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488 PREOPERATIVE LIVER BIOPSY CAN PREDICT LIVERS THAT HAVE AVOIDED CHEMOTHERAPY-INDUCED LIVER INJURY
POSTERS 487 NEW PREDICTIVE FACTORS OF RELAPSE IN ALCOHOLIC PATIENTS EVALUATED FOR LIVER TRANSPLANT M.L. Attilia, P. Pizzelli, C. Rotondo, F. Attilia, R. Tavoletti, M. Ceccanti. Centro di Riferimento Alcologico Regione Lazio, Sapienza University of Rome, Roma, Italy E-mail: [email protected] Background and Aims: The alcoholic cirrhosis is a consolidated indication to the liver transplant (OLT) and is the first and second indication in Europe and USA. 95% of patients with end-stage alcoholic liver disease has never been formally valued for liver transplant. In order to be included in a waiting list it is strictly necessary a documented alcoholic abstinence of almost six months. It is important to underline that some factors as age, socio-economic stability, absence of consumption of other substances have turned out to be prognosis positive factors for the maintaining of post-transplant abstinence. The goal of our research is to identify new relevant predictive factors of relapse. Methods: Since 2004 to date we have been valuing 271 patients (231 men and 40 women) aged 23–68, affected by liver cirrhosis, in order to set alcoholism diagnosis according to DSM-IV criteria and to monitor, as well as sustain abstinence in pre and post OLT. Data analysis was performed by using SPSSW 18. Results: 83.5% of patients presented alcoholic dependence diagnosis; 12.9% abuse; 2.6% polyabuse, while just 1% of patients turned out non-drinker. 65% of patients presented positive familiarity for alcoholism. The average age of first contact with alcoholic beverages was around 15. Risk consumption period was within those aged 25–27, with average consumption of 9 UA/die and maximum of 15 UA/die. 53.9% of the sample were smokers. 29.9% of patients consumed illicit drugs in the past; among them 9.2% came out positive to the toxicological exam. A high number of patients (78.9%) presented a stable family support, fundamental for the compliance pre and post OLT. The percentage of patients with scholastic failures was 51.7%. Conclusions: The relapse percentage pre (18.5%) and post (13.5%) OLT of our sample is lower than the data present in literature; this can be due to the identification of new predictive factors of relapse (positive familiarity for alcoholism, premature first contact, risk consumption years, scholastic failures) as well as to a strict monitoring with specific interventions of rehabilitation in a specialist alcohol service. Hence the importance of the figure of the specialist in alcoholism in transplant team. 488 PREOPERATIVE LIVER BIOPSY CAN PREDICT LIVERS THAT HAVE AVOIDED CHEMOTHERAPY-INDUCED LIVER INJURY J. Belghiti, L. Genser, D. Fuks, S. Dokmak, S. Faivre, V. Paradis. Beaujon Hospital, Assistance Publique-Hˆ opitaux de Paris and Universit´e Paris-Diderot, Clichy, France E-mail: [email protected] Background: Liver parenchymal damage caused by neoadjuvant chemotherapy may increase the surgical risk. The aim of the present study was to assess the performance of preoperative liver biopsy (PLB) in predicting the status of the liver parenchyma at the time of resection. Methods: Among 40 patients who underwent liver resection after neoadjuvant chemotherapy for colorectal liver metastases (CLM) in 2009, 28 had percutaneous PLB from 2 to 6 weeks after onset of the treatment. Patients underwent a mean number of 9 cycles of chemotherapy (range 4–22). Chemotherapy included oxaliplatin (n = 22), irinotecan (n = 10), and bevacizumab (n = 12). PLB and surgical specimens were compared according to the presence S200
and rate of steatosis, sinusoidal obstruction syndrome (SOS) and chemotherapy-associated steatohepatitis (CASH). Results: Surgical specimen analysis showed steatosis in 12 (43%) patients (ranging from 5 to 80%), SOS in 12 patients (43%) and CASH in 1 patient (3%). The sensitivity, specificity, positive predictive value and negative predictive value of PLB for steatosis were 67%, 81%, 73% and 77% respectively. It was 50%, 94%, 86% and 71% respectively for SOS and 0%, 100%, 0% and 96% respectively for CASH. Performance of PLB was not related to the type of chemotherapy. Among the 28 patients, 8 patients had no abnormalities on PLB. In 7 of them, surgical specimen analysis was considered normal. Conclusion: The accuracy of PLB in predicting chemotherapyinduced liver injury appears to be low. It is useful, however, given its high specificity when the PBL is normal, for encouraging hepatic resection without delay. 489 ANDROGENIC-ANABOLIC STEROID USER AND A LARGE SPECTRUM DISEASE P.A. Schwingel1,2,3 , H.P. Cotrim1 , B.C.R. Salles1 , C.E.R. Almeida1 , 2 1 B.S. Nachef1 , C.A.B. Ferreira Filho1 , C.R. Santos Junior ´ . Programa de P´ os-Graduac˜ ¸ ao em Medicina e Sa´ ude (PPgMS), Universidade Federal da Bahia (UFBA), 2 Laborat´ orio de Pesquisa do Exerc´ıcio (LAPEX), Faculdade Social da Bahia (FSBA), Salvador, 3 Departamento de Nutric˜ ¸ ao, Universidade de Pernambuco (UPE), Petrolina, Brazil E-mail: [email protected] Background and Aim: The use of anabolic-androgenic steroids (AAS) has grown in recent years and these drugs have been related with several complications associated with hepatotoxicity. The present study aimed to evaluate the spectrum of the hepatic injuries associated to AAS use. Methods: The study included individuals with history of intramuscular AAS use >2 