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Mo1912 Changes in Autoimmune Markers Occurring in Liver Transplant Recipients
the impact and progression of acute or chronic liver disease with concomitant HEV in pre, peri, and post liver transplant recipient. Larger study needs to validate Demographic of patients in Group B
History and genotypic Characteristics
AASLD Abstracts
Figure 1 Axial slice data of CT cholangiography with carbon dioxide
Mo1911 Three-Dimensional Image of Hepatic Hilum by CT Cholangiography With Carbon Dioxide for Preoperative Assessment of Biliary Malignancies Kojiro Taura, Etsuro Hatano, Takamichi Ishii, Shinji Uemoto [Background] Curative resection for biliary malignancies involving hepatic hilum is technically-demanding due to complex anatomy of the hepatic hilum. Three-dimensional (3D) presentation of the hepatic hilum structures including bile ducts is supposed to be useful for precise understanding of the anatomy and the tumor extension in individual patients and may improve surgical outcomes. Carbon dioxide (CO2) has been utilized as a radiolucent contrast material. Because CO2 has opposite radiopacity to iodinated contrast material, it may be advantageous to CT cholangiography in which 3D images of bile ducts and vasculatures are simultaneously reconstructed and merged. [Purpose] The purpose of this study is to examine usefulness of CO2 CT cholangiography for preoperative assessment of biliary malignancies. [Patients and Methods] Forty consecutive patients with external biliary drainage (endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic biliary drainage (PTBD)) who were considered for surgical resection were the subjects of this study. CO2 was injected via biliary drainage tubes so that the bile ducts are filled with CO2 (figure 1). The patients were also given intravenous injection with iodinated contrast media and underwent dynamic CT scan. The arterial and the portal phase images were obtained 5 seconds and 20 seconds after the peak aortic enhancement time, respectively. 3D images were reconstructed for the arteries and the bile ducts from the arterial phase and for the portal vein from the portal phase with 3D analysis software Virtual Place Lexus (AZE, Japan). [Results] Figure 2 shows a representative case with hilar cholangiocarcinoma involving the right hepatic artery and the portal vein. Bile ducts were successfully demonstrated in all cases without occurrence of cholangitis or elevation of liver enzymes. The biliary branches were visualized up to 4.3 rd-order branches on the average. The fusion 3D images of the vasculatures and the bile ducts were useful for recognition of abnormal anatomy or isolated branches, which are often overlooked in conventional two-dimensional cholangiography. Moreover, the synchronous 3D images helped us understand the relative anatomical relationship between the tumor and the surrounding vessels and facilitated precise determination of the cutting line of the bile duct in the operation. Twenty-one patients actually underwent tumor resection and negative surgical margin was achieved in all but two cases with carcinoma in situ at the cutting line. [Conclusion] 3D CT cholangiography with CO2 is a useful tool for preoperative diagnosis, operative planning, and intraoperative navigation of biliary malignancies involving hepatic hilum. Sophisticated operations based on the precise understanding of the anatomy and the tumor extension in individual patients are expected to improve surgical outcomes.
Figure 2 Three-dimensional fusion image of the artery, portal vein, and bile ducts. "T" indicate the tumor. Mo1912 Changes in Autoimmune Markers Occurring in Liver Transplant Recipients Carmen M. Stanca, Costica Aloman, Maria Isabel Fiel, Thomas Schiano Background: Little is known about the pattern of autoimmune markers (AIM) in liver transplantation (LT) recipients, irrespective of the liver disease etiology, in the context of immunosuppression. Hepatitis C (HCV) recurrence is universal and some patients develop particularly aggressive disease after LT. We hypothesized that AIM may behave differently in LT patients, particularly in those with HCV. Methods: Patients with LT who underwent post-LT biopsies between Oct 2008 and Aug 2011 were enrolled. Patients had AIM checked at time of liver biopsy. Demographic data, AIM, liver histology (explant and post-LT biopsies) were analyzed. Non-parametric tests were employed. Data are presented as median (range). Results: Two hundred and twenty patients (M/F 143/77; age at LT 54 (19-73)) were included in the study; 76 patients had AIM at time of LT. Length of follow up since LT was 285 (30-1462) days. Sixty percent of patients had HCV at time of LT, 83% developed recurrent HCV. Immunosuppression regimens were similar in these patients. Overall, a significant decrease in IgA, IgG, IgM, rheumatoid factor and beta-2 microglobulin levels was observed post LT compared with before LT (p<0.001 for each). HCV patients had higher IgG (p= 0.005) and rheumatoid factor (p=0.044) levels before LT compared to non-HCV patients; elevated IgG (p=0.029) and IgM (p=0.045) levels were associated with high HCV grade in the explant. HCV patients also tended to have increased rheumatoid factor (p=0.071) and beta-2 microglobulin (p=0.065) levels at time of post LT biopsy. On follow up biopsies, only high IgG levels were associated with increased inflammation as measured by HCV grade (p=0.012). Smooth muscle antibodies were present at time of LT in higher percentage in patients who will later develop recurrent HCV, although it did not reach statistical significance (p=0.065). Patients who developed recurrent HCV had lower IgG levels at time of LT as compared to those who did not develop recurrent infection (p=0.004). Some of the AIM stayed negative from LT throughout the follow up period (liver cytosol, soluble liver antigen, liver-kidney microsomal). Conclusions: Autoimmune markers change significantly after LT, and have a different pattern in HCV patients. Some markers are associated with HCV recurrence and advanced inflammation on liver biopsy. Further analysis can help identify predictors of severity of HCV recurrence in LT patients.
