Autoimmune Liver Diseases Confer Increased Risk of Thrombotic Graft Failure

Autoimmune Liver Diseases Confer Increased Risk of Thrombotic Graft Failure

TRANSPLANTATION AND TISSUE ENGINEERING sex, cytomegalovirus status, ischemic time (IT), and Model for End-Stage Liver Disease (MELD). Autoimmune etiol...

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TRANSPLANTATION AND TISSUE ENGINEERING sex, cytomegalovirus status, ischemic time (IT), and Model for End-Stage Liver Disease (MELD). Autoimmune etiologies of liver disease included autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis. Outcomes were early rejection (6 months), graft failure, retransplantation, and mortality. Analysis used Fisher’s exact test and multivariate analysis (MA).

A Novel Classification of Hepatocellular Carcinoma Based on Combined Neutrophil and Platelet-toLymphocyte Ratio: Implications for Prognosis after Liver Transplantation Zhe Yang, MD, Lin Zhou, PhD, Liming Wu, MD, PhD, Shusen Zheng First Affiliated Hospital, Zhejiang University, Hangzhou, China INTRODUCTION: There is increasing evidence that systemic inflammation markers like neutrophil (NLR) and platelet-tolymphocyte ratios (PLR) may play a role in the outcome of hepatocellular carcinoma (HCC). However, the predictive accuracy is still unsatisfactory. We established a novel classification of HCC based on combined NLR and PLR for the prediction of prognosis. METHODS: We analyzed the outcomes of 266 hepatitis B virusassociated HCC patients undergoing liver transplantation (LT). Preoperative risk factors for tumor recurrence and overall survival were evaluated by univariate and multivariate analyses. RESULTS: By using receiver operating characteristic (ROC) analysis, NLR  3 and PLR 100 were considered elevated. The disease-free survival (DFS) and overall survival (OS) for patients with high NLR and PLR were significantly worse than for patients with normal NLR and PLR. By combination of the 2 parameters, the patients with NLRhigh/PLRhigh showed a significantly shorter cumulative OS and DFS rates after LT, compared with NLRnormal/ PLRnormal group (the 5-year DFS and OS were 36.6% and 35.7% vs 60.5% and 67.2%, respectively; p¼0.001). Cox regression analysis shows NLR/PLR combination was an independent prognostic factor. The ROC analysis revealed that the area under the curve of combined NLR and PLR was larger than single NLR and PLR, so had better predictive power. In addition, 23 patients with tumor recurrence after LT and received radical tumor resection, 7/ 12 patients with NLR  3 and/or PLR 100 survived less than 20 months after therapy, while the 5-year OS after radical therapy for patients with NLR  3 and PLR  100 were 66.7%. CONCLUSIONS: Combination of preoperative NLR and PLR could serve as a novel biomarker in predicting the prognosis of HCC after LT, in addition, patients with NLR  3 and PLR  100 could achieve favorable outcomes after receiving radical resection for tumor recurrence after LT.

RESULTS: We identified 54,130 recipients: 6,278 AE and 47,852 controls. The MELD score (21.9 AE vs 20.9), cold IT (6.6 vs 6.9), and warm IT (39.9 vs 41.5) were clinically similar. Groups were otherwise different: AE patients were younger (49 vs 54 years, p<0.001), more likely to be female (55.8% vs 28.6%, p<0.001), have previous transplants (7.1% vs 3.8%, p<0.001), and have living donors (11.2% vs 3.6%, p<0.001). In AE early rejection (18.9% vs 11.4%, p<0.001), thrombotic graft failure (10.3% vs 5.6%, p<0.001), and retransplantation (7.3% vs 5.1%, p<0.001) were higher. Overall graft failure (25.2% vs 30.5%, p<0.001) and mortality (17.9% vs 25.4%, p<0.001) were lower. On MA, AE remained significant for early rejection (odds ratio [OR] 1.47, 95% CI [1.25-1.72]), graft failure (OR 0.75 95% CI [0.66-0.84]), and mortality (OR 0.65 95% CI [0.58-0.73]), and still contributed to thrombotic graft failure (OR 2.1 95% CI [1.5-2.8]) and retransplantation (OR 1.27 95% CI [1.06-1.52]).

CONCLUSIONS: Autoimmune etiologies of liver disease confer increased thrombotic graft failure, retransplantation, and rejection, but lower all-cause graft failure and mortality rates. This is the first study demonstrating increased AE thrombotic graft failure. Future study should stratify risk and evaluate early thromboprophylaxis.

Outcome Early rejection Thrombotic graft failure Graft failure Retransplantation Mortality

Autoimmune Liver Diseases Confer Increased Risk of Thrombotic Graft Failure Vidyaratna A Fleetwood, MD, Martin Hertl, MD, FACS, Edie Y Chan, MD, FACS Rush University Medical Center, Chicago, IL INTRODUCTION: Post-transplant hepatic arterial or portal venous thrombosis occurs in 5% of transplants and frequently requires retransplantation. Autoimmune etiologies of liver disease (AE) may cause hypercoaguability but have not been studied as a risk factor. We hypothesized that AE increases thrombotic graft failures. METHODS: We reviewed the Organ Procurement and Transplantation Network registry 2002-2013. Covariates were age,

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Autoimmune n (%) 834 (18.87)

Other Etiology n (%)

OR (CI)

p Value

3,868 (11.45)

1.47 (1.25-1.72)

<0.001

159 (10.31)

795 (5.60)

2.1 (1.50-2.80)

0.001

1,587 (25.28)

14,611 (30.53)

0.75 (0.66-0.84)

<0.001

459 (7.31) 1,124 (17.9)

2,395 (5.01)

1.27 (1.06-1.52)

0.006

12,165 (25.42)

0.65 (0.58-0.73)

<0.001

Autologous Tissue-Engineered Small Intestine Forms in a New Porcine Preclinical Model Minna M Wieck, MD, Xiaogang Hou, PhD, Tracy C Grikscheit, MD, FACS Children’s Hospital-Los Angeles, Los Angeles, CA INTRODUCTION: Functional and histologically correct tissueengineered small intestine (TESI) has been shown to improve recovery in small animal models of short bowel syndrome. Tissueengineered small intestine has also been successfully generated through a more lengthy and complicated process from autologous tissue in Yorkshire swine, but not in a pediatric-sized model. We

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http://dx.doi.org/10.1016/j.jamcollsurg.2015.07.369 ISSN 1072-7515/15