- Email: [email protected]
Preoperative von willebrand factor – antigen predicts clinical outcome after liver resection: a prospective, international, multicenter trial
POSTER PRESENTATIONS THU-449 Preoperative von willebrand factor – antigen predicts clinical outcome after liver resection: a prospective, international, multicenter trial P. Starlinger1, S. Haegele1, P. Braeuer1, L. Oehlberger2, F. Primavesi3, A. Kohler4, F. Offensperger1, D. Pereyra1, A. Ferlitsch5, G. Beldi6, S. Staettner3, C. Brostjan1,7, T. Gruenberger2. 1Surgical Department, Medical University of Vienna; 2Surgical Department, Rudolfstiftung Hospital, Vienna; 3Surgical Department, Paracelsus Private University, Salzburg, Austria; 4Department of Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland; 5Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; 6 Inselspital Bern, Bern, Switzerland; 7Institute of Physiology, Medical University of Vienna, Vienna, Austria E-mail: [email protected] Background and Aims: vWF-antigen has been shown to be increased in patients with portal hypertension and to predict mortality in patients with chronic liver disease. This study aimed to assess the clinical utility of preoperative vWF-antigen levels to predict poor postoperative outcome in patients undergoing liver resection in a routine clinical setting. Methods: 95 patients undergoing liver resection served as prospective exploration cohort and results were validated in an independent cohort of 133 patients for 4 different institutions. VWF-Ag was evaluated perioperatively and postoperative outcome was recorded. Results: Preoperative vWF-antigen levels significantly predicted postoperative liver dysfunction (LD, area under the curve [AUC]: 0.725, P = 0.009). Furthermore, a cut-off of vWF-antigen ≥182% was defined to identify patients with a higher incidence of postoperative LD or morbidity (LD: ≥182%: 33.3%, <182%: 5.9%, P < 0.001; morbidity: ≥182%: 74.1%, <182%: 44.1%, P = 0.008). We confirmed our results within a prospective validation cohort (LD: ≥182%: 20.0%, <182%: 5.2%, P = 0.008; morbidity: ≥182%: 56.4%, <182%: 35.1%, P = 0.015). Analyzing the entire cohort, we found that patients exceeding the cut-off suffered from a significantly increased incidence of postoperative LD, morbidity, prolonged hospitalization, intensive care unit stay and mortality. Conclusions: Within this study we were able to reveal and subsequently validate the potential of preoperative vWF-antigen levels to predict poor postoperative outcome in patients undergoing liver resection. As vWF-antigen is easily determined and available in most standard laboratories, it seems to be a valuable clinical marker to allow for preoperative risk-stratification of patients undergoing liver resection. THU-450 Nurse-led self-management support across two hospitals in liver transplantation: a win-win situation for patients and health care professionals P. Künzler-Heule1,2, D. Semela1, B. Müllhaupt3, S. Beckmann4,5. 1 Division of Gastroenterology and Hepatology; 2Departement of Nursing, Cantonal Hospital St. Gallen, St. Gallen; 3Swiss HPB (Hepato-PancreatoBiliary) Center and Department of Gastroenterology and Hepatology; 4 Department of Abdomen and Metabolism, University Hospital Zurich, Zurich; 5Institute of Nursing Science, University of Basel, Basel, Switzerland E-mail: [email protected] Background and Aims: In Switzerland, many patients in the liver transplant (LT) process receive medical care across two hospitals as LT is only provided in specialised centres. The teams of the hospital in St. Gallen (SG) and the University Hospital Zurich (ZH) work closely together and both integrated an advanced practice nurse (APN) in their interdisciplinary teams. Since August 2014, the APNs established a structured and systematic nurse-led consultation service including face-to-face appointments and using written material to provide continuous self-management support. We compared the structure and the content of the nurse-led consultation service. S194
Methods: We descriptively analysed all 33 patients (60% male, mean age 57 years) who received care from both APN. At the time of analysis, 19 were still on the waiting list (58%), while 14 had received LT (42%). Results: Both APN provided 121 nurse consultations, lasting 10 to 90 minutes (mean 35), mainly taking place during hospitalisation (67%). Most consultations were delivered in SG (87(72%)), primarily, when patients’ were evaluated for the waiting list or already listed. The 34 consultations in ZH were equally distributed among pre- and post-LT. Duration of a consultation was shorter in SG than in ZH (mean 30 vs. 40 minutes). Patients received from 1 to 10 consultations (mean 3). The content delivered varied according to the individual patient situation and the time in relation to LT. In SG, the APN focused on content related to liver cirrhosis, comorbidities and symptom-management (e.g., hepatic encephalopathy, ascites, fatigue) (41%), followed by dealing with strong emotions (19%). In ZH, the APN focused on health-related behaviours (e.g., nutrition, exercise, sun protection) (38%) as well as medication side effects and adherence (33%). Contents covered by both APN were the self-observatory plan (e.g., assessment of vital signs, symptoms, rejection) (15%) followed by other topics such as organisational issues or finances. Conclusions: Patients experience specific needs at different time points during the process of LT. The collaborative nurse-led counselling service covers both hospitals, using the same structure and material. Both APN provide prompt counselling, which is explicitly tailored to patients’ needs in respect of their situation. This systematic approach facilitates continuous patients’ self-management support and enables seamless transition between the hospitals. THU-451 History of marijuana use does not affect outcomes on the liver transplant waitlist P. Kotwani1, V. Saxena1, J. Dodge1, J. Roberts1, F. Yao1, B. Hameed1. 