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812 OUTCOME OF LIVER TRANSPLANTATION IN RECIPIENTS OLDER THAN 65 YEARS: A SINGLE CENTER EXPERIENCE
POSTERS of not giving priority to patients that have developed hepatic encephalopathy may be reconsidered in those with alcoholic cirrhosis. 811 A MODIFIED CHILD-TURCOTTE-PUGH (CTP) FOR SELECTION OF PATIENTS AFFECTED BY CIRRHOSIS CANDIDATES TO LIVER TRANSPLANTATION (LT) WITH LOW MODEL FOR END-STAGE LIVER DISEASE SCORE (MELD) S. Gitto1 , M. Biselli1 , A. Gramenzi1 , L. Brodosi1 , R. Di Donato1 , G. Vitale1 , S. Lorenzini1 , M. Ravaioli2 , G.L. Grazi2 , A.D. Pinna2 , M. Bernardi1 , P. Andreone1 , Bologna Liver Transplantation Group (BLTG). 1 Department of Clinical Medicine, 2 Department of General Surgery and Organ Transplantation, University of Bologna, Bologna, Italy E-mail: [email protected] Background and Aims: Model for End-Stage Liver Disease (MELD) is widely used for organ allocation, even if it shows a better prognostic accuracy among patients with high score. The aim of this study was to investigate whether other factors were able to better select the low MELD candidates with cirrhosis. Methods: The drop-out rate of 284 cirrhotic patients with MELD <18 listed for LT between January 2003 and March 2009 was evaluated. Univariate analysis was developed by means of actual survival curves taking into account the presence of competing risk represented by LT. Binary logistic regression analysis was used to determine the independent predictors of drop-out. Results: During a median follow-up of 19 months (1 day – 75 months), 54 (19%) patients died, 17 (6%) withdrew from the list because too sick to be transplanted, and 66 (23.2%) underwent LT. At multivariate analysis CTP score >7 (Hazard ratio (HR) 12.9; 95% Confidence Interval (95% CI) 1.7–98.6), serum sodium ≤137 mEq/L (HR 5.3; 95% CI 2.1–13.3) and glomerular filtration rate ≤90 ml/min estimated by the Modification of Diet in Renal Disease formula (MDRD-GFR) (HR 3.1; 95% CI 1.2–7.8) were independently associated with the probability of drop-out at 12 months. We integrated CTP [CTP-sodium-renal function (CTP-SRF)] by adding 1 point if MDRDGFR was >90 ml/min, 2 points if MDRD-GFR was 90–61 ml/min, and 3 points if MDRD-GFR was ≤60 ml/min, plus 1 point if serum sodium was >137 mEq/L, 2 points if serum sodium was 137–135 mEq/L, 3 points if serum sodium was <135 mEq/L. The area under the curve (AUC) for the CTP-SRF, showed an excellent diagnostic accuracy at 6- and 12-month (0.864 and 0.835, respectively), better than CTP (0.722; p = 0.013 and 0.731; p = 0.005; respectively) and MELD (0.515; p < 0.001 and 0.538; p < 0.001; respectively). The best predictive value of CTP-SRF was 12 (sensitivity 83.9% and specificity 73.6%). Patients with CTP-SRF score >12 experienced a 12-month probability of dropout 13-fold higher (HR 13.3; 95% CI 4.9–36.1) than patients with score ≤12. Conclusions: CTP-SRF was found to significantly improve the accuracy of CTP and MELD in predicting waitlist dropout among patients with low MELD score. 812 OUTCOME OF LIVER TRANSPLANTATION IN RECIPIENTS OLDER THAN 65 YEARS: A SINGLE CENTER EXPERIENCE I. Graziadei1 , K. Nachbaur1 , H. Zoller1 , W. Mark2 , W. Vogel1 . 1 Internal Medicine II, 2 Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria E-mail: [email protected] Advanced age was considered a relative contraindication for liver transplantation (LT) in the past. The percentage of older patients referred for LT assessment has markedly increased in almost all LT centers over the last years. The data regarding the outcome of older patients have been contradictory. Therefore, we aimed to evaluate the long-term survival of LT recipients older than 65 years.
