- Email: [email protected]
Influence of Donor and Recipient Gender on Liver Transplantation Outcomes in Europe: A Eltr Study
POSTER PRESENTATIONS FRI-449 DOES MULTIORGAN FAILURE IMPACT PROGNOSIS OF LIVER TRANSPLANTATION IN PATIENTS WITH END-STAGE LIVER DISEASE? RESULTS OF A FRENCH RETROSPECTIVE MULTICENTER CASE-CONTROL STUDY F. Artru1, A. Louvet1, I. Ruiz2, E. Levesque2, J. Labreuche1, S. Jaber3, G. Lassailly1, S. Dharancy1, E. Boleslawski1, G. Lebuffe1, E. Kipnis1, P. Ichai2, A. Coilly2, E. De Martin2, E. Vibert2, A. Herrerro3, D. Samuel2, G.-P. Pageaux3, P. Mathurin1, F. Saliba2. 1Lille University Hospital, Lille; 2 Paul Brousse Hospital, Villejuif; 3Saint Eloi Hospital, Montpellier, France E-mail: [email protected] Background and Aims: Liver transplantation (LT) of cirrhotic patients in the intensive care unit (ICU) with end-stage liver disease (ESLD) and multi-organ failure (MOF), often considered "too sick", remains controversial. Aims of the study: 1) to describe outcome of cirrhotic patients with MOF hospitalized in ICU at time of LT 2) to compare survival of these patients to patients with MOF who were not transplanted and to patients transplanted without MOF. Methods: All patients hospitalized in 3 French liver ICU between 2008 and 2014 were retrospectively included if they had at least two organ failures according to SOFA score or liver failure associated with mechanical ventilation. We performed a case-control study in which each patient with ESLD and MOF was matched a) to 1 or 2 patients hospitalized in ICU with MOF, not transplanted (matching on age, gender, SOFA score) b) to 4 control patients transplanted outside ICU with MELD < 30 at time of LT (matching on age and gender). Results: 69 patients were included (median age 56.9 [51.1-59.5] years, women 26.1%), representing 4.1% of transplantation activity of these centers over the same period. Main causes of cirrhosis were alcoholic liver disease (47.8%) and HCV (28.9%). At time of LT, median MELD score was 40 (95% CI 35–40), SAPS II score 56 (50–61), SOFA score 15 (14–15) and median number of organ failures was 3. Median ICU stay before LT was 8 days (6–11). At time of LT, 63% of patients were ventilated, 55.1% had vasopressors and 47.8% had renal replacement therapy. Median time between registration on waiting list and LT was 8 days (4–15). After LT, median stay in ICU was 16 days and total hospital stay was 46.5 days. No patient had primary graft non-function. 82.3% of patients developed bacterial infection, 32.3% CMV infection and 13.2% fungal infection. Survival of transplanted patients with MOF at 1 year was highly better than that of nontransplanted controls with ESLD and MOF (n = 109): 83.9% vs. 10%, p < 0.0001. This good survival was not different from the 1-year survival of matched cirrhotic control patients transplanted outside ICU with MELD < 30 (n = 276): 83.9% vs. 88.2%, p = 0.3. This was still the case at 3 years: 74.9% vs. 83.7%, p = 0.1. Conclusions: In this multicenter study, LT strongly impacts survival of cirrhotic patients with MOF hospitalized in ICU with a 1-year survival comparable to that of patients with a lower MELD score transplanted outside ICU. LT should be discussed for each of these patients during their ICU stay. FRI-450 LIVER TRANSPLANTATION FOR CHRONIC HCV INFECTION IN THE UNITED STATES 2002–2014: AN ANALYSIS OF THE UNOS/OPTN DATABASE G. Dultz1, B. Graubard2, P. Martin3, M.W. Welker1, B. Borg4, S. Zeuzem1, K.A. McGlynn5, T.M. Welzel1. 1Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, Germany; 2Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda; 3Hepatology Division, University of Miami, Miami; 4 University of Mississippi Medical Center, Jackson; 5HREB, Division of Cancer Epidemiology and Genetics, Bethesda, United States E-mail: [email protected] Background and Aims: Chronic Hepatitis C virus (HCV) infection is a major risk factor for end-stage liver disease. Due to limited efficacy and tolerability of historic PegIFN-based therapies, the incidence of
