- Email: [email protected]
Sofosbuvir and Simeprevir Therapy for Recurrent Hepatitis C Genotype 1, after Liver Transplantation: Efficacy and Safety
POSTER PRESENTATIONS survival was evaluated and compared between groups. Evolution of LT was assessed according to different time periods (1988–1992, 1993–1997, 1998–2002, 2003–2007, 2008–2012). Results: 90156 LT patients were evaluated (59432 male, 30724 female). A significant increase in male recipients was found from 1988–1992 to 2007–2012 (from 54.7% to 64.2%; p < 0.001), whereas the proportion of female recipients decreased from 43.3% to 30.8% ( p < 0.001). The use of female donors in male recipients has significantly increased overtime (from 15.9% to 27%; p < 0.001). Male recipients were transplanted more frequently for ALD (28.9% vs. 12.9%) and HCC (18.6 vs. 6.7%), whereas female patients were transplante more frequently for ALF (12.6% vs. 4.3%), AIH (5% vs. 1%) and PBC 46% vs 1%; all p < 0.001). The proportion of patients transplanted at an age ≤ 40 years was significaly higher in female recipients compared to male ones (23.4% vs. 14.3%; p < 0.001). One, 3, 5 and 10-year graft survival rates after LT were 79%, 71%, 63% and 54% in male recipients and 77%, 71%, 65% and 57% in female recipients ( p < 0.001). Survival rates were significantly lower when a female donor/male recipient matching was used compared with all the other donor/recipient gender matching (all p < 0.001). By multivariate analysis, female donor/ male recipient mismatch ( p = 0.01), older recipient age ( p < 0.001), older donor age (p < 0.001), ALF ( p < 0.001), HCV ( p < 0.001) and reduced size graft ( p < 0.001) were associated with increased risk of death or graft loss. Conclusions: Important gender differences exist regarding aetiology of liver disease, access to LT and outcomes after LT. Long-term survival is better in women, however 1-survival rates are lower, possibly due to the higher frequency of ALF. Female donor/male recipient mismatch is associated with greater risk of death or graft loss after LT. FRI-452 UNEXPECTED VERY EARLY ATHEROSCLEROTIC AND CARDIAC DAMAGE IN PATIENTS UNDERGOING LIVER TRANSPLANTATION G. Pisano1, R. Lombardi1, M. Orlandi2, M.F. Donato3, S. Zannoni2, C.G. Bertelli2, G. Oberti2, L. Caccamo4, M. Colombo5, S. Fargion2, A.L. Fracanzani1. 1Department of Pathophysiology and Transplantation, Unit of internal medicine; 2Department of Pathophysiology and Transplantation; 3Department of Pathophysiology and Transplantation, division of gastroenterology; 4Department of Pathophysiology and Transplantation, Unit of Hepatic Surgery; 5Department of Pathophysiology and Transplantation, division of gastrtoenterology, Fondazione IRCCS Ca’ Granda Policlinico do Milano, Milano, Italy E-mail: [email protected] Background and Aims: The improvement in surgical techniques and the greater effectiveness of new anti-rejection drugs have significantly improved the survival of patients undergoing liver transplantation allowing to detect an increased risk of metabolic disorders and cardiovascular and cerebrovascular diseases. Aims:To evaluate in patients undergoing liver transplantation timing of metabolic and cardiovascular modifications. Methods: From January 2014 we evaluated 55 patients on waiting transplant list of whom 28 were transplanted (group 1) and 13 patients transplanted 6 months before enrollment (group 2), 57 % were transplanted for complications of HCV cirrhosis. All transplanted patients received steroidal therapy associated with other immunosuppressive drugs: tacrolimus (41%), tacrolimus plus mycophenolate mofetil (25%), cyclosporine (8%), cyclosporine plus mycophenolate mofetil (26%). Biochemical parameters, subclinical atherosclerosis (carotid stiffness (cPWV), intima-media thickness (cIMT), presence of plaques) by ultrasound and diastolic dysfunction (E/A), thickness of the interventricular septum, left ventricular mass, ejection function and visceral adiposity estimated as epicardial fat thickness by echocardiography were evaluated in group 1 at time 0 (before transplant) and time 1 (6 months after transplant), in group 2 at time 1, time 2 and time 3 (6, 12 and 18 months after transplant). Results: After 6 months from transplant an increase of lipid values, prevalence of diabetes, hypertension and metabolic syndrome, and, S538
