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Novel biliary reconstruction techniques during liver transplantation
Electronic Poster Abstracts University of Groningen, University Medical Center Groningen, Netherlands Background: Pre- or reconditioning of donor livers can improve organ quality prior to transplantation. The aim of this study was to investigate whether metformin as pre- or reconditioning agent is able to reduce preservation injury in rat donor livers and improve hepatobiliary function during ex situ normothermic machine perfusion (NMP). Methods: To study the preconditioning effects of metformin, metformin was administered via oral gavage 12 and 2 hours before the hepatectomy. To assess the reconditioning effects of metformin, in 2 other groups, metformin was added to the NMP perfusion fluid in two different concentrations (30 and 300 mg/L). In the reference group, no pre- or reconditioning was carried out. In all groups, rat donor livers were preserved for 4 hours in preservation fluid on melting ice. Thereafter, NMP was performed for viability assessment. Results: Preconditioning improved ATP production and hepatobiliary function (assessed by total bile production, biliary bilirubin and bicarbonate) and significantly lowered levels of lactate and glucose during NMP. On the other hand, metformin preconditioning did not reduce markers for hepatobiliary injury such as AST, ALT, LDH, caspase-3 activity, TBARS or biliary gamma-GT and LDH. Reconditioning with metformin did not improve hepatobiliary function or reduce injury markers during NMP. Conclusion: Preconditioning of rat donor livers with metformin improves hepatobiliary function but does not reduce preservation injury as assessed during 3 hours of NMP. Reconditioning with metformin showed no beneficial effects.
EP05A-019 MELD SCORE EXCEPTION IN BRAZIL OVEREMPHASIZES THE BENEFITS TO HEPATOCELLULAR CARCINOMA PATIENTS IN TRANSPLANT. A PROPOSAL TO IMPROVE THE RULES A. Soares Lima, N. Godinho and L. Amado Instituto Alfa de Gastroenterologia, Universidade Federal de Minas Gerais, Brazil In MELD-based allocation systems patients with cancer and some other diseases are assigned a special score. The goal of this study was to assess the fairness of organ distribution by the MELD system among different groups of diseases. Patients and methods: This is a retrospective study with adult patients between 2009 and 2013. Demographics and MELD scores were compared with the incidence of transplant or death, patient origin and disease groups. Results: 260 Selected patients were submitted to transplant or died before the transplant. Their median age was 54.9 years (12.1e73.9 years); 70.4% were men; 63.3% had chronic liver cell diseases (alcoholic cirrhosis 33.1%, Cvirus cirrhosis 24.2%). Exception score was assigned to 26.5% of listed patients. These patients received 31% of transplanted organs and had lower pre-transplant mortality or drop out (14.2 times less) rates than the other patients (p < 0.001). Receiving exception points resulted in a higher likelihood of being transplanted.
HPB 2016, 18 (S1), e385ee601
e547
Conclusion: The authors propose the use of a regional variable score for transplantation in special situations, which should be based on the median MELD score of the latest transplants for chronic liver diseases, to refrain from harming patients who have access to transplant according to the calculated MELD score.
EP05A-020 NOVEL BILIARY RECONSTRUCTION TECHNIQUES DURING LIVER TRANSPLANTATION J. Romano1, A. J. Cohen1,2, H. Bohorquez1,2, I. C. Carmody1,2 and G. Loss1,2 1 The University of Queensland School of Medicine, and 2 Multi-Organ Transplant Institute, Ochsner Clinic Foundation, United States Biliary duct mismatches during a liver transplant typically result in a biliary-enteric anastomosis. Other surgical options exist to deal with a significant size mismatch between the donor and recipient bile ducts. The objective of this study was to compare the outcomes of biliary ductoplasty (BD) and biliary transposition (BT). All livers transplanted from January 1, 2005 to December 31, 2013 were reviewed for biliary reconstruction techniques. This study assessed patient and graft survival, biliary strictures, leaks and number of endoscopic procedures. 723 liver transplants were performed during the study period. We identified 10 patients who underwent BD and 23 patients that underwent BT. Patient and graft survival for BD and BT were both 100.0% at 1 year. The median length of stay was 10 days in both groups. Early stricture rates (<7 days) were similar; 10.0 % in BD and 11.5% in BT (p = 0.5905). The overall stricture rate was 70.0% of patients in the BD group (7/10 patients) while the BT group had a 47.8% (11/23 patients) stricture rate (p = 0.28). Leaks were detected in 20% of BD patients while only 4% of the BT developed leaks. All of the leaks were treated with endoscopic therapy. The average number of ERCPs in the BD group was 1.9 procedures while the BT group underwent an average of 1.2 procedures (p = n.s.).
