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PA.186 FABRY DISEASE AND SMALL INTESTINAL BACTERIAL OVERGROWTH: PREVALENCE AND CORRELATION WITH GASTROINTESTINAL SYMPTOMS
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195 Further case-control studies with consistent number of pts and with LBT control after eradication are necessary to clarify the real impact of SIBO in IBS. # O. Gastrointestinal infections and intestinal microflora 2. Bacterial (excluding H. pylori)
PA.184 IN VITRO SENSITIVITY OF PROBIOTICS TO HUMAN PANCREATIC JUICE S. Carmagnola ∗ , G.P. Strozzi, M. Barba, S. Allesina, M. Ballarè, M. Pagliarulo, M. Orsello, F. Montino, E. Garello, M. Sartori, M. Del Piano Ospedale Maggiore della Carità, Novara Background and aim: The resistance of gut flora with probiotical activity to pancreatic juice is usually tested with artificial pancreatic fluid (Charteris WP, J Appl Microbiol 1998). Previous studies evaluated the sensitivity of diverse probiotics to human gastric and biliary secretion; none tested the resistance of probiotics to human pancreatic juice. Since most bacteria sensitive to artificial pancreatic fluid in vitro have a high rate of isolation from faeces the resistance to human pancreatic juice could be higher. The aim of this study was to compare the sensitivity of different strains of probiotics to artificial and human pancreatic juice. Material and methods: The viability of 8 strains of Lactobacillus and of 4 strains of Bifidobacterium was tested with standard artificial and human pancreatic juice withdrawn from 16 patients during ERCP procedure. The mortality rate (%) of various bacteria was measured after 5, 30 and 60 min contact time. The results were normalized for mortality rate induced by hypotonic condition and time exposure to 37°. Results: When incubated with artificial and human pancreatic juice the mortality rate of all strains of Lactobacillus at 5, 30 and 60 min was respectively 10.1 vs 7.6, 20.5 vs 19.7 and 28.6 vs 29.8. Whereas the mortality rate of all strains of Bifidobacterium was respectively 8.0 vs 9.2, 33.3 vs 28.9 and 42.2 vs 44.4. Conclusions: All the tested strains were sensitive to artificial and human pancreatic juice depending on time contact. Bifidobacterium strains seem to be more sensitive than Lactobacillus strains in particular at higher time contact. There is no significant differences between sensitivity to simulated and human pancreatic juice. For this reason probiotics activity may be tested with artificial pancreatic fluid using a standardized easier and less costly procedure. # O. Gastrointestinal infections and intestinal microflora 3. Probiotics
PA.185 EFFICACY OF LACTOBACILLUS PARACASEI F19 IN THE TREATMENT OF SYMPTOMATIC UNCOMPLICATED DIVERTICULAR DISEASE (SUDD) OF THE COLON R. Cuomo 1 , G. Maconi 2 , F. Di Giorgi ∗ ,1 , G. Sarnelli 1 , E. Lahner 3 , B. Annibale 3 1 Università 3 Università
Federico II, Napoli; 2 Università di Milano, Milano; La Sapienza, Roma
Background and aim: Diverticular disease represents the first most important gastrointestinal disease in Western countries. The vast majority of patients experience symptomatic uncomplicated diverticular disease (SUDD), whose most frequent abdominal symptoms are pain and bloating. No specific standard treatment for SUDD is accepted, guidelines of the Am College Gastroent suggest a high–fibre diet in SUDD pts. A possible role of gut microflora in determining symptoms related to SUDD is
S143