Between 1982 and 2008, 106 out of 1011 patients (10.5%), who underwent LT at our institution, were older than 65 years. Almost all of these patients were transplanted after 1995. The mean age was 67.5 (65.0–76.4) years and the majority of patients were male (76%). Regarding underlying liver disease the percentage of non-alcoholic steatohepatitis associated cirrhosis was significantly higher in the older age group (15.9% vs. 5.8%, p < 0.01) compared to the younger LT cohort. In contrast, alcoholic liver disease was more common in recipients under 65 years (20.4% vs. 14.1%, p < 0.01). Significantly more patients in the older group presented with a concomitant hepatocellular carcinoma (40.6% vs. 23.7%, p < 0.01). Both groups did not differ with regard to Child–Pugh classification and mean MELD score. The median follow-up of the older patients was 3.2 compared to 5.7 years of the younger cohort. The actuarial patient survival rates at 1-, 5- and 10-years with 85%, 65% and 56% were slightly lower in the older recipients compared to 87%, 75% and 66% of recipients ≤65 years. The major causes of death in the elderly were sepsis (n = 13) in the early postoperative period and de-novo cancer (n = 6), HCV/HCC recurrence (each n = 5) and cardiovascular complications (n = 4) in the late one. The incidence of de-novo cancers and cardiovascular diseases were significantly higher in the older age cohort. The percentage of reLTs did not differ between both groups (7.8% vs. 6.5%). Although overall survival was better for younger patients, this study shows that LT recipients older than 65 years have a favourable outcome after LT with a 5- and 10-year survival of 65% and 56% indicating that liver transplantation should be considered in patients older than 65 years. 813 RESULTS OF LIVER TRANSPLANTATION IN ADULT POLYCYSTIC LIVER DISEASE: REPORT OF A SINGLE CENTER EXPERIENCE A. Patris1 , E. Bonaccorsi-Riani2 , O. Ciccarelli2 , P. Goffette3 , Y. Pirson4 , J. Lerut2 , Z. Hassoun1 . 1 Division of Gastroenterology, 2 Abdominal Transplantation Unit, 3 Department of Radiology, 4 Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium E-mail: [email protected] Introduction: Polycystic liver disease (PCLD) occurs either in an isolated form (Autosomal Dominant Polycystic Liver Disease [ADPLD]) or in association with Autosomal Dominant Polycystic Kidney Disease (ADPKD). It remains an uncommon and controversial indication for liver transplantation (LT). Objectives: 1. to assess the results of LT in patients with massive PCLD; 2. to determine whether previous hepatic surgery is associated with a higher rate of complications following LT; 3. to examine the evolution of renal function after LT in order to determine whether pre-emptive renal transplantation is justified in case of ADPKD without (pre-)terminal renal failure. Methods: We retrospectively reviewed the medical charts of 19 patients (15 females) who underwent LT for PCLD between 1999 and 2008. Fifteen patients had ADPKD (12 females). Three received a combined liver and kidney transplantation (LKT) for associated terminal (n = 1) or pre-terminal renal failure. Two patients had previous kidney transplantation (KT) and 7 had undergone hepatic surgery. Results: Median duration of follow-up is 30 months [5–112]. All patients are alive and relieved of their symptoms. Their median Karnofsky score is 90% [80–100]. Intervention tended to be longer (10:30 h vs. 7:20 h, p = 0.098) in the group who had previous surgery. There was no significant difference in intra-operative blood transfusion, severity of postoperative complications, length of ICU or hospital stay. Median pre-LT GFR of ADPLD and ADPKD patients (excluding those who underwent LKT or previous KT) is 89.5 ml/min/1.73m2 [69–114] and 69 ml/min/1.73m2 [33–120] respectively (p = 0.129).