as expected, an improvement of liver parameters was observed. In addition a significant increase of interventricular septum thickness ( p = 0,05), cIMT ( p = 0.02) epicardial fat ( p < 0.001) and a significant reduction of diastolic function ( p < 0,001) was observed. A further increase only of cIMT was observed from 6 to 12 months after transplant ( p = 0.03). Unexpectedly carotid stiffness decreased significantly ( p = 0.04) during follow up. Ejection function and ventricular mass didn’t differ significantly during follow up. No difference in cardiovascular alterations was observed in patients treated with different immunosoppressive therapy. Conclusions: Cardiovascular alterations occur very early after liver transplantation. Recognition and prompt treatment of these alterations may impact long- term survival in patients submitted to OLT. FRI-453 SOFOSBUVIR AND SIMEPREVIR THERAPY FOR RECURRENT HEPATITIS C GENOTYPE 1, AFTER LIVER TRANSPLANTATION: EFFICACY AND SAFETY G.S. Antolin1, M. Testillano2, M. Prieto3, I. Fernandez4, X. Xiol5, M.C. Londoño6, L. Castells7, J.M. Pascasio8, M.L.G. Dieguez9, A.O. Ferreiro10, M. Salcedo11, I. Narvaez12, J.A. Pons13, J.I. Herrero14, S.P. Bartolome15, J.L. Montero16, A. Arencibia17, E.F. Garcia18, S. Lorente19, E. Molina20, J.R. Fernandez2, C.A. Alvarez1, V. CuervasMons21, and The Spanish Liver Transplant Society study Group. 1 Hepatology Unit. Liver Transplant Unit, Hospital U. Rio Hortega, Valladolid; 2Digestive Service. Liver Unit. Liver Transplant Unit, Hospital U. Cruces, Bilbao; 3Hepatology Unit. Liver Transplant Unit, Hospital U. La Fe, Valencia; 4Hepatology Unit, Hospital U.12 de Octubre, Madrid; 5 Gastroenterology Service, Hospital U. Bellvitge; 6Hepatology Service, Hospital Clinic. IDIBAPS, CIBERehd; 7Hepatology Service. CIBERehd, Hospital U. Vall Hebron, Barcelona; 8UGC Enfermedades Digestivas, IBIS, CIBERehd, Hospital Universitario Virgen del Rocío, Sevilla; 9Liver Unit, Hospital U Central de Asturias, Oviedo; 10Liver Transplant Unit, Hospital Universitario de A Coruña, A Coruña; 11Liver Unit, Hospital U. Gregorio Marañon, Madrid; 12Gastroenterology Service, Hospital Infanta Cristina, Badajoz; 13Hepatology Unit. Liver Transplant Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia; 14Liver Unit. CIBERehd. IdiSNA, Clinica Universidad de Navarra., Pamplona; 15Digestive Service. Liver Unit., Hospital GU., Alicante; 16Hepatology Unit. Liver Transplant Unit. IMIBIC, CIBERehd, Hospital U. Reina Sofía, Cordoba; 17Hospital U. La Candelaria, Tenerife; 18Hospital U. Marques de Valdecilla, Santander; 19 Hospital U. Lozano Blesa, Zaragoza; 20Hospital U. de Santiago, Santiago de Compostela; 21Internal Medicine Service. Liver Transplant Unit, Hospital Puerta de Hierro, Madrid, Spain E-mail: [email protected] Background and Aims: The treatments of hepatitis C in liver transplant patients until recently, had low efficacy and many adverse effects. The new direct acting antivirals Simeprevir(SIM) and sofosbuvir(SOF) have significantly increased the efficacy and safety of treatment in liver transplant hepatitis C patients genotype 1. The aim of this study was to determine the efficacy and safety in real life of the combination SOF + SIM ± RBV in a group of liver transplant patients genotype 1. Methods: This is a multicenter, retrospective study including 232 genotype 1 hepatitis C liver transplant patients treated with SIM + SOF ± RBV from 21 Liver transplant Centres. Efficacy and safety data, and mortality rate were assessed. Results: The majority of patients were male(73,7%) and the average age was 61.49 ± 8.9 years. The 63.1% were Ile 28B CT and the genotype 1a was 15.02%. The 59.05% of patients have been previously treated, the most part with interferon based therapy, but 10.8% with IP and the 4.3% with SOF. The 51.14% were null responders. There was a 53.8% of patients with fibrosis 4. The MELD score average was 8.86 ± 2.87(6– 24). In the 60.34% of the patients RBV was included in the treatment. The majority of the patients were treated during 12 weeks(86,63%). At the end of treatment(EOT), all patients had undetectable serum
