- Email: [email protected]
RECIPIENT GENDER MISMATCH MODIFIES THE IMPACT OF DONOR AGE ON GRAFT SURVIVAL FOLLOWING LIVER TRANSPLANTATION
POSTERS Results: 27 patients underwent single-LTx .23/27 were ADPKD of which 3 underwent KTx more than 8 years before.31 patients (all ADPKD) underwent cLTKTx. Overall, at the moment of listing, hepatomegaly-related complaints were:abdominal distention (57%), abdominal pain (71%), early satiety (57%), dyspepsia (36%), and dyspnea (66%). In all patients listed for and/or at the moment of cLTKTx, CrCl was <40 ml/min/1.73m2 (<20 ml/min/1.73m2 :81%). 6/58 patients died 52 months post-Tx (min:2;max:142): malignancy (n = 2;) sepsis (n = 3);trauma (n = 1). Follow-up time of the remaining patients was 58months (min:9.6;max:191). 5/27 singleLTx patients developed biopsy-proven cellular rejection of liver vs nil in cLTKTx (p = 0.04). There were no kidney graft rejections.98% of the patients was complaint-free 1year post-Tx. There was no difference regarding the 1-and 5year CrCl between both groups.22% of single-LTx patients (ADPKD) needed a KTx 8years (SD:±3) later. The 10y patient/LTx graft survivals were 90% (single-LTx) and 87% (cLTKTx). Conclusions: The outcomes of single-LTx and cLTKTx in our PCLD cohort were excellent.cLTKTx protects against cellular rejection. In ADPKD patients with massive hepatomegaly and (pre)terminal renal failure, a CrCl <40 ml/min/1.73m2 is an acceptable cut-off for cLTKTx. P883 DEVELOPMENT AND VALIDATION OF A POLYCYSTIC LIVER DISEASE COMPLAINT SPECIFIC ASSESSMENT (POLCA) F. Temmerman1 , F. Dobbels2 , J. van Pelt1 , T. Ho3 , Y. Pirson3 , R. Vanslembrouck4 , W. Coudyzer4 , B. Bammens5 , J. Pirenne6 , F. Nevens1 . 1 Department and Laboratory of Hepatology, 2 Department of Public Health and Primary Care, University Hospitals KU Leuven, Leuven, 3 Department of Nephrology, Universit´e Catholique de Louvain, Brussels, 4 Department of Radiology, 5 Department of Nephrology, 6 Department of Abdominal Transplant Surgery, University Hospitals KU Leuven, Leuven, Belgium E-mail: [email protected]
pronounced liver enlargement (known-groups-validity) (table). Two subscales scores were significantly lower after 6 months of SA- treatment (responsiveness). LV reduction resulted in a more pronounced relative decrease of all scores. Conclusions: The POLCA is reliable, valid and sensitive to evaluate the presence and severity of hepatomegaly-related complaints of PCLD patients in contrast with the SF-36. This questionnaire can be embedded in research and clinical care, as it allows tracking the evolution of complaints; can guide treatment decisions; and facilitates the evaluation of treatment effects over time. P884 DONOR/RECIPIENT GENDER MISMATCH MODIFIES THE IMPACT OF DONOR AGE ON GRAFT SURVIVAL FOLLOWING LIVER TRANSPLANTATION D. Bitetto1 , S. Pecere1,2 , M. Gambato3 , A. Ferrarese3 , L. Pasulo1 , M.G. Luca` 1 , E. Poli4 , S. Ginanni Corradini4 , U. Baccarani5 , P. Burra3 , P. Toniutto5 , S. Fagiuoli1 . 1 Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, 2 Gastroenterology, A. Gemelli Hospital, Rome, 3 S.S.D. Multivisceral Transplantation, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, 4 Department of Clinical Medicine, Division of Gastroenterology, Sapienza University of Rome, Rome, 5 Liver Transplant Unit, University of Udine, Udine, Italy E-mail: [email protected] Background and Aims: The impact of donor age on graft survival is well known, while the role played by gender is less clear. The aim is to investigate possible interactions between donor age and gender.
