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Paediatric Hepatocellular Carcinoma - Outcomes
e564
Electronic Poster Abstracts
The diagnosis was made by color Doppler ultrasound and confirmed by angiotomography in all cases. Seven patients with stenotic lesions treated by percutaneous transhepatic access, were treated by percutaneous transluminal balloon angioplasty in 6 patients. Seven patients were treated through transperitoneal. Of these, six were treated with primary stenting. Conclusions: Endovascular treatment of stenosis or portal vein thrombosis in post liver transplant children is safe and effective, with good patency in short and medium term.
EP05A-069 FEMALE GENDER AS A NEGATIVE PROGNOSTIC FACTOR IN THE SETTING OF LIVER TRANSPLANTATION FOR VIRAL HEPATITIS C M. F. Chedid1, A. Chedid1, M. R. Alvares-da-Silva2, I. Leipnitz1, T. J. M. Grezzana-Filho1, H. Bosi1, M. Reis3, A. de Araujo2, A. B. Lopes2, C. D. P. Kruel1 and C. R. P. Kruel1 1 Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clinicas de Porto Alegre, 2Division of Gastroenterology and Hepatology, Hospital de Clinicas de Porto Alegre, and 3hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Brazil Background: Detection of negative predictors may help finding strategies for protecting selected liver transplant recipients at higher risk for post-transplant death. Methods: Review of all consecutive hepatitis C-positive (HCV+) adult patients who underwent first orthotopic whole-graft liver transplant for at our institution between 2002 and 2013 was performed. Primary endpoint was overall post-transplant death. Results: Of 127 patients included this study, 47 (37%) were females; median age, 56 years-old (range 19e71). There were overall 46 (36.2%) deaths, 10 (8.7%) of those occurring on first 30 post-transplant days. Univariate analysis revealed female gender as the only predictor of overall mortality (RR = 2.18, CI = 1.22e3.93, p = 0.009). Interestingly, female gender was neither associated to 30day or 90-day mortality (p = 0.55) nor to mortality in the first post-transplant year (p = 0.41). Among all 47 female recipients of this cohort, predictors of overall death were higher calculated MELD scores (p = 0.04) (cut off by receiver operating characteristic curve (ROC) = 16), higher pre-transplant total bilirubin (p = 0.09) (cutoff by ROC = 3.4), and younger age (p = 0.008) (cutoff by ROC = 51 years), and absence of hepatocellular carcinoma (HCC) (RR = 3, CI = 1.31e7.43, p = 0.009). Conclusions: Female gender was the only predictor of death in this cohort. However, this association was not detected before the end of the first post-transplant year. Sicker young female HCV+ recipients (higher MELD scores, higher total bilirubin and patients transplanted without HCC appeal scores) are the ones most predisposed to death. This young HCV+ subgroup deserves careful pretransplant, perioperative and post-transplant care. Strategies for long-term management of this population including early HCV treatment are warranted.
EP05A-070 THE IMPORTANCE OF MELD AFTER LIVER TRANSPLANTATION TO PREDICT EARLY ALLOGRAFT DYSFUNCTION G. Schnorr, J. Padilla, A. David and C. Gritti Beneficencia Portuguesa Hospital, Brazil Early allograft dysfunction (EAD) is a serious complication of liver transplantation (LT). EAD is often multifactorial and The Model for End-Stage Liver Disease (MELD) has the unique ability to incorporate many variables and reflect the overall status of the graft. The MELD score is estimated based on the following variables: creatinine level, total bilirubin level and International normalized ratio (INR). The MELD score is extensively used preoperatively but little is known about the course of the MELD score after LT. The aim of this study was to demonstrate the ideal cut off MELD score for predicting early graft failure in order to re-list the patient as soon as possible. In this single-center, retrospective study, the INR, total bilirubin and creatinine levels were used to calculate the MELD scores within 7 days after LT for a 100 patients. Aspartame aminotransferase (AST) and alkaline phosphatase (ALT) within 7 days after LT were also measured and used as parameters to predict allograft dysfunction.
