M1877 Factors Predicting Relapse in Those Undergoing Orthotopic Liver Transplantation for Alcoholic Cirrhosis

2006. Patients classified as HCV, NASH, ETOH, Cholestatic and other. MS defined through modified NCEP ATP III criteria with fasting glucose>110, total cholesterol>200, BMI>30 and Hypertension >135/85. Data extracted included MS parameters, patient/graft survival; creatinine; HCV related-fibrosis during biopsy and liver chemistries. Fibrosis staged by Metavir in protocol liver biopsies obtained annually in HCV patients. Immunosuppression was tacrolimus with rapid steroid taper. Data were analyzed using Chi Square test, Fisher's Exact test and t-tests. Repeated fibrosis measures per patient were analyzed using population averaged generalized linear models. Results: 440 patients (73% M, 92% White, mean age 52) who underwent OLT from 2001-2006 with cirrhosis (188 HCV, 66 NASH, 49 ETOH, 28 Cholestatic, 101 other) were reviewed. MS was noted prior to OLT in 40/65 NASH pts, 81/180 HCV patients,12/28 cholestatic, 20/46 ETOH, 33/95 other cirrhotic patients; by year 2 MS distribution was 31/58 NASH 50/173 HCV , 6/26 cholestatic, 13/37 ETOH, 16/77 other. Rates of metabolic syndrome were higher among NASH patients as compared to Hep C (p=0.023), and other (p=0.001). 180 patients with HCV infection had annual biopsies for staging of fibrosis with median of 14.6 months (range 0-69 months). At year 1 post OLT, a trend toward fibrosis free HCV recurrence was noted in those without MS pre-OLT but no difference at year 2. Conclusions: MS was present in 45% of HCV patients pre-OLT and the prevalence fell by year 2 in HCV patients. The presence of MS in HCV patients did not affect patient/graft survival, renal function or liver chemistries up to years 2 post transplant but was associated with a trend toward fibrosis recurrence 1 year post OLT. Longer followup will be required to help define the natural history of MS in HCV patients who undergo OLT. HCV recurrence without fibrosis

Hepatitis B Immunoglobulin and Lamivudine Reduce Hepatitis B Virus-Related Morbidity and Mortality in Chronic Hepatitis B Patients Undergoing Liver Transplantation: Meta-Analysis Rohit Loomba, Ayana K. Rowley, Robert Wesley, T Jake Liang, Frank Pucino, Gyorgy Csako Background: Hepatitis B virus (HBV)-recurrence increases both morbidity and mortality in hepatitis B surface antigen positive (HBsAg+) patients undergoing liver transplantation. We aimed to estimate the relative efficacy of combined therapy with hepatitis B immunoglobulin (HBIG) and lamivudine (LAM) vs. HBIG monotherapy for preventing HBV-related morbidity and mortality in this setting. Methods: We performed a meta-analysis of clinical trials that met the pre-specified criteria and provided adequate data for risk estimation of HBV recurrence in HBsAg+ liver transplant patients receiving HBIG and LAM vs. HBIG alone. Databases searched until May 2007 included Medline (Ovid), Pubmed, Embase, Toxnet, Scopus, and Web of Science. Literature search and data extraction were conducted independently by 2 study investigators, then 2 other investigators reviewed and screened eligible studies. Odds ratios (OR) for the risk reduction with HBIG and LAM vs. HBIG alone were calculated for each study and then pooled using a random-effects model. Results: 2 prospective and 4 retrospective cohort studies were eligible for meta-analysis of HBV recurrence as the primary outcome in HBsAg+ patients receiving liver transplants. The OR showing risk reduction with HBIG AND LAM (n=193) vs. HBIG alone (n=124) was 0.08 (95% CI; 0.03-0.21), HBV-related mortality, as a secondary outcome, could only be assessed in 3 studies. The OR showing mortality reduction with HBIG and LAM (n=115) vs. HBIG alone (n=85) was 0.08 (95%CI; 0.02-0.33). Conclusion: While this meta-analysis is limited by small studies and varying levels of immunosuppression, it is apparent that adding LAM to HBIG markedly improves HBV-related morbidity and mortality in HBsAg+ recipients of liver transplants.

