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HBV DNA Suppression During Entecavir Treatment in Previously – Treated Children With CHB
AASLD Abstracts
Hepatitis (AIH) and Primary Sclerosing Cholangitis (PSC), and identify specific prognostic factors adversely effecting it. Methods: The pediatric QOL inventory (PedsQL 4.0) generic core scale, a reliable and validated multidimensional measure of health status, was used as the instrument to collect data on 39 children with AILD followed at the Cleveland Clinic. Specific questions regarding liver disease related symptoms were included. Results: Survey responses were received from 29/39 patients (74.3%).The mean age of the patients was 16+/- 5.5 yrs. They were predominantly caucasians (77%),with a F:M ratio of 1:0.8, and had AILD for an average of 4.4 years, with AIH in 41%, PSC in 44% and overlap syndrome in 15% of the patients. Advanced liver disease was present in 74% patients.The mean overall health summary scores for the group per child and parent reports were 72.7 and 71 respectively, which were significantly lower than healthy controls: 83.9 and 82.3 ( p=0.003 and 0.002),but similar to other chronic pediatric disorders.Abdominal pain was associated with significant impairment in QOL per child report for all 5 domains- physical, emotional, social,psychosocial and overall health summary scores ( p=0.003, 0.027, 0.022, 0.024 and 0.013 respectively),with similar findings per parent report. Fatigue impaired the physical functioning score significantly per child report ( p=0.024), but effected multiple domains per parent report: physical, social, school, psychosocial and overall health summary scores ( p= 0.004, 0.015, 0.027, 0.021 ,0.005 respectively). Frequent liver disease specific symptoms were associated with impaired physical and school functioning by child (p= 0.025 and 0.035) and parent reports ( p=0.048 and 0.018). Advanced disease in the form of cirrhosis, portal hypertension and h/o gastrointestinal bleed did not show significant impairement in QOL, however presence of ascites was associated with poor QOL in social functioning domain per parent report (p=0.044). Hypoalbuminemia, was the only laboratory feature associated with impaired QOL (p=0.048). There were no differences in QOL between AIH vs PSC vs Overlap syndrome. Conclusion: This is the first study to date, showing that AILD in children significantly effects QOL,especially when they are frequently having symptoms related specifically to liver disease. The study also showed a good degree of concordance between children and their parents.These findings need to be validated in larger, multicenter studies and will help practitioners focus their efforts in counseling patients and optimizing care.
analyzed. Subjects were categorized as underweight, normal weight, overweight, or obese by CDC guidelines. Overweight/obesity prevalence was compared using two-sample proportion tests. Incident diabetes was examined using Kaplan-Meier calculations and log rank testing. Results: Patients with previous transplant or incomplete/biologically implausible data were excluded. Of the 3,043 children 6-24 months of age at transplant, 17% were underweight, 69% normal weight, and 14% overweight at transplant. Of the 4,658 subjects 2-20 years of age at transplant, 7% were underweight, 64% normal weight, 16% overweight, and 13% obese at transplant. Children overweight/obese at transplant were more likely to be overweight/obese after transplant than children under/normal weight at transplant in both age groups (Figures 1-2). These patterns did not change with analysis of subgroups by year of transplant or after exclusion of patients with ascites or on dialysis at transplant. Of 7,236 patients without diabetes at transplant, 351 (4.9%) developed diabetes after transplant. Weight status at transplant and follow-up was not associated with incident diabetes. Patients who were adolescent at transplant (p<0.0005) or with metabolic liver disease or acute liver failure (p=0.01) were most likely to develop diabetes. Conclusions: The prevalence and pattern of overweight/obesity in pediatric liver transplant recipients has been stable over the last 20 years despite the U.S. obesity “epidemic.” However, even among children under/ normal weight at transplant, one-third of younger children and one-quarter of older children become overweight or obese within 1-2 years. Children already overweight/obese at transplant have a high risk of remaining overweight/obese. Children less than 24 months of age at transplant were more likely to return to normal weight in long-term follow-up. Post-transplant diabetes in children and adolescents is not driven by overweight/obesity. To optimize longterm outcomes in pediatric liver transplant recipients, monitoring for obesity and its comorbidities is important.
