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Histologic Analysis of Explants of Hepatitis C Patients who Achieved Sustained Virologic Response Prior to Liver Transplantation
patients who achieved SVR prior to liver transplantation (Group A) were compared to twelve randomly selected controls with active viremia at the time of transplantation (Group B). Mean age was 62 years in group A compared to 64 years in group B. The median SVR to transplant interval was 240 days in the 7 patients with documented dates of SVR. Four patients were treated with DAA while eight were treated with interferon-based regimens. Portal inflammation was present in all 24 patients (table 1) with lymphocyte predominance in both groups. Interface hepatitis was more pronounced in group B (p=0.004). Apoptosis was observed in 8% in group A compared to 66% in group B (p=0.01). Steatosis of 0-5% was observed in 92 % of patients in each group. Porto-portal fibrous bands were thick in 25% of group A compared to 75% in group B (p=0.04). Conclusion: Despite SVR, portal inflammation persists in patients with HCV cirrhosis with a lymphocytic predominance similar to patients with active HCV viremia. Other parameters including presence of apoptosis and thickness of bands of fibrosis were significantly improved in those who achieved SVR. The impact of SVR on histologic and clinical parameters in patients undergoing liver transplantation in the DAA era would benefit from further study. Comparison of explants of treated patients with viremic controls
Mo1389 PROPOSED CUT-OFFS IN HCV CHRONIC LIVER DISEASE USING ELASTPQ Ruxandra G. Mare, Ioan Sporea, Raluca Lupusoru, Alina Popescu, Roxana Sirli, Felix Bende, Ana-Maria Stepan, Mirela Danila
Comparing the rate of change in glomerular filtration rate (GFR) one-year after HCV treatment to one-year before treatment in relation to achievement of sustained virologic response (SVR) at 12 weeks.
The aim of this study was to evaluate the diagnostic performance of a point shear wave elastography using ARFI technique - ElastPQ, in patients with C chronic liver disease (HCV), using Transient Elastography (TE) as the reference method, since it is a validated method for liver fibrosis assessment. Subjects and methods: the study included 168 consecutive subjects ( 45.2% women, 54.8% men) with HCV . Liver stiffness (LS) was evaluated in the same session by means of 2 elastographic methods: TE (FibroScan, EchoSens) and ElastPQ (Affinity, Philips) techniques. Reliable LS measurements by TE (M or XL probe) were considered the median value of 10 LS measurements with an interquartile range/median < 30%. For ElastPQ - we calculated the median value of 10 LS measurements in the liver parenchyma, at least 1 cm below the capsule, avoiding large vessels. For differentiating between stages of liver fibrosis we used the TE cut-off values published in the Tsochatzis meta-analysis (2011) [1]: significant fibrosis (F≥2)- 7.0 kPa, severe fibrosis (F≥3)- 9.5 kPa and for liver cirrhosis (F=4)-12 kPa [1]. Results: Valid LS measurements were obtained in 98.8% (166/168) cases by means of TE and in 100% (168/168) cases with ElastPQ. In the final analysis 166 patients were included. The ElastPQ values ranged from 2.32 to 44.07 kPa (median=10.42 kPa). The areas under the receiver operating characteristic curve were calculated considering TE as the reference method: 0.93 CI (0.88-0.98) for mild fibrosis (F≥1), 0.96 CI (0.94-0.99) for significant fibrosis (F≥2), 0.97 CI (0.95-0.99) for severe fibrosis (F≥3) and 0.83 CI(0.70-0.90) for cirrhosis (F=4). The best cut-off values for discriminating mild, significant, severe fibrosis and cirrhosis were 5.9; 6.4; 6.7; and 8.9 kPa, respectively. In our cohort there was a strong correlation between measurements obtained by Transient Elastography and ElastPQ (r=0.85, p<0.001). Conclusions: ElastPQ seems to have a good diagnostic accuracy for staging liver fibrosis in HCV patients and seems to be non-inferior to Transient Elastography assessment. [1] E.A. Tsochatzis et al. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy., J. Hepatol. 54 (2011) 650-9. doi:10.1016/j.jhep.2010.07.033.