HCV-related complications such as liver cirrhosis and hepatocellular carcinoma (HCC) continued to increase in the United States and emerged as one of the most common indications for orthotopic liver transplantation. In this study, we investigated characteristics and outcomes of liver transplantation for HCV using data from the U.S. UNOS/OPTN database. Methods: This retrospective study included adult patients (≥18 yrs.) with chronic HCV registered for cadaveric liver transplantation at UNOS/OPTN between 02/27/2002 (date of MELD score implementation) and 01/06/2014. Characteristics associated with pre- and post-transplant survival were determined by multivariate logistic and cox regression analysis. Results: During the study period, 41.157 patients had a documented diagnosis of chronic HCV. Of those, most were white (n = 28.447, 69.1%) and male (n = 29.141, 70.8%). At listing, mean age was 55 yrs, mean MELD score 16 (± 8 SD), and 11.075 (26.9%) had a HCVassociated HCC. 22.111 (54%) patients received a liver transplantation, 8.634 (21%) died on the list or were too sick to transplant, 6.135 (15%) were delisted for other reasons (improved, lost-to-follow-up); 4277 (10%) were still waiting for liver transplant. Characteristics associated with wait-list mortality were age, male gender, blood type 0, albumin, encephalopathy, labMELD, no HCC, and transplant region (all p < 0.001). Characteristics associated with overall post-transplant survival were donor age (<0.001), male gender ( p < 0.001), donor ethnicity (<0.001), albumin (0.0073), allocation MELD (0.0045), diabetes (<0.001), pre-transplant dialysis (<0.001), cold ischemic time (0.0024), transplant year (0.0062) and region (<0.001). The proportion of waitlist registrations and liver transplantations for HCV-associated HCC increased between 2002 and 2014 (14% to 40% and 27% to 37%, respectively). Conclusions: Registrations for HCV-associated HCC increased 2.9fold between 2002 and 2014. Pre- and post-transplant survival depended on a variety of patient-, donor-, and allocation-factors. Highly effective and tolerable novel DAA combination treatments now have the potential to reduce HCV-related morbidity and reduce the burden of HCV-related liver transplantations in the United States. FRI-451 INFLUENCE OF DONOR AND RECIPIENT GENDER ON LIVER TRANSPLANTATION OUTCOMES IN EUROPE: A ELTR STUDY G. Germani1, A. Ferrarese1, R. Adam2, V. Karam2, L. Belli3, J. O’Grady4, D. Mirza5, J. Klempnauer6, D. Cherqui7, J. Pratschke8, N. Jamieson9, M. Salizzoni10, H. Hidalgo11, J. Lerut12, A. Paul13, J.C. GarciaValdecasas14, F.S.J. Rodriguez15, P. Burra1, and for the European Liver and Intestine Transplant Association (ELITA). 1Multivisceral Transplant Unit, Padova University Hospital, Padova, Italy; 2ELTR, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre HepatoBiliaire, Université Paris-Sud, Villejuif, France; 3Hepatology and Gastroenterology, Ca’ Granda Hospital, Milan, Italy; 4King’s College Hospital, London; 5The Queen Elizabeth Hospital, Birmingham, United Kingdom; 6Paul Brousse Hospital, Villejuif, France; 7Medizinische Hochschule Hannover, Hannover; 8Charité – Campus – Virchow klinikum, Berlin, Germany; 9Addenbrooke’s Hospital, Cambridge, United Kingdom; 10Centro di Trapianti di Fegato, Torino, Italy; 11St. Jame’s & Seacroft University Hospital, Leeds, United Kingdom; 12Cliniques Universitaires Saint Luc, Brussels, Belgium; 13C. U. K. GHs Essen, Essen, Germany; 14Hospital Clinic I Provincial de Barcelona, Barcelona; 15 Hospital Universitario LA FE, Valencia, Spain E-mail: [email protected] Background and Aims: The impact of recipient gender and donor/ recipient gender mismatch on LT outcomes is still a matter of debate. The aim of this study was to compare outcomes and evolution across over 20 years of LT in Europe between male and female recipients, with particular interest on donor/recipient gender mismatch. Methods: Recipient, donor and transplant characteristics were compared between male and female patients and according to donor/recipient gender matching, based on ELTR database. Graft