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POSTER PRESENTATIONS HCV-RNA but one patient had to stop the treatment for liver and kidney impairment. The rates of sustained virological response(SVR) 4 and 12 were 97.28% and 93.75%, respectively. The SVR 12 in cirrhotic patients was 92,4% versus 95,34 in non cirrhotics, and SVR 12 in RBV treated patients was 95,7% versus 90,9%. Treatment was well tolerated and the mortality rate was 1.3% no treatment related Conclusions: The treatment of HCV genotype 1 patients after liver transplantation, with Simeprevir plus sofosbuvir in real life, is a very effective and safe option even in post-transplant liver cirrhosis The mortality rate was very low and no drug-related.
FRI-455 LIVER TRANSPLANTATION FOR ACUTE HEPATIC DECOMPENSATION ACHIEVES EXCELLENT OUTCOMES WITHOUT INCREASED RECIDIVISM RATES: A SINGLE CENTER EXPERIENCE H. Monsour1, D. Victor1, M. Boktour1, J. Galati1, J. Ontiveros1, L. Theriot1, R. McFadden1, C. Mobley1, A. Saharia1, S. GordonBurroughs1, M. Ghobrial1. 1Sherrie and Alan Conover Center for Liver Disease and Transplantation, The Methodist Hospital, Houston, United States E-mail: [email protected]
FRI-454 SHORT-TERM OUTCOMES FOLLOWING HEPATECTOMY IN ELDERLY PATIENTS WITH HEPATOCELLULAR CARCINOMA: AN ANALYSIS OF 10,805 SEPTUAGENARIANS AND 2,381 OCTO-NONAGENARIANS IN JAPAN H. Okinaga1, H. Yasunaga2, K. Hasegawa1, K. Fushimi3, N. Kokudo1. 1 Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo; 2Department of Clinical Epidemiology and Health Economics, University of Tokyo, Hongo, Bunkyo-ward, Tokyo; 3Department of Health Care Informatics, Tokyo Medical and Dental University, 1-5-45 Yushima, bunkyo-ward, Tokyo, Japan E-mail: [email protected]
Background and Aims: The 6-month abstinence requirement before transplantation may be an unreasonable requirement in patients presenting with acute alcoholic decompensated liver disease. Mortality rates for acute alcoholic liver decompensation can be higher than 80% in the first six months. Liver transplantation has recently been recommended for selected patients with acute alcoholic hepatitis (AH), but concerns remain about recidivism. We aimed to review a single-center experiences of recipients with underlying liver disease presenting with acute decompensation who were actively drinking within 6-months prior to transplant. Methods: Retrospective review of 306 consecutive adult who underwent liver transplant (OLT) between June 2011 and June 2015. We identified OLT recipients who were listed and transplanted within 60-days for acute alcohol related liver decompensation. Candidacy was determined for these patients under our institutional policy including SIPAT scoring. Post-transplant recipients had direct face to face counselling to identify recidivism. Family members were also separately questioned about patient’s sobriety. Primary end points were patient survivals. Recidivism was characterized as a slip or problematic drinking. Results: A total of 37 (12%) patients were analyzed with median days on the list 10 (0–56). Median age was 46 (21–76), 21 (57%) were male, and 27 (73%) were Caucasian. At time of transplant, median bioMELD score was 36 (20–45) and median SIPAT score was 32 (17–59). Thirty four (92%) of recipients were transplanted from ICU, and 25 (68%) were on ventilator. Median follow-up was 17-months, with one and 3- year survival rates of 100% and 95% consecutively. Alcohol relapse was noticed in 9 recipients (24%), 3(8%) Slip and 6 (16%) problematic drinking. Graft function was not different when compared to patients without recidivism, ( p = NS). Conclusions: Patients with acute liver decompensation and actively alcohol use within 6 months of OLT achieved excellent survival outcomes in a population that would otherwise have severe mortality. Recidivism rates were selected patients presenting with acute alcohol related liver decompensation who has not met the 6month sobriety were similar to rates of patient’s achieving traditional sobriety goals. Patients with acute hepatic decompensation from alcohol benefit from liver transplantation without increased return to problematic drinking.