Background and Aims: Polycystic liver disease (PCLD) patients may suffer from severe hepatomegaly. Therapeutic decisions, including the use of somatostatin-analogues (SA) and even liver transplantation (LTx), are guided by the patients’ perceived severity of complaints. We developed a self-report instrument to capture the presence and severity of PCLD-specific complaints. Methods: The study population consisted of 129 PCLD patients. At first, items were developed based on historical chart reviews of symptomatic patients (n = 68) and literature; and discussed during expert-consensus-meetings. 61 other patients needing treatment, were asked to complete the PCLD-Complaint-Specific-Assessment (POLCA) and the non-disease specific Short-Form-Health-Survey (SF-36) at baseline and after 6 months of SA-treatment. CT-scan was used to calculate liver volume (LV). Factor analysis was conducted to identify subscales and remove suboptimal items. Reliability was assessed by Cronbach’s alpha. Construct, criterion validity and responsiveness were tested using pre-specified hypotheses. Table: POLCA subscales in no-LTx and LTx groups
LV index a POLCA subscale I: severity of perceived illness II: gastro-esophagal related disease complaints III: Impact on food intake IV: Perception of enlarged liver volume
No LTx group (n = 47)
LTx group (n = 14)
P value
4 (1.5)
5 (1.7)
0.04
16.8 (6) 2 (0.25;4) 3.7 (2.5) 7 (5;9)
20.3 (4.3) 5 (2;7) 4.9 (3.2) 8 (8;11)
0.04 0.03 0.1 <0.01
a Liver index = (liver volume [mL] CT scan)/(706.2·BSA + 2.4).
Results: In the validation group, 47 received SA (no-LTx group) and 14 SA as bridge to LTx (LTx-group). Items’ list (n = 16) Cronbach’s alpha was 0.86. Factor analysis identified 4 subscales, which all significantly correlated with the Physical Component Summary (SF36) (construct validity). Total scores were significantly higher in patients listed for LTx which was in accordance to a more S368
Figure: Donor/recipient gender match and survival.*Log-rank test.
Journal of Hepatology 2014 vol. 60 | S361–S522
POSTERS Methods: From years 2000 to 2010, 1409 consecutive liver transplanted patients (1000 males, median age 54 years) recruited from 4 Italian Centers were enrolled in the study. The outcome was expressed as 3 years graft survival and analyzed by time to event analysis. Results: Five hundred and twenty three (36.5%) patients underwent liver transplantation for hepatitis C virus (HCV) related liver disease, 834 (59.2%) received a graft from a male donor (median donor age 53 years, range 5–89). Overall 3 years graft survival was 74.2%. Donor age >40 years was significantly associated to graft loss for male (Logrank test, p < 0.0001) but not for female donors (Logrank test, p = 0.56). Donor age ≤40, MELD score ≤18 and nonHCV etiology emerged as independent predictors of better graft survival for patients receiving a graft from a male but not for patients receiving a graft from a female donor. The same results were observed in HCV+ recipients. Donors were divided into 4 groups (figure) according to gender (F = female, M = male) and age (Y ≤40 years, O >40 years): grafts from younger female donors are associated to a better survival only when allocated to a female recipient. Conclusions: Donor age emerged as independent predictor of graft survival only with grafts from male donors while grafts from young female donors should be allocated only to a female recipient. P885 RECIPIENT AND DONOR GENDER MATCH PREDICTS THE OUTCOME OF ANTIVIRAL THERAPY FOR RECURRENT HEPATITIS C D. Bitetto1 , S. Pecere1,2 , L. Pasulo1 , L. Belli3 , R.M. Iemmolo4 , M.C. Morelli5 , F. Donato6 , P. Burra7 , M. Rendina8 , F.R. Ponziani2 , L. Miglioresi9 , D. Di Paolo10 , M. Merli11 , A. Gasbarrini2 , P. Toniutto12 , S. Fagiuoli1 . 