suggested, thus these pts may benefit from probiotics treatment. Aim: to assess the efficacy of Lactobacillus paracasei F19 in SUDD pts Material and methods: Multicentric randomized controlled study on 50SUDD pts, aged 47-78 years (18 M, 32 F) diagnosed by double contrast enema and biochemistry to exclude acute inflammation. SUDD was defined as: presence of abdominal symptoms (pain <24h and bloating) for at least 6 months before enrollment. All pts had a validated detailed questionnaire for abdominal symptoms and functional dyspepsia (FD) including a visual analogic scale (VAS). Exclusion criteria: complicated diverticular disease, previous colon surgery, antibiotics or laxatives 30 days before enrollment, use of NSAIDs. In all pts a daily intake of 30 g dietary fibre was recommended. Pts were randomly assigned to receive: 1 sachet b.i.d of L. paracasei F19 for 14 days/month for 6 months (Group A, n=16), only fibre diet (Group B, n=16) or 1 sachet once daily of L. paracasei F19 for 14 days/month for 6 months (Group C, n=18). Endpoint of the study was to evaluate the decrease of abdominal pain and bloating after 6 months of treatment. Results expressed as mean±SD. Results: At baseline, 40 pts had both abdominal pain and bloating, whereas 10 pts had only bloating. 43 (86%) patients completed the study: 1 patient (Group A) was withdrawn for diarrhea and 6 patients (2 from Group A, 1 from Group B, 3 from Group C) were lost at follow-up. A significant decrease of bloating VAS was observed in group A and C whereas of pain VAS in group C. Conclusions: Six-months treatment with L. paracasei F19 significantly decreases the score of abdominal bloating in patients with SUDD. The higher dosage of probiotics is able to also reduce the score of abdominal pain. Thus, treatment with L. paracasei F19 is more efficacious than dietary fibres in controlling abdominal symptoms in SUDD patients. # O. Gastrointestinal infections and intestinal microflora 3. Probiotics
PA.186 FABRY DISEASE AND SMALL INTESTINAL BACTERIAL OVERGROWTH: PREVALENCE AND CORRELATION WITH GASTROINTESTINAL SYMPTOMS F. Franceschi ∗ , G. Gigante ∗ , D. Roccarina, G. Vitale, M.E. Ainora, V. Cesario, E.C. Lauritano, A. Zampetti, D. Antuzzi, G. De Marco, B. Giupponi, C. Feliciani, N. Gentiloni Silveri, G. Gasbarrini, A. Gasbarrini Policlinico Gemelli, Roma Background and aim: Microangiopathic and neuropathic alterations in Anderson Fabry’s disease are caused by an X-linked inborn error of glycosphingolipid catabolism due to a deficient activity of a-galactosidase A. As a result, undegraded glycosphingolipids, especially globotriaosylceramide Gb3, accumulate mainly in the vascular endothelium and peripheral nervous system. Deposits of Gb3 in intramural colon vessels and in the autonomic gastrointestinal (GI) nervous system causes motility dysfunction. Small intestine bacterial overgrowth (SIBO) is a clinical condition caused by an increased level of microorganisms exceeding the presence of more than 106 colony forming units/ml intestinal aspirate or colonic-type bacteria within the small intestine. Interestingly, motility disfunction is classified among possible causes of SIBO. Based on these observations, we designed a study aimed at verifying either the prevalence of SIBO in patients with Fabry’ disease or its role in the occurrence of some GI symptoms (abdominal discomfort, flatulence, and bloating) in these patients. Material and methods: 10 patients with Fabry’ disease (7 male and 3 female, mean age 35±5) were enrolled. The control population consisted of 10 healthy sex and age matched subjects. All patients and controls underwent lactulose breath test (LBT) to detect SIBO. Moreover, all subjects completed a validated questionnaire in order to grade the occurrence of the above mentioned GI symptoms. Differences
S144
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
between groups were assessed by the x2 Yates test. A p value <0.05 was considered to be statistically significant. Results: A total of 5 of 10 patients resulted to be positive to lactulose BT (50%) compared to only 1 of 10 control subjects (10%) (p<0.005). At the same time, all Fabry’s patients presented a delayed intestinal transit. Prevalence of GI symptoms, such as abdominal discomfort, bloating and flatulence, was significantly increased in SIBO-positive patients compared to negative (p<0.001). Conclusions: The occurrence of GI symptoms in patients with Fabry’ disease is not only due to an impairment of the peripheral GI nervous system seen in those patients, but also to the occurrence of SIBO, as a consequence of a delayed intestinal transit. Further studies are now needed in order to verify the effect of decontaminating therapy on GI symptoms in patients with Fabry’ disease. # O. Gastrointestinal infections and intestinal microflora 4. Others
