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Mo1926 The Gross Classification of Hepatocellular Carcinoma: Usefulness of Contrast-Enhanced Sonography Using Perfluorocarbon Microbubbles (Sonazoid)
in the incidences of early rejection between liver transplant recipients of LRD and URD organs. Whether recipients of LRD organs have less steroid-refractory rejection and recurrent rejection during the first year after transplantation warrants further investigation. Mo1928 Usefullness of Contrast-Enhanced Ultrasonography to Evaluate a Post Treatment Effect of Radiofrequentry Ablation About Hepatocellular Carcinoma; Comparion With Contrast-Enhanced CT Tatsuo Inoue, Tadaaki Arizumi, Satoshi Kitai, Norihisa Yada, Satoru Hagiwara, Yasunori Minami, Toshiharu Sakurai, Kazuomi Ueshima, Naoshi Nishida, Masatoshi Kudo Aim: The aim of this study was to evaluate usefulness of contrast-enhanced ultrasonography (CEUS) to evaluate a post treatment effect of Radiofrequentry ablation(RFA) about Hepatocellular carcinoma(HCC) compared to contrast-enhanced (CECT). Methods: From February 2007 to March 2008, 62 patients of 78 HCCs were received RFA. After that, they received both CEUS with Sonazoid and CECT to evaluate a post treatment effect of RFA. For contrastenhanced US and CECT, we independently evaluated therapeutic effect as follows, Completed response with safety margin (CR SM (+); when a tumor was completely ablated with safety margin greater than 5 mm. Completed response without safety margin (CR SM-) ; when a tumor was completely ablated but with safety margin less than 5 mm. Incomplete; There was a residual tumor after treatment. All of evaluation was reviewed and decided by blinded reviewers. After that, we observed the rate of local recurrence rate about these tumors and evaluated a accuracy of treatment evaluation of contrast-enhanced US and CECT. Results: Three patients withdrew follow up examination, finally, 59 patients with 70 HCCs after RFA were evaluated. Mean size of HCC was 16.8±6.1mm, mean follow up tome were 911 days( 55-1461). During follow up period, 11 recurrences were occurred ( 11/70=15%). At initial evaluation of post treatment effect, CEUS judged 30 cases as CR SM+, while CECT did 40 cases. Of those, 2 cases out of 30 of CEUS and 1 cases out of 40 cases of CECT occurred local recurrence (N.S. chi-square-test). CEUS judged 37 cases as CR SM-, while CECT did 27 cases. Of those 8 cases of CEUS and 8 cases of CECT occurred local recurrence (N.S. chi-square-test). Conclusion: CEUS can be used to assess the efficacy of HCC of RFA, with the potential to reduce the number of CT scans required for that purpose.
Daily change in median PT values (in seconds) among survivors and non-survivors Mo1926
AASLD Abstracts
The Gross Classification of Hepatocellular Carcinoma: Usefulness of ContrastEnhanced Sonography Using Perfluorocarbon Microbubbles (Sonazoid) Yasunori Minami, Kinuyo Hatanaka, Tadaaki Arizumi, Sosuke Hayaishi, Masahiro Takita, Satoshi Kitai, Norihisa Yada, Tatsuo Inoue, Satoru Hagiwara, Kazuomi Ueshima, Naoshi Nishida, Masatoshi Kudo Aim. We assessed the usefulness of post-vascular images on contrast-enhanced ultrasonography (CE-US) in the gross classification of hepatcellular carcinoma (HCC) in comparison with contrast-enhanced CT (CE-CT) findings. Methods. 