1 Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, 2 Gastroenterology, A. Gemelli Hospital, Rome, 3 Gastroenterology, Niguarda Ca’ Granda Hospital, Milan, 4 University of Modena, Modena, 5 Sant’Orsola Malpighi Hospital, Bologna, 6 Gastroenterology, IRCCS Foundation Ca’ Granda Maggiore Hospital, Milan, 7 S.S.D. Multivisceral Transplantation, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, 8 Gastroenterology, University of Bari, Bari, 9 San Camillo Spallanzani Hospital, 10 University Tor Vergata, 11 Department of Clinical Medicine, Division of Gastroenterology, Sapienza University of Rome, Rome, 12 Liver Transplant Unit, University of Udine, Udine, Italy E-mail: [email protected] Background and Aims: The study aimed to evaluate whether donor and recipient gender match could influence the sustained virological response (SVR) rates following antiviral therapy with pegylated interferon (IFN) and ribavirin for recurrent hepatitis C (RHCV). Methods: The study included 397 (299 males, median age 55 years) hepatitis C virus (HCV) positive recipients (273 were G1, 61 G2, 37 G3, 17 G4), recruited in 12 Italian liver transplant centers. All of them have been treated for 48 weeks with interferon-a and ribavirin for RHCV. Median donor age was 49 years and 245 (61.7%) donors were males. Results: SVR was achieved in 139/397 (35.0%) patients. The strongest predictors of SVR at univariate analysis were: presence of early viral response (EVR), donor age, adherence ≥80% of IFN schedule, HCV genotypes 2/3 and both recipient and donor male gender. Patients were divided in four groups according to the donor (D) and recipient (R) gender match (M = male, F = female). A significant association between donor and recipient gendermatch and the overall SVR was observed: RF/DF 12/54 (22.2%) vs RF/DM 13/44 (29.5%) vs RM/DF 34/102 (33.3%) vs RM/DM 80/197 (40.6%) (p = 0.007). In HCV G1/4 infected patients SVR was observed in: 6/46 (13.0%) RF/DF vs 7/36 (19.4%) RF/DM
vs 20/79 (25.3%) RM/DF vs 39/138 (28.3%) RM/DM (p = 0.029). Stepwise logistic regression analysis confirmed recipient/donor gender mismatch as independent predictor of SVR (OR 0.739, 95% CI 0.5618–0.9731, p = 0.0312).
Figure 1. Gender match and SVR: (A) all HCV genotypes; (B) genotypes 1/4.
Conclusions: Donor and recipient female gender match has a negative impact on the achievement of SVR following antiviral therapy for RHCV. P886 RELEVANCE OF CHRONIC HEPATITIS E IN LIVER TRANSPLANT RECIPIENTS: A REAL-LIFE-SETTING 2 A. Galante1 , S. Pischke1 , M. Lang1 , M. Lutgehetmann ¨ , S. Polywka2 , B. Nashan3 , A.W. Lohse1 , M. Sterneck1 . 1 Department of Medicine I, 2 Department of Medical Microbiology, Virology and Hygiene, 3 Department of Hepatobiliary and Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany E-mail: [email protected] Background and Aims: Chronic courses of hepatitis E virus (HEV) infections in liver transplant recipients (LTR) were described previously, but prospectively collected data is rare. We aimed to study the role of chronic hepatitis E in LTR in a real-life-setting. Methods: Therefore 287 LTR (169 men (59%), age 18–78 years, median 56 years) were prospectively tested by HEV-PCR (LLoD= 10 IU/ml) irrespective of their level of liver enzymes. Results: In four patients (1.4%) chronic HEV-infection was diagnosed. All four were male, got cyclosporine-based immuno-
Journal of Hepatology 2014 vol. 60 | S361–S522
S369
pronounced liver enlargement (known-groups-validity) (table). Two subscales scores were significantly lower after 6 months of SA- treatment (responsiveness). LV reduction resulted in a more pronounced relative decrease of all scores. Conclusions: The POLCA is reliable, valid and sensitive to evaluate the presence and severity of hepatomegaly-related complaints of PCLD patients in contrast with the SF-36. This questionnaire can be embedded in research and clinical care, as it allows tracking the evolution of complaints; can guide treatment decisions; and facilitates the evaluation of treatment effects over time. P884 DONOR/RECIPIENT GENDER MISMATCH MODIFIES THE IMPACT OF DONOR AGE ON GRAFT SURVIVAL FOLLOWING LIVER TRANSPLANTATION D. Bitetto1 , S. Pecere1,2 , M. Gambato3 , A. Ferrarese3 , L. Pasulo1 , M.G. Luca` 1 , E. Poli4 , S. Ginanni Corradini4 , U. Baccarani5 , P. Burra3 , P. Toniutto5 , S. Fagiuoli1 . 1 Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, 2 Gastroenterology, A. Gemelli Hospital, Rome, 3 S.S.D. Multivisceral Transplantation, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, 4 Department of Clinical Medicine, Division of Gastroenterology, Sapienza University of Rome, Rome, 5 Liver Transplant Unit, University of Udine, Udine, Italy E-mail: [email protected] Background and Aims: The impact of donor age on graft survival is well known, while the role played by gender is less clear. The aim is to investigate possible interactions between donor age and gender.