years. Volunteers ranged in age from 18 to 42 years, their body mass index and fat mass content ranged from 18.0 to 40.3 kg/m2 and 4.4 to 27% respectively. Clinical exam and face-to-face interview were performed. Laboratory evaluation included hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT). Abdominal ultrasound images were obtained by an experienced sonographer. Data were analyzed and categorical variables were presented in absolute and relative frequencies. The exact Fisher’s confidence intervals at 95% (95% CI) were calculated. Results: The sample included 95 males AAS users with mean age of 26.6±5.9 years. Elevated liver enzymes were observed in 32% of the cases (95% CI: 23.4–43.0%). The prevalence of hepatitis B and C virus infection was 0.7% and 0.7% respectively (95% CI: 0.3–7.4%). Abdominal ultrasound showed twelve volunteers with hepatomegaly (12.6%; 95% CI: 6.7–21.0%) and 13 presented steatosis (13.7%; 95% CI: 7.5–22.3%): 76.9% had mild diffuse steatosis, 15.4% had moderate diffuse steatosis and 7.7% had focal steatosis. Six of these cases also showed hepatomegaly. One participant presents hyperplasia nodular focal confirmed by magnetic resonance imaging. One individual presented a periportal fibrosis. Toxicantassociated fatty liver disease – TAFLD – was observed in 12.6% of participants (95% CI: 6.7–21.0%). Alcohol and other risk factors to liver disease were excluded. Chronic alcohol intake was related for 10.5% cases, who present steatosis or elevated liver enzymes (95% CI: 5.2–18.5%). Conclusions: AAS users present a broad spectrum of liver disease that included B and C virus infection, alcoholic and non-alcoholic fatty liver and neoplasy. These findings suggest the relevance to screening the AAS users to hepatic injury to prevent severe disease in the future.
Journal of Hepatology 2011 vol. 54 | S61–S208
and rate of steatosis, sinusoidal obstruction syndrome (SOS) and chemotherapy-associated steatohepatitis (CASH). Results: Surgical specimen analysis showed steatosis in 12 (43%) patients (ranging from 5 to 80%), SOS in 12 patients (43%) and CASH in 1 patient (3%). The sensitivity, specificity, positive predictive value and negative predictive value of PLB for steatosis were 67%, 81%, 73% and 77% respectively. It was 50%, 94%, 86% and 71% respectively for SOS and 0%, 100%, 0% and 96% respectively for CASH. Performance of PLB was not related to the type of chemotherapy. Among the 28 patients, 8 patients had no abnormalities on PLB. In 7 of them, surgical specimen analysis was considered normal. Conclusion: The accuracy of PLB in predicting chemotherapyinduced liver injury appears to be low. It is useful, however, given its high specificity when the PBL is normal, for encouraging hepatic resection without delay. 489 ANDROGENIC-ANABOLIC STEROID USER AND A LARGE SPECTRUM DISEASE P.A. Schwingel1,2,3 , H.P. Cotrim1 , B.C.R. Salles1 , C.E.R. Almeida1 , 2 1 B.S. Nachef1 , C.A.B. Ferreira Filho1 , C.R. Santos Junior ´ . Programa de P´ os-Graduac˜ ¸ ao em Medicina e Sa´ ude (PPgMS), Universidade Federal da Bahia (UFBA), 2 Laborat´ orio de Pesquisa do Exerc´ıcio (LAPEX), Faculdade Social da Bahia (FSBA), Salvador, 3 Departamento de Nutric˜ ¸ ao, Universidade de Pernambuco (UPE), Petrolina, Brazil E-mail: [email protected] Background and Aim: The use of anabolic-androgenic steroids (AAS) has grown in recent years and these drugs have been related with several complications associated with hepatotoxicity. The present study aimed to evaluate the spectrum of the hepatic injuries associated to AAS use. Methods: The study included individuals with history of intramuscular AAS use >2 years. Volunteers ranged in age from 18 to 42 years, their body mass index and fat mass content ranged from 18.0 to 40.3 kg/m2 and 4.4 to 27% respectively. Clinical exam and face-to-face interview were performed. Laboratory evaluation included hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT). Abdominal ultrasound images were obtained by an experienced sonographer. Data were analyzed and categorical variables were presented in absolute and relative frequencies. The exact Fisher’s confidence intervals at 95% (95% CI) were calculated. Results: The sample included 95 males AAS users with mean age of 26.6±5.9 years. Elevated liver enzymes were observed in 32% of the cases (95% CI: 23.4–43.0%). The prevalence of hepatitis B and C virus infection was 0.7% and 0.7% respectively (95% CI: 0.3–7.4%). Abdominal ultrasound showed twelve volunteers with hepatomegaly (12.6%; 95% CI: 6.7–21.0%) and 13 presented steatosis (13.7%; 95% CI: 7.5–22.3%): 76.9% had mild diffuse steatosis, 15.4% had moderate diffuse steatosis and 7.7% had focal steatosis. Six of these cases also showed hepatomegaly. One participant presents hyperplasia nodular focal confirmed by magnetic resonance imaging. One individual presented a periportal fibrosis. Toxicantassociated fatty liver disease – TAFLD – was observed in 12.6% of participants (95% CI: 6.7–21.0%). Alcohol and other risk factors to liver disease were excluded. Chronic alcohol intake was related for 10.5% cases, who present steatosis or elevated liver enzymes (95% CI: 5.2–18.5%). Conclusions: AAS users present a broad spectrum of liver disease that included B and C virus infection, alcoholic and non-alcoholic fatty liver and neoplasy. These findings suggest the relevance to screening the AAS users to hepatic injury to prevent severe disease in the future.
Journal of Hepatology 2011 vol. 54 | S61–S208