51 patients with 61 HCCs underwent hepatectomy, and the gross type of HCC was estimated by CE-US and CE-CT. We assessed the tumor shape by defect images during the post-vascular phase on CE-US using perfluorocarbon microbubbles, whereas the positive enhancement in the arterial phase and wash-out in the equilibrium phase on CE-CT. Patients were divided into two subgroups according to the gross classification: simple nodular type and non-simple nodular type. The capability of each imaging modality to correctly depict tumor shapes was compared. Results. Thirty-nine tumors were macroscopically diagnosed as simple nodule type, 19 tumors as simple nodular type with extranodular growth, and 3 tumors as confluent multinodular type from the resected specimen. The sensitivity and specificity of CE-US to diagnose the non-simple nodule type HCC were 86.4% and 89.7%, while those of CE-CT were 68.2% and 76.9%, respectively. The accuracy was significantly better in CE-US compared with CE-CT (88.5% vs 73.8%; p=0.037). Conclusion. The post-vascular phase image of CE-US is a more reliable tool to evaluate the gross type of HCC than CE-CT and is considered to be essential for the determination of treatment strategy and to estimate the prognosis of HCC patients. The sensitivity, specificity and accuracy of the gross type of HCC on CE-CT and CE-US
Mo1929 Intra and Interoperator Reproducibility of Acoustic Radiation Force Impulse Elastography (ARFI) Simona Bota, Ioan Sporea, Roxana Sirli, Alina Popescu, Mirela Danila, Madalina Sendroiu, Ana Jurchis, Alina F. Martie, Dragos Suseanu Introduction: ARFI elastography is a new method used mainly for the assessment of liver fibrosis. The aim of this paper was to assess the intra and inter-operator reproducibility of ARFI measurements. Methods: Our study included 92 patients. In 59 patients we studied the interobserver reproducibility of ARFI and in 33 patients the intraoperator reproducibility. 10 valid ARFI measurements were performed in each patient and median values were calculated, expressed in meters/second (m/s). For the study of intraoperator reproducibility, measurements were repeated in the same day, the operator being blinded to the severity of fibrosis. For the study of interoperator reproducibility, measurements were performed in the same day by operators blinded to the results of previous measurements and to the severity of fibrosis. Spearman rank correlation coefficient (r) and the inter-rater agreement coefficient (kappa) were used to assess the intra and interoperator reproducibility of ARFI measurements. Results: Regarding the intraoperator reproducibility of ARFI, repeated measurements were strongly correlated (Spearman coefficient r=0.848, 95% confidence interval - 95% CI: 0.712 to 0.923, p<0.0001) and an inter-rater agreement coefficient k was 0.629 (95% CI: 0.503 to 0.754). Regarding the interoperator reproducibility, repeated measurements were also statistically significant correlated (r=0.694, 95% CI: 0.531 to 0.808, p<0.0001), with an inter-rater agreement coefficient k=0.496 (95% CI: 0.356 to 0.682). The correlation of repeated ARFI measurements was higher, but not significantly, in case of intraoperator reprodutibility as compared with the interoperator reproducibility: r=0.848 vs. r=0.694 (Fisher Z test=1.73, p=0.08). For diagnosing liver cirrhosis, using 1.8 m/s as ARFI cut-off value, the agreement in case of intra and respectively interoperator repeated ARFI measurements was similar: 83.4% vs. 90.3% (p=0.75). Conclusion: ARFI elastography had a quite good intra and interoperator reproductibility, especially in patients with liver cirrhosis.
