522 SEQUENTIAL AND PROSPECTIVE EVALUATION OF CIRRHOTIC CARDIOMYOPATHY AFTER LIVER TRANSPLANTATION. ROLE OF BRAIN NATRIURETIC PEPTIDE

POSTERS Methods: Of 323 patients transplanted between 1991 and 1997, 161 (50%) were alive >10 years post-LT. Of these, data were collected on 152 patients (95%). Clinical outcome measures included: immunosuppression (IS), metabolic (obesity, arterial hypertension [AH], diabetes [DM], dislypidemia), cardiovascular complications, renal insufficiency, de novo tumors and recurrent disease. Liver biopsies were performed. Results: Median age at transplantation was 50 years, 67% male, median donor age: 28 years. Most common indication was postnecrotic cirrhosis (88%)-the majority was due to HCV (47%). PreLT, there were 13% diabetics, 5% AH and 10% dislypidemic patients. Immunosuppression mostly consisted of cyclosporine (97.5%) with azathioprine (98%) and steroids (100%). At 10 years post-transplantation, AH was present in 72%, diabetes in 28%, dislypidemia in 39% and obesity in 31%. Most of these patients had already these complications at 1 year post-LT and very few developed it onward. Of 50 patients without AH at 1 year, 16% developed AH at 10 years. Of 112 non 1-year diabetics, 8% had DM at 10 years. Of 80 non 1-yr dislypidemic, 12% had dislypidemia at 10 years. Finally, only 14% of non-1yr obese patients were obese at 10 years. Cardiovascular events occurred in 10% of patients. De novo tumors (excluding skin cancer) developed in 30% (mostly solid tumors) at a median of 4.5 years post-transplantation. While renal insufficiency was present in 31% of patients at 10 years, only 4% required hemodialysis. Graft cirrhosis developed in 20% of cases, 96% related to HCV. Conclusion: Metabolic complications are very common posttransplantation leading to cardiovascular events in a small percent of cases after 10 years of follow-up. A strong effort should be made to detect and treat these complications early after transplantation since it is uncommon for these to develop after the first year. Renal insufficiency is a common complication but rarely results in renal failure. HCV is the most common cause of recurrent graft cirrhosis.

follow-up, 9 patients died, 5 of them (56%) from cardiovascular disease. These patients had high BNP levels pre-LT and these levels worsened after it (104±104 vs. 64±51; p > 0.05). None of echocardiographic parameters was related to survival. 9 patients (21%) developed cardiovascular event, 5 of them during the first month post-LT and the rest after 15 months. These patients had significantly higher levels of BNP pre-LT and at 15 months than patients without cardiovascular events (111±99 vs. 62±52; p < 0.05). Regarding echocardiography, just the presence of left ventricular hypertrophy before LT could significantly predict the development of cardiovascular events after LT (p = 0.03). Conclusions: At 6 and 15 months after LT, cirrhotic patients still showed a great prevalence of diastolic function that does not seem to adversely affect survival. Cardiovascular disease is one of the most important causes of death after LT. This fact could be related to the high prevalence of cardiovascular risk factors present. Elevated BNP levels and left ventricular hypertrophy before LT could be a predictor of death or cardiovascular events after LT.

522 SEQUENTIAL AND PROSPECTIVE EVALUATION OF CIRRHOTIC CARDIOMYOPATHY AFTER LIVER TRANSPLANTATION. ROLE OF BRAIN NATRIURETIC PEPTIDE 3 V. Bernal1 , I. Pascual2 , C. Fernandez2 , C. Lliminana ˜ , S. Garcia3 4 4 1 Castanon ˜ , A. Garcia-Gil , M.A. Simon . Gastroenterology and Hepatology, Hospital San Jorge, Huesca, 2 Cardiology, Hospital Universitario Lozano Blesa, Zaragoza, 3 Biochemistry, Hospital San Jorge, Huesca, 4 Gastroenterology and Hepatology, Hospital Universitario Lozano Blesa, Zaragoza, Spain E-mail: [email protected]