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POSTER PRESENTATIONS survival was evaluated and compared between groups. Evolution of LT was assessed according to different time periods (1988–1992, 1993–1997, 1998–2002, 2003–2007, 2008–2012). Results: 90156 LT patients were evaluated (59432 male, 30724 female). A significant increase in male recipients was found from 1988–1992 to 2007–2012 (from 54.7% to 64.2%; p < 0.001), whereas the proportion of female recipients decreased from 43.3% to 30.8% ( p < 0.001). The use of female donors in male recipients has significantly increased overtime (from 15.9% to 27%; p < 0.001). Male recipients were transplanted more frequently for ALD (28.9% vs. 12.9%) and HCC (18.6 vs. 6.7%), whereas female patients were transplante more frequently for ALF (12.6% vs. 4.3%), AIH (5% vs. 1%) and PBC 46% vs 1%; all p < 0.001). The proportion of patients transplanted at an age ≤ 40 years was significaly higher in female recipients compared to male ones (23.4% vs. 14.3%; p < 0.001). One, 3, 5 and 10-year graft survival rates after LT were 79%, 71%, 63% and 54% in male recipients and 77%, 71%, 65% and 57% in female recipients ( p < 0.001). Survival rates were significantly lower when a female donor/male recipient matching was used compared with all the other donor/recipient gender matching (all p < 0.001). By multivariate analysis, female donor/ male recipient mismatch ( p = 0.01), older recipient age ( p < 0.001), older donor age (p < 0.001), ALF ( p < 0.001), HCV ( p < 0.001) and reduced size graft ( p < 0.001) were associated with increased risk of death or graft loss. Conclusions: Important gender differences exist regarding aetiology of liver disease, access to LT and outcomes after LT. Long-term survival is better in women, however 1-survival rates are lower, possibly due to the higher frequency of ALF. Female donor/male recipient mismatch is associated with greater risk of death or graft loss after LT. FRI-452 UNEXPECTED VERY EARLY ATHEROSCLEROTIC AND CARDIAC DAMAGE IN PATIENTS UNDERGOING LIVER TRANSPLANTATION G. Pisano1, R. Lombardi1, M. Orlandi2, M.F. Donato3, S. Zannoni2, C.G. Bertelli2, G. Oberti2, L. Caccamo4, M. Colombo5, S. Fargion2, A.L. Fracanzani1. 1Department of Pathophysiology and Transplantation, Unit of internal medicine; 2Department of Pathophysiology and Transplantation; 3Department of Pathophysiology and Transplantation, division of gastroenterology; 4Department of Pathophysiology and Transplantation, Unit of Hepatic Surgery; 5Department of Pathophysiology and Transplantation, division of gastrtoenterology, Fondazione IRCCS Ca’ Granda Policlinico do Milano, Milano, Italy E-mail: [email protected] Background and Aims: The improvement in surgical techniques and the greater effectiveness of new anti-rejection drugs have significantly improved the survival of patients undergoing liver transplantation allowing to detect an increased risk of metabolic disorders and cardiovascular and cerebrovascular diseases. Aims:To evaluate in patients undergoing liver transplantation timing of metabolic and cardiovascular modifications. Methods: From January 2014 we evaluated 55 patients on waiting transplant list of whom 28 were transplanted (group 1) and 13 patients transplanted 6 months before enrollment (group 2), 57 % were transplanted for complications of HCV cirrhosis. All transplanted patients received steroidal therapy associated with other immunosuppressive drugs: tacrolimus (41%), tacrolimus plus mycophenolate mofetil (25%), cyclosporine (8%), cyclosporine plus mycophenolate mofetil (26%). Biochemical parameters, subclinical atherosclerosis (carotid stiffness (cPWV), intima-media thickness (cIMT), presence of plaques) by ultrasound and diastolic dysfunction (E/A), thickness of the interventricular septum, left ventricular mass, ejection function and visceral adiposity estimated as epicardial fat thickness by echocardiography were evaluated in group 1 at time 0 (before transplant) and time 1 (6 months after transplant), in group 2 at time 1, time 2 and time 3 (6, 12 and 18 months after transplant). Results: After 6 months from transplant an increase of lipid values, prevalence of diabetes, hypertension and metabolic syndrome, and, S538