Note.- CE-CT = contrast-enhanced CT; CE-US = contrast-enhanced US Mo1927 Incidence of Early Rejection Between Liver Transplant Recipients of Living Related Versus Unrelated Donor Organs Brett E. Fortune, David Sprague, David Chascsa, Heather Kirkland, Lisa M. Forman, Scott W. Biggins, James R. Burton Background: Receiving a living first-degree genetically related donor organ may lead to a lower incidence of early rejection after liver transplantation. Although several prospective studies have shown that liver transplant recipients of live and deceased donor organs have equivocal outcomes, whether the incidence of early rejection differs in recipients of living related and unrelated donor organs remains unclear. Aims: The goals of this retrospective study were to compare the incidence of early rejection between liver transplant recipients of living donors and deceased donors, and between recipients of living related donor (LRD) organs and unrelated donor (URD) organs. Methods: Our study included 134 living donor liver transplant (LDLT) recipients (86 LRD and 48 living URD) and 398 matched deceased donor liver transplant (DDLT) recipients transplanted at a single liver transplant center from 1998 to 2009. The URD cohort included recipients of living non-first-degree related donor organs, living unrelated donor organs and all DDLT recipients (n=446). The primary outcome was the cumulative incidence of early rejection during the first year after liver transplantation. Secondary outcomes were the time to first early rejection, frequency of recurrent rejection, and the incidence of steroid-refractory rejection. Results: There was no difference in the observed incidences of early rejection between recipients of LDLT and recipients of DDLT (38% vs. 40%; p=0.74). The incidences of steroid-refractory rejection between LDLT and DDLT recipients were also similar (p=0.78). However, recurrent rejection occurred significantly less among LDLT recipients than among DDLT recipients (RR 0.46; 95% CI: 0.220.99, p=0.03). When comparing recipients of LRD organs and URD organs, there was no detectable difference in the incidences of early rejection (38% vs. 40%; p=0.67). However, there was a trend for LRD recipients to have less risk for steroid-refractory rejection (RR 0.54; 95% CI: 0.24-1.23, p=0.13) and less risk for recurrent rejection (RR 0.48; 95% CI: 0.18-1.26, p=0.11) during the first year after transplantation. Based on survival analysis, LDLT surgery (HR 0.92; 95% CI: 0.66-1.26, p=0.59) and receiving a LRD organ (HR 0.77; 95% CI: 0.52-1.14, p=0.19) were not found to be significantly associated with the prevention of early rejection. Conclusions: This study confirmed that recipients of LDLT and DDLT had similar incidences of early rejection. More importantly, this study found no difference
AASLD Abstracts
Mo1930 Mini Laparoscopy is Safe and Efficient in Acute Liver Failure Alexander Dechene, Evelyn J. Maldonado, Hideo Baba, Alexander Wree, Guido Gerken, Ali Canbay Introduction: For estimation of prognosis and choice of treatment for patients with acute liver failure (ALF), macroscopic evaluation and histology of the liver are of exceptional importance. Since ALF by definition is associated with impaired coagulation, the risk of postpunctional bleeding is high after percutaneous liver biopsy. The aim of this study was to evaluate the diagnostic yield and the safety of mini laparoscopy (ML) in combination with liver biopsy in patients with ALF. Methods: In 35 patients (20 female, 15 male, median age 40 years) with ALF (International Normalized Ratio (INR) >1.5), ML was performed for assessment of liver surface structure and for liver sampling via laparoscopically guided biopsy of liver parenchyma. Results of macroscopic appearance, liver histology and complications associated with the procedure were evaluated. Results: Etiology of ALV was druginduced liver injury (n=16), viral hepatitis (9), autoimmunity (6) and other reasons (4). Median INR was 1.7 (1.5 - 3.9). Mini laparoscopy was performed successfully in all patients, laparoscopically guided liver biopsy was performed in 33 cases. The biopsy site was treated with electrocoagulation in all biopsy cases. No hemodynamically relevant bleeding occurred. Mean biopsy specimen length was 15mm (7 - 30mm). Macroscopic assessment showed signs of regeneration in 26, fibrotic changes in 24 and cholestatic patterns in 3 cases.