Su1858 HBV DNA Suppression During Entecavir Treatment in Previously - Treated Children With CHB Malgorzata Pawlowska, Waldemar Halota, Ewa Smukalska Background and aims: The aim of this study was to assess the HBV DNA suppression after 4 and 12 weeks of treatment with entecavir of children and adolescens with chronic hepatitis B (CHB). Materials and methods: 24 children aged 5-17 years (mean age 14,5+3) were treated with entecavir (0,5 mg or 1mg daily according to previous anti-HBV treatment). There were 21 males and 3 females in the group, 16 children were HBeAg-positive and 8 were HBeAg-negative. 7 children had previously been treated with recombinant interferon (IFN), 2 with lamivudine (LAM), 1 with adefovir (ADV), 13 with IFN and LAM, 1 with IFN, LAM and ADV. Baseline HBV DNA viral load was in 9 children >10^7 IU/mL, in 3 patients between 10^6 and 10^7 IU/mL, in 3 between 10^5 and 10^6, in 7 between 10^4 and 10^5 IU/mL and in 2 children between 10^3 and 10^4 IU/mL In 2 children HBV polymerase mutations L180M and M204V, and in one L80I and M204I were detected. No child had liver disease assessed as greater than grade 2, stage 2. Serum HBV DNA was quantified at baseline and after 4 and 12 weeks of treatment with RT PCR method (Roche TaqMan). Results: During treatment the serum HBV DNA was decreased in all examined children. HBV DNA suppression is presented in table Conclusion: Entecavir induced fast and strong HBV DNA suppression in children with CHB non-responded to previous treatment, especially in HBeAg-negative CHB. HBV DNA suppression
Analysis includes 1513 patients under/normal weight and 582 patients overweight/obese at transplant. P-values from two-sample test of proportions, comparing prevalence of overweight/obesity at follow-up in patients under/normal weight vs. overweight/obese at transplant. *p<0.0005. **p=0.09.
Analysis includes 1163 patients under/normal weight and 183 patients overweight/obese at transplant. P-values from two-sample test of proportions, comparing prevalence of overweight/obesity at follow-up in patients under/normal weight vs. overweight/obese at transplant. *p<0.0005. Su1860 Need for Dialysis Following Pediatric Liver Transplantation as a Function of Pre-Operative GFR and Intra-Operative Fluid Load Sanjiv Harpavat, Ramya Ramraj, Elliot. O. Smith, John A. Goss, Christine O'Mahony, Daniel I. Feig, Saul J. Karpen Background: One early complication of pediatric liver transplantation (LT) is acute kidney injury. While the pathophysiology is poorly understood, there are likely many contributing factors. We sought to identify pre- and intra-operative factors that correlate with the need for dialysis. Hypothesis: Pre-existing subclinical renal dysfunction and increased intra-operative fluid load associate with need for dialysis in the immediate post-operative period. Methods: Charts from 42 patients undergoing LT at Texas Children's Hospital between 2006-2010 were reviewed retrospectively. Estimated glomerular filtration rate (eGFR) was calculated using the traditional Schwartz formula. Total fluids, including crystalloid, colloid, parental nutrition, and blood products, were obtained from the operative note. Using binary logistic regression, an equation was derived relating need for dialysis as a function of GFR and total fluids. The equation's utility for predicting individual patient outcomes was assessed through receiver operator curve (ROC) analysis. Results: Of the 42 patients, 6 required dialysis 3-5 days following LT. Pre-operative eGFR (p=0.041) and intra-operative fluid (p=0.032) were independently associated with need for dialysis. Using the model, an ROC was created and cut-off values determined to achieve 100% sensitivity (confidence interval 54-100%) and 83% specificity (confidence interval 67-94%) (Figure 1). Conclusions: Pre-existing GFR and intra-operative fluid load are associated with the need for dialysis in the immediate postLT period. In the future, the model can be refined with larger sample sizes, and may be used as a tool that identifies patients at risk for developing acute kidney injury and requiring dialysis.
