- Email: [email protected]
P895 MODEL TO PREDICT RECURRENCE AFTER LIVING DONOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA BEYOND THE MILAN CRITERIA
POSTERS Methods: • Patients: Consecutive outpatient LT recipients between January and December 2012 • Reference group G0: – >2-fold increase in liver function tests (LFT) or unexplained fibrosis >7 kPa (Fibroscan® ) – Excluded: ischemic cholangiopathy, HBV, HVC, HVE post LT infections. • Control groups: – G1:primary LT, normal LFT – G2:primary LT, abnormal LFT – G3: HCV post-LT Patients were tested for donor specific antibodies (DSA) (Luminex SA), and the results expressed in MFI. Comparison of prevalence of DSA and MFI between G0 and control groups was made. Results: 91pts including 22 pts in G0 and 31, 19, 16 pts in G1, G2, G3 were investigated 9.6 yrs after LT. Fourteen (18.7%) pts had been re-transplanted. DSA were found in 95.5% in G0, anti class II in all cases, vs 50.9% in G1-G3 (p < 0.001). Prevalences of DSA in G1, G2 and G3 were 45.2, 52.6 and 68.8% (p = 0.003), respectively. In pts with DSA, median MFI was 9916 in G0 vs 3443 in G0-G3 (p = 0.02). Conclusions: Prevalence of DSA (95%) and MFI in G0 patients are significantly higher than in control groups. This highly suggests a role of AMR in long-term unexplained liver graft dysfunctions. In HCV positive pts, the prevalence of DSA was also found high and raises the issue of HCV as a contributor anti-HLA sensitization. P893 RADIOFREQUENCY ABLATION OF RECURRENT HEPATOCELLULAR CARCINOMA AFTER LIVER TRANSPLANTATION Q. Deng1 , H. Zou1 , K. Ma2 . 1 Third Military Medical University, 2 Hepatobiliary Surgery Department of Southwest Hospital, Third Military Medical University, Chongqing, China E-mail: [email protected] Background and Aims: Hepatocellular carcinoma (HCC) recurrence remains a major challenge in achieving long-term survival after orthotropic liver transplantation (OLT). In a retrospective study, we examined the outcomes of radiofrequency ablation (RFA) for the treatment of recurrent HCC after OLT. Methods: We analyzed 35 patients who underwent RFA for recurrent HCC after OLT between 1999 and 2011. Results: The mean follow-up time was 45.17 months (range: 8–117 months). Among the 35 patients followed, 67 ablations were performed on 63 hepatic nodules. Complete necrosis was achieved in 95.2% (60/63) of the nodules as indicated by contrastenhanced ultrasound performed two days after RFA. The overall and recurrence-free survival rates were 71.4% and 48.6%, respectively. The 1-, 2-, and 5-year cumulative survival rates after transplantation were 94.2, 88, and 74.2%, respectively. Tumor size, number, and alpha-fetoprotein (AFP) measurements before OLT or RFA were all significantly associated with increased risk of tumor recurrence within one year of RFA. No severe complications developed during follow-up in patients who received RFA therapy. Conclusions: RFA is an alternative modality for the treatment of recurrent HCC after OLT. Tumor size, number of tumors, and AFP before OLT or RFA can predict HCC recurrence after RFA.