EP05A-071 PAEDIATRIC HEPATOCELLULAR CARCINOMA - OUTCOMES K. Palaniappan, S. Govil and M. Rela Institute of Liver Disease and Transplantation, Global Health City, India Introduction: Hepatocellular carcinoma (HCC) is the second most common malignant liver tumour of childhood. It typically affects children with a median age of 10e14 years on background Hepatitis B related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of 5 years typically constitute less than 10% of all children with HCC and occur on a background of congenital or metabolic liver disease. Method: The records of all children with HCC who presented to our department over a 6-year study period were reviewed. Results: Twelve patients with a median age of 5.9 years (range 1.6e15.4 years) were diagnosed to have HCC. All patients underwent liver transplantation, none were resected. Eleven patients had background congenital or metabolic liver disease. All 5 of those with Hereditary Tyrosinemia Type 1 who presented to us were found to have HCC. No patient had Hepatitis B related liver (HBV) disease. Eight (66.7%) patients had incidentally discovered HCC on examination of the explant. Incidentally discovered HCC were smaller, well differentiated and did not show microvascular invasion compared to those diagnosed preoperatively. There was no recurrence with a median follow-up of 5 months. Conclusion: The patient demographic for pediatric HCC is changing probably as a consequence of successful immunization against HBV. Younger patients with congenital and metabolic liver disease in whom liver transplantation is the ideal treatment are likely to constitute an ever-increasing proportion of patients with HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts pediatric HCC as HBV disease is controlled or eradicated.
EP05A-073 ONCE-DAILY PROLONGED-RELEASE TACROLIMUS (ADVAGRAFÒ) VERSUS TWICE-DAILY TACROLIMUS (PROGRAFÒ) IN DE NOVO LIVINGDONOR LIVER TRANSPLANTATION: A PHASE IV, RANDOMIZED, OPENLABEL, COMPARATIVE, SINGLECENTER STUDY G. -W. Song, S. -G. Lee, M. -H. Shin, H. Shin, K. -H. Kim, C. -S. Ahn, D. -B. Moon, T. -Y. Ha, D. -H. Jung, G. -C. Park and S. -H. Kim Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea Introduction: The pharmacokinetics (PKs), safety, and efficacy of once-daily prolonged-release tacrolimus (TAC QD) and twice-daily TAC (TAC BID) were compared in 100 de novo adult recipients of living-donor liver transplants in a controlled, randomized, open-label, comparative, single-center phase IV study. Method: Following continuous administration of intravenous TAC from Day 1 to Day 5, oral TAC QD and TAC BID were randomized among the recipients. Results: The mean total daily dose of TAC QD was higher than that of TAC BID throughout the study; the mean whole-blood trough levels of TAC in the two treatment arms were in the recommended range and were similar. PK profiles were made on Day 6 and Day 21 in 39 patients receiving TAC QD and 47 receiving TAC BID. The mean systemic exposure (AUC0e24) to TAC on Day 6 was comparable for the two formulations. On Day 21 the AUC0e24 for TAC QD was about 30% higher than the AUC0e24for TAC BID. Non-inferiority of systemic treatment with TAC QD compared with TAC BID was demonstrated. In the relationship between AUC0e24 and trough levels, there was a good correlation between TAC QD and TAC BID for both PK profiles. Assessment of acute rejection and survival of graft and patients showed that efficacy, drug-related adverse events, and safety did not differ between the two TAC regimens. Conclusion: Once-daily TAC was efficacious and safe, and was not inferior to twice-daily TAC in de novo recipients of living-donor liver transplants.
EP05A-075 BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION T. Unek1, M. Ozbilgin1, T. Egeli1, M. Akarsu2, A. Gulcu3, A. Bacakoglu1, S. Karademir4 and I. Astarcioglu1 1 General Surgery, 2Gastroenterology, 3Radiology, Dokuz Eylul University School of Medicine, and 4Hepatopancreatobiliary Surgery and Liver and Renal Transplantation, Ankara Guven Hospital, Turkey Introduction: Biliary complications (BC) are the most common reason for morbidity and mortality after liver
HPB 2016, 18 (S1), e385ee601
e565
transplantation (LT). In this abstract, we present BC after LT in our institution. Patients and methods: Between February 1997 and September 2014, 513 LT in 507 patients (219 deceased donor LT (DDLT) and 288 living donor LT (LDLT)) were performed in our institution. Mean age was 43.5. 356 (70.2%) patients were male and 151 (29.8%) were female. The most common etiology of end-stage liver disease was Hepatitis B and D. Bilio-biliary, bilio-enteric and combined bilio-biliary/bilio-enteric anastomoses were performed in 323(63.7%), 181(35.7%) and 3(0.5%) patients. Results: Thirty six (7.1%) patients had BC. LDLT was performed in 23(63.8%) patients and DDLT was performed in 13(36.2%) patients. Anastomoses were biliobiliary in 30(83.3%) patients, bilio-enteric in 5(13.8%) and combined in 1(2.9%) patients. Indication of the LT was chronic Hepatitis B, Hepatitis C and Hepatitis B with Hepatitis D infection, chronic ethilism, fulminant liver failure and primary sclerosing cholangitis. Biliary complications were anastomotic stricture in 14 (38.8%) patients, bile leakage in 8 (22.2%) patients, non-anastomotic stricture in 6 (16.6%) patients, minimal dilatation in biliary tract in 6 (16.6%) patients and bile stone in 2 (5.5%) patients. Immunosuppression was achieved with calcineurin inhibitors based medication in all patients. Thirteen (36.1%) patients had cholangitis at the time of diagnosis. In treatment, PTC and ERCP were used. Mortality was seen in 6 (16.6%) patients (5 biliary sepsis, 1 chronic rejection). Conclusion: Biliary complications can be minimized with appropriate surgical technique and close postoperative follow-up. Most of the patients can be treated with interventional methods.
