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Functional hepatic venous outflow and its correlation with early graft function in live donor liver transplantation
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Electronic Poster Abstracts
none of control or MP groups. At the end of cold preservation, ATP content was higher in MP group vs. SCS group. After reperfusion, MP livers functioned better (INR, bilirubin) and showed less hepatocellular and endothelial cell injury, in agreement with better preserved liver integrity (histology). MP livers also exhibited higher ATP recovery than SCS livers. The protective effect of AirdriveÒ was associated with attenuation of oxidative and endoplasmic reticulum stress leading to reduced mitochondrial injury and apoptosis. We demonstrate for the first time the efficacy of MP AirdriveÒ device to enhance donor liver viability for transplantation in a clinically relevant DCD model.
EP05A-048 CHEMOEMBOLIZATION AS SELECTION TOOL FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA (HCC) ABOVE UCSF CRITERIA e A NATIONAL DOWN STAGING STUDY M. Rizell1, P. Stal2, M. Sternby1, P. Sandstrom3, A. Noren4, B. Ardnor5, G. Lindell6 and G. Soderdahl2 1 Sahlgrenska University Hospital, 2Karolinska University Hospital, 3Linköping University Hospital, 4Akademiska University Hospital, Uppsala, 5Umeå University Hospital, and 6Lund University Hospital, Sweden Purpose of study: National guidelines in Sweden stipulate that transplantation is indicated in HCC with a tumor up to San Francisco (UCSF) criteria. However, studies and caseseries report successful transplantation after down staging. Vascularised tumor diameter, as measured by mRECIST correlate to survival, and improvements in intervention (standardisation and selection of beads and increased dose administration of doxorubicin) increase response rate after chemoembolization. Hypothesis: Survival will be prolonged for HCC patients selected to be downsized (in comparison to historical registry data). Transplantation will be possible with a 50% 5year survival. Patient selection: Patients are eligible for study irrespective of tumor burden in the liver, of there is no extra hepatic growth or vascular invasion, and if the performance and comorbidity or social situation does not contraindicate transplantation. Method: A nationwide multi centre study selecting HCC above UCSF without size-limit. Intervention: Chemoembolization until response or failure. Ablation is allowed. Response is measured as decrease in vascularised diameter (in accordance with mRECIST), as a decrease of at least 30% and with a sum of maximum tumor diameter 80 mm. Prognostic factors is registered. Study is ongoing since autumn 2015. This study is affiliated to the national liver tumor register (SweLiv), which will add the possibility to describe the selection among all HCC patients.
EP05A-049 FUNCTIONAL HEPATIC VENOUS OUTFLOW AND ITS CORRELATION WITH EARLY GRAFT FUNCTION IN LIVE DONOR LIVER TRANSPLANTATION M. Appukuttan1, V. Pamecha1, S. Kumar1, K. G. S. Bharathy1, S. V. Sasturkar1, P. K. Sihha1 and S. Sarin2 1 Liver Transplantation & HPB Surgery, and 2Hepatology, Institute of Liver & Biliary Sciences, India Introduction: To evaluate the effect of central venous pressure (CVP) on early graft function in live donor liver transplantation (LDLT). Methods: 61 Recipients of LDLT without any technical complications from May 2013 to November 2014 were included. CVP was measured at five time points e before surgery, anhepatic phase, 30 minutes after reperfusion, end of surgery and post operatively (days 1e5). Patients were divided into two groups based on CVP 10, >10 mm Hg at various time points for analysis. Results: Elevated postoperative CVP (p 0.001) and drain culture positivity in the first week (p < 0.001) were found to be independent predictors of mortality on multivariate analysis. Optimum cut off of CVP in predicting mortality is 10.8. High cardiac output at the end of surgery (p = 0.005), high MELD scores (p = 0.011) and culture proven infection at any site (p = 0.002) were all independent predictors of early graft dysfunction (EGD) on multivariate analysis. There was an inverse correlation between CVP and SVR at the beginning of surgery which reversed to a positive correlation at the end of surgery. Conclusions: Elevated CVP in the postoperative period in recipients is a risk factor of mortality in the setting of LDLT. EGD is associated with high MELD scores, higher cardiac output at the end of surgery and infection at any site. A restrictive fluid management protocol aiming for a CVP <11 seems beneficial.
EP05A-050 RISK FACTORS FOR MAJOR BLOOD TRANSFUSION DURING LIVER TRANSPLANTATION K. Kobry n, M. Gra¸ t, K. Kobry n, E. Soba nska, W. Patkowski and M. Krawczyk General, Transplant and Liver Surgery, Medical University of Warsaw, Poland Introduction: Liver transplantation (LTx) is associated with high risk of blood loss and need for major blood transfusions. Data in literature report results from a mean 0.5e13 packed red blood cells (PRBC) transfused per operation. The aim of this study was to assess risk factors for major blood transfusions in deceased donor liver transplantation. Methods: More than 1650 liver transplantations performed in the Department of General, Transplant and
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
none of control or MP groups. At the end of cold preservation, ATP content was higher in MP group vs. SCS group. After reperfusion, MP livers functioned better (INR, bilirubin) and showed less hepatocellular and endothelial cell injury, in agreement with better preserved liver integrity (histology). MP livers also exhibited higher ATP recovery than SCS livers. The protective effect of AirdriveÒ was associated with attenuation of oxidative and endoplasmic reticulum stress leading to reduced mitochondrial injury and apoptosis. We demonstrate for the first time the efficacy of MP AirdriveÒ device to enhance donor liver viability for transplantation in a clinically relevant DCD model.
