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Endovascular treatment of stenosis and portal vein thrombosis after liver transplantation in children
Electronic Poster Abstracts and breast cancer in Korea. Therefore, optimal immunosuppressive regimen after de novo solid cancer is necessary. In this study, we evaluated the “in vitro” effects of various immunosuppressants alone or in combination with- or without metformin on colon cancer cell lines. Material and methods: HT-29 and SW620 colon cancer cell lines were tested. MTT assay and Western blot for mTOR pathway protein were performed. Sirolimus, FK506, MMF and Metformin in various combination were used. Results: The triple combination of Sirolimus/MMF/ Metformin showed the best inhibitory effect in HT29 cell line and SW620 (37.1%, 39.4% respectively compared to control). The mTOR pathway proteins (pmTOR, p70S6K and p4EBP1) were most strongly suppressed in Sirolimus/MMF combination in HT-29 and Sirolimus/MMF/Metformin combination in SW620. Conclusion: Sirolimus/MMF/Metformin combination showed best anti-cancer effect in this in vitro study. Therefore, conversion to sirolimus and MMF combination with/without metformin can be good strategy in cases with de novo colon cancer. However, further clinical study is necessary to confirm this result.
EP05A-067 SURGICAL COMPLICATIONS AFTER ORTHOTOPIC LIVER USING GRAFTS FROM MARGINAL DONORS A. Fraile, P. Barros Schellto, D. Ramisch, P. Farinelli, L. M. Mercado, S. Yantorno, V. Descalzi and G. E. Gondolesi Instituto de Trasplante Multiorgánico, Hospital Universitario Fundación Favaloro, Argentina Introduction: Orthotopic liver transplantation (OLT) is still the treatment of choice for patients with end-stage liver disease. But applicability is limited if only ideal donors are used. The aim of this paper was to assess the post OLT surgical complications (SC) associated with the use of nonideal cadaveric liver donors at a single centre. Methods: From 8/2009 to 7/2015, 291 OLT were performed. We analyzed SC rates comparing patients transplanted using donors with DRI <1.7 vs. DRI >1.7. Hemoperitoneum, vascular and biliary complications, primary no function (PNF), intraabdominal fluid collections and other were evaluated. Pediatric patients, partial grafts, retransplant, multi-organ transplants and living donors were excluded. Results: 190 met were evaluated. 60.5% were male. Mean age 54 12 years. SC frequency was 24.6% vs 34.6% for DRI <1.7 vs DRI >1.7 (p = ns). Details are showed in Table 1. Conclusions: The use of non-ideal donors did not increase the number of SC and did not compromise entry patient and
HPB 2016, 18 (S1), e385ee601
e563 DRI <1,7 n: 138 (%)
DRI >1,7 n: 52 (%)
Hemoperitoneo
3(5,8)
9(6,5) p = ns
Arterial complications
5(3,6)
5(9,8) p = ns
Portal complications
2(1,4)
2(3,9) p = ns
Biliary complication
12(8,7)
7(13,7) p = ns
Intra abdominal fluid collections
4(2,9)
0 p = ns
PNF
1(0,7)
1(1,9) p = ns
Retrasplant
6(4,3)
4(7,6) p = ns
30–90 day actuarial patient survival
97.1–94.9
94.2–92.2 p = ns
30–90 day actuarial graft survival
94.2–92
92.3–90.3 p = ns
graft survival. Its use should promote in order so increase OLT applicability.