Su1859 Overweight and Obesity in Pediatric Liver Transplant Recipients: Prevalence and Predictors at Transplant and in Long-Term Follow-up, United Network for Organ Sharing (UNOS) Data, 1987-2010 Emily J. Rothbaum Perito, Philip Rosenthal Introduction: Obesity and metabolic syndrome are increasingly common in adult liver transplant recipients and in the general U.S. pediatric population, but little is known about obesity in pediatric liver transplant recipients. One recent analysis of children linked obesity at liver transplant to increased post-transplant mortality. Survival in pediatric liver transplant recipients at 5 years exceeds 90%, so attention to long-term complications like obesity and its comorbidities is important. Aim: To describe the prevalence and persistence of overweight/ obesity in children with liver transplants and to delineate risk factors. Methods: UNOS data on all U.S. liver transplants 1987-2010 in children 6 months-20 years at transplant was
AASLD Abstracts
S-940
Hepatitis (AIH) and Primary Sclerosing Cholangitis (PSC), and identify specific prognostic factors adversely effecting it. Methods: The pediatric QOL inventory (PedsQL 4.0) generic core scale, a reliable and validated multidimensional measure of health status, was used as the instrument to collect data on 39 children with AILD followed at the Cleveland Clinic. Specific questions regarding liver disease related symptoms were included. Results: Survey responses were received from 29/39 patients (74.3%).The mean age of the patients was 16+/- 5.5 yrs. They were predominantly caucasians (77%),with a F:M ratio of 1:0.8, and had AILD for an average of 4.4 years, with AIH in 41%, PSC in 44% and overlap syndrome in 15% of the patients. Advanced liver disease was present in 74% patients.The mean overall health summary scores for the group per child and parent reports were 72.7 and 71 respectively, which were significantly lower than healthy controls: 83.9 and 82.3 ( p=0.003 and 0.002),but similar to other chronic pediatric disorders.Abdominal pain was associated with significant impairment in QOL per child report for all 5 domains- physical, emotional, social,psychosocial and overall health summary scores ( p=0.003, 0.027, 0.022, 0.024 and 0.013 respectively),with similar findings per parent report. Fatigue impaired the physical functioning score significantly per child report ( p=0.024), but effected multiple domains per parent report: physical, social, school, psychosocial and overall health summary scores ( p= 0.004, 0.015, 0.027, 0.021 ,0.005 respectively). Frequent liver disease specific symptoms were associated with impaired physical and school functioning by child (p= 0.025 and 0.035) and parent reports ( p=0.048 and 0.018). Advanced disease in the form of cirrhosis, portal hypertension and h/o gastrointestinal bleed did not show significant impairement in QOL, however presence of ascites was associated with poor QOL in social functioning domain per parent report (p=0.044). Hypoalbuminemia, was the only laboratory feature associated with impaired QOL (p=0.048). There were no differences in QOL between AIH vs PSC vs Overlap syndrome. Conclusion: This is the first study to date, showing that AILD in children significantly effects QOL,especially when they are frequently having symptoms related specifically to liver disease. The study also showed a good degree of concordance between children and their parents.These findings need to be validated in larger, multicenter studies and will help practitioners focus their efforts in counseling patients and optimizing care.
analyzed. Subjects were categorized as underweight, normal weight, overweight, or obese by CDC guidelines. Overweight/obesity prevalence was compared using two-sample proportion tests. Incident diabetes was examined using Kaplan-Meier calculations and log rank testing. Results: Patients with previous transplant or incomplete/biologically implausible data were excluded. Of the 3,043 children 6-24 months of age at transplant, 17% were underweight, 69% normal weight, and 14% overweight at transplant. Of the 4,658 subjects 2-20 years of age at transplant, 7% were underweight, 64% normal weight, 16% overweight, and 13% obese at transplant. Children overweight/obese at transplant were more likely to be overweight/obese after transplant than children under/normal weight at transplant in both age groups (Figures 1-2). These patterns did not change with analysis of subgroups by year of transplant or after exclusion of patients with ascites or on dialysis at transplant. Of 7,236 patients without diabetes at transplant, 351 (4.9%) developed diabetes after transplant. Weight status at transplant and follow-up was not associated with incident diabetes. Patients who were adolescent at transplant (p<0.0005) or with metabolic liver disease or acute liver failure (p=0.01) were most likely to develop diabetes. Conclusions: The prevalence and pattern of overweight/obesity in pediatric liver transplant recipients has been stable over the last 20 years despite the U.S. obesity “epidemic.” However, even among children under/ normal weight at transplant, one-third of younger children and one-quarter of older children become overweight or obese within 1-2 years. Children already overweight/obese at transplant have a high risk of remaining overweight/obese. Children less than 24 months of age at transplant were more likely to return to normal weight in long-term follow-up. Post-transplant diabetes in children and adolescents is not driven by overweight/obesity. To optimize longterm outcomes in pediatric liver transplant recipients, monitoring for obesity and its comorbidities is important.