EP05A-048 CHEMOEMBOLIZATION AS SELECTION TOOL FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA (HCC) ABOVE UCSF CRITERIA e A NATIONAL DOWN STAGING STUDY M. Rizell1, P. Stal2, M. Sternby1, P. Sandstrom3, A. Noren4, B. Ardnor5, G. Lindell6 and G. Soderdahl2 1 Sahlgrenska University Hospital, 2Karolinska University Hospital, 3Linköping University Hospital, 4Akademiska University Hospital, Uppsala, 5Umeå University Hospital, and 6Lund University Hospital, Sweden Purpose of study: National guidelines in Sweden stipulate that transplantation is indicated in HCC with a tumor up to San Francisco (UCSF) criteria. However, studies and caseseries report successful transplantation after down staging. Vascularised tumor diameter, as measured by mRECIST correlate to survival, and improvements in intervention (standardisation and selection of beads and increased dose administration of doxorubicin) increase response rate after chemoembolization. Hypothesis: Survival will be prolonged for HCC patients selected to be downsized (in comparison to historical registry data). Transplantation will be possible with a 50% 5year survival. Patient selection: Patients are eligible for study irrespective of tumor burden in the liver, of there is no extra hepatic growth or vascular invasion, and if the performance and comorbidity or social situation does not contraindicate transplantation. Method: A nationwide multi centre study selecting HCC above UCSF without size-limit. Intervention: Chemoembolization until response or failure. Ablation is allowed. Response is measured as decrease in vascularised diameter (in accordance with mRECIST), as a decrease of at least 30% and with a sum of maximum tumor diameter 80 mm. Prognostic factors is registered. Study is ongoing since autumn 2015. This study is affiliated to the national liver tumor register (SweLiv), which will add the possibility to describe the selection among all HCC patients.
EP05A-049 FUNCTIONAL HEPATIC VENOUS OUTFLOW AND ITS CORRELATION WITH EARLY GRAFT FUNCTION IN LIVE DONOR LIVER TRANSPLANTATION M. Appukuttan1, V. Pamecha1, S. Kumar1, K. G. S. Bharathy1, S. V. Sasturkar1, P. K. Sihha1 and S. Sarin2 1 Liver Transplantation & HPB Surgery, and 2Hepatology, Institute of Liver & Biliary Sciences, India Introduction: To evaluate the effect of central venous pressure (CVP) on early graft function in live donor liver transplantation (LDLT). Methods: 61 Recipients of LDLT without any technical complications from May 2013 to November 2014 were included. CVP was measured at five time points e before surgery, anhepatic phase, 30 minutes after reperfusion, end of surgery and post operatively (days 1e5). Patients were divided into two groups based on CVP 10, >10 mm Hg at various time points for analysis. Results: Elevated postoperative CVP (p 0.001) and drain culture positivity in the first week (p < 0.001) were found to be independent predictors of mortality on multivariate analysis. Optimum cut off of CVP in predicting mortality is 10.8. High cardiac output at the end of surgery (p = 0.005), high MELD scores (p = 0.011) and culture proven infection at any site (p = 0.002) were all independent predictors of early graft dysfunction (EGD) on multivariate analysis. There was an inverse correlation between CVP and SVR at the beginning of surgery which reversed to a positive correlation at the end of surgery. Conclusions: Elevated CVP in the postoperative period in recipients is a risk factor of mortality in the setting of LDLT. EGD is associated with high MELD scores, higher cardiac output at the end of surgery and infection at any site. A restrictive fluid management protocol aiming for a CVP <11 seems beneficial.
EP05A-050 RISK FACTORS FOR MAJOR BLOOD TRANSFUSION DURING LIVER TRANSPLANTATION K. Kobry n, M. Gra¸ t, K. Kobry n, E. Soba nska, W. Patkowski and M. Krawczyk General, Transplant and Liver Surgery, Medical University of Warsaw, Poland Introduction: Liver transplantation (LTx) is associated with high risk of blood loss and need for major blood transfusions. Data in literature report results from a mean 0.5e13 packed red blood cells (PRBC) transfused per operation. The aim of this study was to assess risk factors for major blood transfusions in deceased donor liver transplantation. Methods: More than 1650 liver transplantations performed in the Department of General, Transplant and
HPB 2016, 18 (S1), e385ee601