Gernzany E-mail: [email protected];[email protected]
Background and Aims: Liver transplantation (OLT) is substantially burdened by a severe shortage of organs. In the Eurotransplant zone (ET) the severity of liver disease is grouped in medical urgency criteria (MUC) to ensure necessity-oriented OLT. The group of complicated T2-patients exhibiting 1 I Child-Pugh points or more with a reduced post OLT survival is increasing. Therefore a prediction of short term outcome is required to optimize preoperative management. Methods: All adult 104 consecutive OLT patients between May 2004 and April 2005 were analyzed retrospectively using the Mann-Whitney-test
and multiple logistic regression. They represent a homogeneous cohort without changes in graft allocation or transplant procedures. Results: I04 patients (6 I .5% men, mean age 46.3+- 12.1 years) underwent OLT: 25% viral Hepatitis (10.6% Hepatitis B, 14.4% Hepatitis C), 20.2% primary sclerosing cholangitis, 13.5‘% alcoholic liver disease, 10.6% metabolic liver disease (5.8‘X hemochromatosis), 6.7% primary biliary cirrhosis. 13.5% had developed hepatocellular carcinoma. 56.7% were on Eurotransplant T2 status, 33.7%) were T3, 9.6%) underwent high urgency OLT. Overall 6-month-survival was 84.6%. All deaths were because of multi organ failure. T2-patients showed a lower 6-month survival (T2: 81.4%, T3: 91.4%), longer pre-OLT hospitalization (26.W3.7 vs 1 1.3+-3.1 days, p = 0.002) and higher costs (€9015.69 vs. €4276.57, p = 0.005). 6-month mortality was associated with age (52.4+-2.5 vs. 45.2+-I .3 years, p = 0.041) and lower cholinesterase (2.3+-0.4 vs. 3.7+-0.2 kU/l, p = 0.004). Pre-OLT serum creatinine (p = 0.034), sodium (P = 0.048) and choline esterase (P = 0.01 9) but not pre-OLT MELD were independent parameters of 6-month survival. Conclusion: The allocation of organs to patients with severe liver failure has lead to an increase of OLT in patients with a reduced prognosis (ET T2). Age, pre-OLT creatinine and cholinesterase but not MELD predict short term post-OLT survival. In consideration of an increased utilization of resources, higher costs, lower survival rates, and a resulting increase of waiting time for less critically ill patients (T3) these parameters may be helpful for pre-OLT clinical management, outcome prediction and decision making.
11841 LIVER TRANSPLANTARION FOR FAMILIAL AMYLOID POLYNEUROPATHY. TEN YEARS EXPERIENCE OF HOSPITAL ARGERICH (ARGENTINA) P. Trigo, E. Varela, G. Aballay, G. Braslasky, N. Cejas, R Barros Schelotto, C. Romero, A. Oks, G. Cueto, D. Rodriguez, J. Lendoire, 0. Imventarza. Liurr Tr-LEnsIilant Unit, Hospitul Argrrich, Ciudud de Burnos Airrs, Argentinu E-mail: [email protected]
Introduction: Familial amiloidotic polyneuropathy (FAP) is a rare disease, but is an important cause of morbidity and mortality in certain locations of the world. The disease is characterized mainly by progressive peripheral and autonomic neuropathy secondary to deposition of a mutant transthyretin. Transthyretin is predominantly expressed in the hepatocytes and orthotopic liver transplantation stabilized or improve many aspects of the disease. Recently we describe a new focus of this disease in Argentina. The Argerich Hospital has the mayor experience of liver transplantation for familial amyloidotic polyneuropathy in Argentine. Aims: Describe the Argerich Hospital experience in ten years of liver transplantation for FAP. Patients and Methods: From July 1995 to July 2005, 296 patients were transplanted in our center. Fourteen (4.73%) by FAR All had the MET 30 mutation variant. Twelve male, median age 39 years (28-63 y). The duration of symptoms prior to transplantation ranged from 3 to 13 years. The polyneuropathy Disability Score were: 5 patients score 1, 6 patients score 11, 3 patients score 111. Median follow up were 83 month. Results: 1 and 8 years patient’s survival were 86‘X and 77% respectively, the acute rejection rate was 38.5‘%, the acute renal dysfunction was 69%, the incidence of biliary complication was 30.7% 23% experience progression of the disease after transplantation. Discussion: Overall patient’s survival is according to FAP World Registry. Liver transplantation for FAP has high morbidity and should probably be performed only in specialized centers