Su1858 HBV DNA Suppression During Entecavir Treatment in Previously - Treated Children With CHB Malgorzata Pawlowska, Waldemar Halota, Ewa Smukalska Background and aims: The aim of this study was to assess the HBV DNA suppression after 4 and 12 weeks of treatment with entecavir of children and adolescens with chronic hepatitis B (CHB). Materials and methods: 24 children aged 5-17 years (mean age 14,5+3) were treated with entecavir (0,5 mg or 1mg daily according to previous anti-HBV treatment). There were 21 males and 3 females in the group, 16 children were HBeAg-positive and 8 were HBeAg-negative. 7 children had previously been treated with recombinant interferon (IFN), 2 with lamivudine (LAM), 1 with adefovir (ADV), 13 with IFN and LAM, 1 with IFN, LAM and ADV. Baseline HBV DNA viral load was in 9 children >10^7 IU/mL, in 3 patients between 10^6 and 10^7 IU/mL, in 3 between 10^5 and 10^6, in 7 between 10^4 and 10^5 IU/mL and in 2 children between 10^3 and 10^4 IU/mL In 2 children HBV polymerase mutations L180M and M204V, and in one L80I and M204I were detected. No child had liver disease assessed as greater than grade 2, stage 2. Serum HBV DNA was quantified at baseline and after 4 and 12 weeks of treatment with RT PCR method (Roche TaqMan). Results: During treatment the serum HBV DNA was decreased in all examined children. HBV DNA suppression is presented in table Conclusion: Entecavir induced fast and strong HBV DNA suppression in children with CHB non-responded to previous treatment, especially in HBeAg-negative CHB. HBV DNA suppression
Analysis includes 1513 patients under/normal weight and 582 patients overweight/obese at transplant. P-values from two-sample test of proportions, comparing prevalence of overweight/obesity at follow-up in patients under/normal weight vs. overweight/obese at transplant. *p<0.0005. **p=0.09.
Analysis includes 1163 patients under/normal weight and 183 patients overweight/obese at transplant. P-values from two-sample test of proportions, comparing prevalence of overweight/obesity at follow-up in patients under/normal weight vs. overweight/obese at transplant. *p<0.0005. Su1860 Need for Dialysis Following Pediatric Liver Transplantation as a Function of Pre-Operative GFR and Intra-Operative Fluid Load Sanjiv Harpavat, Ramya Ramraj, Elliot. O. Smith, John A. Goss, Christine O'Mahony, Daniel I. Feig, Saul J. Karpen Background: One early complication of pediatric liver transplantation (LT) is acute kidney injury. While the pathophysiology is poorly understood, there are likely many contributing factors. We sought to identify pre- and intra-operative factors that correlate with the need for dialysis. Hypothesis: Pre-existing subclinical renal dysfunction and increased intra-operative fluid load associate with need for dialysis in the immediate post-operative period. Methods: Charts from 42 patients undergoing LT at Texas Children's Hospital between 2006-2010 were reviewed retrospectively. Estimated glomerular filtration rate (eGFR) was calculated using the traditional Schwartz formula. Total fluids, including crystalloid, colloid, parental nutrition, and blood products, were obtained from the operative note. Using binary logistic regression, an equation was derived relating need for dialysis as a function of GFR and total fluids. The equation's utility for predicting individual patient outcomes was assessed through receiver operator curve (ROC) analysis. Results: Of the 42 patients, 6 required dialysis 3-5 days following LT. Pre-operative eGFR (p=0.041) and intra-operative fluid (p=0.032) were independently associated with need for dialysis. Using the model, an ROC was created and cut-off values determined to achieve 100% sensitivity (confidence interval 54-100%) and 83% specificity (confidence interval 67-94%) (Figure 1). Conclusions: Pre-existing GFR and intra-operative fluid load are associated with the need for dialysis in the immediate postLT period. In the future, the model can be refined with larger sample sizes, and may be used as a tool that identifies patients at risk for developing acute kidney injury and requiring dialysis.
Su1859 Overweight and Obesity in Pediatric Liver Transplant Recipients: Prevalence and Predictors at Transplant and in Long-Term Follow-up, United Network for Organ Sharing (UNOS) Data, 1987-2010 Emily J. Rothbaum Perito, Philip Rosenthal Introduction: Obesity and metabolic syndrome are increasingly common in adult liver transplant recipients and in the general U.S. pediatric population, but little is known about obesity in pediatric liver transplant recipients. One recent analysis of children linked obesity at liver transplant to increased post-transplant mortality. Survival in pediatric liver transplant recipients at 5 years exceeds 90%, so attention to long-term complications like obesity and its comorbidities is important. Aim: To describe the prevalence and persistence of overweight/ obesity in children with liver transplants and to delineate risk factors. Methods: UNOS data on all U.S. liver transplants 1987-2010 in children 6 months-20 years at transplant was
AASLD Abstracts
S-940