Figure 1 Kaplan–Meir curve comparing patient survival
following liver transplantation in patients who had BD vs BT for biliary reconstruction
e548
Electronic Poster Abstracts
EP05A-023 LIVER TRANSPLANTATION: EXPERIENCE IN KAZAKHSTAN
Figure
2 Kaplan–Meir
curve
comparing
graft
survival
following liver transplantation in patients who had BD vs BT for biliary reconstruction.
[Patient survival/graft survival] This study demonstrates favorable outcomes with both biliary reconstruction techniques. Choice of reconstruction is dependent on multiple factors including sizes of the ducts and surgeon experience.
EP05A-021 POOR OUTCOME OF DECEASED DONOR LIVER TRANSPLANTATION FOR ALCOHOLIC LIVER DISEASE S. K. Hong1, N. -J. Yi1, H. Kim2, K. C. Yoon2, H. -S. Kim2, K. -W. Lee2 and K. -S. Suh2 1 Seoul National University Hospital/Seoul National University College of Medicine, and 2Seoul National University Hospital, Republic of Korea Alcoholic liver disease (ALD) is the second leading indication for liver transplantation (LT) in the United States and Europe. In Korea, there has been a gradual increase in number of patients with ALD undergoing liver transplantation, but minimum of 6 month’s abstinence before transplantation is not strictly performed. Moreover, little is known following the post-transplant outcomes for ALD in Asian countries. The aim of this study is to assess the post-transplant outcome focusing on complication and mortality rate. The results were retrospectively reviewed from 1079 patients, who underwent LT from January 2007 to Dec 2014 at Seoul National University Hospital. Among these, 142 patients (13.2%) were ALD group. The proportion of ALD patients out of total LT patients in 2007 e 2014 were 7.4%, 8.9%, 11.5%, 9.6%, 14.9%, 13.3%, 17.5%, and 17.2%, respectively. Out of 142 ALD patients, 82 patients (57.7%) underwent living donor LT (LDLT) and 60 patients (42.3%) deceased donor LT (DDLT). The mortality rate of non-ALD group and ALD group were 14.6% and 12.0%. The mortality rate of ALD patients who underwent DDLT was 20.0%. Considering the shortage of deceased donor and relatively poor outcome of DDLT for ALD, more attention and strict criteria is needed for improving the survival of DDLT for ALD without causing a loss of opportunity for LT for other indications.
D. Toksanbayev, N. Sadykov, M. Duisebekov, M. Doskhanov and S. Kaniyev Hepatopancreatobiliary Surgery and Liver Transplantation, Syzganov’s National Scientific Center of Surgery, Kazakhstan Liver transplantation program in Kazakhstan started in December 2011. As of September 2015, there were 96 operations provided in the country in total. Despite of the numerous problem, liver transplantation program develops gradually. The leading cause of end-stage liver disease in operated patients was viral hepatitis: most of patients had hepatitis B, B with delta agent or C liver cirrhosis. About 3/ 4 of operations were done using living donors, as deceased donation system is weakly developed due to the lack of legislation system in this regard and mentality of population. In case of living donor liver transplantation, acceptance of person from potential recipient’s family as a living related donor of a fragment of liver was decided with confidence the procedure has minimal risks for the donor. Appropriate candidate for liver’s fragment donation was a relative elder than 18 and younger than 45 years, compatible with the recipient anthropomorphically, without liver and other organs diseases, blood type identical/compatible with the recipient. The selection of graft type have been basing of precise calculations of the alleged graft and volume remaining fragment of the liver from a donor, in each case. Deceased donor liver transplantation done as a result of multi-organ harvesting (heart, liver, kidneys), when the families of deceased donors gave consent for organs donation. Survival rate of recipients after liver transplant operations in Kazakhstan is 82.3% in present days, with zero mortality in living donors. Liver transplantation gives a chance to survive for many patients with end-stage liver disease in Kazakhstan.
