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Risk factors and costs associated with hemodialysis after liver transplant
S104
Mini Oral Session Abstracts
Table 1 Comparison of hepatectomy patients at liver transplant centers and non-liver transplant centers. Values presented as
median (interquartile range) unless otherwise noted. Alpha set at p=0.05. Transplant (n [ 11,680)
Non-Transplant (n [ 1,805)
p
Age
58 (48,68)
63 (53,71)
<0.001
Female gender # (%)
5851 (50.1%)
958 (53.1%)
0.02
CCI
6 (3,9)
8 (4,9)
<0.001
Cirrhosis # (%)
2203 (18.86%)
187 (10.36%)
<0.001
Biliary reconstruction # (%)
1040 (6.24%)
57 (3.16%)
<0.001
Primary liver tumor # (%)
4713 (28.26%)
225 (12.46%)
<0.001
Adjusted mortality OR (95% CI)
0.67 (0.48, 0.94)
1.00 (N/A)
0.02
MO 140 BREAST CANCER LIVER METASTASES IN A UK TERTIARY CENTRE: OUTCOMES FOLLOWING REFERRAL TO TUMOR BOARD MEETING H. Abbas, S. Erridge, M. H. Sodergren, M. Papoulas, A. Nawaz, A. Prachalias, K. Menon, W. Jassem, N. Heaton and P. Srinivasan King’s College Hospital, London, United Kingdom Objective: To assess the outcomes from multidisciplinary board meetings (MDM) for patients with breast cancer liver metastases (BCLM) and identify prognostic factors for survival. Methods: A retrospective review of MDM records for patients referred with BCLM to a tertiary center between 2005 and 2016. Patient demographics, disease factors and intervention type were analyzed to find predictive factors for overall survival. Results: 51 patients with BCLM with a median age of 55 yrs (range: 26e94) were referred to the MDM of whom 35 (92.1%) had an original diagnosis of ductal carcinoma. Treatment pathways included surgical resection (n = 19), radiofrequency ablation (RFA, n = 10), or chemotherapy (n = 22). Surgical resection resulted in an improved median overall survival compared to chemotherapy (48 v 16 months; p < 0.001). RFA showed comparable survival benefit (42.5 v 16 months; p = 0.002). Resection and RFA showed no significant difference in survival over one another (48 v 42.5; p = 0.731). Survival analysis identified that resection (p = 0.002) and RFA (p = 0.004) were associated with improved overall survival compared to chemotherapy. Univariate analysis identified the following negative prognostic factors for overall survival: extrahepatic metastases (HR = 3.43; p = 0.031), lack of response to chemotherapy (HR = 6.02; p = 0.017) and chemotherapy only compared to resection (HR = 2.59; p = 0.006). Bone metastases were not associated with reduced survival (HR = 2.83; p = 0.51). Multivariate analysis confirmed extrahepatic disease as a prognostic factor (HR = 5.76; p = 0.037). Conclusion: Surgical resection of BCLM may improve the overall survival in selected patients groups. This study identifies a cohort of patients, without extrahepatic disease and responsive to chemotherapy, who may particularly benefit from surgery.
MO 141 RISK FACTORS AND COSTS ASSOCIATED WITH HEMODIALYSIS AFTER LIVER TRANSPLANT N. Cortolillo, A. Castillo, J. Parreco and S. Orloff University of Miami, Lake Worth, FL, USA Objective: Renal failure (RF) is a known complication after liver transplantation (LT), now seen more commonly in the MELD era. True incidence, cost and factors associated with it are not well known. Methods: The Nationwide Readmission Database for 2013 was queried for patients over 18 years of age undergoing LT. Results: 2,638 patients undergoing LT and 450 (17.1%) patients required dialysis during the initial admission. The weighted mean cost of admission for patients requiring dialysis was $462,250 (325,877) versus $306,358 ($371,050) for all others (p < 0.01, 95% CI 193,339 to 118,444). During the initial admission, 102 (3.9%) patients died. Of the survivors 43.6% had a nonelective readmission with 80 (7.2%) requiring dialysis. Factors associated with dialysis at the initial admission were Charlson comorbidity score >5 (OR 7.31, p < 0.01, 95% CI 5.49 to 9.74), LOS >30 days (OR 5.14, p < 0.01, 95% CI 4.04 to 6.55), and Hep C (OR 1.56, p < 0.01, 95% CI 1.20 to 2.01). Variables associated with reduced risk were primary hepatic malignancy (OR 0.20, p < 0.01, 95% CI 0.14 to 0.28) and hospital in the lowest quartile for transplant volume (OR 0.50, p = 0.02, 95% CI 0.28 to 0.90). The factors associated with an increased risk for dialysis at readmission were initial LOS >30 days (OR 3.61, p < 0.01, 95% CI 2.18 to 5.96) and dialysis at initial admission (OR 2.20, p < 0.01, 95% CI 1.29 to 3.75). The only protective factor was primary liver malignancy (OR 0.44, p = 0.03, 95% CI 0.22 to 0.91). Conclusion: For the high MELD LT, careful monitoring renal protective interventions are warranted.