523 PROTRACTED ANTIVIRAL TREATMENT BEYOND CONVENTIONAL TIME LIMITS IMPROVES SURVIVAL IN NON-RESPONDERS TO INTERFERON+RIBAVIRIN ADMINISTERED FOR HCV RECURRENCE AFTER LIVER TRANSPLANTATION V. Bertuzzo1 , R. Vigano` 2 , M.F. Donato3 , M. Marino4 , M. Rendina5 , E. Fornasiere6 , L. Pasulo7 , P. Burra8 , L. Miglioresi9 , V. Giannelli10 , D. Di Paolo11 , M. Pompili12 , F.R. Ponziani12 , S. Fagiuoli7 , M. Cescon13 . 1 Department of General Surgery and Organ Transplantation, University of Bologna, Bologna, 2 Niguarda Hospital, 3 Gastroenterologia I e Centro Trapianti Fegato e Polmone, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, 4 Chirurgia Trapianti di Fegato e Multiviscerale, Azienda Ospedaliero Universitaria di Modena, Modena, 5 Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari, Bari, 6 Medical Liver Transplantation Unit, Internal Medicine, University of Udine, Udine, 7 Gastroenterology Unit, Liver and Lung Transplantation Centre, Ospedali Riuniti, Bergamo, 8 Department of Surgical and Gastroenterological Sciences, Padua University Hospital, Padova, 9 San Camillo-Spallanzani Hospital, 10 Division of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, 11 Transplant Unit, Department of Surgery, University of Rome Tor Vergata, 12 Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Roma, 13 Department of General and Organ Transplantation, University of Bologna, Bologna, Italy E-mail: [email protected]

Background and Aims: The evolution of cirrhotic cardiomyopathy after liver transplantation (LT) is not established. Our aims were: 1. To elucidate the exact time sequence of this evolution. 2. To evaluate the prognosis role of brain natriuretic peptide (BNP). Methods: Sequential and prospective evaluation of the same cohort before LT and, at 6 and 15 months after LT. Clinical data, echocardiography with tissue Doppler, and BNP plasma levels were analyzed. Primary endpoint was death and secondary endpoint was cardiovascular event. Results: 43 patients (54±9.7 years; 30%/13&. Child A4/B15/C24. MELD score: 15.3±5.1 (7–29). Causes: OH18/VHC12/otras13. Evolution of cardiovascular abnormalities pre-LT, at 6 months and at 15 months, respectively (%): systolic dysfunction: 16.7%, 5.6% and 0%; diastolic dysfunction (conventional Doppler): 31.7%, 65.8%, 69.2%; diastolic dysfunction (tissue Doppler): 15.4%, 13.5%, 15.4%; left ventricular hypertrophy: 17.1%, 10.5%, 0%; BNP >100 pg/ml: 15%, 26.5%, 16%. The prevalence of cardiovascular risk factor significantly and progressively increased after LT, except smokers prevalence who decreased significantly at 6 months and increased again at 15 months (39.5%, 6% y 20%, respectively). During

Background: The management of patients treated for hepatitis C (HCV) recurrence after liver transplantation (LT) and not achieving HCV-RNA clearance following antiviral treatment (AVT) with interferon+ribavirin is controversial. Methods: A retrospective evaluation of 259 non-responders to AVT after LT included in a multi-institutional database generated from 13 Italian LT Centers was performed. The aim of the study was to compare the characteristics and outcomes of patients treated for <12 months (Group A, N = 178) or for >12 months (Group B, N = 81). Group A patients deceased due to HCV recurrence during AVT were excluded from the analysis. Survivals were computed starting from the initiation of AVT. Results: The median follow-up was 59.1 months. Patient sex, age, pre-LT diagnosis of hepatocellular carcinoma, prevalence of hepatitis B co-infection, donor age, pre-treatment HCV-RNA, viral genotype, staging score and time between LT and initiation of AVT were comparable between groups. Prevalence of pre-LT MELD score >20 was lower in Group A vs. Group B (26% vs. 41%; P = 0.03). Median duration of AVT was 6.6 months in Group A and 13.6 months in Group B. Absence of response was the main cause of AVT discontinuation (Group A=82%; Group B=97%). Seven-year HCV

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Journal of Hepatology 2011 vol. 54 | S209–S361