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P.03.3 TRANSIENT ELASTOGRAPHY IN CELIAC PATIENTS: A NON INVASIVE METHOD TO DETECT LIVER INVOLVEMENT ASSOCIATED TO CELIAC DISEASE
S100
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
Conclusions: SIRT1 inhibition in HSC increases stress-related apoptosis and decreases cell activation in vitro and decreases the number of activated and proliferating HSC in the animal model of liver injury. The inhibition of SIRT1 could therefore prevent the fibrogenic alteration of the parenchyma during liver injury.
P.03.3 TRANSIENT ELASTOGRAPHY IN CELIAC PATIENTS: A NON INVASIVE METHOD TO DETECT LIVER INVOLVEMENT ASSOCIATED TO CELIAC DISEASE R.E. Rossi ∗ ,5 , S. Massironi 2 , M. Fraquelli 2 , M.T. Bardella 3 , L. Elli 3 , M. Maggioni 4 , C. Terrani 1 , M. Colombo 6 , D. Conte 5 1 Postgraduate School of Gastroenterology, Università degli Studi di Milano, Milan, Italy; 2 Gastroenterology Unit II, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 3 Center For Prevention and Diagnosis of Celiac Disease, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 4 U.O.C. Anatomia Patologica, A.O. San Paolo and Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 5 Postgraduate School of Gastroenterology, Università degli Studi di Milano; Gastroenterology Unit II, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 6 Postgraduate School of Gastroenterology, Università degli Studi di Milano; Gastroenterology Unit I, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Background and aim: The identification of liver involvement in celiac disease (CD) may have significant clinical implications, due to possible association with autoimmune liver disorders, which require specific treatment in addition to gluten free diet (GFD). Transient elastography (TE) is a non invasive tool for assessing liver stiffness (LS), a surrogate marker of liver fibrosis. Aim of the study was to prospectively identify celiac patients with liver involvement by TE and to assess response to GFD. Material and methods: From June 2010 to June 2011, 95 histologically confirmed CD patients were consecutively evaluated by TE and compared to 146 consecutive patients with chronic hepatitis C (HCV) and 54 healthy controls. Results: LS in healthy controls ranged between 2.8–6.7 kPa (median 4.9), defining 6.9 kPa as the upper reference limit (2 SD above the mean levels). TE values were above 6.9 kPa in 10 (10.5%) CD patients and in 87 (60%) HCV patients (p<0.01). Celiacs with hypertransaminasemia had higher median TE values than celiacs with persistently normal transaminases [6.1 kPa (range: 3.2–14.7) vs. 4.2 kPa (range: 2.5–8.8) (p<0.01)] and similar to HCV patients [7.8 kPa (range: 3.4–21.1) (p=NS)]. In CD patients, no significant correlation was found between transaminases and TE values. Among the 24 newly diagnosed CD, median TE values declined from 4.4 to 4 kPa, after six months of GFD. One CD patient with increased ALT, despite the GFD, showed a TE value higher than 12.5 kPa and underwent liver biopsy, showing a picture of autoimmune hepatitis. Conclusions: A minority of CD patients showed liver involvement by TE, which was confined to the subgroup of patients with hypertransaminasemia. In view of its predicting power for liver disease, TE stands as a first line approach for the identification of CD patients with liver complications, who are suitable for liver biopsy.
