P0070 : Efficacy of therapeutic ercp in biliary complications following liver transplant: 10-Years experience

POSTERS in 24.9% (98/393; group A 37.9%, group B 22.6%, p = 0.003). Overall multivariate analysis identified pre-OLT hyperglycemia and postOLT weight gain as predictive risk factors for PTMS. However, independent risk factors were different in the two groups: postOLT weight gain (OR 1.53, 95% CI 1.26–1.85, p = 0.0001) and post-OLT US liver steatosis (OR 4.12, 95% CI 1.48–11.4, p = 0.006) in group A; post-OLT weight gain (OR 1.36, 95% CI 1.17–1.57, p = 0.0001), pre-OLT hyperglycemia (OR 3.57, 95% CI 1.28–9.88, p = 0.014), macrovacuolar steatosis ≥20% in the allograft (OR 4.74, 95% CI 1.23–18.27, p = 0.024) and treatment with m-TOR inhibitors (OR 17.43, 95% CI 3.36–90.39, p = 0.001) in group B. Cardiovascular (CVD) events were reported in 2.7% (10/393; group A 4.2%, group B 1.8%, p = ns). Overall 18.5% (73/393) died, 6.8% (5/73) for CVD (group A 2.1%, group B 0.9%, p = ns). Conclusions: Overall, host-related factors contribute to PTMS development, but the introduction of mTOR inhibitors is an additional risk factor particularly when suboptimal livers are transplanted. P0070 EFFICACY OF THERAPEUTIC ERCP IN BILIARY COMPLICATIONS FOLLOWING LIVER TRANSPLANT: 10-YEARS EXPERIENCE A.R. Alves1 , D. Gomes1 , S. Mendes1 , N. Almeida1 , R. Mesquita1 , E. Camacho1 , E. Furtado2 , C. Sofia1 . 1 Gastrenterology Department, 2 Pediatric and Adult Liver Transplantation Unit, Centro Hospitalar e Universit´ ario de Coimbra, Coimbra, Portugal E-mail: [email protected] Background and Aims: Biliary tract complications following liver transplant remain an important source of morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) has become a common therapeutic option before other invasive procedures. The aim of this study was to evaluate ERCP efficacy in managing these complications. Methods: It was performed a retrospective study of all patients submitted to therapeutic ERCP due to post-liver transplant biliary complications, between September 2004 and September 2014, in a predominantly deceased donor liver transplantation center. Results: Therapeutic ERCP was performed in 120 patients (64.2% men; mean age at first ERCP of 46.3±14.3years). Mean time between liver transplant and first ERCP was 19.8±38.8 months. Biliary complications were anastomotic strictures (AS) in 59.3%, non anastomotic strictures (NAS) in 14.1%, bile leaks in 5.9% and biliary filling defects (like stones or sludge) in 7.4%. Stents were placed in 61.7% patients, balloon dilation was performed in 62.5% and filling defects were removed in 29.5%. Each patient needed a mean of 3.27±2.40 ERCPs, performed during a period of 18.7±19.3 months. Mean follow-up was 32.9±30.5 months. Globally, biliary complications were successfully managed by ERCP in 43.3% of patients. Per complication, ERCP was successful in 41.2% of AS, 15.8% of NAS, 87.5% of leaks and 90.0% of lithiasis. One quarter of patients required a percutaneous or surgical intervention due to ERCP inefficacy. Diagnose of a bile leak (p = 0.001) or lithiasis (p = 0.003) was associated with higher chance of successful ERCP treatment, while the presence of a NAS was associated with unsuccessful ERCP (p = 0.001). No statistical difference was found for AS. Conclusions: ERCP allowed resolution of a biliary complication in 43.3% of patients, avoiding a more invasive procedure. Endoscopic treatment is particularly efficient in patients with bile leaks, lithiasis and AS.