PA.187 SEQUENTIAL CHANGES IN NUTRITIONAL STATUS, ENERGY EXPENDITURE, DIETARY INTAKE DURING THE FIRST SIX MONTHS AFTER LIVER TRANSPLANTATION M. Giusto ∗ , F. Gentili, I. Loria, O. Riggio, M. Rossi, G. Novelli, G. Mennini, S. Ginanni Corradini, M. Merli Centro Trapianti Policlinico Umberto I “La Sapienza”, Roma Background and aim: Nutritional impairment is frequent in patients with end stage liver disease. The pathogenesis of malnutrition in chronic liver diseases is multifactorial. Liver transplantation (LT) may revert many metabolic abnormalities causing an improvement in nutritional status. Detailed quantification of the nutritional and metabolic changes that occur after LT has not been performed. The present study was aimed at investigating the changes in nutritional status, energy expenditure and dietary intake during the first six months after LT. Material and methods: Patients undergoing elective LT at the University of Rome “La Sapienza” from March 2006 were included when a complete nutritional assessment before and after LT was available and when follow up was > 6 months. Before LT patients were classified according to the Subjective Global Assessment (SGA): no malnutrition = SGA0, malnutrition = SGA1-2. Nutritional assessment was performed in each patient before, 90 and 180 days after LT. The following parameters were considered: Anthropometry: body weight (kg), Arm Muscle Circumference (AMC) calculated from Arm Circumference (AC) and Triceps Skinfold (TSF) [(AC- TSF)/p]. Basal Energy Expenditure (BEE) was measured using indirect calorimetry (Deltatrac Metabolic Monitor; Datex Instruments, Helsinki). Dietary history interview was used to evaluate 24 hr Total Energy Intake (TEI) and daily protein intake (g/kg). Physical activity interview was used to evaluate the 24 hr energy expended for physical activity and to calculate the Total Energy Expenditure (TEE) by multiplying BEE for an activity factor obtained in a reference Italian population. Total Energy Balance (TEB) was calculated as: (TEE –TEI). Statistical Analysis: the differences before and after LT were analyzed by using the Student’s t test for paired data. Results: Sixteen patients (12M, 4F, age 54±10 years, MELD 19.7±4;
7 no malnutrition and 9 malnourished before LT) completed the study. The main modifications of nutritional parameters at 90 and 180 days after LT are reported in Table 1. Conclusions: These data suggest that 90 days after LT total calories and protein intake significantly increased in all patients but nutritional status is still unchanged or even deteriorated. At 180 days patients malnourished before LT show a significant improvement in nutritional status. # P. Organ transplantation 1. Liver
PA.188 LIVER TRANSPLANTATION FOR CHOLESTATIC LIVER DISEASES: A SINGLE CENTER EXPERIENCE M. Di Girolamo ∗ ,1 , F. Lodato 1 , D. Fortuna 2 , M.R. Tamè 1 , F. Azzaroli 1 , P. Cecinato 1 , V. Feletti 1 , A. Colecchia 1 , E. Roda 1 , A.D. Pinna 1 , G. Mazzella 1 1 University
of Bologna, Bologna; 2 Igene Regional Service, Bologna
Background and aim: PBC and PSC are indications for liver transplantation (LT). Aim of this retrospective study is to review all cases of PBC and PSC transplanted in Bologna Liver Transplantation Centre (BLTC) between 1986 and 2006 in terms of: indication for LT, post-LT outcome, relationship between disease severity and survival, recurrence between the first decade of LT (D1) and the second (D2). Material and methods: 42 pts with PBC (19D1:23D2,6M:36F) and 25 with PSC (9D1:16D2,15M:10F) out of a total of 1091 received LT in BLTC and were followed-up for a median of 120 months. All data were collected prospectively. Biopsies for histological diagnosis of rejection [acute (AR) and chronic (CR), Banff criteria] and recurrence (Ludwig classification) were performed every time any clinical or biochemical signs of liver dysfunction occurred. All data were analyzed with MedCalc and SAS package. Results: Pts with PBC are significantly older compared to PSC. Mayo Risk Score (MRS) at enrolment and at LT is significantly higher in PSC. Rate of UDCA treatment post-LT were 62% for PBC and 56% for PSC pts with higher doses in PSC (P= 0.042). Recurrence was observed in 21.4% of PBC and 40% of PSC at 120 months post-LT. One patient for each group had a re-LT because of recurrence. 