P.03.4 NEW PROGNOSTIC EVIDENCES FOR RELAPSE IN SUBJECTS WITH ALCOHOLIC PATHOLOGIES VALUED FOR LIVER TRANSPLANT M.L. Attilia, R. Tavoletti, P. Pizzelli, F. Attilia, C. Rotondo ∗ , M. Ceccanti Azienda Policlinico Umberto I, Roma, Italy Background and aim: The alcoholic cirrhosis is a consolidated index to the liver transplant (OLT) and in Europe and USA is taken into account respectively as the first and second indicator. Evidence shows that 95% of patients with alcoholic liver disease at ending stage has never been formally valued for liver transplant. A documented alcoholic abstinence of almost six
months is strictly necessary to be part of a waiting list. Research highlighted age, socio-economic stability and absence of consumption of other substances as positive prognosis factors for the maintaining of post-transplant abstinence. Our research goal is to identify new relevant predictive factors of relapse. Material and methods: Since 2004, 325 patients (278 men and 47 women) aged 23-68, affected by liver cirrhosis, have been observed to set alcoholism diagnosis according to DSM-IV criteria and to control and support abstinence in pre and post OLT. Data analysis was performed by using SPSSW 18. Results: 81.5% of patients showed alcoholic dependence diagnosis; 13.8% abuse; 2.1% polyabuse, and only 2.6% of patients had a moderate or absent drinking. 68% of patients presented positive familiarity for alcoholism. 15 is the average age of first contact with alcoholic beverages. 25-27 age period is considered a consumption risky one, with average consumption of 10 UA/die. Within the sample 53.8% were smokers. 29,5% of patients consumed illicit drugs in the past; among them 8.3% resulted positive to the toxicological exam. A major percentage of patients (79.3%) could count on a stable family support, crucial aspect for the compliance pre and post OLT. 48.6%.of patients suffered scholastic failures. Conclusions: Our study evidences a lower pre (11,4%) and post (15,4%) OLT relapse percentage than the one in literature; this is mainly driven by the identification of new predictive factors of relapse (positive familiarity for alcoholism, premature first contact, risk consumption years, scholastic failures) and by a strict monitoring carried out with specific rehabilitation interventions in a specialist alcohol service. Hence the importance of the figure of the alcoholism specialist in transplant team.
P.03.5 RECIPIENT SERUM TOTAL AND LDL CHOLESTEROL CONCENTRATION AT TRANSPLANT PREDICTS GRAFT SURVIVAL AFTER LIVER TRANSPLANTATION INDEPENDENTLY FROM MELD SCORE S. Ginanni Corradini 1 , M.T. Siciliano 1 , L. Parlati ∗ ,1 , A. Molinaro 1 , F. Ferri 1 , F. Maldarelli 1 , E. Poli 1 , A. Cantafora 1 , G. Mennini 2 , F. Melandro 2 , M. Merli 1 , A.F. Attili 1 , P.B. Berloco 2 , M. Rossi 2 1 Department 2 Chirurgia
of Clinical Medicine University Sapienza, Roma, Italy; Generale Paride Stefanini University Sapienza, Roma, Italy
Background and aim: The model for end-stage liver disease (MELD) score has been shown to be a good predictor of survival in non-transplanted cirrhotic patients, but not after liver transplantation (LT). Serum HDL, but not LDL cholesterol (CH), has been shown to predict survival in non-transplanted cirrhotic patients independently from the MELD score, while no data are available on its prognostic value in patients submitted to LT. Material and methods: We prospectively analyzed the prognostic value of pre-transplant recipient serum lipid concentrations and MELD score, measured on the day of surgery, in 139 noncholestatic cirrhotic patients submitted to whole organ, non-urgent, primary, deceased donor LT performed at our Institution from January 2004 to May 2011. Results: Before LT, MELD score negatively correlated with serum HDL, but not with LDL CH. Median follow-up was 30.67 months (range 0.03-100.50). At univariate analysis (Log-Rank), serum total (P=0.004) and LDL (P=0.001) CH quartile distribution before LT significantly predicted graft survival (quartile 1 worst and quartile 4 better survival), while no association of serum HDL CH, triglycerides and MELD score with graft survival was found. After adjustement for recipient gender, age, HCV status and MELD score, and donor gender, age, cause of death, HBcAb status, warm and cold ischemia time, serum total (HR 0.959; 0.929-0.989 95% CI; P=0.008) and LDL (HR 0.957; 0.922-0.994 95% CI; P=0.024) CH concentration before LT, as continuous variables, predicted 3 month graft survival. Pre-LT serum total (HR 0.982; 0.968-0.997 95% CI; P=0.017) and LDL (HR 0.979; 0.959-0.999 95% CI; P=0.039) CH concentration were also independently associated with time to graft loss at Cox regression analysis. Conclusions: Low pre-transplant recipient serum total and LDL, but not HDL CH concentration predict poor graft outcome after LT, independently from the MELD score.