as expected, an improvement of liver parameters was observed. In addition a significant increase of interventricular septum thickness ( p = 0,05), cIMT ( p = 0.02) epicardial fat ( p < 0.001) and a significant reduction of diastolic function ( p < 0,001) was observed. A further increase only of cIMT was observed from 6 to 12 months after transplant ( p = 0.03). Unexpectedly carotid stiffness decreased significantly ( p = 0.04) during follow up. Ejection function and ventricular mass didn’t differ significantly during follow up. No difference in cardiovascular alterations was observed in patients treated with different immunosoppressive therapy. Conclusions: Cardiovascular alterations occur very early after liver transplantation. Recognition and prompt treatment of these alterations may impact long- term survival in patients submitted to OLT. FRI-453 SOFOSBUVIR AND SIMEPREVIR THERAPY FOR RECURRENT HEPATITIS C GENOTYPE 1, AFTER LIVER TRANSPLANTATION: EFFICACY AND SAFETY G.S. Antolin1, M. Testillano2, M. Prieto3, I. Fernandez4, X. Xiol5, M.C. Londoño6, L. Castells7, J.M. Pascasio8, M.L.G. Dieguez9, A.O. Ferreiro10, M. Salcedo11, I. Narvaez12, J.A. Pons13, J.I. Herrero14, S.P. Bartolome15, J.L. Montero16, A. Arencibia17, E.F. Garcia18, S. Lorente19, E. Molina20, J.R. Fernandez2, C.A. Alvarez1, V. CuervasMons21, and The Spanish Liver Transplant Society study Group. 1 Hepatology Unit. Liver Transplant Unit, Hospital U. Rio Hortega, Valladolid; 2Digestive Service. Liver Unit. Liver Transplant Unit, Hospital U. Cruces, Bilbao; 3Hepatology Unit. Liver Transplant Unit, Hospital U. La Fe, Valencia; 4Hepatology Unit, Hospital U.12 de Octubre, Madrid; 5 Gastroenterology Service, Hospital U. Bellvitge; 6Hepatology Service, Hospital Clinic. IDIBAPS, CIBERehd; 7Hepatology Service. CIBERehd, Hospital U. Vall Hebron, Barcelona; 8UGC Enfermedades Digestivas, IBIS, CIBERehd, Hospital Universitario Virgen del Rocío, Sevilla; 9Liver Unit, Hospital U Central de Asturias, Oviedo; 10Liver Transplant Unit, Hospital Universitario de A Coruña, A Coruña; 11Liver Unit, Hospital U. Gregorio Marañon, Madrid; 12Gastroenterology Service, Hospital Infanta Cristina, Badajoz; 13Hepatology Unit. Liver Transplant Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia; 14Liver Unit. CIBERehd. IdiSNA, Clinica Universidad de Navarra., Pamplona; 15Digestive Service. Liver Unit., Hospital GU., Alicante; 16Hepatology Unit. Liver Transplant Unit. IMIBIC, CIBERehd, Hospital U. Reina Sofía, Cordoba; 17Hospital U. La Candelaria, Tenerife; 18Hospital U. Marques de Valdecilla, Santander; 19 Hospital U. Lozano Blesa, Zaragoza; 20Hospital U. de Santiago, Santiago de Compostela; 21Internal Medicine Service. Liver Transplant Unit, Hospital Puerta de Hierro, Madrid, Spain E-mail: [email protected] Background and Aims: The treatments of hepatitis C in liver transplant patients until recently, had low efficacy and many adverse effects. The new direct acting antivirals Simeprevir(SIM) and sofosbuvir(SOF) have significantly increased the efficacy and safety of treatment in liver transplant hepatitis C patients genotype 1. The aim of this study was to determine the efficacy and safety in real life of the combination SOF + SIM ± RBV in a group of liver transplant patients genotype 1. Methods: This is a multicenter, retrospective study including 232 genotype 1 hepatitis C liver transplant patients treated with SIM + SOF ± RBV from 21 Liver transplant Centres. Efficacy and safety data, and mortality rate were assessed. Results: The majority of patients were male(73,7%) and the average age was 61.49 ± 8.9 years. The 63.1% were Ile 28B CT and the genotype 1a was 15.02%. The 59.05% of patients have been previously treated, the most part with interferon based therapy, but 10.8% with IP and the 4.3% with SOF. The 51.14% were null responders. There was a 53.8% of patients with fibrosis 4. The MELD score average was 8.86 ± 2.87(6– 24). In the 60.34% of the patients RBV was included in the treatment. The majority of the patients were treated during 12 weeks(86,63%). At the end of treatment(EOT), all patients had undetectable serum