54.7% and 20% of PBC and PSC had AR (P=0,03).In PBC pts, rejection was more frequent (35.7% vs 16% for one episode, 16% vs 4% for 2 events and 2% vs none for more than 2; P= 0,015) and severe (2 vs 1; P=0,04). 19% and 40% of PBC and PSC had CR (P= 0,005). Previous AR episodes were significantly associated with CR (P=0. 005). The median survival for PBC and PSC pts is 93 and 72 months with a survival rate of 75.5% and 63.6%, respectively. At bivariate analysis, statistically significant predictive factors of worse outcome are MRS at LT is related with worse outcome (P=0. 046) and with early death (P=0,02) in PBC pts. At multivariate analysis, PSC, MRS at enrolment and at LT, D2, Child-Pugh-Turcotte (CTP) at enrolment, displasia, ANA pre-LT, days in ICU, AMA post-LT, recurrence. Conclusions: AR is more frequent and severe in PBC and CR in PSC. Early death is more frequent in PBC and is related to MRS at LT. A worse outcome is related to PSC, MRS at enrolment and at LT, D2,
Abstract PA.187 – Table 1. Changes in nutritional status and energy expenditure in 16 patients after LT No malnutrition (7) Weight kg TSF mm AMC cm Protein intake g/kg/day TEI kcal/kg/day TEE kcal/kg/day TEB kcal/day
Malnutrition (9)
Before LT
90 days
180 days
Before LT
90 days
180 days
78,6±11,1 13,4±5,9 25,7±3,2 0,99±0,8 25,4±7,6 30,4±4,2 -317,6±259,6
74,1±8,4* 12,9±14,0 24,4±2,3 1,3±0,4* 27,6±3,8* 29,9±4,1 -187,0±493,6*
73,8±7,5* 13,1±9,7 24,6 ±1,5 1,1±0,6* 26,8±4,6* 31,4±2,7 -448,0±598,1*
70,6±7,1 9,7±4,6 22,9±3,5 0,9±0,6 22,9±5,3 31,9±7,6 -638,5±299,9
60,9±5,1* 10,8±2,7 21,8±1,8 1,4±0,4* 32,9±6,5* 32,1±3,3 +54,3±452,9*
65,3±6,5*† 16,3±4,7*† 23,7±2,9† 1,4±0,4* 32,9±4,1* 31,5±4,9 +80,1±548,2*
P<0.05 *vs before LT, †vs 90 days after.
PA.184 IN VITRO SENSITIVITY OF PROBIOTICS TO HUMAN PANCREATIC JUICE S. Carmagnola ∗ , G.P. Strozzi, M. Barba, S. Allesina, M. Ballarè, M. Pagliarulo, M. Orsello, F. Montino, E. Garello, M. Sartori, M. Del Piano Ospedale Maggiore della Carità, Novara Background and aim: The resistance of gut flora with probiotical activity to pancreatic juice is usually tested with artificial pancreatic fluid (Charteris WP, J Appl Microbiol 1998). Previous studies evaluated the sensitivity of diverse probiotics to human gastric and biliary secretion; none tested the resistance of probiotics to human pancreatic juice. Since most bacteria sensitive to artificial pancreatic fluid in vitro have a high rate of isolation from faeces the resistance to human pancreatic juice could be higher. The aim of this study was to compare the sensitivity of different strains of probiotics to artificial and human pancreatic juice. Material and methods: The viability of 8 strains of Lactobacillus and of 4 strains of Bifidobacterium was tested with standard artificial and human pancreatic juice withdrawn from 16 patients during ERCP procedure. The mortality rate (%) of various bacteria was measured after 5, 30 and 60 min contact time. The results were normalized for mortality rate induced by hypotonic condition and time exposure to 37°. Results: When incubated with artificial and human pancreatic juice the mortality rate of all strains of Lactobacillus at 5, 30 and 60 min was respectively 10.1 vs 7.6, 20.5 vs 19.7 and 28.6 vs 29.8. Whereas the mortality rate of all strains of Bifidobacterium was respectively 8.0 vs 9.2, 33.3 vs 28.9 and 42.2 vs 44.4. Conclusions: All the tested strains were sensitive to artificial and human pancreatic juice depending on time contact. Bifidobacterium strains seem to be more sensitive than Lactobacillus strains in particular at higher time contact. There is no significant differences between sensitivity to simulated and human pancreatic juice. For this reason probiotics activity may be tested with artificial pancreatic fluid using a standardized easier and less costly procedure. # O. Gastrointestinal infections and intestinal microflora 3. Probiotics