Mo1388
Mo1390
HISTOLOGIC ANALYSIS OF EXPLANTS OF HEPATITIS C PATIENTS WHO ACHIEVED SUSTAINED VIROLOGIC RESPONSE PRIOR TO LIVER TRANSPLANTATION Manhal J. Izzy, Wendy Rabbenou, Ashwin Akki, Kathryn Tanaka, Paul J. Gaglio, Kristina Chacko
DIAGNOSTIC UTILITY OF NON-INVASIVE MARKERS FOR STAGING OF LIVER DISEASE IN HEPATITIS C PATIENTS WITH ESRD ON HEMODIALYSIS Ruchi Patel, Supannee Rassameehiran, Rashmee Patil, Sadhna Dhingra, Gagan K. Sood Background: Chronic Hepatitis C infection is an important cause of liver disease in patients with ESRD on hemodialysis. The stage of liver disease impacts the decision for kidney transplant along vs. simultaneous liver-kidney transplant (SLK). Liver biopsy in patients with ESRD is useful but it carries a risk of complications. The main aim of our study was to determine the diagnostic accuracy of aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB4) score in predicting significant fibrosis in patients with ESRD and HCV infection. Methods: We reviewed electronic medical records of patients seen between January 1, 2014 and November 30, 2016 at our institution. Inclusion criteria were age > 18 years and the diagnosis of chronic hepatitis C and ESRD. We compared non-invasive markers of significant fibrosis using APRI and FIB-4 scores to liver biopsies. Results: Fifty patients with Hepatitis C infection confirmed by positive HCV RNA PCR (Mean age 56.66 ± 7.26, 34 men, and 16 women) with ESRD on hemodialysis were included. All patients underwent liver biopsy. The fibrosis stage on liver biopsies was scored using the Metavir score. (Fibrosis Score F0 -F4). Significant fibrosis was defined as F3-F4. The performance of APRI and
Introduction: Chronic liver disease secondary to hepatitis C virus (HCV) infection is the leading indication for liver transplantation in the USA. The rates of sustained virologic response (SVR) in cirrhotic patients have significantly increased with the advent of direct acting antivirals (DAA). Data describing the histologic features observed in the explanted livers of patients who had achieved SVR prior to transplantation are scarce. Methods: This was a retrospective review of HCV-monoinfected adult patients who underwent liver transplantation at a single academic transplant center between June 2008 and September 2015. Patients with evidence of co-existing chronic liver disease were excluded. Patients who had achieved SVR prior to liver transplantation were 1:1 paired with controls with active HCV viremia at the time of liver transplantation. The controls were selected using an online randomization tool. The explants were reviewed by two pathologists. The study was approved by the institutional review board of Montefiore Medical Center. Results: Twelve
S-1165
AASLD Abstracts
AASLD Abstracts
one-year after treatment, which is statistically significant. Further trials are needed to determine whether treatment of HCV infection can prevent the progression of chronic kidney disease over a longer follow up period and if treatment can improve kidney related patient outcomes. Baseline Characteristics for patients undergoing treamtent for Hepatitis C (HCV) at the West Los Angles Veterans Adminitration (n = 187)
Mo1389 PROPOSED CUT-OFFS IN HCV CHRONIC LIVER DISEASE USING ELASTPQ Ruxandra G. Mare, Ioan Sporea, Raluca Lupusoru, Alina Popescu, Roxana Sirli, Felix Bende, Ana-Maria Stepan, Mirela Danila
Comparing the rate of change in glomerular filtration rate (GFR) one-year after HCV treatment to one-year before treatment in relation to achievement of sustained virologic response (SVR) at 12 weeks.