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220
Conclusions: SIRT1 inhibition in HSC increases stress-related apoptosis and decreases cell activation in vitro and decreases the number of activated and proliferating HSC in the animal model of liver injury. The inhibition of SIRT1 could therefore prevent the fibrogenic alteration of the parenchyma during liver injury.
P.03.3 TRANSIENT ELASTOGRAPHY IN CELIAC PATIENTS: A NON INVASIVE METHOD TO DETECT LIVER INVOLVEMENT ASSOCIATED TO CELIAC DISEASE R.E. Rossi ∗ ,5 , S. Massironi 2 , M. Fraquelli 2 , M.T. Bardella 3 , L. Elli 3 , M. Maggioni 4 , C. Terrani 1 , M. Colombo 6 , D. Conte 5 1 Postgraduate School of Gastroenterology, Università degli Studi di Milano, Milan, Italy; 2 Gastroenterology Unit II, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 3 Center For Prevention and Diagnosis of Celiac Disease, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 4 U.O.C. Anatomia Patologica, A.O. San Paolo and Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 5 Postgraduate School of Gastroenterology, Università degli Studi di Milano; Gastroenterology Unit II, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 6 Postgraduate School of Gastroenterology, Università degli Studi di Milano; Gastroenterology Unit I, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Background and aim: The identification of liver involvement in celiac disease (CD) may have significant clinical implications, due to possible association with autoimmune liver disorders, which require specific treatment in addition to gluten free diet (GFD). Transient elastography (TE) is a non invasive tool for assessing liver stiffness (LS), a surrogate marker of liver fibrosis. Aim of the study was to prospectively identify celiac patients with liver involvement by TE and to assess response to GFD. Material and methods: From June 2010 to June 2011, 95 histologically confirmed CD patients were consecutively evaluated by TE and compared to 146 consecutive patients with chronic hepatitis C (HCV) and 54 healthy controls. Results: LS in healthy controls ranged between 2.8–6.7 kPa (median 4.9), defining 6.9 kPa as the upper reference limit (2 SD above the mean levels). TE values were above 6.9 kPa in 10 (10.5%) CD patients and in 87 (60%) HCV patients (p<0.01). Celiacs with hypertransaminasemia had higher median TE values than celiacs with persistently normal transaminases [6.1 kPa (range: 3.2–14.7) vs. 4.2 kPa (range: 2.5–8.8) (p<0.01)] and similar to HCV patients [7.8 kPa (range: 3.4–21.1) (p=NS)]. In CD patients, no significant correlation was found between transaminases and TE values. Among the 24 newly diagnosed CD, median TE values declined from 4.4 to 4 kPa, after six months of GFD. One CD patient with increased ALT, despite the GFD, showed a TE value higher than 12.5 kPa and underwent liver biopsy, showing a picture of autoimmune hepatitis. Conclusions: A minority of CD patients showed liver involvement by TE, which was confined to the subgroup of patients with hypertransaminasemia. In view of its predicting power for liver disease, TE stands as a first line approach for the identification of CD patients with liver complications, who are suitable for liver biopsy.