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P894 PROPHYLAXIS OF DE NOVO HEPATITIS B VIRUS INFECTION WITH LAMIVUDINE IN HBsAg-NEGATIVE NAIVE RECIPIENTS OF HEPATITIS B CORE ANTIBODY-POSITIVE LIVERS: A 13-YEAR SINGLE-CENTER EXPERIENCE M. Prieto1 , A. Braithwaite2 , M. Garc´ıa-Eliz1 , V. Aguilera1 , S. Benlloch1 , M. Berenguer1 , A. Rub´ın1 , C. Vinaixa1 , V. Hontangas2 . 1 Hepatology Unit, CIBEREHD, 2 Hepatology Unit, Hospital Universitario y Polit´ecnico La Fe, Valencia, Spain E-mail: [email protected] Background and Aims: Lamivudine (LAM) is extensively used to prevent hepatitis B virus (HBV) infection in HBsAg-negative recipients of HBcAb+ livers. However, this practice is mainly derived from studies with short follow-up and limited number of naive recipients. The aim of this study was to assess the long-term efficacy of LAM in HBsAg-negative naive recipients of HBcAb+ livers. We aimed also to assess the relative contribution of LAM resistance when HBV infection occurs. Methods: The study population consisted of 52 HBsAgnegative naive recipients of HBcAb+ livers who underwent liver transplantation (LT) between 1/1/1999 and 31/12–2011 and received LAM to prevent HBV infection, defined as detection of HBsAg on at least two occasions. Results: After a median follow-up of 3.8 years (range: 0.1–11.6 yrs), 7 (13.5%) patients developed HBV infection at a median of 2 years (range: 1–6.5 yrs) after LT: in 3 cases after accidental LAM withdrawal and while on continued LAM therapy in 4 cases. The cumulated probability of HBV infection was 2%, 13%, 17%, and 23% at 1, 3, 5, and 10 years, respectively. LAM-specific mutations were present only in the 4 patients with HBV infection while on continued LAM therapy. HBcAb turned from negative to persistently positive after LT in four (11%) of the 45 patients who remained HBsAg-. Patient survival was 4%, 74%, and 55% at 1, 5, and 10 years, respectively, with no deaths due to hepatitis B. Conclusions: HBV infection either overt or cryptic is increasingly observed with prolonged follow-up in HBsAg-negative naive recipients of HBcAb+ grafts treated with lamivudine. P895 MODEL TO PREDICT RECURRENCE AFTER LIVING DONOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA BEYOND THE MILAN CRITERIA J.-H. Lee1 , Y. Cho1 , D.H. Lee1 , Y.B. Lee1 , S.J. Yu1 , N.-J. Yi2 , K.-W. Lee2 , S.H. Kim3 , Y.J. Kim1 , J.-H. Yoon1 , K.-S. Suh2 , H.-S. Lee1 . 1 Department of Internal Medicine and Liver Research Institute, 2 Department of Surgery, Seoul National University College of Medicine, Seoul, 3 Center for Liver Cancer, National Cancer Center, National Cancer Center, Goyang-Si, Korea, Republic of E-mail: [email protected] Background and Aims: Some subgroups of hepatocellular carcinoma (HCC) patients experience substantial benefit from living donor liver transplantation (LDLT) even if their tumor exceed the Milan criteria (MC). This study was designed to develop a model to predict tumor recurrence after LDLT (MoRAL) for HCC beyond the MC and to externally validate it. Methods: A total of consecutive 137 patients who had undergone LDLT beyond the MC were included from two large volume centers in Korea and the derivation (from Seoul National University Hospital; n=92) and the validation cohorts (from Korean National Cancer Center; n=45) were established. Results: In multivariate analysis, the independent pre-transplant risk factors for HCC recurrence were serum alpha-fetoprotein (AFP; odds ratio=1.003, P = 0.013) and serum PIVKA-II (odds ratio=1.001, P = 0.050) levels. Serum AFP level reflected maximal tumor size and PIVKA-II reflected tumor number and type (nodular or diffuse/infiltrative) (all P < 0.001). Using Cox proportional hazards
Journal of Hepatology 2014 vol. 60 | S361–S522