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Daily change in median PT values (in seconds) among survivors and non-survivors Mo1926
AASLD Abstracts
The Gross Classification of Hepatocellular Carcinoma: Usefulness of ContrastEnhanced Sonography Using Perfluorocarbon Microbubbles (Sonazoid) Yasunori Minami, Kinuyo Hatanaka, Tadaaki Arizumi, Sosuke Hayaishi, Masahiro Takita, Satoshi Kitai, Norihisa Yada, Tatsuo Inoue, Satoru Hagiwara, Kazuomi Ueshima, Naoshi Nishida, Masatoshi Kudo Aim. We assessed the usefulness of post-vascular images on contrast-enhanced ultrasonography (CE-US) in the gross classification of hepatcellular carcinoma (HCC) in comparison with contrast-enhanced CT (CE-CT) findings. Methods. 51 patients with 61 HCCs underwent hepatectomy, and the gross type of HCC was estimated by CE-US and CE-CT. We assessed the tumor shape by defect images during the post-vascular phase on CE-US using perfluorocarbon microbubbles, whereas the positive enhancement in the arterial phase and wash-out in the equilibrium phase on CE-CT. Patients were divided into two subgroups according to the gross classification: simple nodular type and non-simple nodular type. The capability of each imaging modality to correctly depict tumor shapes was compared. Results. Thirty-nine tumors were macroscopically diagnosed as simple nodule type, 19 tumors as simple nodular type with extranodular growth, and 3 tumors as confluent multinodular type from the resected specimen. The sensitivity and specificity of CE-US to diagnose the non-simple nodule type HCC were 86.4% and 89.7%, while those of CE-CT were 68.2% and 76.9%, respectively. The accuracy was significantly better in CE-US compared with CE-CT (88.5% vs 73.8%; p=0.037). Conclusion. The post-vascular phase image of CE-US is a more reliable tool to evaluate the gross type of HCC than CE-CT and is considered to be essential for the determination of treatment strategy and to estimate the prognosis of HCC patients. The sensitivity, specificity and accuracy of the gross type of HCC on CE-CT and CE-US
Mo1929 Intra and Interoperator Reproducibility of Acoustic Radiation Force Impulse Elastography (ARFI) Simona Bota, Ioan Sporea, Roxana Sirli, Alina Popescu, Mirela Danila, Madalina Sendroiu, Ana Jurchis, Alina F. Martie, Dragos Suseanu Introduction: ARFI elastography is a new method used mainly for the assessment of liver fibrosis. The aim of this paper was to assess the intra and inter-operator reproducibility of ARFI measurements. Methods: Our study included 92 patients. In 59 patients we studied the interobserver reproducibility of ARFI and in 33 patients the intraoperator reproducibility. 10 valid ARFI measurements were performed in each patient and median values were calculated, expressed in meters/second (m/s). For the study of intraoperator reproducibility, measurements were repeated in the same day, the operator being blinded to the severity of fibrosis. For the study of interoperator reproducibility, measurements were performed in the same day by operators blinded to the results of previous measurements and to the severity of fibrosis. Spearman rank correlation coefficient (r) and the inter-rater agreement coefficient (kappa) were used to assess the intra and interoperator reproducibility of ARFI measurements. Results: Regarding the intraoperator reproducibility of ARFI, repeated measurements were strongly correlated (Spearman coefficient r=0.848, 95% confidence interval - 95% CI: 0.712 to 0.923, p<0.0001) and an inter-rater agreement coefficient k was 0.629 (95% CI: 0.503 to 0.754). Regarding the interoperator reproducibility, repeated measurements were also statistically significant correlated (r=0.694, 95% CI: 0.531 to 0.808, p<0.0001), with an inter-rater agreement coefficient k=0.496 (95% CI: 0.356 to 0.682). The correlation of repeated ARFI measurements was higher, but not significantly, in case of intraoperator reprodutibility as compared with the interoperator reproducibility: r=0.848 vs. r=0.694 (Fisher Z test=1.73, p=0.08). For diagnosing liver cirrhosis, using 1.8 m/s as ARFI cut-off value, the agreement in case of intra and respectively interoperator repeated ARFI measurements was similar: 83.4% vs. 90.3% (p=0.75). Conclusion: ARFI elastography had a quite good intra and interoperator reproductibility, especially in patients with liver cirrhosis.