EP05A-068 ENDOVASCULAR TREATMENT OF STENOSIS AND PORTAL VEIN THROMBOSIS AFTER LIVER TRANSPLANTATION IN CHILDREN J. P. K. Matushita Junior1, C. E. Zurstrassen1, C. J. Tyng1, M. D. O. Matos2, A. C. B. Cavalcante1, M. K. Amoedo2, D. C. Lima2, N. F. Delmonte1, L. P. Girelli2, R. Chojniak2 and J. Seda2 1 Interventional Radiology, and 2AC Camargo Cancer Center, Brazil Introduction and objectives: Portal vein thrombosis (PVT) represents an uncommon but serious complication of major surgery, especially after orthotopic liver transplantation (OLT), occurring in up to 2.7% of cases. The development of early PVT can compromise patient survival due to acute liver failure. Percutaneous transluminal angioplasty (PTA) with or without stenting has become a safe and effective therapeutic modality, and in many cases, the first option for treatment of the vascular complications after transplantation. The aim of this study was to retrospectively review our series in short and medium term cases of stenosis and portal vein thrombosis after liver transplantation in children treated with percutaneous transluminal angioplasty. Methods: The procedures were performed through transhepatic percutaneous access or transperitoneal access through inferior mesenteric vein branch catheterization. Patients with anastomotic stenosis were elected to treatment through percutaneous access. However, patients with chronic obstructions, due to the technical difficulty of recanalization of lesions with the hydrophilic guidewire, were chosen for transperitoneal approach. Results: In the study period, 14 patients showed stenosis or portal vein thrombosis.
e564
Electronic Poster Abstracts
The diagnosis was made by color Doppler ultrasound and confirmed by angiotomography in all cases. Seven patients with stenotic lesions treated by percutaneous transhepatic access, were treated by percutaneous transluminal balloon angioplasty in 6 patients. Seven patients were treated through transperitoneal. Of these, six were treated with primary stenting. Conclusions: Endovascular treatment of stenosis or portal vein thrombosis in post liver transplant children is safe and effective, with good patency in short and medium term.
EP05A-069 FEMALE GENDER AS A NEGATIVE PROGNOSTIC FACTOR IN THE SETTING OF LIVER TRANSPLANTATION FOR VIRAL HEPATITIS C M. F. Chedid1, A. Chedid1, M. R. Alvares-da-Silva2, I. Leipnitz1, T. J. M. Grezzana-Filho1, H. Bosi1, M. Reis3, A. de Araujo2, A. B. Lopes2, C. D. P. Kruel1 and C. R. P. Kruel1 1 Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clinicas de Porto Alegre, 2Division of Gastroenterology and Hepatology, Hospital de Clinicas de Porto Alegre, and 3hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Brazil Background: Detection of negative predictors may help finding strategies for protecting selected liver transplant recipients at higher risk for post-transplant death. Methods: Review of all consecutive hepatitis C-positive (HCV+) adult patients who underwent first orthotopic whole-graft liver transplant for at our institution between 2002 and 2013 was performed. Primary endpoint was overall post-transplant death. Results: Of 127 patients included this study, 47 (37%) were females; median age, 56 years-old (range 19e71). There were overall 46 (36.2%) deaths, 10 (8.7%) of those occurring on first 30 post-transplant days. Univariate analysis revealed female gender as the only predictor of overall mortality (RR = 2.18, CI = 1.22e3.93, p = 0.009). Interestingly, female gender was neither associated to 30day or 90-day mortality (p = 0.55) nor to mortality in the first post-transplant year (p = 0.41). Among all 47 female recipients of this cohort, predictors of overall death were higher calculated MELD scores (p = 0.04) (cut off by receiver operating characteristic curve (ROC) = 16), higher pre-transplant total bilirubin (p = 0.09) (cutoff by ROC = 3.4), and younger age (p = 0.008) (cutoff by ROC = 51 years), and absence of hepatocellular carcinoma (HCC) (RR = 3, CI = 1.31e7.43, p = 0.009). Conclusions: Female gender was the only predictor of death in this cohort. However, this association was not detected before the end of the first post-transplant year. Sicker young female HCV+ recipients (higher MELD scores, higher total bilirubin and patients transplanted without HCC appeal scores) are the ones most predisposed to death. This young HCV+ subgroup deserves careful pretransplant, perioperative and post-transplant care. Strategies for long-term management of this population including early HCV treatment are warranted.