1 UCSF, San Francisco, United States E-mail: [email protected] Background and Aims: There is conflicting data on marijuana use and progression of liver disease. Liver transplant outcomes research among marijuana users is limited. We aim to assess the risk of waitlist death/delisting and receiving transplant among prior marijuana users. We also determine the prevalence and factors associated with marijuana use. Methods: Retrospective cohort of adults evaluated for transplant over two-year period at UCSF. Marijuana use was defined as selfreport in psychosocial assessment and/or positive urine toxicology. Statistics included Poisson regression and competing risk regression. Results: 884 adults were evaluated and 585 (66%) were listed with a median follow up of 1.4 years. Prevalence of marijuana use was 48%, with 7% being current users and 41% prior users. Among listed patients, unadjusted incidence of death/delisting or receiving transplant was not different among marijuana users and non-users. In adjusted competing risk regression among listed patients, marijuana use was not a significant predictor of death/delisting whereas current illicit drug use (HR = 1.8) was. Similarly, marijuana use was not a predictor of receiving a transplant whereas MELD ≥ 20 (HR = 1.6) and HCC (HR = 1.3) were. In multivariate analysis, statistically significant predictors of marijuana use included age 18–29 years (IRR = 2.2), white race (IRR = 1.2), alcoholic liver disease (IRR = 1.9), HCV (IRR = 2.1), tobacco use ( prior use IRR = 1.4; current use IRR = 1.3), alcohol use (never use IRR 0.1; heavy use/abuse IRR 1.2), illicit drug use ( prior use IRR = 2.3; current use = 1.9), and MELD < 20 (IRR = 1.2).
Journal of Hepatology 2017 vol. 66 | S95–S332
Methods: We descriptively analysed all 33 patients (60% male, mean age 57 years) who received care from both APN. At the time of analysis, 19 were still on the waiting list (58%), while 14 had received LT (42%). Results: Both APN provided 121 nurse consultations, lasting 10 to 90 minutes (mean 35), mainly taking place during hospitalisation (67%). Most consultations were delivered in SG (87(72%)), primarily, when patients’ were evaluated for the waiting list or already listed. The 34 consultations in ZH were equally distributed among pre- and post-LT. Duration of a consultation was shorter in SG than in ZH (mean 30 vs. 40 minutes). Patients received from 1 to 10 consultations (mean 3). The content delivered varied according to the individual patient situation and the time in relation to LT. In SG, the APN focused on content related to liver cirrhosis, comorbidities and symptom-management (e.g., hepatic encephalopathy, ascites, fatigue) (41%), followed by dealing with strong emotions (19%). In ZH, the APN focused on health-related behaviours (e.g., nutrition, exercise, sun protection) (38%) as well as medication side effects and adherence (33%). Contents covered by both APN were the self-observatory plan (e.g., assessment of vital signs, symptoms, rejection) (15%) followed by other topics such as organisational issues or finances. Conclusions: Patients experience specific needs at different time points during the process of LT. The collaborative nurse-led counselling service covers both hospitals, using the same structure and material. Both APN provide prompt counselling, which is explicitly tailored to patients’ needs in respect of their situation. This systematic approach facilitates continuous patients’ self-management support and enables seamless transition between the hospitals. THU-451 History of marijuana use does not affect outcomes on the liver transplant waitlist P. Kotwani1, V. Saxena1, J. Dodge1, J. Roberts1, F. Yao1, B. Hameed1. 1 UCSF, San Francisco, United States E-mail: [email protected] Background and Aims: There is conflicting data on marijuana use and progression of liver disease. Liver transplant outcomes research among marijuana users is limited. We aim to assess the risk of waitlist death/delisting and receiving transplant among prior marijuana users. We also determine the prevalence and factors associated with marijuana use. Methods: Retrospective cohort of adults evaluated for transplant over two-year period at UCSF. Marijuana use was defined as selfreport in psychosocial assessment and/or positive urine toxicology. Statistics included Poisson regression and competing risk regression. Results: 884 adults were evaluated and 585 (66%) were listed with a median follow up of 1.4 years. Prevalence of marijuana use was 48%, with 7% being current users and 41% prior users. Among listed patients, unadjusted incidence of death/delisting or receiving transplant was not different among marijuana users and non-users. In adjusted competing risk regression among listed patients, marijuana use was not a significant predictor of death/delisting whereas current illicit drug use (HR = 1.8) was. Similarly, marijuana use was not a predictor of receiving a transplant whereas MELD ≥ 20 (HR = 1.6) and HCC (HR = 1.3) were. In multivariate analysis, statistically significant predictors of marijuana use included age 18–29 years (IRR = 2.2), white race (IRR = 1.2), alcoholic liver disease (IRR = 1.9), HCV (IRR = 2.1), tobacco use ( prior use IRR = 1.4; current use IRR = 1.3), alcohol use (never use IRR 0.1; heavy use/abuse IRR 1.2), illicit drug use ( prior use IRR = 2.3; current use = 1.9), and MELD < 20 (IRR = 1.2).
Journal of Hepatology 2017 vol. 66 | S95–S332