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Elevated lactate is independently associated with adverse outcomes following hepatectomy
Electronic Poster Abstracts post-share 35 period (p = 0.21). No difference in mean match MELD score (26vs.26) was seen between the 2 periods (p = 0.34). In the post-share 35 period, no organs were regionally shared for exception MELD scores greater than 35 in regions 3,4,6,7,10 and 11. All other regions had 1% of transplants for HCC being regionally shared for exception MELD scores greater than 35, except for region 5 (6%). No difference in wait-time for HCC patients was seen in any of the regions between the pre-share 35 and post-share 35 period; while wait-time for non-HCC patients didn’t change for any of the regions except region 1 (213days vs. 289days; p = 0.03). The proportion of patients newly listed with HCC exception did not change between the 2 periods (24% vs.24%;p = 0.06). Conclusion: No significant changes to liver allocation or listing practices in patients with HCC have occurred following the “share 35” policy change. Despite initial concerns, liver allografts are not being regionally shared for exception MELD scores greater than 35 in any of the UNOS regions except for region 5.
FP09-05 NOMOGRAMS FOR PRE- AND POSTOPERATIVE PREDICTION OF LONG-TERM SURVIVAL FOR PATIENTS WHO UNDERWENT HEPATECTOMY FOR MULTIPLE HEPATOCELLULAR CARCINOMAS F. Shen The Second Military Medical University/ The Eastern Hepatobiliary Surgery Hospital, China Objective: To develop prognostic nomograms for patients undergoing hepatectomy for multiple hepatocellular carcinomas (mHCCs). Background: The prognostic prediction after hepatectomy for mHCCs has not been well established. Methods: A training cohort (n = 540) was analyzed to construct two nomograms based separately on data obtained before and after hepatectomy for mHCCs at the Eastern Hepatobiliary Surgery Hospital (EHBH) between 2000 and 2006. The internal and external validations were performed in two independent cohorts (n = 180 each) collected from the EHBH between 2007 and 2010 and the Sun Yat-Sen University between 2000 and 2007. The predictive accuracy was measured by concordance index (C-index) and calibration curve. Results: Serum AFP level, HBV-DNA load, MELD score, tumor number, total tumor diameter and the ratio of largest to smallest tumor diameter were incorporated into the preoperative nomogram for overall survival (OS) prediction. In addition to these variables, microvascular invasion, tumor capsule, type of hepatectomy and local invasion/metastasis were incorporated into the postoperative nomogram. All calibration curves for probability of OS fitted well. In the training cohort, the preoperative nomogram achieved a Cindex of 0.75 (95% CI, 0.72e0.78) in predicting OS, and accurately stratified patients into 4 prognostic subgroups (5year OS rates: 65.9%, 46.3%, 29.6%, and 4.1%, p < 0.001). The postoperative nomogram had a C-index of 0.80 which was higher than those of the 4 conventional staging systems (0.53e0.62). These results were supported by the internal and external validations. HPB 2016, 18 (S1), e1ee384
e35
Conclusions: The two nomograms showed accurate preand postoperative prediction of post-hepatectomy prognosis in patients with mHCCs.
FP09-06 ELEVATED LACTATE IS INDEPENDENTLY ASSOCIATED WITH ADVERSE OUTCOMES FOLLOWING HEPATECTOMY M. Lemke, P. Karanicolas, R. Habashi, R. Behman, N. Coburn, S. Hanna, C. Law and J. Hallet University of Toronto, Canada Introduction: Arterial lactate is frequently monitored in the critical care setting as an indicator of tissue hypoxia and to direct therapy. Hepatocyte ischemia and injury during transection may increase lactate concentration. We sought to determine whether early post-hepatectomy lactate is associated with adverse outcomes. Methods: We used a prospectively maintained institutional database of hepatectomy patients from 2003 to 2012. Patients with lactate available on the night following hepatectomy were included. Logistic regression was used to model the relationship between post-hepatectomy lactate and 30-day major morbidity (Clavien grade III). Results: Of 749 patients undergoing hepatectomy, 490 patients had post-hepatectomy lactate measured and were included. Included patients were more frequently returned to an intensive care unit for monitoring (92.4% vs. 36.8%, p < 0.01), had more major hepatectomy (3 segments, 75.1% vs 57.1%, p < 0.01), higher rates of major morbidity (19.2% vs. 14.3%, p = 0.10), and longer length of stay (IQR 612 vs. 5e10 days, p < 0.01) compared with patients who did not have lactate measured. Post-hepatectomy lactate was elevated (>2 mmol/L) in 71.4% of patients. Rates of morbidity and ninety date mortality were higher with increased lactatemia (Figure 1). Increased lactate was associated with a higher rate of major morbidity (OR 1.19, 95% CI 1.07-1.33) after controlling for age, co-morbidities, extent of surgery, use of inflow occlusion, blood loss and transfusions.