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HCV-related complications such as liver cirrhosis and hepatocellular carcinoma (HCC) continued to increase in the United States and emerged as one of the most common indications for orthotopic liver transplantation. In this study, we investigated characteristics and outcomes of liver transplantation for HCV using data from the U.S. UNOS/OPTN database. Methods: This retrospective study included adult patients (≥18 yrs.) with chronic HCV registered for cadaveric liver transplantation at UNOS/OPTN between 02/27/2002 (date of MELD score implementation) and 01/06/2014. Characteristics associated with pre- and post-transplant survival were determined by multivariate logistic and cox regression analysis. Results: During the study period, 41.157 patients had a documented diagnosis of chronic HCV. Of those, most were white (n = 28.447, 69.1%) and male (n = 29.141, 70.8%). At listing, mean age was 55 yrs, mean MELD score 16 (± 8 SD), and 11.075 (26.9%) had a HCVassociated HCC. 22.111 (54%) patients received a liver transplantation, 8.634 (21%) died on the list or were too sick to transplant, 6.135 (15%) were delisted for other reasons (improved, lost-to-follow-up); 4277 (10%) were still waiting for liver transplant. Characteristics associated with wait-list mortality were age, male gender, blood type 0, albumin, encephalopathy, labMELD, no HCC, and transplant region (all p < 0.001). Characteristics associated with overall post-transplant survival were donor age (<0.001), male gender ( p < 0.001), donor ethnicity (<0.001), albumin (0.0073), allocation MELD (0.0045), diabetes (<0.001), pre-transplant dialysis (<0.001), cold ischemic time (0.0024), transplant year (0.0062) and region (<0.001). The proportion of waitlist registrations and liver transplantations for HCV-associated HCC increased between 2002 and 2014 (14% to 40% and 27% to 37%, respectively). Conclusions: Registrations for HCV-associated HCC increased 2.9fold between 2002 and 2014. Pre- and post-transplant survival depended on a variety of patient-, donor-, and allocation-factors. Highly effective and tolerable novel DAA combination treatments now have the potential to reduce HCV-related morbidity and reduce the burden of HCV-related liver transplantations in the United States. FRI-451 INFLUENCE OF DONOR AND RECIPIENT GENDER ON LIVER TRANSPLANTATION OUTCOMES IN EUROPE: A ELTR STUDY G. Germani1, A. Ferrarese1, R. Adam2, V. Karam2, L. Belli3, J. O’Grady4, D. Mirza5, J. Klempnauer6, D. Cherqui7, J. Pratschke8, N. Jamieson9, M. Salizzoni10, H. Hidalgo11, J. Lerut12, A. Paul13, J.C. GarciaValdecasas14, F.S.J. Rodriguez15, P. Burra1, and for the European Liver and Intestine Transplant Association (ELITA). 1Multivisceral Transplant Unit, Padova University Hospital, Padova, Italy; 2ELTR, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre HepatoBiliaire, Université Paris-Sud, Villejuif, France; 3Hepatology and Gastroenterology, Ca’ Granda Hospital, Milan, Italy; 4King’s College Hospital, London; 5The Queen Elizabeth Hospital, Birmingham, United Kingdom; 6Paul Brousse Hospital, Villejuif, France; 7Medizinische Hochschule Hannover, Hannover; 8Charité – Campus – Virchow klinikum, Berlin, Germany; 9Addenbrooke’s Hospital, Cambridge, United Kingdom; 10Centro di Trapianti di Fegato, Torino, Italy; 11St. Jame’s & Seacroft University Hospital, Leeds, United Kingdom; 12Cliniques Universitaires Saint Luc, Brussels, Belgium; 13C. U. K. GHs Essen, Essen, Germany; 14Hospital Clinic I Provincial de Barcelona, Barcelona; 15 Hospital Universitario LA FE, Valencia, Spain E-mail: [email protected] Background and Aims: The impact of recipient gender and donor/ recipient gender mismatch on LT outcomes is still a matter of debate. The aim of this study was to compare outcomes and evolution across over 20 years of LT in Europe between male and female recipients, with particular interest on donor/recipient gender mismatch. Methods: Recipient, donor and transplant characteristics were compared between male and female patients and according to donor/recipient gender matching, based on ELTR database. Graft
Journal of Hepatology 2016 vol. 64 | S425–S630
