- Email: [email protected]
Impact of hepatitis C virus treatment on renal function in liver transplant patients
POSTER PRESENTATIONS 12.50, p = 0.002) or 2 (OR 9.63, p < 0.001). A greater age at LT ( p < 0.001), female gender ( p = 0.02), time since LT (0–18 months vs. 60– 120 months, p = 0.04) and higher serum Tacrolimus trough levels ( p < 0.001) were independently associated with lower estimated glomerular filtration rate (eGFR). While there was a trend, neither MetS nor its associated metabolic disturbances were independently associated with lower eGFR.
GFR < 60%. Among those patients, 8.33% had improved GFR, in 10% GFR has not changed, and in 26.67% GFR has worsened. 55% of patients had normal renal function as defined by GFR >60%. Among those patients, 10% had improved GFR, in 36.67% GFR has not changed and in 8.33% GFR has worsened. 52% of patients had improved or stable creatinine and 48 had worsened creatinine. The average amount of change in serum creatinine between baseline and 24 weeks was 0.038 (24 weeks minus baseline) and the difference was not statistically significant ( p = 0.2465). Conclusions: This study showed improvement or unchanged renal function in 65% and worsened renal function in 35% in liver transplant patients who achieved SVR12. Worsening of renal function was more frequently encountered in those with impaired renal function prior to treatment. Caution should be entertained in treating HCV in liver transplant patients especially those with base line of renal impairment. THU-448 Long term success rates and complications of metallic and plastic stents in post transplant bile duct strictures: a large single center experience P.S. Mantry1, H. Woller2. 1The Liver Institute; 2Division of Gastroenterology, Methodist Dallas Medical Center, Dallas, United States E-mail: [email protected]
Conclusions: With improved outcomes in the early post-LT period, the impact of MetS on cardiovascular health in LT recipients is likely to increase. Future studies should determine the role of early identification and intervention in addressing metabolic disturbances associated with MetS in order to reduce the risk of CVE in this cohort of patients. THU-447 Impact of hepatitis C virus treatment on renal function in liver transplant patients M. Shoreibah1, D. Jones1, J. Orr1, K. Venkata1, J. Zhang1, O. Massoud1. 1 University of Alabama at Birmingham, Birmingham, United States E-mail: [email protected] Background and Aims: HCV is uniformly recurrent after liver transplantation. Liver transplant patients with HCV have higher mortality than those without HCV. It is estimated that 10–20% of all HCV-infected patients have some degree kidney disease. This percentage may be even higher in liver transplant patients, secondary to immunosuppressive medications toxicity. The presence of kidney disease presents a challenge for HCV treatment in liver transplant patients. The aim of this study is to evaluate the impact of successful HCV treatment on the renal function in liver transplant patients. Methods: This is a prospective study which involved liver transplant patients who received HCV treatment between 2015 and 2016. There were two outcomes: difference in serum creatinine levels and in glomerular filtration rates (GFR) measured at treatment initiation and at 24 weeks after. We examined the proportions of patients who experienced an increase, a decrease, or no change between these two measurements. In addition, we performed paired T-test to examine whether the difference between serum creatinine at baseline and 24 weeks is statistically significant. Results: Sixty patients were enrolled, 70% males, 88% Caucasians, age 60 (SD 7.2) yrs., 15% cirrhotics and 45% treatment experienced. Treatment duration ranged between 8 and 24 weeks. All patients received Sofosbuvir/Ledipasvir without Ribavirin. All patients achieved sustained virologic response at 12 weeks after treatment (SVR12). 45% of patients had baseline renal impairment as defined by
Background and Aims: Common Bile Duct Strictures (CBDS) remain a significant source of morbidity after Liver Transplantation (LT). Data on removable self expanding metal stents (SEMS) is evolving in the treatment of this condition. We report data from a single center with a large experience on treatment of CBDS after deceased donor LT using SEMS in combination with plastic stents. Methods: We collected de-identified data on patients undergoing endoscopic therapy at our institution for CBDS with complete data and 6 months follow up between January 2004 and August 2016. Demographics, etiology of liver disease, procedural details, complications and survival data were collected. Patency rate was calculated as the number of procedures required to resolve the stricture. Endoscopic failure was defined by need for surgical revision of the stricture with a Roux-en-Y choledochojejunostomy. Results: We had complete data on 51 patients during this time period. A total of 213 procedures were performed with 143 stents placed. Median age of this cohort was 58 yrs and The median time between transplant and the first ERCP for suspected stricture was 49 days (avg of 224 days). 97 of the stents were plastic stents (most commonly 10F 10 cm) and 46 were SEMS (most commonly a fully covered ultraflex 10 mm × 80 mm). An average number of 3.7 (median of 3) stenting procedures was required per patient to resolve the stricture. Time between procedures was 10–12 weeks unless there were complications or non compliance. The success rate of endoscopic therapy in our cohort was 83% (41/51) with 8 patients requiring surgery. Differences in number and types of stents in patients successfully treated with endotherapy vs those failing endotherapy are outlined in Table 1. Stent occlusion was the most common complication of endotherapy. Recurrence of the stricture was reported 11.8% of the time at a median of 20 months after the resolution through endotherapy. There were 2 deaths related to complications from the procedure (one related to sepsis from cholangitis and one from a post sphincterotomy bleed). Median duration of follow up and survival of the successfully treated group was 26.5 and 32 months respectively. Conclusions: We report a large single center experience of endotherapy using a combination of metallic and plastic stents to treat post transplant CBDS. Endotherapy was successful 83% of the time and was very well tolerated requiring approximately 3.7 procedures per patient. SEMS use improves patency rates in this population.