EP05A-070 THE IMPORTANCE OF MELD AFTER LIVER TRANSPLANTATION TO PREDICT EARLY ALLOGRAFT DYSFUNCTION G. Schnorr, J. Padilla, A. David and C. Gritti Beneficencia Portuguesa Hospital, Brazil Early allograft dysfunction (EAD) is a serious complication of liver transplantation (LT). EAD is often multifactorial and The Model for End-Stage Liver Disease (MELD) has the unique ability to incorporate many variables and reflect the overall status of the graft. The MELD score is estimated based on the following variables: creatinine level, total bilirubin level and International normalized ratio (INR). The MELD score is extensively used preoperatively but little is known about the course of the MELD score after LT. The aim of this study was to demonstrate the ideal cut off MELD score for predicting early graft failure in order to re-list the patient as soon as possible. In this single-center, retrospective study, the INR, total bilirubin and creatinine levels were used to calculate the MELD scores within 7 days after LT for a 100 patients. Aspartame aminotransferase (AST) and alkaline phosphatase (ALT) within 7 days after LT were also measured and used as parameters to predict allograft dysfunction.
EP05A-071 PAEDIATRIC HEPATOCELLULAR CARCINOMA - OUTCOMES K. Palaniappan, S. Govil and M. Rela Institute of Liver Disease and Transplantation, Global Health City, India Introduction: Hepatocellular carcinoma (HCC) is the second most common malignant liver tumour of childhood. It typically affects children with a median age of 10e14 years on background Hepatitis B related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of 5 years typically constitute less than 10% of all children with HCC and occur on a background of congenital or metabolic liver disease. Method: The records of all children with HCC who presented to our department over a 6-year study period were reviewed. Results: Twelve patients with a median age of 5.9 years (range 1.6e15.4 years) were diagnosed to have HCC. All patients underwent liver transplantation, none were resected. Eleven patients had background congenital or metabolic liver disease. All 5 of those with Hereditary Tyrosinemia Type 1 who presented to us were found to have HCC. No patient had Hepatitis B related liver (HBV) disease. Eight (66.7%) patients had incidentally discovered HCC on examination of the explant. Incidentally discovered HCC were smaller, well differentiated and did not show microvascular invasion compared to those diagnosed preoperatively. There was no recurrence with a median follow-up of 5 months. Conclusion: The patient demographic for pediatric HCC is changing probably as a consequence of successful immunization against HBV. Younger patients with congenital and metabolic liver disease in whom liver transplantation is the ideal treatment are likely to constitute an ever-increasing proportion of patients with HPB 2016, 18 (S1), e385ee601
EP05A-067 SURGICAL COMPLICATIONS AFTER ORTHOTOPIC LIVER USING GRAFTS FROM MARGINAL DONORS A. Fraile, P. Barros Schellto, D. Ramisch, P. Farinelli, L. M. Mercado, S. Yantorno, V. Descalzi and G. E. Gondolesi Instituto de Trasplante Multiorgánico, Hospital Universitario Fundación Favaloro, Argentina Introduction: Orthotopic liver transplantation (OLT) is still the treatment of choice for patients with end-stage liver disease. But applicability is limited if only ideal donors are used. The aim of this paper was to assess the post OLT surgical complications (SC) associated with the use of nonideal cadaveric liver donors at a single centre. Methods: From 8/2009 to 7/2015, 291 OLT were performed. We analyzed SC rates comparing patients transplanted using donors with DRI <1.7 vs. DRI >1.7. Hemoperitoneum, vascular and biliary complications, primary no function (PNF), intraabdominal fluid collections and other were evaluated. Pediatric patients, partial grafts, retransplant, multi-organ transplants and living donors were excluded. Results: 190 met were evaluated. 60.5% were male. Mean age 54 12 years. SC frequency was 24.6% vs 34.6% for DRI <1.7 vs DRI >1.7 (p = ns). Details are showed in Table 1. Conclusions: The use of non-ideal donors did not increase the number of SC and did not compromise entry patient and
HPB 2016, 18 (S1), e385ee601
e563 DRI <1,7 n: 138 (%)
DRI >1,7 n: 52 (%)
Hemoperitoneo
3(5,8)
9(6,5) p = ns
Arterial complications
5(3,6)
5(9,8) p = ns
Portal complications
2(1,4)
2(3,9) p = ns
Biliary complication
12(8,7)
7(13,7) p = ns
Intra abdominal fluid collections
4(2,9)
0 p = ns
PNF
1(0,7)
1(1,9) p = ns
Retrasplant
6(4,3)
4(7,6) p = ns
30–90 day actuarial patient survival
97.1–94.9
94.2–92.2 p = ns
30–90 day actuarial graft survival
94.2–92
92.3–90.3 p = ns
graft survival. Its use should promote in order so increase OLT applicability.