M1877 Factors Predicting Relapse in Those Undergoing Orthotopic Liver Transplantation for Alcoholic Cirrhosis Kashif J. Khan, Colin Terry, Audrey Krause, Amy Bax, Mazen Alsatie, Jonathan A. Fridell, Marco A. Lacerda, Richard S. Mangus, Vijay Laxmi Misra, A Joseph Tector, Rodrigo Vianna, Rakesh -. Vinayek, Paul Kwo Cirrhosis due to alcoholic liver disease is a major cause of orthotopic liver transplantation (OLT). Alcohol recidivism has been reported after transplantation with reported relapse rates of 7-33%. Our AIM was to assess pre and post-transplant risk factors associated with alcohol relapse after OLT and to determine effects of alcohol recidivism on patient survival. METHODS: Retrospective review of electronic medical records for all patients transplanted at our institution from 1988 to January 2006 transplanted for alcoholic cirrhosis (ETOH) and cirrhosis due to Hepatitis C with alcoholism (HCV/ETOH). Post OLT variables included hospitalizations, episodes of acute rejection, chronic rejection, survival, return to work. Alcohol relapse defined as any documented use of alcohol post OLT. Demographics and post-transplant measures were summarized using descriptive statistics. Categorical measures were compared between groups using Fisher's exact test and continuous measures were compared between groups using Student t-tests or Wilcoxon rank sum tests. RESULTS: 140 subjects (mean follow-up 290 weeks) underwent OLT for ETOH cirrhosis, 140 underwent OLT for HCV/ETOH cirrhosis (mean follow-up 221 weeks). Post OLT alcohol relapse rate in ETOH only group was 18.3% vs 10.5% in HCV/ETOH group (p=0.10). A history of > 1 alcohol relapse after a period of sobriety prior to OLT (p <0.001), and living alone (p= 0.004) were associated with alcohol relapse post OLT in the ETOH group. Living with spouse/children prior to OLT marginally associated with no relapse in both groups (ETOH, p = 0.010;HCV/ETOH, p= 0.058). There were trends noted with less abstinence duration and shorter wait time for OLT predicting relapse (table). Finally a trend toward increased mortality was noted in the ETOH group with relapse (52% vs 30%, p=0.07). CONCLUSIONS: Alcohol relapse post OLT occurred in 18% of our ETOH cohort and 10.5% of our ETOH/ HCV cohort. In the ETOH group, post-OLT relapse was associated with multiple pre-OLT ETOH relapses, and living situation with trends noted in duration of abstinence, wait list time prior to OLT and mortality. Close post OLT follow-up will be required for those who are at higher risk for relapse. ETOH Patient Factors To Predict Relapse

M1875 Use of Growth Factors During Interferon-Based Therapy for Recurrent Hepatitis C Virus Infection Following Liver Transplantation Sarah Sheibani, Anastasia Waechter, Jason Lee, Lynn Shapiro, Maximilian Lee, Aijaz Ahmed, Ahmad Kamal BACKGROUND: Recurrent hepatitis C is universal in liver transplant recipients with active viremia at the time of transplantation. Recurrent hepatitis C may lead to rapidly progressive fibrosis and graft loss. The efficacy of antiviral therapy is suboptimal at best in this special HCV population with significantly higher prevalence of anemia and neutropenia related to interferon plus ribavirin combination therapy. We investigated the use of hematopoetic growth factors to maintain antiviral therapy following liver transplantation. METHODS: We performed a retrospective review of patients treated for recurrent hepatitis C following liver transplantation at our institution between January, 1996 and October, 2005. Incidence of anemia and neutropenia, use of growth factors, need for blood transfusions, and occurrence of infection was examined. RESULTS: 51 patients underwent 68 courses of treatment. 38 patients (75%) had genotype 1 infection. Growth factors were required in 42 (62%) courses due to anemia (n= 11), neutropenia (n = 7), or both (n= 24). Patients who required epoetinalfa were similar to those who did not except for having a lower mean pre-treatment hematocrit (36.3 vs. 38.5, p = 0.05). No significant predictors of G-CSF use were identified in multivariate analysis. Among patients who required growth factors, mean time to onset of anemia was 3.2 weeks into treatment. Moderate neutropenia occurred at a mean of 3.7 weeks, and severe neutropenia at 10.4 weeks. Despite use of growth factors, ribavirin (RBV) dose reduction was required in 56% of treatment courses, and interferon (IFN) dose reduction in 43%. In addition to epoetin-alfa, blood transfusions were needed in 25 (37%) treatments courses. Infection requiring antibiotics was seen in 31% of courses, and did not appear to correlate with degree of neutropenia or time to onset of neutropenia. Overall SVR rate was 30%. CONCLUSION: Treatment of recurrent hepatitis C following liver transplantation is associated with a high incidence of hematological side effects, but SVR rate of 30% was seen with aggressive use of growth factors. The rapid onset of anemia and neutropenia suggests that vigilance is warranted to promptly identify these complications and initiate supportive treatment in a timely manner. M1876 The Effect of Pre-Transplant Metabolic Syndrome in HCV Patients Undergoing OLT Veronika Gagovic, Beth E. Juliar, Mazen Alsatie, Naga P. Chalasani, Jonathan A. Fridell, Marco A. Lacerda, Suthat Liangpunsakul, Richard S. Mangus, Vijay Laxmi Misra, A Joseph Tector, Rodrigo Vianna, Rakesh -. Vinayek, Raj Vuppalanchi, Paul Kwo

M1878 Risk Factors and Outcomes in Post Orthotopic Liver Transplantation Bile Duct Stones and Casts: A Case Control Study Bret J. Spier, Patrick R. Pfau, Michael R. Lucey, Adnan Said

Hepatitis C, the most common etiology for orthotopic liver transplantation (OLT), may be associated with metabolic syndrome (MS) prior to OLT with recent data suggesting that HCV and MS may lead more advanced fibrosis. Our AIM was to determine the effects of pre-OLT MS in HCV patients undergoing OLT and to assess differences in outcome and complications regarding MS compared to non-HCV related cirrhosis. Methods: Retrospective single center review of all patients who underwent OLT from January 2000 to October

Background: Bile duct stones and casts (BDS) after orthotopic liver transplantation (OLT) are associated with significant morbidity. Risk factors for BDS formation and efficacy of treatment in OLT patients have not been systematically studied. Aim: Evaluate potential risk factors for the formation of BDS in patients post-OLT. Methods: Pre and post OLT risk

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AASLD Abstracts

AASLD Abstracts

M1874