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POSTER PRESENTATIONS survival was evaluated and compared between groups. Evolution of LT was assessed according to different time periods (1988–1992, 1993–1997, 1998–2002, 2003–2007, 2008–2012). Results: 90156 LT patients were evaluated (59432 male, 30724 female). A significant increase in male recipients was found from 1988–1992 to 2007–2012 (from 54.7% to 64.2%; p < 0.001), whereas the proportion of female recipients decreased from 43.3% to 30.8% ( p < 0.001). The use of female donors in male recipients has significantly increased overtime (from 15.9% to 27%; p < 0.001). Male recipients were transplanted more frequently for ALD (28.9% vs. 12.9%) and HCC (18.6 vs. 6.7%), whereas female patients were transplante more frequently for ALF (12.6% vs. 4.3%), AIH (5% vs. 1%) and PBC 46% vs 1%; all p < 0.001). The proportion of patients transplanted at an age ≤ 40 years was significaly higher in female recipients compared to male ones (23.4% vs. 14.3%; p < 0.001). One, 3, 5 and 10-year graft survival rates after LT were 79%, 71%, 63% and 54% in male recipients and 77%, 71%, 65% and 57% in female recipients ( p < 0.001). Survival rates were significantly lower when a female donor/male recipient matching was used compared with all the other donor/recipient gender matching (all p < 0.001). By multivariate analysis, female donor/ male recipient mismatch ( p = 0.01), older recipient age ( p < 0.001), older donor age (p < 0.001), ALF ( p < 0.001), HCV ( p < 0.001) and reduced size graft ( p < 0.001) were associated with increased risk of death or graft loss. Conclusions: Important gender differences exist regarding aetiology of liver disease, access to LT and outcomes after LT. Long-term survival is better in women, however 1-survival rates are lower, possibly due to the higher frequency of ALF. Female donor/male recipient mismatch is associated with greater risk of death or graft loss after LT. FRI-452 UNEXPECTED VERY EARLY ATHEROSCLEROTIC AND CARDIAC DAMAGE IN PATIENTS UNDERGOING LIVER TRANSPLANTATION G. Pisano1, R. Lombardi1, M. Orlandi2, M.F. Donato3, S. Zannoni2, C.G. Bertelli2, G. Oberti2, L. Caccamo4, M. Colombo5, S. Fargion2, A.L. Fracanzani1. 1Department of Pathophysiology and Transplantation, Unit of internal medicine; 2Department of Pathophysiology and Transplantation; 3Department of Pathophysiology and Transplantation, division of gastroenterology; 4Department of Pathophysiology and Transplantation, Unit of Hepatic Surgery; 5Department of Pathophysiology and Transplantation, division of gastrtoenterology, Fondazione IRCCS Ca’ Granda Policlinico do Milano, Milano, Italy E-mail: [email protected] Background and Aims: The improvement in surgical techniques and the greater effectiveness of new anti-rejection drugs have significantly improved the survival of patients undergoing liver transplantation allowing to detect an increased risk of metabolic disorders and cardiovascular and cerebrovascular diseases. Aims:To evaluate in patients undergoing liver transplantation timing of metabolic and cardiovascular modifications. Methods: From January 2014 we evaluated 55 patients on waiting transplant list of whom 28 were transplanted (group 1) and 13 patients transplanted 6 months before enrollment (group 2), 57 % were transplanted for complications of HCV cirrhosis. All transplanted patients received steroidal therapy associated with other immunosuppressive drugs: tacrolimus (41%), tacrolimus plus mycophenolate mofetil (25%), cyclosporine (8%), cyclosporine plus mycophenolate mofetil (26%). Biochemical parameters, subclinical atherosclerosis (carotid stiffness (cPWV), intima-media thickness (cIMT), presence of plaques) by ultrasound and diastolic dysfunction (E/A), thickness of the interventricular septum, left ventricular mass, ejection function and visceral adiposity estimated as epicardial fat thickness by echocardiography were evaluated in group 1 at time 0 (before transplant) and time 1 (6 months after transplant), in group 2 at time 1, time 2 and time 3 (6, 12 and 18 months after transplant). Results: After 6 months from transplant an increase of lipid values, prevalence of diabetes, hypertension and metabolic syndrome, and, S538
