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Vol. 7, No. 2 2003

eral studies have demonstrated leukocyte-endothelial interactions in various I/R models. Recently, Drs. Maguire and Zibari have demonstrated that antiplatelet antibody induced thrombocytopenia attenuated the effects of I/R. The purpose of our experiment is to determine the platelet interactions with the endothelium in the murine hepatic I/R injury model. Forty C57BL/6 wild type mice, 6 to 8 weeks of age were divided into two groups of 20 each. One group received donor platelets that underwent I/R and the other group received platelets that did not. Each group is then subdivided into the control group that received a sham laparotomy with no ischemia and the experimental group that received a laparotomy, with 30-minute ischemia of the left lateral lobe of the liver and a one-hour reperfusion period. The donor platelets were isolated, tagged with fluorescent Rhodamine, centrifuged and rid of leukocytes, RBCs and plasma. This donor platelet rich suspension is infused into the control and experimental mice over 2 minutes using the external jugular vein cannulation. The left lateral lobe of the liver was placed on the video microscope and the terminal hepatic venules were observed for plateletendothelial interaction. A 100 micrometer length was isolated and its flow recorded for 2 minutes. The platelet interactions with the endothelium were then divided into rolling, saltation and adherence. The unpaired t test was used to analyse the data. Our study showed no statistical significance in the platelet interaction with the endothelium between the control and the experimental groups irrespective of the donor platelets being activated or not. There may not be any direct platelet-endothelial interactions resulting in the ischemia/reperfusion injury. Although our study did not demonstrate any direct platelet-endothelial interactions, multiple studies showed that the leukocytes and the platelets are both necessary to mount the ischemic reperfusion injury. It is possible that the platelets may indirectly cause the leukocytes to sequester either through chemical mediation or upregulation of certain adhesion receptors, somehow priming the leukocytes to adhere to the endothelial wall eventually causing parenchymal damage. This may be one of several factors that are involved in the I/R injury, which is yet to be clearly understood.

56 Preoperative Surveillance for Hepatocellular Carcinoma in Liver Transplant Candidates: Image Isn’t Everything Jeffrey Rogers, Kenneth Chavin, Angello Lin, David Lewin, Adrian Reuben, Ira Willner, Prabhakar Baliga, Medical University of South Carolina, Charleston, SC Background: The optimal screening protocol for hepatocellular carcinoma (HCC) before liver transplantation (OLT) is controversial. Aim: To evaluate the ability of our Program’s screening protocol to preoperatively detect HCC, and to examine the impact of this on patient survival. Methods: A retrospective review of 424 consecutive adult OLT at our institution was performed. Preoperative HCC screening in these patients consisted of abdominal ultrasound (US) every 6 months and serum alphafetoprotein (AFP) every 3 months until OLT. Patients with suspicious lesions on US or AFP20 ng/ml were further evaluated with biphasic, contrast-enhanced helical computed tomography (CT) or with magnetic resonance imaging (MRI). Patient demographics, etiology of liver disease, results of preoperative imaging and AFP, and explant pathology were recorded. Results: Seventeen of 424 (4%) OLT recipients had HCC identified on pathologic examination of the explant. There were 15 men and 2 women, mean age 45.8  15 years (range 18.9-61.9), with a mean followup of 17.4 months 19.9 months (range 0.43-78.6). The most common indications for OLT in patients with HCC were hepatitis C (53%) and Laennec’s cirrhosis (17.6%). There was a trend toward more hepatitis C infection in patients with HCC (53%) compared to those without HCC (32%), p0.07. Screening US and AFP detected (DET) only 8/17 HCC preoperatively (47.1%). Nine of 17 HCC were discovered incidentally (INC) in the explant (52.9%). Seven of 8 patients with DET HCC had a liver mass identified on US; 6 of these underwent confirmatory CT or MRI. One of 8 patients with DET HCC had a normal US and an elevated AFP, with subsequent confirmation of a liver mass on MRI. AFP

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correlated poorly with presence of HCC, with only 3/17 patients demonstrating elevated preoperative AFP, all in the DET group. Fifty six percent of INC and 75% of DET HCC were either stage I or II (p0.14). Despite a surprisingly higher (but statistically insignificant) percentage of stage III tumors in patients with INC HCC, 1- and 3-year actuarial survival was comparable between INC and DET. Conclusions: Despite the poor ability of US and AFP to detect HCC preoperatively, the similar long-term survival between patients with INC and DET HCC suggests that routine surveillance with CT or MRI would be unlikely to significantly alter management strategy for the vast majority of OLT candidates. In this series, only 2/424 patients (0.5%) would have been excluded as OLT candidates had surveillance imaging detected their advanced HCC preoperatively. Better screening and risk stratification tools are needed to more accurately predict which patients require more extensive imaging in order to most efficiently utilizes diagnostic resources. Kaplan-Meier Patient Survival

INC DET

1 year

3 years

63% 72%

63% 72%

p0.9.

57 Prevention of Hepatitis B Virus Infection After Liver Transplantation With Hepatitis B Immunoglobulin and Lamivudine Kyung-Suk Suha, Seong-Hwan Chang, Nam-Joon Yi, Seok Ho Choi, SunWhe Kim, Kuhn Uk Lee Sr., Seoul National University College of Medicine, Seoul, South Korea The outcome of liver transplantation (LT) in patients with hepatitis B related liver diseases improved significantly by introduction of passive immunoprophylaxis and antiviral drugs. But there was no consensus concerning dosage and duration of these agents for prevention of hepatitis B recurrence after LT. The aim of this study is to investigate the efficacy of HBV prophylaxis with HBIG and lamivudine. (Patients and methods) Between 1999 and 2001, LT was done in 59 patients who have positive HBsAg. Twenty two of them carried hepatocellular carcinoma (HCC) also. Imunnosuppression were FK 506 or cyclosporine based protocol. Prophylaxis against HBV related disease was started in the anhepatic phase with application of 10.000 IU HBIG and consisted of HBIG infusion of 10000 IU per day for seven days postoperatively and following infusion of 10000 IU per week for three times. After then, hepatitis B antibody titer was checked and maintained above 350 IU/L by intermittent infusion of HBIG. Also all HBV associated patients received lamivudine 100 mg po daily for one year. After stopping lamivudine, hepatitis B antibody titer was maintained above 250 IU/L. Mean follow up period was 19.910.2 months. Recurrence of hepatitis B was found in 3 patients. But in 2 patients, HCC had recurred and after that HBIG was not administered. Only one patient with proper administration of HBIG and lamivudine (at that time no lamivudine was administered because 1 year has passed) as protocol became HBsAg positive and HBV DNA probe positive at 14 months postoperatively. Then lamivudine was administered. But he has normal liver function test profile and no subjective symptoms. Combination prophylaxis with hepatitis B immunoglobulin and lamivudine is safe and highly effective in prevention of HBV recurrence after liver transplantation.

58 Outcome of Liver Transplantation Using the Grafts From the Living Donor With Isolated Hyperbilirubinemia Nam-Joon Yi, Kyung-Suk Suh, Seong-Hwan Chang, Seok Ho Choi, SunWhe Kim, Kuhn Uk Lee, Seoul National University College of Medicine, Seoul, South Korea