POSTERS model, MoRAL score [11·root(PIVKA-II) + 2·root(AFP)] was derived (median, 108.3; range 33.7–3928.3). According to MoRAL score, 2-yr cumulative recurrence rates of 1st (33.7–60.2), 2nd (61.7– 108.3), 3rd (109.6–314.8), and 4th quartile (314.8–3928.3) groups were 0%. 16.7%, 46.7%, and 70.7%, respectively (P < 0.001). The concordance (c)-statistic for the MoRAL (0.836) was superior to that for CLIP score (0.772), TNM stage (0.600), and JIS stage (0.601). The c-statistics of MoRAL was maintained at 0.778 in the validation cohort. Conclusions: A new model to predict tumor recurrence of HCC beyond the MC after LDLT based on serum AFP and PIVKA-II levels provides refined prognostication. P896 ABC-TRANSPORTER GENE POLYMORPHISMS PREDICT RISK FOR BILIARY COMPLICATIONS IN PATIENTS UNDERGOING LIVER TRANSPLANTATION S. Iacob1,2,3 , V.R. Cicinnati1,4 , I. Kabar1 , H.H.J. Schmidt1 , S. Beckebaum1,2 . 1 Department of Transplant Medicine, University Hospital M¨ unster, M¨ unster, 2 Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany; 3 Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania; 4 Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany E-mail: [email protected]
(A)
Background and Aims: Biliary tract complications (BC) such as anastomotic and non-anastomotic strictures contribute to morbidity after liver transplantation (LT). Bile salt toxicity is an established risk factor for BC development. Intestinal absorption and hepatic secretion of cholesterol is controlled by ATP-binding cassette (ABC) transporters. ABC transporter gene single nucleotide polymorphisms (SNPs) are associated with a higher risk of gallstone disease. The aim of our study was to create a model for prediction of BC after LT based on donor and recipient parameters. Methods: A training group of eighty two patients were investigated for gene polymorphisms of the ABC transporter family. Logistic regression was used for prediction of BC. Results: Overall graft survival was significantly lower in patients with BC (HR= 4.16, 95% CI: 2.02–8.57, p = 0.0001). Logistic regression analysis showed that donor BMI, recipient ABCG8-C1199A and multidrug resistance (MDR)1-C3435T gene polymorphisms remained independent predictors for BC (p < 0.05). A score that includes donor BMI and both ABCG8–1199CA/AA and MDR1– 3435CC/CT polymorphisms of the recipient, calculated as a sum of these 3 parameters, can accurately predict BC at a cutoff level of 1 point (sensitivity 81.2%, specificity 62%, positive likelihood ratio 2.14 and AUC of 0.76). Conclusions: Screening for ABCG8 and MDR1 gene polymorphisms in candidates on the waiting list may help to identify patients at increased risk of BC after LT. Our model for prediction of BC in LT recipients is currently investigated in a validation group.
(B)
Figure 1. Cumulative HCC recurrence rates. (A) In the derivation cohort, patients were divided into four groups at the 25th , 50th and 75th percentiles of the MoRAL score (P < 0.001). (B) In the validation cohort, patients were divided into three groups at the 25th and 75th percentiles of the MoRAL score (P < 0.001) .
P897 THE PREDICTORS OF TRANSPLANT FREE SURVIVAL IN FULMINANT AUTOIMMUNE ACUTE LIVER FAILURE: THE ACUTE LIVER FAILURE STUDY GROUP EXPERIENCE D. Ganger1 , R.T. Stravitz2 , K.R. Reddy3 , H. Battenhouse4 , J. Speiser4 , Z. Lominadze1 , W. Lee5 , Acute Liver Failure Study Group. 1 Northwestern University, Chicago, IL, 2 Virginia Commonwealth University, Richmond, VA, 3 University of Pennsylvania, Philadelphia, PA, 4 Medical University of South Carolina, Charleston, SC, 5 University of Texas Southwestern Medical Center, Dallas, TX, United States E-mail: [email protected] Background and Aims: Fulminant autoimmune liver failure has a variable course and often requires transplantation. The role of corticosteroids (CS) remains undefined. Our aim was to identify the
Journal of Hepatology 2014 vol. 60 | S361–S522