EP05A-077 USE OF HEPATIC INTRA-ARTERIAL INFUSION OF YTTRIUM-90 MICROSPHERES FOR DOWNSTAGING AND BRIDGING TO LIVER TRANSPLANTATION IN PATIENTS WITH ADVANCED HEPATOCELLULAR CARCINOMA G. Vennarecci, R. L. Meniconi, N. Guglielmo, A. Laurenzi, R. Santoro, P. Lepiane, M. Colasanti and G. M. Ettorre San Camillo Hospital, Italy Background: Liver Transplantation is a well-established procedure for Hepatocellular Carcinoma within the Milan criteria. Yttrium-90 microspheres radioembolization has shown to be an effective and safe modality of treatment in patients with primary liver tumors. Aims: The primary end point of this study was to retrospectively evaluate the efficacy of the Yttrium-90 radioembolization in patients with Hepatocellular Carcinoma prior to liver transplantation. The second end point was to evaluate the safety of the procedure and the correlation between the radiological and pathological response. Methods: From April 2007 to December 2014, patients who underwent radioembolization were retrospectively evaluated. Patients were divided in two groups: bridging
Electronic Poster Abstracts
The diagnosis was made by color Doppler ultrasound and confirmed by angiotomography in all cases. Seven patients with stenotic lesions treated by percutaneous transhepatic access, were treated by percutaneous transluminal balloon angioplasty in 6 patients. Seven patients were treated through transperitoneal. Of these, six were treated with primary stenting. Conclusions: Endovascular treatment of stenosis or portal vein thrombosis in post liver transplant children is safe and effective, with good patency in short and medium term.
EP05A-069 FEMALE GENDER AS A NEGATIVE PROGNOSTIC FACTOR IN THE SETTING OF LIVER TRANSPLANTATION FOR VIRAL HEPATITIS C M. F. Chedid1, A. Chedid1, M. R. Alvares-da-Silva2, I. Leipnitz1, T. J. M. Grezzana-Filho1, H. Bosi1, M. Reis3, A. de Araujo2, A. B. Lopes2, C. D. P. Kruel1 and C. R. P. Kruel1 1 Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clinicas de Porto Alegre, 2Division of Gastroenterology and Hepatology, Hospital de Clinicas de Porto Alegre, and 3hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Brazil Background: Detection of negative predictors may help finding strategies for protecting selected liver transplant recipients at higher risk for post-transplant death. Methods: Review of all consecutive hepatitis C-positive (HCV+) adult patients who underwent first orthotopic whole-graft liver transplant for at our institution between 2002 and 2013 was performed. Primary endpoint was overall post-transplant death. Results: Of 127 patients included this study, 47 (37%) were females; median age, 56 years-old (range 19e71). There were overall 46 (36.2%) deaths, 10 (8.7%) of those occurring on first 30 post-transplant days. Univariate analysis revealed female gender as the only predictor of overall mortality (RR = 2.18, CI = 1.22e3.93, p = 0.009). Interestingly, female gender was neither associated to 30day or 90-day mortality (p = 0.55) nor to mortality in the first post-transplant year (p = 0.41). Among all 47 female recipients of this cohort, predictors of overall death were higher calculated MELD scores (p = 0.04) (cut off by receiver operating characteristic curve (ROC) = 16), higher pre-transplant total bilirubin (p = 0.09) (cutoff by ROC = 3.4), and younger age (p = 0.008) (cutoff by ROC = 51 years), and absence of hepatocellular carcinoma (HCC) (RR = 3, CI = 1.31e7.43, p = 0.009). Conclusions: Female gender was the only predictor of death in this cohort. However, this association was not detected before the end of the first post-transplant year. Sicker young female HCV+ recipients (higher MELD scores, higher total bilirubin and patients transplanted without HCC appeal scores) are the ones most predisposed to death. This young HCV+ subgroup deserves careful pretransplant, perioperative and post-transplant care. Strategies for long-term management of this population including early HCV treatment are warranted.