EP05A-024 RACIAL DISPARITY IN LIVER TRANSPLANTATION IN AN INNER CITY POPULATION A. Smith1, A. Hauch2, E. Kandil1, M. Killackey1, A. Paramesch1, M. Moehlen3, L. Balart1 and J. Buell1 1 Surgery, Tulane University, 2Tulane University, and 3 Medicine, Tulane University, United States Introduction: Multiple studies have identified racial disparity in access to advanced surgical procedures as liver transplantation among African Americans (AA). Our University program has traditionally served the socioeconomically challenged patients of New Orleans. Methods: Retrospective analyses comparing racial presentation and outcomes of all adult liver transplant recipients ’07e’15. Statistical analysis was carried out with SAS software. Results: Of 223 recipients 65 were AA (29.1%) which was representative of the general racial makeup of Louisiana. AA were younger than Caucasians (CA) at transplant (55
HPB 2016, 18 (S1), e385ee601
EP05A-019 MELD SCORE EXCEPTION IN BRAZIL OVEREMPHASIZES THE BENEFITS TO HEPATOCELLULAR CARCINOMA PATIENTS IN TRANSPLANT. A PROPOSAL TO IMPROVE THE RULES A. Soares Lima, N. Godinho and L. Amado Instituto Alfa de Gastroenterologia, Universidade Federal de Minas Gerais, Brazil In MELD-based allocation systems patients with cancer and some other diseases are assigned a special score. The goal of this study was to assess the fairness of organ distribution by the MELD system among different groups of diseases. Patients and methods: This is a retrospective study with adult patients between 2009 and 2013. Demographics and MELD scores were compared with the incidence of transplant or death, patient origin and disease groups. Results: 260 Selected patients were submitted to transplant or died before the transplant. Their median age was 54.9 years (12.1e73.9 years); 70.4% were men; 63.3% had chronic liver cell diseases (alcoholic cirrhosis 33.1%, Cvirus cirrhosis 24.2%). Exception score was assigned to 26.5% of listed patients. These patients received 31% of transplanted organs and had lower pre-transplant mortality or drop out (14.2 times less) rates than the other patients (p < 0.001). Receiving exception points resulted in a higher likelihood of being transplanted.
HPB 2016, 18 (S1), e385ee601
e547
Conclusion: The authors propose the use of a regional variable score for transplantation in special situations, which should be based on the median MELD score of the latest transplants for chronic liver diseases, to refrain from harming patients who have access to transplant according to the calculated MELD score.
EP05A-020 NOVEL BILIARY RECONSTRUCTION TECHNIQUES DURING LIVER TRANSPLANTATION J. Romano1, A. J. Cohen1,2, H. Bohorquez1,2, I. C. Carmody1,2 and G. Loss1,2 1 The University of Queensland School of Medicine, and 2 Multi-Organ Transplant Institute, Ochsner Clinic Foundation, United States Biliary duct mismatches during a liver transplant typically result in a biliary-enteric anastomosis. Other surgical options exist to deal with a significant size mismatch between the donor and recipient bile ducts. The objective of this study was to compare the outcomes of biliary ductoplasty (BD) and biliary transposition (BT). All livers transplanted from January 1, 2005 to December 31, 2013 were reviewed for biliary reconstruction techniques. This study assessed patient and graft survival, biliary strictures, leaks and number of endoscopic procedures. 723 liver transplants were performed during the study period. We identified 10 patients who underwent BD and 23 patients that underwent BT. Patient and graft survival for BD and BT were both 100.0% at 1 year. The median length of stay was 10 days in both groups. Early stricture rates (<7 days) were similar; 10.0 % in BD and 11.5% in BT (p = 0.5905). The overall stricture rate was 70.0% of patients in the BD group (7/10 patients) while the BT group had a 47.8% (11/23 patients) stricture rate (p = 0.28). Leaks were detected in 20% of BD patients while only 4% of the BT developed leaks. All of the leaks were treated with endoscopic therapy. The average number of ERCPs in the BD group was 1.9 procedures while the BT group underwent an average of 1.2 procedures (p = n.s.).
Figure 1 Kaplan–Meir curve comparing patient survival
following liver transplantation in patients who had BD vs BT for biliary reconstruction
e548
Electronic Poster Abstracts
EP05A-023 LIVER TRANSPLANTATION: EXPERIENCE IN KAZAKHSTAN
Figure
2 Kaplan–Meir
curve
comparing
graft
survival
following liver transplantation in patients who had BD vs BT for biliary reconstruction.