Journal of Hepatology 2010 vol. 52 | S183–S317
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Between 1982 and 2008, 106 out of 1011 patients (10.5%), who underwent LT at our institution, were older than 65 years. Almost all of these patients were transplanted after 1995. The mean age was 67.5 (65.0–76.4) years and the majority of patients were male (76%). Regarding underlying liver disease the percentage of non-alcoholic steatohepatitis associated cirrhosis was significantly higher in the older age group (15.9% vs. 5.8%, p < 0.01) compared to the younger LT cohort. In contrast, alcoholic liver disease was more common in recipients under 65 years (20.4% vs. 14.1%, p < 0.01). Significantly more patients in the older group presented with a concomitant hepatocellular carcinoma (40.6% vs. 23.7%, p < 0.01). Both groups did not differ with regard to Child–Pugh classification and mean MELD score. The median follow-up of the older patients was 3.2 compared to 5.7 years of the younger cohort. The actuarial patient survival rates at 1-, 5- and 10-years with 85%, 65% and 56% were slightly lower in the older recipients compared to 87%, 75% and 66% of recipients ≤65 years. The major causes of death in the elderly were sepsis (n = 13) in the early postoperative period and de-novo cancer (n = 6), HCV/HCC recurrence (each n = 5) and cardiovascular complications (n = 4) in the late one. The incidence of de-novo cancers and cardiovascular diseases were significantly higher in the older age cohort. The percentage of reLTs did not differ between both groups (7.8% vs. 6.5%). Although overall survival was better for younger patients, this study shows that LT recipients older than 65 years have a favourable outcome after LT with a 5- and 10-year survival of 65% and 56% indicating that liver transplantation should be considered in patients older than 65 years. 813 RESULTS OF LIVER TRANSPLANTATION IN ADULT POLYCYSTIC LIVER DISEASE: REPORT OF A SINGLE CENTER EXPERIENCE A. Patris1 , E. Bonaccorsi-Riani2 , O. Ciccarelli2 , P. Goffette3 , Y. Pirson4 , J. Lerut2 , Z. Hassoun1 . 1 Division of Gastroenterology, 2 Abdominal Transplantation Unit, 3 Department of Radiology, 4 Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium E-mail: [email protected] Introduction: Polycystic liver disease (PCLD) occurs either in an isolated form (Autosomal Dominant Polycystic Liver Disease [ADPLD]) or in association with Autosomal Dominant Polycystic Kidney Disease (ADPKD). It remains an uncommon and controversial indication for liver transplantation (LT). Objectives: 1. to assess the results of LT in patients with massive PCLD; 2. to determine whether previous hepatic surgery is associated with a higher rate of complications following LT; 3. to examine the evolution of renal function after LT in order to determine whether pre-emptive renal transplantation is justified in case of ADPKD without (pre-)terminal renal failure. Methods: We retrospectively reviewed the medical charts of 19 patients (15 females) who underwent LT for PCLD between 1999 and 2008. Fifteen patients had ADPKD (12 females). Three received a combined liver and kidney transplantation (LKT) for associated terminal (n = 1) or pre-terminal renal failure. Two patients had previous kidney transplantation (KT) and 7 had undergone hepatic surgery. Results: Median duration of follow-up is 30 months [5–112]. All patients are alive and relieved of their symptoms. Their median Karnofsky score is 90% [80–100]. Intervention tended to be longer (10:30 h vs. 7:20 h, p = 0.098) in the group who had previous surgery. There was no significant difference in intra-operative blood transfusion, severity of postoperative complications, length of ICU or hospital stay. Median pre-LT GFR of ADPLD and ADPKD patients (excluding those who underwent LKT or previous KT) is 89.5 ml/min/1.73m2 [69–114] and 69 ml/min/1.73m2 [33–120] respectively (p = 0.129).
Journal of Hepatology 2010 vol. 52 | S183–S317
S315