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P894 PROPHYLAXIS OF DE NOVO HEPATITIS B VIRUS INFECTION WITH LAMIVUDINE IN HBsAg-NEGATIVE NAIVE RECIPIENTS OF HEPATITIS B CORE ANTIBODY-POSITIVE LIVERS: A 13-YEAR SINGLE-CENTER EXPERIENCE M. Prieto1 , A. Braithwaite2 , M. Garc´ıa-Eliz1 , V. Aguilera1 , S. Benlloch1 , M. Berenguer1 , A. Rub´ın1 , C. Vinaixa1 , V. Hontangas2 . 1 Hepatology Unit, CIBEREHD, 2 Hepatology Unit, Hospital Universitario y Polit´ecnico La Fe, Valencia, Spain E-mail: [email protected] Background and Aims: Lamivudine (LAM) is extensively used to prevent hepatitis B virus (HBV) infection in HBsAg-negative recipients of HBcAb+ livers. However, this practice is mainly derived from studies with short follow-up and limited number of naive recipients. The aim of this study was to assess the long-term efficacy of LAM in HBsAg-negative naive recipients of HBcAb+ livers. We aimed also to assess the relative contribution of LAM resistance when HBV infection occurs. Methods: The study population consisted of 52 HBsAgnegative naive recipients of HBcAb+ livers who underwent liver transplantation (LT) between 1/1/1999 and 31/12–2011 and received LAM to prevent HBV infection, defined as detection of HBsAg on at least two occasions. Results: After a median follow-up of 3.8 years (range: 0.1–11.6 yrs), 7 (13.5%) patients developed HBV infection at a median of 2 years (range: 1–6.5 yrs) after LT: in 3 cases after accidental LAM withdrawal and while on continued LAM therapy in 4 cases. The cumulated probability of HBV infection was 2%, 13%, 17%, and 23% at 1, 3, 5, and 10 years, respectively. LAM-specific mutations were present only in the 4 patients with HBV infection while on continued LAM therapy. HBcAb turned from negative to persistently positive after LT in four (11%) of the 45 patients who remained HBsAg-. Patient survival was 4%, 74%, and 55% at 1, 5, and 10 years, respectively, with no deaths due to hepatitis B. Conclusions: HBV infection either overt or cryptic is increasingly observed with prolonged follow-up in HBsAg-negative naive recipients of HBcAb+ grafts treated with lamivudine. P895 MODEL TO PREDICT RECURRENCE AFTER LIVING DONOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA BEYOND THE MILAN CRITERIA J.-H. Lee1 , Y. Cho1 , D.H. Lee1 , Y.B. Lee1 , S.J. Yu1 , N.-J. Yi2 , K.-W. Lee2 , S.H. Kim3 , Y.J. Kim1 , J.-H. Yoon1 , K.-S. Suh2 , H.-S. Lee1 . 1 Department of Internal Medicine and Liver Research Institute, 2 Department of Surgery, Seoul National University College of Medicine, Seoul, 3 Center for Liver Cancer, National Cancer Center, National Cancer Center, Goyang-Si, Korea, Republic of E-mail: [email protected] Background and Aims: Some subgroups of hepatocellular carcinoma (HCC) patients experience substantial benefit from living donor liver transplantation (LDLT) even if their tumor exceed the Milan criteria (MC). This study was designed to develop a model to predict tumor recurrence after LDLT (MoRAL) for HCC beyond the MC and to externally validate it. Methods: A total of consecutive 137 patients who had undergone LDLT beyond the MC were included from two large volume centers in Korea and the derivation (from Seoul National University Hospital; n=92) and the validation cohorts (from Korean National Cancer Center; n=45) were established. Results: In multivariate analysis, the independent pre-transplant risk factors for HCC recurrence were serum alpha-fetoprotein (AFP; odds ratio=1.003, P = 0.013) and serum PIVKA-II (odds ratio=1.001, P = 0.050) levels. Serum AFP level reflected maximal tumor size and PIVKA-II reflected tumor number and type (nodular or diffuse/infiltrative) (all P < 0.001). Using Cox proportional hazards
Journal of Hepatology 2014 vol. 60 | S361–S522