P0071 REAL-TIME MEASUREMENTS OF TISSUE OXYGEN MICROTENSION AS A MARKER OF BILE DUCT VIABILITY IN LIVER TRANSPLANTATION E. Navarro-Rodr´ıguez1 , R. Ciria-Bru1 , M. Sanchez-Frias2 , 1 J. Medina-Fernandez ´ , A.B. Gallardo-Herrera1 , M.D. Ayllon-Teran1 , 1 1 1 S. Rufian-Pe ´ na ˜ 1 , P. Lopez-Cillero ´ , J. Briceno-Delgado ˜ . General Surgery, 2 Anatomic Pathology, HU Reina Sof´ıa (C´ ordoba), C´ ordoba, Spain E-mail: [email protected] Background and Aims: The main aim was to evaluate bile duct viability by assessing its microvascular quality using an innovative real-time oxygen tension device by testing different areas in both donor and recipient’s side. The findings were subsequently correlated with immunohistochemical and histopathological results. As a secondary aim, differences in bile duct micro-oxygenation status were analysed according to several donor, recipient and technical factors. Methods: Observational prospective cohort study with 18 patients included from November 2013 to September 2014. Tissue oxygen microtension measurements were made using Oxylite® device in different areas of recipient and donor’s bile duct intraoperatively after biliary anastomosis was made. Bile duct and hepatic artery biopsies were taken from donor and recipient. Results: A total of 18 patients underwent liver transplantation with a median age of 53 years old (44–60) and MELD of 18 (17–26). Mean oxygen microtension value in the graft bile duct at anastomosis level was 106 (92–118) mmHg, being 125 (108–134) mmHg 1.5 cm proximal to the hilar plate. Mean micro-oxygenation value in the bile duct recipient was 117 (100–150) mmHg, whilst a value of 138 (119–183) mmHg was observed 1.5 cms distal to the anastomosis. Tissue oxygen microtension was statistically higher in distal areas to section border of the biliary anastomosis, with an overall pO2 increase distal to the anastomosis of 17.94 mmHg (p < 0.001) and 21.61 mmHg (p < 0.001) in the graft and recipient, respectively. Biliary anastomosis was performed above the cystic duct insertion in the donor bile duct in 10 patients, with significant higher values of pO2 microtension (p = 0.017). Histological injury grade 2–3 in biliary mural stroma and grade 1–3 in peribiliary vascular plexus of graft’s bile duct graft were associated with lower tissue oxygen pressure, as well as injury grade 2 in biliary epithelium and grade 1–3 in peribiliary vascular plexus of recipient’s bile duct were associated with lower micro-oxygenation (p < 0.05). Conclusions: Biliary anastomosis is a critical point in liver transplantation. Our results demonstrates that terminal border of donor and recipient bile duct are low-vascularized areas. Tissue microoxygenation improves significantly in areas close to the hilar plate and to the duodenum in the donor and recipient’s sides, respectively. Histopathological findings of bile duct injury are associated to worst tissue microoxigenation. P0072 MICROINVASIVE INTRAOPERATIVE ULTRASOUND PATTERN IN PREDICTING OUTCOMES FOR SINGLE SMALL (<3 cm) HEPATOCELLULAR CARCINOMA M. Costa1,2 , R. Santambrogio1 , M. Barabino1 , M. Zuin3 , E. Bertolini3 , E. Opocher1 . 1 Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Milano, Italy; 2 Hepato-bilio-pancreatique et Transplantation Hepatique, Hˆ opital Henri Mondor, Cr´eteil, France; 3 Medicina VI, Ospedale San Paolo, Milano, Italy E-mail: [email protected] Background and Aims: The significance of tumor microinvasion (portal venous, hepatic vein, or bile duct infiltration and/or intrahepatic metastasis, MI) in patients with single, small (<3 cm) hepatocellular carcinoma (HCC) remains unclear. Aim of the study was to evaluate MI impact (MI+ vs MI− ) on HCC recurrence and

Journal of Hepatology 2015 vol. 62 | S263–S864

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