The aim of this study was to evaluate the diagnostic performance of a point shear wave elastography using ARFI technique - ElastPQ, in patients with C chronic liver disease (HCV), using Transient Elastography (TE) as the reference method, since it is a validated method for liver fibrosis assessment. Subjects and methods: the study included 168 consecutive subjects ( 45.2% women, 54.8% men) with HCV . Liver stiffness (LS) was evaluated in the same session by means of 2 elastographic methods: TE (FibroScan, EchoSens) and ElastPQ (Affinity, Philips) techniques. Reliable LS measurements by TE (M or XL probe) were considered the median value of 10 LS measurements with an interquartile range/median < 30%. For ElastPQ - we calculated the median value of 10 LS measurements in the liver parenchyma, at least 1 cm below the capsule, avoiding large vessels. For differentiating between stages of liver fibrosis we used the TE cut-off values published in the Tsochatzis meta-analysis (2011) [1]: significant fibrosis (F≥2)- 7.0 kPa, severe fibrosis (F≥3)- 9.5 kPa and for liver cirrhosis (F=4)-12 kPa [1]. Results: Valid LS measurements were obtained in 98.8% (166/168) cases by means of TE and in 100% (168/168) cases with ElastPQ. In the final analysis 166 patients were included. The ElastPQ values ranged from 2.32 to 44.07 kPa (median=10.42 kPa). The areas under the receiver operating characteristic curve were calculated considering TE as the reference method: 0.93 CI (0.88-0.98) for mild fibrosis (F≥1), 0.96 CI (0.94-0.99) for significant fibrosis (F≥2), 0.97 CI (0.95-0.99) for severe fibrosis (F≥3) and 0.83 CI(0.70-0.90) for cirrhosis (F=4). The best cut-off values for discriminating mild, significant, severe fibrosis and cirrhosis were 5.9; 6.4; 6.7; and 8.9 kPa, respectively. In our cohort there was a strong correlation between measurements obtained by Transient Elastography and ElastPQ (r=0.85, p<0.001). Conclusions: ElastPQ seems to have a good diagnostic accuracy for staging liver fibrosis in HCV patients and seems to be non-inferior to Transient Elastography assessment. [1] E.A. Tsochatzis et al. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy., J. Hepatol. 54 (2011) 650-9. doi:10.1016/j.jhep.2010.07.033.
Mo1388
Mo1390
HISTOLOGIC ANALYSIS OF EXPLANTS OF HEPATITIS C PATIENTS WHO ACHIEVED SUSTAINED VIROLOGIC RESPONSE PRIOR TO LIVER TRANSPLANTATION Manhal J. Izzy, Wendy Rabbenou, Ashwin Akki, Kathryn Tanaka, Paul J. Gaglio, Kristina Chacko
DIAGNOSTIC UTILITY OF NON-INVASIVE MARKERS FOR STAGING OF LIVER DISEASE IN HEPATITIS C PATIENTS WITH ESRD ON HEMODIALYSIS Ruchi Patel, Supannee Rassameehiran, Rashmee Patil, Sadhna Dhingra, Gagan K. Sood Background: Chronic Hepatitis C infection is an important cause of liver disease in patients with ESRD on hemodialysis. The stage of liver disease impacts the decision for kidney transplant along vs. simultaneous liver-kidney transplant (SLK). Liver biopsy in patients with ESRD is useful but it carries a risk of complications. The main aim of our study was to determine the diagnostic accuracy of aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB4) score in predicting significant fibrosis in patients with ESRD and HCV infection. Methods: We reviewed electronic medical records of patients seen between January 1, 2014 and November 30, 2016 at our institution. Inclusion criteria were age > 18 years and the diagnosis of chronic hepatitis C and ESRD. We compared non-invasive markers of significant fibrosis using APRI and FIB-4 scores to liver biopsies. Results: Fifty patients with Hepatitis C infection confirmed by positive HCV RNA PCR (Mean age 56.66 ± 7.26, 34 men, and 16 women) with ESRD on hemodialysis were included. All patients underwent liver biopsy. The fibrosis stage on liver biopsies was scored using the Metavir score. (Fibrosis Score F0 -F4). Significant fibrosis was defined as F3-F4. The performance of APRI and
Introduction: Chronic liver disease secondary to hepatitis C virus (HCV) infection is the leading indication for liver transplantation in the USA. The rates of sustained virologic response (SVR) in cirrhotic patients have significantly increased with the advent of direct acting antivirals (DAA). Data describing the histologic features observed in the explanted livers of patients who had achieved SVR prior to transplantation are scarce. Methods: This was a retrospective review of HCV-monoinfected adult patients who underwent liver transplantation at a single academic transplant center between June 2008 and September 2015. Patients with evidence of co-existing chronic liver disease were excluded. Patients who had achieved SVR prior to liver transplantation were 1:1 paired with controls with active HCV viremia at the time of liver transplantation. The controls were selected using an online randomization tool. The explants were reviewed by two pathologists. The study was approved by the institutional review board of Montefiore Medical Center. Results: Twelve
S-1165
AASLD Abstracts
AASLD Abstracts
one-year after treatment, which is statistically significant. Further trials are needed to determine whether treatment of HCV infection can prevent the progression of chronic kidney disease over a longer follow up period and if treatment can improve kidney related patient outcomes. Baseline Characteristics for patients undergoing treamtent for Hepatitis C (HCV) at the West Los Angles Veterans Adminitration (n = 187)