POSTERS model, MoRAL score [11·root(PIVKA-II) + 2·root(AFP)] was derived (median, 108.3; range 33.7–3928.3). According to MoRAL score, 2-yr cumulative recurrence rates of 1st (33.7–60.2), 2nd (61.7– 108.3), 3rd (109.6–314.8), and 4th quartile (314.8–3928.3) groups were 0%. 16.7%, 46.7%, and 70.7%, respectively (P < 0.001). The concordance (c)-statistic for the MoRAL (0.836) was superior to that for CLIP score (0.772), TNM stage (0.600), and JIS stage (0.601). The c-statistics of MoRAL was maintained at 0.778 in the validation cohort. Conclusions: A new model to predict tumor recurrence of HCC beyond the MC after LDLT based on serum AFP and PIVKA-II levels provides refined prognostication. P896 ABC-TRANSPORTER GENE POLYMORPHISMS PREDICT RISK FOR BILIARY COMPLICATIONS IN PATIENTS UNDERGOING LIVER TRANSPLANTATION S. Iacob1,2,3 , V.R. Cicinnati1,4 , I. Kabar1 , H.H.J. Schmidt1 , S. Beckebaum1,2 . 1 Department of Transplant Medicine, University Hospital M¨ unster, M¨ unster, 2 Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany; 3 Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania; 4 Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany E-mail: [email protected]
(A)
Background and Aims: Biliary tract complications (BC) such as anastomotic and non-anastomotic strictures contribute to morbidity after liver transplantation (LT). Bile salt toxicity is an established risk factor for BC development. Intestinal absorption and hepatic secretion of cholesterol is controlled by ATP-binding cassette (ABC) transporters. ABC transporter gene single nucleotide polymorphisms (SNPs) are associated with a higher risk of gallstone disease. The aim of our study was to create a model for prediction of BC after LT based on donor and recipient parameters. Methods: A training group of eighty two patients were investigated for gene polymorphisms of the ABC transporter family. Logistic regression was used for prediction of BC. Results: Overall graft survival was significantly lower in patients with BC (HR= 4.16, 95% CI: 2.02–8.57, p = 0.0001). Logistic regression analysis showed that donor BMI, recipient ABCG8-C1199A and multidrug resistance (MDR)1-C3435T gene polymorphisms remained independent predictors for BC (p < 0.05). A score that includes donor BMI and both ABCG8–1199CA/AA and MDR1– 3435CC/CT polymorphisms of the recipient, calculated as a sum of these 3 parameters, can accurately predict BC at a cutoff level of 1 point (sensitivity 81.2%, specificity 62%, positive likelihood ratio 2.14 and AUC of 0.76). Conclusions: Screening for ABCG8 and MDR1 gene polymorphisms in candidates on the waiting list may help to identify patients at increased risk of BC after LT. Our model for prediction of BC in LT recipients is currently investigated in a validation group.
(B)
Figure 1. Cumulative HCC recurrence rates. (A) In the derivation cohort, patients were divided into four groups at the 25th , 50th and 75th percentiles of the MoRAL score (P < 0.001). (B) In the validation cohort, patients were divided into three groups at the 25th and 75th percentiles of the MoRAL score (P < 0.001) .
P897 THE PREDICTORS OF TRANSPLANT FREE SURVIVAL IN FULMINANT AUTOIMMUNE ACUTE LIVER FAILURE: THE ACUTE LIVER FAILURE STUDY GROUP EXPERIENCE D. Ganger1 , R.T. Stravitz2 , K.R. Reddy3 , H. Battenhouse4 , J. Speiser4 , Z. Lominadze1 , W. Lee5 , Acute Liver Failure Study Group. 1 Northwestern University, Chicago, IL, 2 Virginia Commonwealth University, Richmond, VA, 3 University of Pennsylvania, Philadelphia, PA, 4 Medical University of South Carolina, Charleston, SC, 5 University of Texas Southwestern Medical Center, Dallas, TX, United States E-mail: [email protected] Background and Aims: Fulminant autoimmune liver failure has a variable course and often requires transplantation. The role of corticosteroids (CS) remains undefined. Our aim was to identify the
Journal of Hepatology 2014 vol. 60 | S361–S522
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