Background and Aims: Hepatectomy is an effective therapeutic modality for hepatocellular carcinoma (HCC), but data on its safety in elderly patients, in particular for those over 80 years, have been lacking. We examined the safety of hepatectomy for octononagenarians using large-scale data obtained from the Diagnosis Procedure Combination database, a national administrative database in Japan. Methods: We identified 27,094 patients who underwent hepatectomy for HCC in 941 hospitals between 2007 and 2012. Patient age was divided into five categories: ≤59, 60–69, 70–79, 80– 84, and ≥ 85 years old (n = 5099, 8809, 10805, 2011, and 370, respectively). Less-invasive procedures and significantly shorter duration of anesthesia were used for patients aged ≥ 80 years. We also assessed in-hospital 90-day mortality and postoperative complications. Results: Mortality and morbidity rates were 2.6% and 23.4%, respectively. Compared with patients in their 70s, the mortality was significantly lower in patients aged ≤ 59 years [odds ratio (OR) 0.34; 95% confidence interval (CI), 0.26–0.45; p < 0.001] and those in their 60s (OR 0.63; 95% CI, 0.53–0.74; p < 0.001), whereas no significant difference was observed in those aged 80–84 years (OR 1.03; 95% CI, 0.78–1.385; p = 0.844) and those aged ≥ 85 years (OR 0.95; 95% CI, 0.50–1.79; p = 0.870). Compared with patients in their 70s, the morbidity rate was significantly lower in those aged ≤ 59 years (OR, 0.77; 95% CI, 0.70–0.84; p < 0.001) and those in their 60s (OR, 0.89; 95% CI, 0.83–0.95; p = 0.001), whereas no significant difference was observed for those aged 80–84 years (OR 1.10; 95% CI, 0.99-1.23; p = 0.072) and those aged ≥ 85 years (OR 1.05; 95% CI, 0.85–1.35; p = 0.577). Age ≥ 70 years, male gender, low hospital volume, and surgical procedure were identified as independent predictors of mortality using a multivariate logistic regression analysis. Conclusions: The operative risk for hepatectomy gradually increases by age until patients are in their 70s and appears to reach a plateau among octo-nonagenarians, probably because of appropriate patient selection by surgeons; less-invasive procedures were selected for patients with less co-morbidity.