EP05A-068 ENDOVASCULAR TREATMENT OF STENOSIS AND PORTAL VEIN THROMBOSIS AFTER LIVER TRANSPLANTATION IN CHILDREN J. P. K. Matushita Junior1, C. E. Zurstrassen1, C. J. Tyng1, M. D. O. Matos2, A. C. B. Cavalcante1, M. K. Amoedo2, D. C. Lima2, N. F. Delmonte1, L. P. Girelli2, R. Chojniak2 and J. Seda2 1 Interventional Radiology, and 2AC Camargo Cancer Center, Brazil Introduction and objectives: Portal vein thrombosis (PVT) represents an uncommon but serious complication of major surgery, especially after orthotopic liver transplantation (OLT), occurring in up to 2.7% of cases. The development of early PVT can compromise patient survival due to acute liver failure. Percutaneous transluminal angioplasty (PTA) with or without stenting has become a safe and effective therapeutic modality, and in many cases, the first option for treatment of the vascular complications after transplantation. The aim of this study was to retrospectively review our series in short and medium term cases of stenosis and portal vein thrombosis after liver transplantation in children treated with percutaneous transluminal angioplasty. Methods: The procedures were performed through transhepatic percutaneous access or transperitoneal access through inferior mesenteric vein branch catheterization. Patients with anastomotic stenosis were elected to treatment through percutaneous access. However, patients with chronic obstructions, due to the technical difficulty of recanalization of lesions with the hydrophilic guidewire, were chosen for transperitoneal approach. Results: In the study period, 14 patients showed stenosis or portal vein thrombosis.
e564
Electronic Poster Abstracts
The diagnosis was made by color Doppler ultrasound and confirmed by angiotomography in all cases. Seven patients with stenotic lesions treated by percutaneous transhepatic access, were treated by percutaneous transluminal balloon angioplasty in 6 patients. Seven patients were treated through transperitoneal. Of these, six were treated with primary stenting. Conclusions: Endovascular treatment of stenosis or portal vein thrombosis in post liver transplant children is safe and effective, with good patency in short and medium term.
