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Liver transplantation for the treatment of complicated iatrogenic biliary injuries: analysis from the UNOS dataset
S68
Mini Oral Session Abstracts
patients with lower BDR were tended to be lower liver function. BDR was also strongly correlated with postoperative bilirubin increasing value (r = 0.694, P = 0.018), the patients with lower BDR were tended to be higher bilirubin increasing value. Conclusion: The patients in jaundice group with lower BDR were suspected to be lower liver function.
MO 65 LIVER TRANSPLANTATION FOR THE TREATMENT OF COMPLICATED IATROGENIC BILIARY INJURIES: ANALYSIS FROM THE UNOS DATASET C. Garcia, X. Mei, J. Berger, M. Shah, M. Daily and R. Gedaly University of Kentucky, Lexington, KY, USA Objective: To study outcomes on patients Transplanted for complicated biliary injuries in the US. Methods: The UNOS database was queried for all liver transplants performed in the US between October 1988 and January 2013. Of the 110,353 transplants performed, 42 were for complicated iatrogenic biliary injuries. Results: The median age for this cohort was 50.6 years (range 25e74) with a median MELD score of 21.1. Patients receiving liver transplantation for IBDI were more likely women (54.8%, p = 0.01), had a higher rate of portal vein thrombosis (14.3%, p = 0.01), and had less incidence of HCV infection (78.6%, p = 0.0001). The median BMI was 25.6 in patients transplanted for IBDI. Fifty percent of these cases were performed in UNOS regions 3, 5 and 7. IBDI was found as an independent predictor associated with 5fold increased risk of early graft loss (p = 0.002, CI 1.7e 9.8, HR 4.9). IBDI was also associated with a 2.7 fold increased risk of 30-day mortality after liver transplantation (p = 0.04, CI 1.0e7.0, HR 2.7). Conclusion: IBDI is an uncommon but challenging indication for liver transplantation. IBDI patients undergoing liver transplantation have significant increased rates of early graft loss and re-transplantation. IBDI is also an independent factor related to increased risk of perioperative death after liver transplantation. Further studies are needed to determine the causes of perioperative morbidity and to identify potential modifiable factors to improve outcomes in patients undergoing transplantation for IBDI.
MO 66 DISPARITIES AND SURVIVAL OUTCOMES IN THE MANAGEMENT OF HEPATOCELLULAR CARCINOMA: A NATIONAL PERSPECTIVE D. Pointer, A. Volk, M. Darden, G. Parker, R. Marshall, P. Friedlander and J. Buell Tulane University, New Orleans, LA, USA Objective: Hepatocellular carcinoma is the second leading cause of cancer death worldwide. Current data suggest patients in the United States may not receive equal access to care. Our study attempts to dissect the effect of race and socioeconomics, as measured by community risk, on patient outcomes. Methods: A cross-sectional analysis was performed using adult Surveillance, Epidemiology, and End Results (SEER) data for hepatocellular cancer. Community risk is a surrogate comprised of premature death rate, general health status, low birth weight rate, comorbidities, alcoholism and hospitalization rate, education, unemployment, and household income. Cancer specific mortality was then analyzed based on race, gender, stage, treatment, and community risk score. Results: 32,384 patients were identified with hepatocellular cancer: 26,797 Caucasian and 5487 African American. The majority were male between the age of 45e65 years old. Cancer-specific mortality was significantly increased for African Americans [HR: 1.04, 95% CI: (1.00, 1.09), p = 0.05] as were patients living in a communities with intermediate [HR: 1.10, 95% CI: (1.06, 1.15), p < 0.001] and high [HR: 1.17, 95% CI: (1.12, 1.23), p < 0.001] risk scores. Outcomes for African Americans in intermediateand high-risk communities were compared to Caucasians living in similar risk communities. African Americans persisted with an increased cancer specific mortality [HR: 1.10, 95% CI: (1.04, 1.16), p = 0.001]. Conclusion: Racial and socioeconomic factors play a prominent role in the management and outcomes of all patients with hepatocellular carcinoma. This includes patients living in higher risk communities as well as African Americans. Unfortunately, African Americans incur the highest cancer specific mortality even matched with equivalent community risk with Caucasians.
MO 67 CONDITIONAL PROBABILITY OF LONG-TERM SURVIVAL IN PATIENTS WITH LOCALLY ADVANCED AND METASTATIC HILAR CHOLANGIOCARCINOMA M. Gaspersz, S. Buettner, J. van Vugt, E. Roos, R. Coelen, J. IJzermans, T. van Gulik and B. Groot Koerkamp Erasmus MC University Medical Center, Rotterdam, Netherlands Objective: In recent years conditional survival (CS) has gained more attention, because it takes into account the amount of years a patient has already survived. CS estimates are especially interesting in patients with non-curative perihilar cholangiocarcinoma (PHC) because of the limited treatment options and their poor prognosis.