EP05A-070 THE IMPORTANCE OF MELD AFTER LIVER TRANSPLANTATION TO PREDICT EARLY ALLOGRAFT DYSFUNCTION G. Schnorr, J. Padilla, A. David and C. Gritti Beneficencia Portuguesa Hospital, Brazil Early allograft dysfunction (EAD) is a serious complication of liver transplantation (LT). EAD is often multifactorial and The Model for End-Stage Liver Disease (MELD) has the unique ability to incorporate many variables and reflect the overall status of the graft. The MELD score is estimated based on the following variables: creatinine level, total bilirubin level and International normalized ratio (INR). The MELD score is extensively used preoperatively but little is known about the course of the MELD score after LT. The aim of this study was to demonstrate the ideal cut off MELD score for predicting early graft failure in order to re-list the patient as soon as possible. In this single-center, retrospective study, the INR, total bilirubin and creatinine levels were used to calculate the MELD scores within 7 days after LT for a 100 patients. Aspartame aminotransferase (AST) and alkaline phosphatase (ALT) within 7 days after LT were also measured and used as parameters to predict allograft dysfunction.
EP05A-071 PAEDIATRIC HEPATOCELLULAR CARCINOMA - OUTCOMES K. Palaniappan, S. Govil and M. Rela Institute of Liver Disease and Transplantation, Global Health City, India Introduction: Hepatocellular carcinoma (HCC) is the second most common malignant liver tumour of childhood. It typically affects children with a median age of 10e14 years on background Hepatitis B related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of 5 years typically constitute less than 10% of all children with HCC and occur on a background of congenital or metabolic liver disease. Method: The records of all children with HCC who presented to our department over a 6-year study period were reviewed. Results: Twelve patients with a median age of 5.9 years (range 1.6e15.4 years) were diagnosed to have HCC. All patients underwent liver transplantation, none were resected. Eleven patients had background congenital or metabolic liver disease. All 5 of those with Hereditary Tyrosinemia Type 1 who presented to us were found to have HCC. No patient had Hepatitis B related liver (HBV) disease. Eight (66.7%) patients had incidentally discovered HCC on examination of the explant. Incidentally discovered HCC were smaller, well differentiated and did not show microvascular invasion compared to those diagnosed preoperatively. There was no recurrence with a median follow-up of 5 months. Conclusion: The patient demographic for pediatric HCC is changing probably as a consequence of successful immunization against HBV. Younger patients with congenital and metabolic liver disease in whom liver transplantation is the ideal treatment are likely to constitute an ever-increasing proportion of patients with HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts pediatric HCC as HBV disease is controlled or eradicated.
EP05A-073 ONCE-DAILY PROLONGED-RELEASE TACROLIMUS (ADVAGRAFÒ) VERSUS TWICE-DAILY TACROLIMUS (PROGRAFÒ) IN DE NOVO LIVINGDONOR LIVER TRANSPLANTATION: A PHASE IV, RANDOMIZED, OPENLABEL, COMPARATIVE, SINGLECENTER STUDY G. -W. Song, S. -G. Lee, M. -H. Shin, H. Shin, K. -H. Kim, C. -S. Ahn, D. -B. Moon, T. -Y. Ha, D. -H. Jung, G. -C. Park and S. -H. Kim Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea Introduction: The pharmacokinetics (PKs), safety, and efficacy of once-daily prolonged-release tacrolimus (TAC QD) and twice-daily TAC (TAC BID) were compared in 100 de novo adult recipients of living-donor liver transplants in a controlled, randomized, open-label, comparative, single-center phase IV study. Method: Following continuous administration of intravenous TAC from Day 1 to Day 5, oral TAC QD and TAC BID were randomized among the recipients. Results: The mean total daily dose of TAC QD was higher than that of TAC BID throughout the study; the mean whole-blood trough levels of TAC in the two treatment arms were in the recommended range and were similar. PK profiles were made on Day 6 and Day 21 in 39 patients receiving TAC QD and 47 receiving TAC BID. The mean systemic exposure (AUC0e24) to TAC on Day 6 was comparable for the two formulations. On Day 21 the AUC0e24 for TAC QD was about 30% higher than the AUC0e24for TAC BID. Non-inferiority of systemic treatment with TAC QD compared with TAC BID was demonstrated. In the relationship between AUC0e24 and trough levels, there was a good correlation between TAC QD and TAC BID for both PK profiles. Assessment of acute rejection and survival of graft and patients showed that efficacy, drug-related adverse events, and safety did not differ between the two TAC regimens. Conclusion: Once-daily TAC was efficacious and safe, and was not inferior to twice-daily TAC in de novo recipients of living-donor liver transplants.