Figure 1. Patients experiencing post-hepatectomy major morbidity (Clavien grade III) and ninety day mortality by lactate levels following hepatectomy.
Conclusions: Lactate remains a useful predictor of posthepatectomy morbidity despite known associations with pre and intra-operative patient factors. Further research should investigate the role of early post-hepatectomy lactate in goal-directed fluid management.
FP09-05 NOMOGRAMS FOR PRE- AND POSTOPERATIVE PREDICTION OF LONG-TERM SURVIVAL FOR PATIENTS WHO UNDERWENT HEPATECTOMY FOR MULTIPLE HEPATOCELLULAR CARCINOMAS F. Shen The Second Military Medical University/ The Eastern Hepatobiliary Surgery Hospital, China Objective: To develop prognostic nomograms for patients undergoing hepatectomy for multiple hepatocellular carcinomas (mHCCs). Background: The prognostic prediction after hepatectomy for mHCCs has not been well established. Methods: A training cohort (n = 540) was analyzed to construct two nomograms based separately on data obtained before and after hepatectomy for mHCCs at the Eastern Hepatobiliary Surgery Hospital (EHBH) between 2000 and 2006. The internal and external validations were performed in two independent cohorts (n = 180 each) collected from the EHBH between 2007 and 2010 and the Sun Yat-Sen University between 2000 and 2007. The predictive accuracy was measured by concordance index (C-index) and calibration curve. Results: Serum AFP level, HBV-DNA load, MELD score, tumor number, total tumor diameter and the ratio of largest to smallest tumor diameter were incorporated into the preoperative nomogram for overall survival (OS) prediction. In addition to these variables, microvascular invasion, tumor capsule, type of hepatectomy and local invasion/metastasis were incorporated into the postoperative nomogram. All calibration curves for probability of OS fitted well. In the training cohort, the preoperative nomogram achieved a Cindex of 0.75 (95% CI, 0.72e0.78) in predicting OS, and accurately stratified patients into 4 prognostic subgroups (5year OS rates: 65.9%, 46.3%, 29.6%, and 4.1%, p < 0.001). The postoperative nomogram had a C-index of 0.80 which was higher than those of the 4 conventional staging systems (0.53e0.62). These results were supported by the internal and external validations. HPB 2016, 18 (S1), e1ee384
e35
Conclusions: The two nomograms showed accurate preand postoperative prediction of post-hepatectomy prognosis in patients with mHCCs.
FP09-06 ELEVATED LACTATE IS INDEPENDENTLY ASSOCIATED WITH ADVERSE OUTCOMES FOLLOWING HEPATECTOMY M. Lemke, P. Karanicolas, R. Habashi, R. Behman, N. Coburn, S. Hanna, C. Law and J. Hallet University of Toronto, Canada Introduction: Arterial lactate is frequently monitored in the critical care setting as an indicator of tissue hypoxia and to direct therapy. Hepatocyte ischemia and injury during transection may increase lactate concentration. We sought to determine whether early post-hepatectomy lactate is associated with adverse outcomes. Methods: We used a prospectively maintained institutional database of hepatectomy patients from 2003 to 2012. Patients with lactate available on the night following hepatectomy were included. Logistic regression was used to model the relationship between post-hepatectomy lactate and 30-day major morbidity (Clavien grade III). Results: Of 749 patients undergoing hepatectomy, 490 patients had post-hepatectomy lactate measured and were included. Included patients were more frequently returned to an intensive care unit for monitoring (92.4% vs. 36.8%, p < 0.01), had more major hepatectomy (3 segments, 75.1% vs 57.1%, p < 0.01), higher rates of major morbidity (19.2% vs. 14.3%, p = 0.10), and longer length of stay (IQR 612 vs. 5e10 days, p < 0.01) compared with patients who did not have lactate measured. Post-hepatectomy lactate was elevated (>2 mmol/L) in 71.4% of patients. Rates of morbidity and ninety date mortality were higher with increased lactatemia (Figure 1). Increased lactate was associated with a higher rate of major morbidity (OR 1.19, 95% CI 1.07-1.33) after controlling for age, co-morbidities, extent of surgery, use of inflow occlusion, blood loss and transfusions.
Figure 1. Patients experiencing post-hepatectomy major morbidity (Clavien grade III) and ninety day mortality by lactate levels following hepatectomy.
Conclusions: Lactate remains a useful predictor of posthepatectomy morbidity despite known associations with pre and intra-operative patient factors. Further research should investigate the role of early post-hepatectomy lactate in goal-directed fluid management.