PA.185 EFFICACY OF LACTOBACILLUS PARACASEI F19 IN THE TREATMENT OF SYMPTOMATIC UNCOMPLICATED DIVERTICULAR DISEASE (SUDD) OF THE COLON R. Cuomo 1 , G. Maconi 2 , F. Di Giorgi ∗ ,1 , G. Sarnelli 1 , E. Lahner 3 , B. Annibale 3 1 Università 3 Università
Federico II, Napoli; 2 Università di Milano, Milano; La Sapienza, Roma
Background and aim: Diverticular disease represents the first most important gastrointestinal disease in Western countries. The vast majority of patients experience symptomatic uncomplicated diverticular disease (SUDD), whose most frequent abdominal symptoms are pain and bloating. No specific standard treatment for SUDD is accepted, guidelines of the Am College Gastroent suggest a high–fibre diet in SUDD pts. A possible role of gut microflora in determining symptoms related to SUDD is
S143
suggested, thus these pts may benefit from probiotics treatment. Aim: to assess the efficacy of Lactobacillus paracasei F19 in SUDD pts Material and methods: Multicentric randomized controlled study on 50SUDD pts, aged 47-78 years (18 M, 32 F) diagnosed by double contrast enema and biochemistry to exclude acute inflammation. SUDD was defined as: presence of abdominal symptoms (pain <24h and bloating) for at least 6 months before enrollment. All pts had a validated detailed questionnaire for abdominal symptoms and functional dyspepsia (FD) including a visual analogic scale (VAS). Exclusion criteria: complicated diverticular disease, previous colon surgery, antibiotics or laxatives 30 days before enrollment, use of NSAIDs. In all pts a daily intake of 30 g dietary fibre was recommended. Pts were randomly assigned to receive: 1 sachet b.i.d of L. paracasei F19 for 14 days/month for 6 months (Group A, n=16), only fibre diet (Group B, n=16) or 1 sachet once daily of L. paracasei F19 for 14 days/month for 6 months (Group C, n=18). Endpoint of the study was to evaluate the decrease of abdominal pain and bloating after 6 months of treatment. Results expressed as mean±SD. Results: At baseline, 40 pts had both abdominal pain and bloating, whereas 10 pts had only bloating. 43 (86%) patients completed the study: 1 patient (Group A) was withdrawn for diarrhea and 6 patients (2 from Group A, 1 from Group B, 3 from Group C) were lost at follow-up. A significant decrease of bloating VAS was observed in group A and C whereas of pain VAS in group C. Conclusions: Six-months treatment with L. paracasei F19 significantly decreases the score of abdominal bloating in patients with SUDD. The higher dosage of probiotics is able to also reduce the score of abdominal pain. Thus, treatment with L. paracasei F19 is more efficacious than dietary fibres in controlling abdominal symptoms in SUDD patients. # O. Gastrointestinal infections and intestinal microflora 3. Probiotics
PA.186 FABRY DISEASE AND SMALL INTESTINAL BACTERIAL OVERGROWTH: PREVALENCE AND CORRELATION WITH GASTROINTESTINAL SYMPTOMS F. Franceschi ∗ , G. Gigante ∗ , D. Roccarina, G. Vitale, M.E. Ainora, V. Cesario, E.C. Lauritano, A. Zampetti, D. Antuzzi, G. De Marco, B. Giupponi, C. Feliciani, N. Gentiloni Silveri, G. Gasbarrini, A. Gasbarrini Policlinico Gemelli, Roma Background and aim: Microangiopathic and neuropathic alterations in Anderson Fabry’s disease are caused by an X-linked inborn error of glycosphingolipid catabolism due to a deficient activity of a-galactosidase A. As a result, undegraded glycosphingolipids, especially globotriaosylceramide Gb3, accumulate mainly in the vascular endothelium and peripheral nervous system. Deposits of Gb3 in intramural colon vessels and in the autonomic gastrointestinal (GI) nervous system causes