EP05A-075 BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION T. Unek1, M. Ozbilgin1, T. Egeli1, M. Akarsu2, A. Gulcu3, A. Bacakoglu1, S. Karademir4 and I. Astarcioglu1 1 General Surgery, 2Gastroenterology, 3Radiology, Dokuz Eylul University School of Medicine, and 4Hepatopancreatobiliary Surgery and Liver and Renal Transplantation, Ankara Guven Hospital, Turkey Introduction: Biliary complications (BC) are the most common reason for morbidity and mortality after liver
HPB 2016, 18 (S1), e385ee601
e565
transplantation (LT). In this abstract, we present BC after LT in our institution. Patients and methods: Between February 1997 and September 2014, 513 LT in 507 patients (219 deceased donor LT (DDLT) and 288 living donor LT (LDLT)) were performed in our institution. Mean age was 43.5. 356 (70.2%) patients were male and 151 (29.8%) were female. The most common etiology of end-stage liver disease was Hepatitis B and D. Bilio-biliary, bilio-enteric and combined bilio-biliary/bilio-enteric anastomoses were performed in 323(63.7%), 181(35.7%) and 3(0.5%) patients. Results: Thirty six (7.1%) patients had BC. LDLT was performed in 23(63.8%) patients and DDLT was performed in 13(36.2%) patients. Anastomoses were biliobiliary in 30(83.3%) patients, bilio-enteric in 5(13.8%) and combined in 1(2.9%) patients. Indication of the LT was chronic Hepatitis B, Hepatitis C and Hepatitis B with Hepatitis D infection, chronic ethilism, fulminant liver failure and primary sclerosing cholangitis. Biliary complications were anastomotic stricture in 14 (38.8%) patients, bile leakage in 8 (22.2%) patients, non-anastomotic stricture in 6 (16.6%) patients, minimal dilatation in biliary tract in 6 (16.6%) patients and bile stone in 2 (5.5%) patients. Immunosuppression was achieved with calcineurin inhibitors based medication in all patients. Thirteen (36.1%) patients had cholangitis at the time of diagnosis. In treatment, PTC and ERCP were used. Mortality was seen in 6 (16.6%) patients (5 biliary sepsis, 1 chronic rejection). Conclusion: Biliary complications can be minimized with appropriate surgical technique and close postoperative follow-up. Most of the patients can be treated with interventional methods.
EP05A-077 USE OF HEPATIC INTRA-ARTERIAL INFUSION OF YTTRIUM-90 MICROSPHERES FOR DOWNSTAGING AND BRIDGING TO LIVER TRANSPLANTATION IN PATIENTS WITH ADVANCED HEPATOCELLULAR CARCINOMA G. Vennarecci, R. L. Meniconi, N. Guglielmo, A. Laurenzi, R. Santoro, P. Lepiane, M. Colasanti and G. M. Ettorre San Camillo Hospital, Italy Background: Liver Transplantation is a well-established procedure for Hepatocellular Carcinoma within the Milan criteria. Yttrium-90 microspheres radioembolization has shown to be an effective and safe modality of treatment in patients with primary liver tumors. Aims: The primary end point of this study was to retrospectively evaluate the efficacy of the Yttrium-90 radioembolization in patients with Hepatocellular Carcinoma prior to liver transplantation. The second end point was to evaluate the safety of the procedure and the correlation between the radiological and pathological response. Methods: From April 2007 to December 2014, patients who underwent radioembolization were retrospectively evaluated. Patients were divided in two groups: bridging