FRI-456 RENAL DYSFUNCTION IN DONATION AFTER CIRCULATORY DEATH LIVER TRANSPLANTATION: UK SINGLE CENTRE STUDY I. Umbro1,2, F. Tinti1,2, F. Evison3, A. Sharif4, B. Gunson5, A.P. Mitterhofer2, J. Ferguson1, P. Muiesan1. 1The Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; 2Department of Clinical Medicine, Nephrology and Dialysis Unit, Sapienza University of Rome, Rome, Italy; 3Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust; 4Department of Nephrology and Transplantation, Queen Elizabeth Hospital; 5NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom E-mail: [email protected] Background and Aims: Acute kidney injury (AKI) is a major cause of morbidity and mortality after liver transplantation (LT). Liver transplant recipients with post-operative AKI are more likely to develop chronic kidney disease (CKD), compared to the transplant
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as expected, an improvement of liver parameters was observed. In addition a significant increase of interventricular septum thickness ( p = 0,05), cIMT ( p = 0.02) epicardial fat ( p < 0.001) and a significant reduction of diastolic function ( p < 0,001) was observed. A further increase only of cIMT was observed from 6 to 12 months after transplant ( p = 0.03). Unexpectedly carotid stiffness decreased significantly ( p = 0.04) during follow up. Ejection function and ventricular mass didn’t differ significantly during follow up. No difference in cardiovascular alterations was observed in patients treated with different immunosoppressive therapy. Conclusions: Cardiovascular alterations occur very early after liver transplantation. Recognition and prompt treatment of these alterations may impact long- term survival in patients submitted to OLT. FRI-453 SOFOSBUVIR AND SIMEPREVIR THERAPY FOR RECURRENT HEPATITIS C GENOTYPE 1, AFTER LIVER TRANSPLANTATION: EFFICACY AND SAFETY G.S. Antolin1, M. Testillano2, M. Prieto3, I. Fernandez4, X. Xiol5, M.C. Londoño6, L. Castells7, J.M. Pascasio8, M.L.G. Dieguez9, A.O. Ferreiro10, M. Salcedo11, I. Narvaez12, J.A. Pons13, J.I. Herrero14, S.P. Bartolome15, J.L. Montero16, A. Arencibia17, E.F. Garcia18, S. Lorente19, E. Molina20, J.R. Fernandez2, C.A. Alvarez1, V. CuervasMons21, and The Spanish Liver Transplant Society study Group. 1 Hepatology Unit. Liver Transplant Unit, Hospital U. Rio Hortega, Valladolid; 2Digestive Service. Liver Unit. Liver Transplant Unit, Hospital U. Cruces, Bilbao; 3Hepatology Unit. Liver Transplant Unit, Hospital U. La Fe, Valencia; 4Hepatology Unit, Hospital U.12 de Octubre, Madrid; 5 Gastroenterology Service, Hospital U. Bellvitge; 6Hepatology Service, Hospital Clinic. IDIBAPS, CIBERehd; 7Hepatology Service. CIBERehd, Hospital U. Vall Hebron, Barcelona; 8UGC Enfermedades Digestivas, IBIS, CIBERehd, Hospital Universitario Virgen del Rocío, Sevilla; 9Liver Unit, Hospital U Central de Asturias, Oviedo; 10Liver Transplant Unit, Hospital Universitario de A Coruña, A Coruña; 11Liver Unit, Hospital U. Gregorio Marañon, Madrid; 12Gastroenterology Service, Hospital Infanta Cristina, Badajoz; 13Hepatology Unit. Liver Transplant Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia; 14Liver Unit. CIBERehd. IdiSNA, Clinica Universidad de Navarra., Pamplona; 15Digestive Service. Liver Unit., Hospital GU., Alicante; 16Hepatology Unit. Liver Transplant Unit. IMIBIC, CIBERehd, Hospital U. Reina Sofía, Cordoba; 17Hospital U. La Candelaria, Tenerife; 18Hospital U. Marques de Valdecilla, Santander; 19 Hospital U. Lozano Blesa, Zaragoza; 20Hospital U. de Santiago, Santiago de Compostela; 21Internal Medicine Service. Liver Transplant Unit, Hospital Puerta de Hierro, Madrid, Spain E-mail: [email protected] Background and Aims: The treatments of hepatitis C in liver transplant patients until recently, had low efficacy and many adverse effects. The new direct acting antivirals Simeprevir(SIM) and sofosbuvir(SOF) have significantly increased the efficacy and safety of treatment in liver transplant hepatitis C patients genotype 1. The aim of this study was to determine the efficacy and safety in real life of the combination SOF + SIM ± RBV in a group of liver transplant patients genotype 1. Methods: This is a multicenter, retrospective study including 232 genotype 1 hepatitis C liver transplant patients treated with SIM + SOF ± RBV from 21 Liver transplant Centres. Efficacy and safety data, and mortality rate were assessed. Results: The majority of patients were male(73,7%) and the average age was 61.49 ± 8.9 years. The 63.1% were Ile 28B CT and the genotype 1a was 15.02%. The 59.05% of patients have been previously treated, the most part with interferon based therapy, but 10.8% with IP and the 4.3% with SOF. The 51.14% were null responders. There was a 53.8% of patients with fibrosis 4. The MELD score average was 8.86 ± 2.87(6– 24). In the 60.34% of the patients RBV was included in the treatment. The majority of the patients were treated during 12 weeks(86,63%). At the end of treatment(EOT), all patients had undetectable serum