motility dysfunction. Small intestine bacterial overgrowth (SIBO) is a clinical condition caused by an increased level of microorganisms exceeding the presence of more than 106 colony forming units/ml intestinal aspirate or colonic-type bacteria within the small intestine. Interestingly, motility disfunction is classified among possible causes of SIBO. Based on these observations, we designed a study aimed at verifying either the prevalence of SIBO in patients with Fabry’ disease or its role in the occurrence of some GI symptoms (abdominal discomfort, flatulence, and bloating) in these patients. Material and methods: 10 patients with Fabry’ disease (7 male and 3 female, mean age 35±5) were enrolled. The control population consisted of 10 healthy sex and age matched subjects. All patients and controls underwent lactulose breath test (LBT) to detect SIBO. Moreover, all subjects completed a validated questionnaire in order to grade the occurrence of the above mentioned GI symptoms. Differences
S144
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
between groups were assessed by the x2 Yates test. A p value <0.05 was considered to be statistically significant. Results: A total of 5 of 10 patients resulted to be positive to lactulose BT (50%) compared to only 1 of 10 control subjects (10%) (p<0.005). At the same time, all Fabry’s patients presented a delayed intestinal transit. Prevalence of GI symptoms, such as abdominal discomfort, bloating and flatulence, was significantly increased in SIBO-positive patients compared to negative (p<0.001). Conclusions: The occurrence of GI symptoms in patients with Fabry’ disease is not only due to an impairment of the peripheral GI nervous system seen in those patients, but also to the occurrence of SIBO, as a consequence of a delayed intestinal transit. Further studies are now needed in order to verify the effect of decontaminating therapy on GI symptoms in patients with Fabry’ disease. # O. Gastrointestinal infections and intestinal microflora 4. Others
PA.187 SEQUENTIAL CHANGES IN NUTRITIONAL STATUS, ENERGY EXPENDITURE, DIETARY INTAKE DURING THE FIRST SIX MONTHS AFTER LIVER TRANSPLANTATION M. Giusto ∗ , F. Gentili, I. Loria, O. Riggio, M. Rossi, G. Novelli, G. Mennini, S. Ginanni Corradini, M. Merli Centro Trapianti Policlinico Umberto I “La Sapienza”, Roma Background and aim: Nutritional impairment is frequent in patients with end stage liver disease. The pathogenesis of malnutrition in chronic liver diseases is multifactorial. Liver transplantation (LT) may revert many metabolic abnormalities causing an improvement in nutritional status. Detailed quantification of the nutritional and metabolic changes that occur after LT has not been performed. The present study was aimed at investigating the changes in nutritional status, energy expenditure and dietary intake during the first six months after LT. Material and methods: Patients undergoing elective LT at the University of Rome “La Sapienza” from March 2006 were included when a complete nutritional assessment before and after LT was available and when follow up was > 6 months. Before LT patients were classified according to the Subjective Global Assessment (SGA): no malnutrition = SGA0, malnutrition = SGA1-2. Nutritional assessment was performed in each patient before, 90 and 180 days after LT. The following parameters were considered: Anthropometry: body weight (kg), Arm Muscle Circumference (AMC) calculated from Arm Circumference (AC) and Triceps Skinfold (TSF) [(AC- TSF)/p]. Basal Energy Expenditure (BEE) was measured using indirect calorimetry (Deltatrac Metabolic Monitor; Datex Instruments, Helsinki). Dietary history interview was used to evaluate 24 hr Total Energy Intake (TEI) and daily protein intake (g/kg). Physical activity interview was used to evaluate the 24 hr energy expended for physical activity and to calculate the Total Energy Expenditure (TEE) by multiplying BEE for an activity factor obtained in a reference Italian population. Total Energy Balance (TEB) was calculated as: (TEE –TEI). Statistical Analysis: the differences before and after LT were analyzed by using the Student’s t test for paired data. Results: Sixteen patients (12M, 4F, age 54±10 years, MELD 19.7±4;