MO 142 IN VIVO STUDY ON THE FEASIBILITY OF A SINGLE NEEDLE ELECTRODE TO PERFORM IRREVERSIBLE ELECTROPORATION (IRE) IN HEPATIC TISSUE E. Latouche, M. Dewitt, I. Siddiqui, J. Swet, R. Kirks, E. Baker, C. Arena, D. Vrochides, I. McKillop, R. Davalos and D. Iannitti Carolinas Medical Center, Charlotte, NC, USA HPB 2017, 19 (S1), S40eS108
Mini Oral Session Abstracts
Table 1 Comparison of hepatectomy patients at liver transplant centers and non-liver transplant centers. Values presented as
median (interquartile range) unless otherwise noted. Alpha set at p=0.05. Transplant (n [ 11,680)
Non-Transplant (n [ 1,805)
p
Age
58 (48,68)
63 (53,71)
<0.001
Female gender # (%)
5851 (50.1%)
958 (53.1%)
0.02
CCI
6 (3,9)
8 (4,9)
<0.001
Cirrhosis # (%)
2203 (18.86%)
187 (10.36%)
<0.001
Biliary reconstruction # (%)
1040 (6.24%)
57 (3.16%)
<0.001
Primary liver tumor # (%)
4713 (28.26%)
225 (12.46%)
<0.001
Adjusted mortality OR (95% CI)
0.67 (0.48, 0.94)
1.00 (N/A)
0.02
MO 140 BREAST CANCER LIVER METASTASES IN A UK TERTIARY CENTRE: OUTCOMES FOLLOWING REFERRAL TO TUMOR BOARD MEETING H. Abbas, S. Erridge, M. H. Sodergren, M. Papoulas, A. Nawaz, A. Prachalias, K. Menon, W. Jassem, N. Heaton and P. Srinivasan King’s College Hospital, London, United Kingdom Objective: To assess the outcomes from multidisciplinary board meetings (MDM) for patients with breast cancer liver metastases (BCLM) and identify prognostic factors for survival. Methods: A retrospective review of MDM records for patients referred with BCLM to a tertiary center between 2005 and 2016. Patient demographics, disease factors and intervention type were analyzed to find predictive factors for overall survival. Results: 51 patients with BCLM with a median age of 55 yrs (range: 26e94) were referred to the MDM of whom 35 (92.1%) had an original diagnosis of ductal carcinoma. Treatment pathways included surgical resection (n = 19), radiofrequency ablation (RFA, n = 10), or chemotherapy (n = 22). Surgical resection resulted in an improved median overall survival compared to chemotherapy (48 v 16 months; p < 0.001). RFA showed comparable survival benefit (42.5 v 16 months; p = 0.002). Resection and RFA showed no significant difference in survival over one another (48 v 42.5; p = 0.731). Survival analysis identified that resection (p = 0.002) and RFA (p = 0.004) were associated with improved overall survival compared to chemotherapy. Univariate analysis identified the following negative prognostic factors for overall survival: extrahepatic metastases (HR = 3.43; p = 0.031), lack of response to chemotherapy (HR = 6.02; p = 0.017) and chemotherapy only compared to resection (HR = 2.59; p = 0.006). Bone metastases were not associated with reduced survival (HR = 2.83; p = 0.51). Multivariate analysis confirmed extrahepatic disease as a prognostic factor (HR = 5.76; p = 0.037). Conclusion: Surgical resection of BCLM may improve the overall survival in selected patients groups. This study identifies a cohort of patients, without extrahepatic disease and responsive to chemotherapy, who may particularly benefit from surgery.
MO 141 RISK FACTORS AND COSTS ASSOCIATED WITH HEMODIALYSIS AFTER LIVER TRANSPLANT N. Cortolillo, A. Castillo, J. Parreco and S. Orloff University of Miami, Lake Worth, FL, USA Objective: Renal failure (RF) is a known complication after liver transplantation (LT), now seen more commonly in the MELD era. True incidence, cost and factors associated with it are not well known. Methods: The Nationwide Readmission Database for 2013 was queried for patients over 18 years of age undergoing LT. Results: 2,638 patients undergoing LT and 450 (17.1%) patients required dialysis during the initial admission. The weighted mean cost of admission for patients requiring dialysis was $462,250 (325,877) versus $306,358 ($371,050) for all others (p < 0.01, 95% CI 193,339 to 118,444). During the initial admission, 102 (3.9%) patients died. Of the survivors 43.6% had a nonelective readmission with 80 (7.2%) requiring dialysis. Factors associated with dialysis at the initial admission were Charlson comorbidity score >5 (OR 7.31, p < 0.01, 95% CI 5.49 to 9.74), LOS >30 days (OR 5.14, p < 0.01, 95% CI 4.04 to 6.55), and Hep C (OR 1.56, p < 0.01, 95% CI 1.20 to 2.01). Variables associated with reduced risk were primary hepatic malignancy (OR 0.20, p < 0.01, 95% CI 0.14 to 0.28) and hospital in the lowest quartile for transplant volume (OR 0.50, p = 0.02, 95% CI 0.28 to 0.90). The factors associated with an increased risk for dialysis at readmission were initial LOS >30 days (OR 3.61, p < 0.01, 95% CI 2.18 to 5.96) and dialysis at initial admission (OR 2.20, p < 0.01, 95% CI 1.29 to 3.75). The only protective factor was primary liver malignancy (OR 0.44, p = 0.03, 95% CI 0.22 to 0.91). Conclusion: For the high MELD LT, careful monitoring renal protective interventions are warranted.
MO 142 IN VIVO STUDY ON THE FEASIBILITY OF A SINGLE NEEDLE ELECTRODE TO PERFORM IRREVERSIBLE ELECTROPORATION (IRE) IN HEPATIC TISSUE E. Latouche, M. Dewitt, I. Siddiqui, J. Swet, R. Kirks, E. Baker, C. Arena, D. Vrochides, I. McKillop, R. Davalos and D. Iannitti Carolinas Medical Center, Charlotte, NC, USA HPB 2017, 19 (S1), S40eS108