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POSTER PRESENTATIONS HCV-RNA but one patient had to stop the treatment for liver and kidney impairment. The rates of sustained virological response(SVR) 4 and 12 were 97.28% and 93.75%, respectively. The SVR 12 in cirrhotic patients was 92,4% versus 95,34 in non cirrhotics, and SVR 12 in RBV treated patients was 95,7% versus 90,9%. Treatment was well tolerated and the mortality rate was 1.3% no treatment related Conclusions: The treatment of HCV genotype 1 patients after liver transplantation, with Simeprevir plus sofosbuvir in real life, is a very effective and safe option even in post-transplant liver cirrhosis The mortality rate was very low and no drug-related.
FRI-455 LIVER TRANSPLANTATION FOR ACUTE HEPATIC DECOMPENSATION ACHIEVES EXCELLENT OUTCOMES WITHOUT INCREASED RECIDIVISM RATES: A SINGLE CENTER EXPERIENCE H. Monsour1, D. Victor1, M. Boktour1, J. Galati1, J. Ontiveros1, L. Theriot1, R. McFadden1, C. Mobley1, A. Saharia1, S. GordonBurroughs1, M. Ghobrial1. 1Sherrie and Alan Conover Center for Liver Disease and Transplantation, The Methodist Hospital, Houston, United States E-mail: [email protected]
FRI-454 SHORT-TERM OUTCOMES FOLLOWING HEPATECTOMY IN ELDERLY PATIENTS WITH HEPATOCELLULAR CARCINOMA: AN ANALYSIS OF 10,805 SEPTUAGENARIANS AND 2,381 OCTO-NONAGENARIANS IN JAPAN H. Okinaga1, H. Yasunaga2, K. Hasegawa1, K. Fushimi3, N. Kokudo1. 1 Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo; 2Department of Clinical Epidemiology and Health Economics, University of Tokyo, Hongo, Bunkyo-ward, Tokyo; 3Department of Health Care Informatics, Tokyo Medical and Dental University, 1-5-45 Yushima, bunkyo-ward, Tokyo, Japan E-mail: [email protected]
Background and Aims: The 6-month abstinence requirement before transplantation may be an unreasonable requirement in patients presenting with acute alcoholic decompensated liver disease. Mortality rates for acute alcoholic liver decompensation can be higher than 80% in the first six months. Liver transplantation has recently been recommended for selected patients with acute alcoholic hepatitis (AH), but concerns remain about recidivism. We aimed to review a single-center experiences of recipients with underlying liver disease presenting with acute decompensation who were actively drinking within 6-months prior to transplant. Methods: Retrospective review of 306 consecutive adult who underwent liver transplant (OLT) between June 2011 and June 2015. We identified OLT recipients who were listed and transplanted within 60-days for acute alcohol related liver decompensation. Candidacy was determined for these patients under our institutional policy including SIPAT scoring. Post-transplant recipients had direct face to face counselling to identify recidivism. Family members were also separately questioned about patient’s sobriety. Primary end points were patient survivals. Recidivism was characterized as a slip or problematic drinking. Results: A total of 37 (12%) patients were analyzed with median days on the list 10 (0–56). Median age was 46 (21–76), 21 (57%) were male, and 27 (73%) were Caucasian. At time of transplant, median bioMELD score was 36 (20–45) and median SIPAT score was 32 (17–59). Thirty four (92%) of recipients were transplanted from ICU, and 25 (68%) were on ventilator. Median follow-up was 17-months, with one and 3- year survival rates of 100% and 95% consecutively. Alcohol relapse was noticed in 9 recipients (24%), 3(8%) Slip and 6 (16%) problematic drinking. Graft function was not different when compared to patients without recidivism, ( p = NS). Conclusions: Patients with acute liver decompensation and actively alcohol use within 6 months of OLT achieved excellent survival outcomes in a population that would otherwise have severe mortality. Recidivism rates were selected patients presenting with acute alcohol related liver decompensation who has not met the 6month sobriety were similar to rates of patient’s achieving traditional sobriety goals. Patients with acute hepatic decompensation from alcohol benefit from liver transplantation without increased return to problematic drinking.