[Patient survival/graft survival] This study demonstrates favorable outcomes with both biliary reconstruction techniques. Choice of reconstruction is dependent on multiple factors including sizes of the ducts and surgeon experience.
EP05A-021 POOR OUTCOME OF DECEASED DONOR LIVER TRANSPLANTATION FOR ALCOHOLIC LIVER DISEASE S. K. Hong1, N. -J. Yi1, H. Kim2, K. C. Yoon2, H. -S. Kim2, K. -W. Lee2 and K. -S. Suh2 1 Seoul National University Hospital/Seoul National University College of Medicine, and 2Seoul National University Hospital, Republic of Korea Alcoholic liver disease (ALD) is the second leading indication for liver transplantation (LT) in the United States and Europe. In Korea, there has been a gradual increase in number of patients with ALD undergoing liver transplantation, but minimum of 6 month’s abstinence before transplantation is not strictly performed. Moreover, little is known following the post-transplant outcomes for ALD in Asian countries. The aim of this study is to assess the post-transplant outcome focusing on complication and mortality rate. The results were retrospectively reviewed from 1079 patients, who underwent LT from January 2007 to Dec 2014 at Seoul National University Hospital. Among these, 142 patients (13.2%) were ALD group. The proportion of ALD patients out of total LT patients in 2007 e 2014 were 7.4%, 8.9%, 11.5%, 9.6%, 14.9%, 13.3%, 17.5%, and 17.2%, respectively. Out of 142 ALD patients, 82 patients (57.7%) underwent living donor LT (LDLT) and 60 patients (42.3%) deceased donor LT (DDLT). The mortality rate of non-ALD group and ALD group were 14.6% and 12.0%. The mortality rate of ALD patients who underwent DDLT was 20.0%. Considering the shortage of deceased donor and relatively poor outcome of DDLT for ALD, more attention and strict criteria is needed for improving the survival of DDLT for ALD without causing a loss of opportunity for LT for other indications.
D. Toksanbayev, N. Sadykov, M. Duisebekov, M. Doskhanov and S. Kaniyev Hepatopancreatobiliary Surgery and Liver Transplantation, Syzganov’s National Scientific Center of Surgery, Kazakhstan Liver transplantation program in Kazakhstan started in December 2011. As of September 2015, there were 96 operations provided in the country in total. Despite of the numerous problem, liver transplantation program develops gradually. The leading cause of end-stage liver disease in operated patients was viral hepatitis: most of patients had hepatitis B, B with delta agent or C liver cirrhosis. About 3/ 4 of operations were done using living donors, as deceased donation system is weakly developed due to the lack of legislation system in this regard and mentality of population. In case of living donor liver transplantation, acceptance of person from potential recipient’s family as a living related donor of a fragment of liver was decided with confidence the procedure has minimal risks for the donor. Appropriate candidate for liver’s fragment donation was a relative elder than 18 and younger than 45 years, compatible with the recipient anthropomorphically, without liver and other organs diseases, blood type identical/compatible with the recipient. The selection of graft type have been basing of precise calculations of the alleged graft and volume remaining fragment of the liver from a donor, in each case. Deceased donor liver transplantation done as a result of multi-organ harvesting (heart, liver, kidneys), when the families of deceased donors gave consent for organs donation. Survival rate of recipients after liver transplant operations in Kazakhstan is 82.3% in present days, with zero mortality in living donors. Liver transplantation gives a chance to survive for many patients with end-stage liver disease in Kazakhstan.
EP05A-024 RACIAL DISPARITY IN LIVER TRANSPLANTATION IN AN INNER CITY POPULATION A. Smith1, A. Hauch2, E. Kandil1, M. Killackey1, A. Paramesch1, M. Moehlen3, L. Balart1 and J. Buell1 1 Surgery, Tulane University, 2Tulane University, and 3 Medicine, Tulane University, United States Introduction: Multiple studies have identified racial disparity in access to advanced surgical procedures as liver transplantation among African Americans (AA). Our University program has traditionally served the socioeconomically challenged patients of New Orleans. Methods: Retrospective analyses comparing racial presentation and outcomes of all adult liver transplant recipients ’07e’15. Statistical analysis was carried out with SAS software. Results: Of 223 recipients 65 were AA (29.1%) which was representative of the general racial makeup of Louisiana. AA were younger than Caucasians (CA) at transplant (55
HPB 2016, 18 (S1), e385ee601