HPB 2017, 19 (S1), S40eS108
Mini Oral Session Abstracts
patients with lower BDR were tended to be lower liver function. BDR was also strongly correlated with postoperative bilirubin increasing value (r = 0.694, P = 0.018), the patients with lower BDR were tended to be higher bilirubin increasing value. Conclusion: The patients in jaundice group with lower BDR were suspected to be lower liver function.
MO 65 LIVER TRANSPLANTATION FOR THE TREATMENT OF COMPLICATED IATROGENIC BILIARY INJURIES: ANALYSIS FROM THE UNOS DATASET C. Garcia, X. Mei, J. Berger, M. Shah, M. Daily and R. Gedaly University of Kentucky, Lexington, KY, USA Objective: To study outcomes on patients Transplanted for complicated biliary injuries in the US. Methods: The UNOS database was queried for all liver transplants performed in the US between October 1988 and January 2013. Of the 110,353 transplants performed, 42 were for complicated iatrogenic biliary injuries. Results: The median age for this cohort was 50.6 years (range 25e74) with a median MELD score of 21.1. Patients receiving liver transplantation for IBDI were more likely women (54.8%, p = 0.01), had a higher rate of portal vein thrombosis (14.3%, p = 0.01), and had less incidence of HCV infection (78.6%, p = 0.0001). The median BMI was 25.6 in patients transplanted for IBDI. Fifty percent of these cases were performed in UNOS regions 3, 5 and 7. IBDI was found as an independent predictor associated with 5fold increased risk of early graft loss (p = 0.002, CI 1.7e 9.8, HR 4.9). IBDI was also associated with a 2.7 fold increased risk of 30-day mortality after liver transplantation (p = 0.04, CI 1.0e7.0, HR 2.7). Conclusion: IBDI is an uncommon but challenging indication for liver transplantation. IBDI patients undergoing liver transplantation have significant increased rates of early graft loss and re-transplantation. IBDI is also an independent factor related to increased risk of perioperative death after liver transplantation. Further studies are needed to determine the causes of perioperative morbidity and to identify potential modifiable factors to improve outcomes in patients undergoing transplantation for IBDI.
MO 66 DISPARITIES AND SURVIVAL OUTCOMES IN THE MANAGEMENT OF HEPATOCELLULAR CARCINOMA: A NATIONAL PERSPECTIVE D. Pointer, A. Volk, M. Darden, G. Parker, R. Marshall, P. Friedlander and J. Buell Tulane University, New Orleans, LA, USA Objective: Hepatocellular carcinoma is the second leading cause of cancer death worldwide. Current data suggest patients in the United States may not receive equal access to care. Our study attempts to dissect the effect of race and socioeconomics, as measured by community risk, on patient outcomes. Methods: A cross-sectional analysis was performed using adult Surveillance, Epidemiology, and End Results (SEER) data for hepatocellular cancer. Community risk is a surrogate comprised of premature death rate, general health status, low birth weight rate, comorbidities, alcoholism and hospitalization rate, education, unemployment, and household income. Cancer specific mortality was then analyzed based on race, gender, stage, treatment, and community risk score. Results: 32,384 patients were identified with hepatocellular cancer: 26,797 Caucasian and 5487 African American. The majority were male between the age of 45e65 years old. Cancer-specific mortality was significantly increased for African Americans [HR: 1.04, 95% CI: (1.00, 1.09), p = 0.05] as were patients living in a communities with intermediate [HR: 1.10, 95% CI: (1.06, 1.15), p < 0.001] and high [HR: 1.17, 95% CI: (1.12, 1.23), p < 0.001] risk scores. Outcomes for African Americans in intermediateand high-risk communities were compared to Caucasians living in similar risk communities. African Americans persisted with an increased cancer specific mortality [HR: 1.10, 95% CI: (1.04, 1.16), p = 0.001]. Conclusion: Racial and socioeconomic factors play a prominent role in the management and outcomes of all patients with hepatocellular carcinoma. This includes patients living in higher risk communities as well as African Americans. Unfortunately, African Americans incur the highest cancer specific mortality even matched with equivalent community risk with Caucasians.
MO 67 CONDITIONAL PROBABILITY OF LONG-TERM SURVIVAL IN PATIENTS WITH LOCALLY ADVANCED AND METASTATIC HILAR CHOLANGIOCARCINOMA M. Gaspersz, S. Buettner, J. van Vugt, E. Roos, R. Coelen, J. IJzermans, T. van Gulik and B. Groot Koerkamp Erasmus MC University Medical Center, Rotterdam, Netherlands Objective: In recent years conditional survival (CS) has gained more attention, because it takes into account the amount of years a patient has already survived. CS estimates are especially interesting in patients with non-curative perihilar cholangiocarcinoma (PHC) because of the limited treatment options and their poor prognosis.
HPB 2017, 19 (S1), S40eS108