Background and Aims: Polycystic liver disease (PCLD) patients may suffer from severe hepatomegaly. Therapeutic decisions, including the use of somatostatin-analogues (SA) and even liver transplantation (LTx), are guided by the patients’ perceived severity of complaints. We developed a self-report instrument to capture the presence and severity of PCLD-specific complaints. Methods: The study population consisted of 129 PCLD patients. At first, items were developed based on historical chart reviews of symptomatic patients (n = 68) and literature; and discussed during expert-consensus-meetings. 61 other patients needing treatment, were asked to complete the PCLD-Complaint-Specific-Assessment (POLCA) and the non-disease specific Short-Form-Health-Survey (SF-36) at baseline and after 6 months of SA-treatment. CT-scan was used to calculate liver volume (LV). Factor analysis was conducted to identify subscales and remove suboptimal items. Reliability was assessed by Cronbach’s alpha. Construct, criterion validity and responsiveness were tested using pre-specified hypotheses. Table: POLCA subscales in no-LTx and LTx groups
LV index a POLCA subscale I: severity of perceived illness II: gastro-esophagal related disease complaints III: Impact on food intake IV: Perception of enlarged liver volume
No LTx group (n = 47)
LTx group (n = 14)
P value
4 (1.5)
5 (1.7)
0.04
16.8 (6) 2 (0.25;4) 3.7 (2.5) 7 (5;9)
20.3 (4.3) 5 (2;7) 4.9 (3.2) 8 (8;11)
0.04 0.03 0.1 <0.01
a Liver index = (liver volume [mL] CT scan)/(706.2·BSA + 2.4).
Results: In the validation group, 47 received SA (no-LTx group) and 14 SA as bridge to LTx (LTx-group). Items’ list (n = 16) Cronbach’s alpha was 0.86. Factor analysis identified 4 subscales, which all significantly correlated with the Physical Component Summary (SF36) (construct validity). Total scores were significantly higher in patients listed for LTx which was in accordance to a more S368
Figure: Donor/recipient gender match and survival.*Log-rank test.
Journal of Hepatology 2014 vol. 60 | S361–S522
POSTERS Methods: From years 2000 to 2010, 1409 consecutive liver transplanted patients (1000 males, median age 54 years) recruited from 4 Italian Centers were enrolled in the study. The outcome was expressed as 3 years graft survival and analyzed by time to event analysis. Results: Five hundred and twenty three (36.5%) patients underwent liver transplantation for hepatitis C virus (HCV) related liver disease, 834 (59.2%) received a graft from a male donor (median donor age 53 years, range 5–89). Overall 3 years graft survival was 74.2%. Donor age >40 years was significantly associated to graft loss for male (Logrank test, p < 0.0001) but not for female donors (Logrank test, p = 0.56). Donor age ≤40, MELD score ≤18 and nonHCV etiology emerged as independent predictors of better graft survival for patients receiving a graft from a male but not for patients receiving a graft from a female donor. The same results were observed in HCV+ recipients. Donors were divided into 4 groups (figure) according to gender (F = female, M = male) and age (Y ≤40 years, O >40 years): grafts from younger female donors are associated to a better survival only when allocated to a female recipient. Conclusions: Donor age emerged as independent predictor of graft survival only with grafts from male donors while grafts from young female donors should be allocated only to a female recipient. P885 RECIPIENT AND DONOR GENDER MATCH PREDICTS THE OUTCOME OF ANTIVIRAL THERAPY FOR RECURRENT HEPATITIS C D. Bitetto1 , S. Pecere1,2 , L. Pasulo1 , L. Belli3 , R.M. Iemmolo4 , M.C. Morelli5 , F. Donato6 , P. Burra7 , M. Rendina8 , F.R. Ponziani2 , L. Miglioresi9 , D. Di Paolo10 , M. Merli11 , A. Gasbarrini2 , P. Toniutto12 , S. Fagiuoli1 . 