S-997
AASLD Abstracts
History and genotypic Characteristics
AASLD Abstracts
Figure 1 Axial slice data of CT cholangiography with carbon dioxide
Mo1911 Three-Dimensional Image of Hepatic Hilum by CT Cholangiography With Carbon Dioxide for Preoperative Assessment of Biliary Malignancies Kojiro Taura, Etsuro Hatano, Takamichi Ishii, Shinji Uemoto [Background] Curative resection for biliary malignancies involving hepatic hilum is technically-demanding due to complex anatomy of the hepatic hilum. Three-dimensional (3D) presentation of the hepatic hilum structures including bile ducts is supposed to be useful for precise understanding of the anatomy and the tumor extension in individual patients and may improve surgical outcomes. Carbon dioxide (CO2) has been utilized as a radiolucent contrast material. Because CO2 has opposite radiopacity to iodinated contrast material, it may be advantageous to CT cholangiography in which 3D images of bile ducts and vasculatures are simultaneously reconstructed and merged. [Purpose] The purpose of this study is to examine usefulness of CO2 CT cholangiography for preoperative assessment of biliary malignancies. [Patients and Methods] Forty consecutive patients with external biliary drainage (endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic biliary drainage (PTBD)) who were considered for surgical resection were the subjects of this study. CO2 was injected via biliary drainage tubes so that the bile ducts are filled with CO2 (figure 1). The patients were also given intravenous injection with iodinated contrast media and underwent dynamic CT scan. The arterial and the portal phase images were obtained 5 seconds and 20 seconds after the peak aortic enhancement time, respectively. 3D images were reconstructed for the arteries and the bile ducts from the arterial phase and for the portal vein from the portal phase with 3D analysis software Virtual Place Lexus (AZE, Japan). [Results] Figure 2 shows a representative case with hilar cholangiocarcinoma involving the right hepatic artery and the portal vein. Bile ducts were successfully demonstrated in all cases without occurrence of cholangitis or elevation of liver enzymes. The biliary branches were visualized up to 4.3 rd-order branches on the average. The fusion 3D images of the vasculatures and the bile ducts were useful for recognition of abnormal anatomy or isolated branches, which are often overlooked in conventional two-dimensional cholangiography. Moreover, the synchronous 3D images helped us understand the relative anatomical relationship between the tumor and the surrounding vessels and facilitated precise determination of the cutting line of the bile duct in the operation. Twenty-one patients actually underwent tumor resection and negative surgical margin was achieved in all but two cases with carcinoma in situ at the cutting line. [Conclusion] 3D CT cholangiography with CO2 is a useful tool for preoperative diagnosis, operative planning, and intraoperative navigation of biliary malignancies involving hepatic hilum. Sophisticated operations based on the precise understanding of the anatomy and the tumor extension in individual patients are expected to improve surgical outcomes.
Figure 2 Three-dimensional fusion image of the artery, portal vein, and bile ducts. "T" indicate the tumor. Mo1912 Changes in Autoimmune Markers Occurring in Liver Transplant Recipients Carmen M. Stanca, Costica Aloman, Maria Isabel Fiel, Thomas Schiano Background: Little is known about the pattern of autoimmune markers (AIM) in liver transplantation (LT) recipients, irrespective of the liver disease etiology, in the context of immunosuppression. Hepatitis C (HCV) recurrence is universal and some patients develop particularly aggressive disease after LT. We hypothesized that AIM may behave differently in LT patients, particularly in those with HCV. Methods: Patients with LT who underwent post-LT biopsies between Oct 2008 and Aug 2011 were enrolled. Patients had AIM checked at time of liver biopsy. Demographic data, AIM, liver histology (explant and post-LT biopsies) were analyzed. Non-parametric tests were employed. Data are presented as median (range). Results: Two hundred and twenty patients (M/F 143/77; age at LT 54 (19-73)) were included in the study; 76 patients had AIM at time of LT. Length of follow up since LT was 285 (30-1462) days. Sixty percent of patients had HCV at time of LT, 83% developed recurrent HCV. Immunosuppression regimens were similar in these patients. Overall, a significant decrease in IgA, IgG, IgM, rheumatoid factor and beta-2 microglobulin levels was observed post LT compared with before LT (p<0.001 for each). HCV patients had higher IgG (p= 0.005) and rheumatoid factor (p=0.044) levels before LT compared to non-HCV patients; elevated IgG (p=0.029) and IgM (p=0.045) levels were associated with high HCV grade in the explant. HCV patients also tended to have increased rheumatoid factor (p=0.071) and beta-2 microglobulin (p=0.065) levels at time of post LT biopsy. On follow up biopsies, only high IgG levels were associated with increased inflammation as measured by HCV grade (p=0.012). Smooth muscle antibodies were present at time of LT in higher percentage in patients who will later develop recurrent HCV, although it did not reach statistical significance (p=0.065). Patients who developed recurrent HCV had lower IgG levels at time of LT as compared to those who did not develop recurrent infection (p=0.004). Some of the AIM stayed negative from LT throughout the follow up period (liver cytosol, soluble liver antigen, liver-kidney microsomal). Conclusions: Autoimmune markers change significantly after LT, and have a different pattern in HCV patients. Some markers are associated with HCV recurrence and advanced inflammation on liver biopsy. Further analysis can help identify predictors of severity of HCV recurrence in LT patients.
S-997
AASLD Abstracts