as expected, an improvement of liver parameters was observed. In addition a significant increase of interventricular septum thickness ( p = 0,05), cIMT ( p = 0.02) epicardial fat ( p < 0.001) and a significant reduction of diastolic function ( p < 0,001) was observed. A further increase only of cIMT was observed from 6 to 12 months after transplant ( p = 0.03). Unexpectedly carotid stiffness decreased significantly ( p = 0.04) during follow up. Ejection function and ventricular mass didn’t differ significantly during follow up. No difference in cardiovascular alterations was observed in patients treated with different immunosoppressive therapy. Conclusions: Cardiovascular alterations occur very early after liver transplantation. Recognition and prompt treatment of these alterations may impact long- term survival in patients submitted to OLT. FRI-453 SOFOSBUVIR AND SIMEPREVIR THERAPY FOR RECURRENT HEPATITIS C GENOTYPE 1, AFTER LIVER TRANSPLANTATION: EFFICACY AND SAFETY G.S. Antolin1, M. Testillano2, M. Prieto3, I. Fernandez4, X. Xiol5, M.C. Londoño6, L. Castells7, J.M. Pascasio8, M.L.G. Dieguez9, A.O. Ferreiro10, M. Salcedo11, I. Narvaez12, J.A. Pons13, J.I. Herrero14, S.P. Bartolome15, J.L. Montero16, A. Arencibia17, E.F. Garcia18, S. Lorente19, E. Molina20, J.R. Fernandez2, C.A. Alvarez1, V. CuervasMons21, and The Spanish Liver Transplant Society study Group. 1 Hepatology Unit. Liver Transplant Unit, Hospital U. Rio Hortega, Valladolid; 2Digestive Service. Liver Unit. Liver Transplant Unit, Hospital U. Cruces, Bilbao; 3Hepatology Unit. Liver Transplant Unit, Hospital U. La Fe, Valencia; 4Hepatology Unit, Hospital U.12 de Octubre, Madrid; 5 Gastroenterology Service, Hospital U. Bellvitge; 6Hepatology Service, Hospital Clinic. IDIBAPS, CIBERehd; 7Hepatology Service. CIBERehd, Hospital U. Vall Hebron, Barcelona; 8UGC Enfermedades Digestivas, IBIS, CIBERehd, Hospital Universitario Virgen del Rocío, Sevilla; 9Liver Unit, Hospital U Central de Asturias, Oviedo; 10Liver Transplant Unit, Hospital Universitario de A Coruña, A Coruña; 11Liver Unit, Hospital U. Gregorio Marañon, Madrid; 12Gastroenterology Service, Hospital Infanta Cristina, Badajoz; 13Hepatology Unit. Liver Transplant Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia; 14Liver Unit. CIBERehd. IdiSNA, Clinica Universidad de Navarra., Pamplona; 15Digestive Service. Liver Unit., Hospital GU., Alicante; 16Hepatology Unit. Liver Transplant Unit. IMIBIC, CIBERehd, Hospital U. Reina Sofía, Cordoba; 17Hospital U. La Candelaria, Tenerife; 18Hospital U. Marques de Valdecilla, Santander; 19 Hospital U. Lozano Blesa, Zaragoza; 20Hospital U. de Santiago, Santiago de Compostela; 21Internal Medicine Service. Liver Transplant Unit, Hospital Puerta de Hierro, Madrid, Spain E-mail: [email protected] Background and Aims: The treatments of hepatitis C in liver transplant patients until recently, had low efficacy and many adverse effects. The new direct acting antivirals Simeprevir(SIM) and sofosbuvir(SOF) have significantly increased the efficacy and safety of treatment in liver transplant hepatitis C patients genotype 1. The aim of this study was to determine the efficacy and safety in real life of the combination SOF + SIM ± RBV in a group of liver transplant patients genotype 1. Methods: This is a multicenter, retrospective study including 232 genotype 1 hepatitis C liver transplant patients treated with SIM + SOF ± RBV from 21 Liver transplant Centres. Efficacy and safety data, and mortality rate were assessed. Results: The majority of patients were male(73,7%) and the average age was 61.49 ± 8.9 years. The 63.1% were Ile 28B CT and the genotype 1a was 15.02%. The 59.05% of patients have been previously treated, the most part with interferon based therapy, but 10.8% with IP and the 4.3% with SOF. The 51.14% were null responders. There was a 53.8% of patients with fibrosis 4. The MELD score average was 8.86 ± 2.87(6– 24). In the 60.34% of the patients RBV was included in the treatment. The majority of the patients were treated during 12 weeks(86,63%). At the end of treatment(EOT), all patients had undetectable serum
Journal of Hepatology 2016 vol. 64 | S425–S630