Background and Aims: Hepatectomy is an effective therapeutic modality for hepatocellular carcinoma (HCC), but data on its safety in elderly patients, in particular for those over 80 years, have been lacking. We examined the safety of hepatectomy for octononagenarians using large-scale data obtained from the Diagnosis Procedure Combination database, a national administrative database in Japan. Methods: We identified 27,094 patients who underwent hepatectomy for HCC in 941 hospitals between 2007 and 2012. Patient age was divided into five categories: ≤59, 60–69, 70–79, 80– 84, and ≥ 85 years old (n = 5099, 8809, 10805, 2011, and 370, respectively). Less-invasive procedures and significantly shorter duration of anesthesia were used for patients aged ≥ 80 years. We also assessed in-hospital 90-day mortality and postoperative complications. Results: Mortality and morbidity rates were 2.6% and 23.4%, respectively. Compared with patients in their 70s, the mortality was significantly lower in patients aged ≤ 59 years [odds ratio (OR) 0.34; 95% confidence interval (CI), 0.26–0.45; p < 0.001] and those in their 60s (OR 0.63; 95% CI, 0.53–0.74; p < 0.001), whereas no significant difference was observed in those aged 80–84 years (OR 1.03; 95% CI, 0.78–1.385; p = 0.844) and those aged ≥ 85 years (OR 0.95; 95% CI, 0.50–1.79; p = 0.870). Compared with patients in their 70s, the morbidity rate was significantly lower in those aged ≤ 59 years (OR, 0.77; 95% CI, 0.70–0.84; p < 0.001) and those in their 60s (OR, 0.89; 95% CI, 0.83–0.95; p = 0.001), whereas no significant difference was observed for those aged 80–84 years (OR 1.10; 95% CI, 0.99-1.23; p = 0.072) and those aged ≥ 85 years (OR 1.05; 95% CI, 0.85–1.35; p = 0.577). Age ≥ 70 years, male gender, low hospital volume, and surgical procedure were identified as independent predictors of mortality using a multivariate logistic regression analysis. Conclusions: The operative risk for hepatectomy gradually increases by age until patients are in their 70s and appears to reach a plateau among octo-nonagenarians, probably because of appropriate patient selection by surgeons; less-invasive procedures were selected for patients with less co-morbidity.
FRI-456 RENAL DYSFUNCTION IN DONATION AFTER CIRCULATORY DEATH LIVER TRANSPLANTATION: UK SINGLE CENTRE STUDY I. Umbro1,2, F. Tinti1,2, F. Evison3, A. Sharif4, B. Gunson5, A.P. Mitterhofer2, J. Ferguson1, P. Muiesan1. 1The Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; 2Department of Clinical Medicine, Nephrology and Dialysis Unit, Sapienza University of Rome, Rome, Italy; 3Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust; 4Department of Nephrology and Transplantation, Queen Elizabeth Hospital; 5NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom E-mail: [email protected] Background and Aims: Acute kidney injury (AKI) is a major cause of morbidity and mortality after liver transplantation (LT). Liver transplant recipients with post-operative AKI are more likely to develop chronic kidney disease (CKD), compared to the transplant
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