Characteristics and Outcomes of Liver Transplant in Cirrhotic Patients with Hepatocellular Carcinoma According to Body Mass Index

to increase the rate of post-operative complications in patients with cirrhosis and HCC undergoing OLT. Similarly, higher BMI does not appear to impact long-term survival. Table 1: Patient Characteristics Statistics presented as Mean ± SD, Median [P25, P75] or N (column %). p-values: a=ANOVA, b=Kruskal-Wallis test, c=Pearson's chi-square test, d=Fisher's Exact test. 1: Significantly different from Normal weight; 2: Significantly different from Overweight; 3: Significantly different from Class I Obesity ; 4: Significantly different from Class II-IV Obesity A significance level of 0.08 was used for pairwise ad-hoc comparisons -- Abbreviations: OLT: orthotopic liver transplant; op: operative; NASH non-alcoholic steatohepatitis; LOS: length of stay; ICU: intensive care unit

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AASLD Abstracts

Su1425 HIGHER MORTALITY AMONG LIVER TRANSPLANT PATIENTS WITH CLOSTRIDIUM DIFFICILE INFECTION: META-ANALYSIS Mohammad Maysara Asfari, Tarek Sawas, Arthur McCullough BACKGROUND AND AIMS: Liver transplant patients have a high risk of developing Clostridium difficile infection (CDI) due to multiple hospitalization and frequent use of antibiotics in the perioperative period. Many trials studied the risk factors for CDI and reported different outcomes among liver transplant patients who get CDI. In this metaanalysis, we compared the mortality between liver transplant patients who develop CDI and liver transplant patients without CDI. METHODS: We searched PubMed and EMBASE for controlled trials published in the last 20 years (1996-2016) studying the CDI in liver transplant patients. The studies which compared the outcomes between liver transplant patients with CDI versus liver transplant patients without CDI were included in this analysis. RESULTS: Out of a total of 98 studies reviewed, four studies involving 1433 patients with liver transplantation were included. Of those, 212 individuals had CDI versus 1221 individuals had no CDI. The one year mortality among liver transplant patients with CDI was significantly increased comparing to those with no CDI (odd ratio OR, 2.44; 95% CI, 1.76 - 3.37; P < 0.001). None of the studies attributed the cause of death directly to CDI. Length of hospital stay and hospital costs were reported higher in liver transplant patients who develop CDI but there was no available data for analysis. CONCLUSIONS: In liver transplant patients, the incidence of CDI increases the mortality significantly in this high risk population. Multiple trials reported higher length of hospital stay and healthcare cost between liver transplant patients who develop CDI. Preventing CDI should be taken very seriously by following the hand WASH hygiene and avoiding unnecessary use of antibiotic.

Figure 1: Survival in cirhotic patients with hepatocellular carcinoma undergoing orthotopic liver transplant

Su1427 TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT AS MONOTHERAPY FOR MAINTAINING PORTAL VEIN PATENCY PRIOR TO LIVER TRANSPLANTATION Michael Rowley, Meera Ramanathan, Amitkumar Patel, Myunghan Choi, Anil B. Seetharam Rationale: While no longer a contraindication to Liver Transplant (LT), portal vein thrombosis (PVT) may lead to longer operative time and complexity in venous reconstruction. Strategies to maintain pre-operative patency include systemic anticoagulation and/or transjugular intrahepatic portosystemic shunt (TIPS) placement. The former may not be ideal in cirrhotics prone to luminal gastrointestinal tract bleeding while factors predicting improvement of PVT with the latter are not well defined. Aims: Evaluate effectiveness of TIPS as monotherapy to improve/resolve PVT in otherwise eligible LT candidates with partial/ complete PVT and identify factors predicting success. Methods: Retrospective (2010-2015) case series identifying 44 subjects with TIPS placement for primary indication to maintain PV patency; 3 excluded secondary to use of concomitant systemic anticoagulation. Primary endpoint: improvement/resolution of PVT on follow up cross sectional imaging within 6 months of TIPS. Secondary endpoints: improvement/resolution of TIPS in total and partial PVT as well as 3 month complication rate. Pre-TIPS demographics: age, gender, race, cirrhosis etiology, hepatocellular cancer, biologic MELD, hemoglobin, creatinine, INR, total bilirubin, albumin, and history of hepatic encephalopathy along with TIPS procedure variables analyzed to determine predictors of success. Categorical variables analyzed using Fisher's exact test. Continuous variables compared using Levene's t-test for equal variances and student's ttest; p < 0.05 significant. Results: 41 patients underwent TIPS monotherapy for PVT, 26 patients (partial) and 15 (complete). 31 (75.6%) had improvement or resolution of PVT and 10 (24.4%) had no change or worsening. TIPS was successful in 12 of 15 patients (80%) with total occlusion and 19 of 26 (73.1%) with partial occlusion. Total bilirubin of <2g/dL was associated with an increased rate of success with TIPS monotherapy (21/24 vs 10/17, p = 0.030). There was no change in MELD score at 3 months post-TIPS for the entire cohort (12.8 vs 13.1, p = 0.693). 14 patients (34.1%) required hospitalization within 3 months for hepatic encephalopathy. There were 4 non TIPS related deaths (9.8%). 10 patients underwent LT post- TIPS (median 14 months, range 1-32 months). 9/10 were in the improvement/resolution group. Conclusions: TIPS appears effective as monotherapy for maintaining PV patency in select LT candidates. Utility is greatest early when applied at relatively lower MELDs and serum bilirubin <2g/dL. Prospective study is warranted to evaluate durability of PV patency with this approach.