EP05A-069 FEMALE GENDER AS A NEGATIVE PROGNOSTIC FACTOR IN THE SETTING OF LIVER TRANSPLANTATION FOR VIRAL HEPATITIS C M. F. Chedid1, A. Chedid1, M. R. Alvares-da-Silva2, I. Leipnitz1, T. J. M. Grezzana-Filho1, H. Bosi1, M. Reis3, A. de Araujo2, A. B. Lopes2, C. D. P. Kruel1 and C. R. P. Kruel1 1 Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clinicas de Porto Alegre, 2Division of Gastroenterology and Hepatology, Hospital de Clinicas de Porto Alegre, and 3hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Brazil Background: Detection of negative predictors may help finding strategies for protecting selected liver transplant recipients at higher risk for post-transplant death. Methods: Review of all consecutive hepatitis C-positive (HCV+) adult patients who underwent first orthotopic whole-graft liver transplant for at our institution between 2002 and 2013 was performed. Primary endpoint was overall post-transplant death. Results: Of 127 patients included this study, 47 (37%) were females; median age, 56 years-old (range 19e71). There were overall 46 (36.2%) deaths, 10 (8.7%) of those occurring on first 30 post-transplant days. Univariate analysis revealed female gender as the only predictor of overall mortality (RR = 2.18, CI = 1.22e3.93, p = 0.009). Interestingly, female gender was neither associated to 30day or 90-day mortality (p = 0.55) nor to mortality in the first post-transplant year (p = 0.41). Among all 47 female recipients of this cohort, predictors of overall death were higher calculated MELD scores (p = 0.04) (cut off by receiver operating characteristic curve (ROC) = 16), higher pre-transplant total bilirubin (p = 0.09) (cutoff by ROC = 3.4), and younger age (p = 0.008) (cutoff by ROC = 51 years), and absence of hepatocellular carcinoma (HCC) (RR = 3, CI = 1.31e7.43, p = 0.009). Conclusions: Female gender was the only predictor of death in this cohort. However, this association was not detected before the end of the first post-transplant year. Sicker young female HCV+ recipients (higher MELD scores, higher total bilirubin and patients transplanted without HCC appeal scores) are the ones most predisposed to death. This young HCV+ subgroup deserves careful pretransplant, perioperative and post-transplant care. Strategies for long-term management of this population including early HCV treatment are warranted.
EP05A-070 THE IMPORTANCE OF MELD AFTER LIVER TRANSPLANTATION TO PREDICT EARLY ALLOGRAFT DYSFUNCTION G. Schnorr, J. Padilla, A. David and C. Gritti Beneficencia Portuguesa Hospital, Brazil Early allograft dysfunction (EAD) is a serious complication of liver transplantation (LT). EAD is often multifactorial and The Model for End-Stage Liver Disease (MELD) has the unique ability to incorporate many variables and reflect the overall status of the graft. The MELD score is estimated based on the following variables: creatinine level, total bilirubin level and International normalized ratio (INR). The MELD score is extensively used preoperatively but little is known about the course of the MELD score after LT. The aim of this study was to demonstrate the ideal cut off MELD score for predicting early graft failure in order to re-list the patient as soon as possible. In this single-center, retrospective study, the INR, total bilirubin and creatinine levels were used to calculate the MELD scores within 7 days after LT for a 100 patients. Aspartame aminotransferase (AST) and alkaline phosphatase (ALT) within 7 days after LT were also measured and used as parameters to predict allograft dysfunction.
EP05A-071 PAEDIATRIC HEPATOCELLULAR CARCINOMA - OUTCOMES K. Palaniappan, S. Govil and M. Rela Institute of Liver Disease and Transplantation, Global Health City, India Introduction: Hepatocellular carcinoma (HCC) is the second most common malignant liver tumour of childhood. It typically affects children with a median age of 10e14 years on background Hepatitis B related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of 5 years typically constitute less than 10% of all children with HCC and occur on a background of congenital or metabolic liver disease. Method: The records of all children with HCC who presented to our department over a 6-year study period were reviewed. Results: Twelve patients with a median age of 5.9 years (range 1.6e15.4 years) were diagnosed to have HCC. All patients underwent liver transplantation, none were resected. Eleven patients had background congenital or metabolic liver disease. All 5 of those with Hereditary Tyrosinemia Type 1 who presented to us were found to have HCC. No patient had Hepatitis B related liver (HBV) disease. Eight (66.7%) patients had incidentally discovered HCC on examination of the explant. Incidentally discovered HCC were smaller, well differentiated and did not show microvascular invasion compared to those diagnosed preoperatively. There was no recurrence with a median follow-up of 5 months. Conclusion: The patient demographic for pediatric HCC is changing probably as a consequence of successful immunization against HBV. Younger patients with congenital and metabolic liver disease in whom liver transplantation is the ideal treatment are likely to constitute an ever-increasing proportion of patients with HPB 2016, 18 (S1), e385ee601