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GFR < 60%. Among those patients, 8.33% had improved GFR, in 10% GFR has not changed, and in 26.67% GFR has worsened. 55% of patients had normal renal function as defined by GFR >60%. Among those patients, 10% had improved GFR, in 36.67% GFR has not changed and in 8.33% GFR has worsened. 52% of patients had improved or stable creatinine and 48 had worsened creatinine. The average amount of change in serum creatinine between baseline and 24 weeks was 0.038 (24 weeks minus baseline) and the difference was not statistically significant ( p = 0.2465). Conclusions: This study showed improvement or unchanged renal function in 65% and worsened renal function in 35% in liver transplant patients who achieved SVR12. Worsening of renal function was more frequently encountered in those with impaired renal function prior to treatment. Caution should be entertained in treating HCV in liver transplant patients especially those with base line of renal impairment. THU-448 Long term success rates and complications of metallic and plastic stents in post transplant bile duct strictures: a large single center experience P.S. Mantry1, H. Woller2. 1The Liver Institute; 2Division of Gastroenterology, Methodist Dallas Medical Center, Dallas, United States E-mail: [email protected]
Conclusions: With improved outcomes in the early post-LT period, the impact of MetS on cardiovascular health in LT recipients is likely to increase. Future studies should determine the role of early identification and intervention in addressing metabolic disturbances associated with MetS in order to reduce the risk of CVE in this cohort of patients. THU-447 Impact of hepatitis C virus treatment on renal function in liver transplant patients M. Shoreibah1, D. Jones1, J. Orr1, K. Venkata1, J. Zhang1, O. Massoud1. 1 University of Alabama at Birmingham, Birmingham, United States E-mail: [email protected] Background and Aims: HCV is uniformly recurrent after liver transplantation. Liver transplant patients with HCV have higher mortality than those without HCV. It is estimated that 10–20% of all HCV-infected patients have some degree kidney disease. This percentage may be even higher in liver transplant patients, secondary to immunosuppressive medications toxicity. The presence of kidney disease presents a challenge for HCV treatment in liver transplant patients. The aim of this study is to evaluate the impact of successful HCV treatment on the renal function in liver transplant patients. Methods: This is a prospective study which involved liver transplant patients who received HCV treatment between 2015 and 2016. There were two outcomes: difference in serum creatinine levels and in glomerular filtration rates (GFR) measured at treatment initiation and at 24 weeks after. We examined the proportions of patients who experienced an increase, a decrease, or no change between these two measurements. In addition, we performed paired T-test to examine whether the difference between serum creatinine at baseline and 24 weeks is statistically significant. Results: Sixty patients were enrolled, 70% males, 88% Caucasians, age 60 (SD 7.2) yrs., 15% cirrhotics and 45% treatment experienced. Treatment duration ranged between 8 and 24 weeks. All patients received Sofosbuvir/Ledipasvir without Ribavirin. All patients achieved sustained virologic response at 12 weeks after treatment (SVR12). 45% of patients had baseline renal impairment as defined by
Background and Aims: Common Bile Duct Strictures (CBDS) remain a significant source of morbidity after Liver Transplantation (LT). Data on removable self expanding metal stents (SEMS) is evolving in the treatment of this condition. We report data from a single center with a large experience on treatment of CBDS after deceased donor LT using SEMS in combination with plastic stents. Methods: We collected de-identified data on patients undergoing endoscopic therapy at our institution for CBDS with complete data and 6 months follow up between January 2004 and August 2016. Demographics, etiology of liver disease, procedural details, complications and survival data were collected. Patency rate was calculated as the number of procedures required to resolve the stricture. Endoscopic failure was defined by need for surgical revision of the stricture with a Roux-en-Y choledochojejunostomy. Results: We had complete data on 51 patients during this time period. A total of 213 procedures were performed with 143 stents placed. Median age of this cohort was 58 yrs and The median time between transplant and the first ERCP for suspected stricture was 49 days (avg of 224 days). 97 of the stents were plastic stents (most commonly 10F 10 cm) and 46 were SEMS (most commonly a fully covered ultraflex 10 mm × 80 mm). An average number of 3.7 (median of 3) stenting procedures was required per patient to resolve the stricture. Time between procedures was 10–12 weeks unless there were complications or non compliance. The success rate of endoscopic therapy in our cohort was 83% (41/51) with 8 patients requiring surgery. Differences in number and types of stents in patients successfully treated with endotherapy vs those failing endotherapy are outlined in Table 1. Stent occlusion was the most common complication of endotherapy. Recurrence of the stricture was reported 11.8% of the time at a median of 20 months after the resolution through endotherapy. There were 2 deaths related to complications from the procedure (one related to sepsis from cholangitis and one from a post sphincterotomy bleed). Median duration of follow up and survival of the successfully treated group was 26.5 and 32 months respectively. Conclusions: We report a large single center experience of endotherapy using a combination of metallic and plastic stents to treat post transplant CBDS. Endotherapy was successful 83% of the time and was very well tolerated requiring approximately 3.7 procedures per patient. SEMS use improves patency rates in this population.
Journal of Hepatology 2017 vol. 66 | S95–S332
S193