Forest plot of comparison: Mortality in Liver transplant patients with and wihout C.diff infection

Su1426 CHARACTERISTICS AND OUTCOMES OF LIVER TRANSPLANT IN CIRRHOTIC PATIENTS WITH HEPATOCELLULAR CARCINOMA ACCORDING TO BODY MASS INDEX Carol Rouphael, Rocio Lopez, Jamak Modaresi Esfeh Introduction: Hepatocellular carcinoma (HCC) is an indication for orthotopic liver transplantation (OLT) in patients with cirrhosis. There is conflicting data on whether body mass index (BMI) affects OLT outcomes in these patients. We hence sought to address whether BMI affects post OLT complications and long-term survival in cirrhotic patients with HCC. Methods: All cirrhotic patients with HCC who underwent OLT at our institution from April 2004 to December 2010 were included. Patients were divided into 4 groups per BMI: Normal (BMI 18.5-24.9), overweight (BMI 25-29.9), Class I obesity (BMI 30-34.9) and Class IIIV (BMI≥35). Patients' baseline demographics, tumor's characteristics and post-operative complications were collected. Survival at 10 years was determined by scheduled follow-up encounters and follow-up time was defined as months from OLT to either death or last follow-up visit. Time-to-event analysis, including Kaplan-Meier survival, was used for mortality outcomes. A p-value <0.05 was considered statistically significant. Results: A total of 236 patients were included. Mean age at the time of OLT was 58.3±7.8 and 22% were females (N=51). Among those patients, 19% were normal weight (N=44), 40% overweight (N=95), 25% had class I obesity (N=59) and 16% had class II-IV Obesity (N=38). Table 1 represents the patient's characteristics and post OLT complications per BMI groups. Baseline variables were comparable, except for more prevalent diabetes mellitus (DM) (p 0.004) and non-alcoholic steatohepaittis (NASH) cirrhosis (0.002) in Class II-IV obesity patients as compared to normal weight patients, and also compared to the overweight group for NASH cirrhosis. There were no significant differences in the hospital length of stay, bleeding, thrombosis, biliary and infectious complications among the different BMI groups. On 10year follow-up, 40% of patients died (N=94). There was no significant difference in survival among the 4 BMI groups (p=0.25) (Figure1). Conclusion: Increasing BMI does not appear

AASLD Abstracts

Su1428 LEAKY GUT DOES NOT AFFECT THE RISK OF INFECTIOUS COMPLICATIONS AND SURVIVAL IN LIVER TRANSPLANT RECIPIENTS: COMPARISON WITH CIRRHOTIC PATIENTS AND HEALTHY INDIVIDUALS Francesca Romana Ponziani, Venanzio Valenza, Margherita Lorusso, Myrtò E. Carvelli, Rosalba Paone, Massimo Siciliano, Alfonso W. Avolio, Antonio Grieco, Salvatore Agnes, Antonio Gasbarrini, Maurizio Pompili, Gabriele Sganga Background and Aims: Increased intestinal permeability (IP) is common in patients with cirrhosis. Leaky gut is associated with the development of systemic inflammation, which is the main cause of complications in patients with liver cirrhosis. After liver transplant (LT) IP is supposed to become normal, but data about this topic are scarce. The aim of this study was to compare IP of LT recipients to that of patients with liver cirrhosis and that of healthy

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