7 no malnutrition and 9 malnourished before LT) completed the study. The main modifications of nutritional parameters at 90 and 180 days after LT are reported in Table 1. Conclusions: These data suggest that 90 days after LT total calories and protein intake significantly increased in all patients but nutritional status is still unchanged or even deteriorated. At 180 days patients malnourished before LT show a significant improvement in nutritional status. # P. Organ transplantation 1. Liver
PA.188 LIVER TRANSPLANTATION FOR CHOLESTATIC LIVER DISEASES: A SINGLE CENTER EXPERIENCE M. Di Girolamo ∗ ,1 , F. Lodato 1 , D. Fortuna 2 , M.R. Tamè 1 , F. Azzaroli 1 , P. Cecinato 1 , V. Feletti 1 , A. Colecchia 1 , E. Roda 1 , A.D. Pinna 1 , G. Mazzella 1 1 University
of Bologna, Bologna; 2 Igene Regional Service, Bologna
Background and aim: PBC and PSC are indications for liver transplantation (LT). Aim of this retrospective study is to review all cases of PBC and PSC transplanted in Bologna Liver Transplantation Centre (BLTC) between 1986 and 2006 in terms of: indication for LT, post-LT outcome, relationship between disease severity and survival, recurrence between the first decade of LT (D1) and the second (D2). Material and methods: 42 pts with PBC (19D1:23D2,6M:36F) and 25 with PSC (9D1:16D2,15M:10F) out of a total of 1091 received LT in BLTC and were followed-up for a median of 120 months. All data were collected prospectively. Biopsies for histological diagnosis of rejection [acute (AR) and chronic (CR), Banff criteria] and recurrence (Ludwig classification) were performed every time any clinical or biochemical signs of liver dysfunction occurred. All data were analyzed with MedCalc and SAS package. Results: Pts with PBC are significantly older compared to PSC. Mayo Risk Score (MRS) at enrolment and at LT is significantly higher in PSC. Rate of UDCA treatment post-LT were 62% for PBC and 56% for PSC pts with higher doses in PSC (P= 0.042). Recurrence was observed in 21.4% of PBC and 40% of PSC at 120 months post-LT. One patient for each group had a re-LT because of recurrence. 54.7% and 20% of PBC and PSC had AR (P=0,03).In PBC pts, rejection was more frequent (35.7% vs 16% for one episode, 16% vs 4% for 2 events and 2% vs none for more than 2; P= 0,015) and severe (2 vs 1; P=0,04). 19% and 40% of PBC and PSC had CR (P= 0,005). Previous AR episodes were significantly associated with CR (P=0. 005). The median survival for PBC and PSC pts is 93 and 72 months with a survival rate of 75.5% and 63.6%, respectively. At bivariate analysis, statistically significant predictive factors of worse outcome are MRS at LT is related with worse outcome (P=0. 046) and with early death (P=0,02) in PBC pts. At multivariate analysis, PSC, MRS at enrolment and at LT, D2, Child-Pugh-Turcotte (CTP) at enrolment, displasia, ANA pre-LT, days in ICU, AMA post-LT, recurrence. Conclusions: AR is more frequent and severe in PBC and CR in PSC. Early death is more frequent in PBC and is related to MRS at LT. A worse outcome is related to PSC, MRS at enrolment and at LT, D2,
Abstract PA.187 – Table 1. Changes in nutritional status and energy expenditure in 16 patients after LT No malnutrition (7) Weight kg TSF mm AMC cm Protein intake g/kg/day TEI kcal/kg/day TEE kcal/kg/day TEB kcal/day
Malnutrition (9)
Before LT
90 days
180 days
Before LT
90 days
180 days
78,6±11,1 13,4±5,9 25,7±3,2 0,99±0,8 25,4±7,6 30,4±4,2 -317,6±259,6
74,1±8,4* 12,9±14,0 24,4±2,3 1,3±0,4* 27,6±3,8* 29,9±4,1 -187,0±493,6*
73,8±7,5* 13,1±9,7 24,6 ±1,5 1,1±0,6* 26,8±4,6* 31,4±2,7 -448,0±598,1*
70,6±7,1 9,7±4,6 22,9±3,5 0,9±0,6 22,9±5,3 31,9±7,6 -638,5±299,9
60,9±5,1* 10,8±2,7 21,8±1,8 1,4±0,4* 32,9±6,5* 32,1±3,3 +54,3±452,9*
65,3±6,5*† 16,3±4,7*† 23,7±2,9† 1,4±0,4* 32,9±4,1* 31,5±4,9 +80,1±548,2*
P<0.05 *vs before LT, †vs 90 days after.