P.03.4 NEW PROGNOSTIC EVIDENCES FOR RELAPSE IN SUBJECTS WITH ALCOHOLIC PATHOLOGIES VALUED FOR LIVER TRANSPLANT M.L. Attilia, R. Tavoletti, P. Pizzelli, F. Attilia, C. Rotondo ∗ , M. Ceccanti Azienda Policlinico Umberto I, Roma, Italy Background and aim: The alcoholic cirrhosis is a consolidated index to the liver transplant (OLT) and in Europe and USA is taken into account respectively as the first and second indicator. Evidence shows that 95% of patients with alcoholic liver disease at ending stage has never been formally valued for liver transplant. A documented alcoholic abstinence of almost six
months is strictly necessary to be part of a waiting list. Research highlighted age, socio-economic stability and absence of consumption of other substances as positive prognosis factors for the maintaining of post-transplant abstinence. Our research goal is to identify new relevant predictive factors of relapse. Material and methods: Since 2004, 325 patients (278 men and 47 women) aged 23-68, affected by liver cirrhosis, have been observed to set alcoholism diagnosis according to DSM-IV criteria and to control and support abstinence in pre and post OLT. Data analysis was performed by using SPSSW 18. Results: 81.5% of patients showed alcoholic dependence diagnosis; 13.8% abuse; 2.1% polyabuse, and only 2.6% of patients had a moderate or absent drinking. 68% of patients presented positive familiarity for alcoholism. 15 is the average age of first contact with alcoholic beverages. 25-27 age period is considered a consumption risky one, with average consumption of 10 UA/die. Within the sample 53.8% were smokers. 29,5% of patients consumed illicit drugs in the past; among them 8.3% resulted positive to the toxicological exam. A major percentage of patients (79.3%) could count on a stable family support, crucial aspect for the compliance pre and post OLT. 48.6%.of patients suffered scholastic failures. Conclusions: Our study evidences a lower pre (11,4%) and post (15,4%) OLT relapse percentage than the one in literature; this is mainly driven by the identification of new predictive factors of relapse (positive familiarity for alcoholism, premature first contact, risk consumption years, scholastic failures) and by a strict monitoring carried out with specific rehabilitation interventions in a specialist alcohol service. Hence the importance of the figure of the alcoholism specialist in transplant team.
P.03.5 RECIPIENT SERUM TOTAL AND LDL CHOLESTEROL CONCENTRATION AT TRANSPLANT PREDICTS GRAFT SURVIVAL AFTER LIVER TRANSPLANTATION INDEPENDENTLY FROM MELD SCORE S. Ginanni Corradini 1 , M.T. Siciliano 1 , L. Parlati ∗ ,1 , A. Molinaro 1 , F. Ferri 1 , F. Maldarelli 1 , E. Poli 1 , A. Cantafora 1 , G. Mennini 2 , F. Melandro 2 , M. Merli 1 , A.F. Attili 1 , P.B. Berloco 2 , M. Rossi 2 1 Department 2 Chirurgia
of Clinical Medicine University Sapienza, Roma, Italy; Generale Paride Stefanini University Sapienza, Roma, Italy
Background and aim: The model for end-stage liver disease (MELD) score has been shown to be a good predictor of survival in non-transplanted cirrhotic patients, but not after liver transplantation (LT). Serum HDL, but not LDL cholesterol (CH), has been shown to predict survival in non-transplanted cirrhotic patients independently from the MELD score, while no data are available on its prognostic value in patients submitted to LT. Material and methods: We prospectively analyzed the prognostic value of pre-transplant recipient serum lipid concentrations and MELD score, measured on the day of surgery, in 139 noncholestatic cirrhotic patients submitted to whole organ, non-urgent, primary, deceased donor LT performed at our Institution from January 2004 to May 2011. Results: Before LT, MELD score negatively correlated with serum HDL, but not with LDL CH. Median follow-up was 30.67 months (range 0.03-100.50). At univariate analysis (Log-Rank), serum total (P=0.004) and LDL (P=0.001) CH quartile distribution before LT significantly predicted graft survival (quartile 1 worst and quartile 4 better survival), while no association of serum HDL CH, triglycerides and MELD score with graft survival was found. After adjustement for recipient gender, age, HCV status and MELD score, and donor gender, age, cause of death, HBcAb status, warm and cold ischemia time, serum total (HR 0.959; 0.929-0.989 95% CI; P=0.008) and LDL (HR 0.957; 0.922-0.994 95% CI; P=0.024) CH concentration before LT, as continuous variables, predicted 3 month graft survival. Pre-LT serum total (HR 0.982; 0.968-0.997 95% CI; P=0.017) and LDL (HR 0.979; 0.959-0.999 95% CI; P=0.039) CH concentration were also independently associated with time to graft loss at Cox regression analysis. Conclusions: Low pre-transplant recipient serum total and LDL, but not HDL CH concentration predict poor graft outcome after LT, independently from the MELD score.