1 Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, 2 Gastroenterology, A. Gemelli Hospital, Rome, 3 Gastroenterology, Niguarda Ca’ Granda Hospital, Milan, 4 University of Modena, Modena, 5 Sant’Orsola Malpighi Hospital, Bologna, 6 Gastroenterology, IRCCS Foundation Ca’ Granda Maggiore Hospital, Milan, 7 S.S.D. Multivisceral Transplantation, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, 8 Gastroenterology, University of Bari, Bari, 9 San Camillo Spallanzani Hospital, 10 University Tor Vergata, 11 Department of Clinical Medicine, Division of Gastroenterology, Sapienza University of Rome, Rome, 12 Liver Transplant Unit, University of Udine, Udine, Italy E-mail: [email protected] Background and Aims: The study aimed to evaluate whether donor and recipient gender match could influence the sustained virological response (SVR) rates following antiviral therapy with pegylated interferon (IFN) and ribavirin for recurrent hepatitis C (RHCV). Methods: The study included 397 (299 males, median age 55 years) hepatitis C virus (HCV) positive recipients (273 were G1, 61 G2, 37 G3, 17 G4), recruited in 12 Italian liver transplant centers. All of them have been treated for 48 weeks with interferon-a and ribavirin for RHCV. Median donor age was 49 years and 245 (61.7%) donors were males. Results: SVR was achieved in 139/397 (35.0%) patients. The strongest predictors of SVR at univariate analysis were: presence of early viral response (EVR), donor age, adherence ≥80% of IFN schedule, HCV genotypes 2/3 and both recipient and donor male gender. Patients were divided in four groups according to the donor (D) and recipient (R) gender match (M = male, F = female). A significant association between donor and recipient gendermatch and the overall SVR was observed: RF/DF 12/54 (22.2%) vs RF/DM 13/44 (29.5%) vs RM/DF 34/102 (33.3%) vs RM/DM 80/197 (40.6%) (p = 0.007). In HCV G1/4 infected patients SVR was observed in: 6/46 (13.0%) RF/DF vs 7/36 (19.4%) RF/DM
vs 20/79 (25.3%) RM/DF vs 39/138 (28.3%) RM/DM (p = 0.029). Stepwise logistic regression analysis confirmed recipient/donor gender mismatch as independent predictor of SVR (OR 0.739, 95% CI 0.5618–0.9731, p = 0.0312).
Figure 1. Gender match and SVR: (A) all HCV genotypes; (B) genotypes 1/4.
Conclusions: Donor and recipient female gender match has a negative impact on the achievement of SVR following antiviral therapy for RHCV. P886 RELEVANCE OF CHRONIC HEPATITIS E IN LIVER TRANSPLANT RECIPIENTS: A REAL-LIFE-SETTING 2 A. Galante1 , S. Pischke1 , M. Lang1 , M. Lutgehetmann ¨ , S. Polywka2 , B. Nashan3 , A.W. Lohse1 , M. Sterneck1 . 1 Department of Medicine I, 2 Department of Medical Microbiology, Virology and Hygiene, 3 Department of Hepatobiliary and Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany E-mail: [email protected] Background and Aims: Chronic courses of hepatitis E virus (HEV) infections in liver transplant recipients (LTR) were described previously, but prospectively collected data is rare. We aimed to study the role of chronic hepatitis E in LTR in a real-life-setting. Methods: Therefore 287 LTR (169 men (59%), age 18–78 years, median 56 years) were prospectively tested by HEV-PCR (LLoD= 10 IU/ml) irrespective of their level of liver enzymes. Results: In four patients (1.4%) chronic HEV-infection was diagnosed. All four were male, got cyclosporine-based immuno-
Journal of Hepatology 2014 vol. 60 | S361–S522
S369