Note.- CE-CT = contrast-enhanced CT; CE-US = contrast-enhanced US Mo1927 Incidence of Early Rejection Between Liver Transplant Recipients of Living Related Versus Unrelated Donor Organs Brett E. Fortune, David Sprague, David Chascsa, Heather Kirkland, Lisa M. Forman, Scott W. Biggins, James R. Burton Background: Receiving a living first-degree genetically related donor organ may lead to a lower incidence of early rejection after liver transplantation. Although several prospective studies have shown that liver transplant recipients of live and deceased donor organs have equivocal outcomes, whether the incidence of early rejection differs in recipients of living related and unrelated donor organs remains unclear. Aims: The goals of this retrospective study were to compare the incidence of early rejection between liver transplant recipients of living donors and deceased donors, and between recipients of living related donor (LRD) organs and unrelated donor (URD) organs. Methods: Our study included 134 living donor liver transplant (LDLT) recipients (86 LRD and 48 living URD) and 398 matched deceased donor liver transplant (DDLT) recipients transplanted at a single liver transplant center from 1998 to 2009. The URD cohort included recipients of living non-first-degree related donor organs, living unrelated donor organs and all DDLT recipients (n=446). The primary outcome was the cumulative incidence of early rejection during the first year after liver transplantation. Secondary outcomes were the time to first early rejection, frequency of recurrent rejection, and the incidence of steroid-refractory rejection. Results: There was no difference in the observed incidences of early rejection between recipients of LDLT and recipients of DDLT (38% vs. 40%; p=0.74). The incidences of steroid-refractory rejection between LDLT and DDLT recipients were also similar (p=0.78). However, recurrent rejection occurred significantly less among LDLT recipients than among DDLT recipients (RR 0.46; 95% CI: 0.220.99, p=0.03). When comparing recipients of LRD organs and URD organs, there was no detectable difference in the incidences of early rejection (38% vs. 40%; p=0.67). However, there was a trend for LRD recipients to have less risk for steroid-refractory rejection (RR 0.54; 95% CI: 0.24-1.23, p=0.13) and less risk for recurrent rejection (RR 0.48; 95% CI: 0.18-1.26, p=0.11) during the first year after transplantation. Based on survival analysis, LDLT surgery (HR 0.92; 95% CI: 0.66-1.26, p=0.59) and receiving a LRD organ (HR 0.77; 95% CI: 0.52-1.14, p=0.19) were not found to be significantly associated with the prevention of early rejection. Conclusions: This study confirmed that recipients of LDLT and DDLT had similar incidences of early rejection. More importantly, this study found no difference
AASLD Abstracts
Mo1930 Mini Laparoscopy is Safe and Efficient in Acute Liver Failure Alexander Dechene, Evelyn J. Maldonado, Hideo Baba, Alexander Wree, Guido Gerken, Ali Canbay Introduction: For estimation of prognosis and choice of treatment for patients with acute liver failure (ALF), macroscopic evaluation and histology of the liver are of exceptional importance. Since ALF by definition is associated with impaired coagulation, the risk of postpunctional bleeding is high after percutaneous liver biopsy. The aim of this study was to evaluate the diagnostic yield and the safety of mini laparoscopy (ML) in combination with liver biopsy in patients with ALF. Methods: In 35 patients (20 female, 15 male, median age 40 years) with ALF (International Normalized Ratio (INR) >1.5), ML was performed for assessment of liver surface structure and for liver sampling via laparoscopically guided biopsy of liver parenchyma. Results of macroscopic appearance, liver histology and complications associated with the procedure were evaluated. Results: Etiology of ALV was druginduced liver injury (n=16), viral hepatitis (9), autoimmunity (6) and other reasons (4). Median INR was 1.7 (1.5 - 3.9). Mini laparoscopy was performed successfully in all patients, laparoscopically guided liver biopsy was performed in 33 cases. The biopsy site was treated with electrocoagulation in all biopsy cases. No hemodynamically relevant bleeding occurred. Mean biopsy specimen length was 15mm (7 - 30mm). Macroscopic assessment showed signs of regeneration in 26, fibrotic changes in 24 and cholestatic patterns in 3 cases.
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