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Su1031 High Liver Stiffness Measurement by Transient Elastography Predicts High Grade Post-Hepatectomy Liver Failure in Patients With Hepatocellular Carcinoma: A Prospective Cohort Study
Characteristics of patients with GVHD post-Liver Transplantation.
histologic features from liver biopsies (H&E stained sections and histochemical stains): 1) portal tracts are expanded by a mononuclear infiltrate in which plasma cells comprise at least 30%, 2) interface hepatitis, and 3) centrilobular hepatocytic injury accompanied by predominantly plasma cell infiltrates. Results Eleven (4%) PCH patients were identified, from a total of 321 patients with recurrent HCV after LT. From those, 46% were female and the average age was 62 year. The interval period from LT to development of PCH was 13.9 (2.5-245.5) months. Their mean international autoimmune hepatitis score was 7.0. Patients were followed over 4.2 (2-25.8) year-period post-LT, during which 6 (54.5%) patients were treated with increasing immunosuppressant and interferon-based therapy (n= 5) and sofosbuvir+ribavirin (n=1). Among patients treated with anti-HCV therapy, 3/6 patients achieved sustained virological response (SVR) and showed biochemical and histologic response, one remained with PCH even with SVR, and two subjects remained with PCH in the absence of SVR and progressed to liver cirrhosis. Five patients without anti-HCV therapy showed biochemical response to increasing immunosuppressant but 2 (40%) patients progressed to liver cirrhosis. Conclusions The present study suggests that PCH represents one of causes of graft loss post LT, in patients with recurrent hepatitis C after LT. Modulation between anti HCV therapy and increasing immunosuppressant should be carefully considered in patients who develop PCH in the setting of recurrent HCV post-liver transplant. Su1030
OLT: Orthotopic Liver Transplantation, CLD: Chronic Liver Disease, NASH: Non-alcoholic SteatoHepatitis, ALD: Alcoholic Liver disease, HCC: Hepatocellular carcinoma, HCV: Hepatitis C Virus, DM: Diabetes Mellitus, GVHD: Graft versus Liver disease, WBC: white blood cells.
Background:Recent evidences indicate that CD133, a primitive haematopoietic and neuronal stem cell marker, is known to be present in cancer stem cells (CSCs) in hepatocellular carcinoma. However , the biological significance of CD133 in hepatocellular carcinoma is controversial. This study was undertaken to explore the expression and significance of stem cell marker CD133 in prognosis of liver transplantation after hepatocellular carcinoma. Methods: Real-time PCR and western blot analysis were performed to examine CD133 expression in human hepatoma cell lines, HCC tissue and normal hepatic tissue. Immunohistochemistry (IHC) assays assessed CD133 protein expression in paraffin-embedded clinical samples taken from 109 HCC patients. The correlation of CD133 expression with the clinicopathological parameters was evaluated along with the prognostic impact of CD133 expression in these HCC patients. Results:Our study showed that CD133 is expressed in human hepatoma cell lines and HCC tissue. CD133 positive HCC cells showed higher clonogenicity in vitro and tumorigenicity in vivo. Immunohistochemical analysis of 109 HCC tissue specimens revealed that CD133 positive immunostaining was found in 44 specimens (40.4%), but was not found in normal liver tissue. CD133 positive expression levels were correlated with tumour grade(P<0.05) and tumor diameter(P<0.05). KaplanMeier analysis indicated that patients with CD133 positive levels had shorter 1,3,5-year overall survival(OS) in compared with patients with CD133 negative expression(1,3,5-year OS of 92.6% ,71.5% and 36.7% vs. 100% , 82.6% and 76.3%, respectively, P<0.001). Multivariate analyses revealed that CD133 positive expression was an independent prognostic factor for survival and tumour recurrence in patients with liver transplantation after HCC. Conclusion:Our findings suggest that CD133 positive cells are frequently present in HCC. Additionally, CD133 positive expression indicate a poor prognosis for patients.
Su1028 Renal Impairment During the Immediate Postoperative Period Is Associated With Increased Risk of Biliary Stricture (BS)- Retrospective Study Suresh Vasan Venkatachalapathy, Naina K. Shah, John Devlin, Nigel Heaton, Andreas Prachalias, Srinivasan Parthi, Wayel Jassem, Hector Melendez, Krishna Menon Introduction: Biliary stricture is a common complication following orthoptic Liver transplantation. The reported incidence of biliary stricture is 5-15% following deceased donor liver transplantation (1). There is no published data to suggest renal impairment following OLT either increases or decrease the incidence of strictures. We conducted retrospective review to assess the above. Methods: A retrospective review of all adult patients who had OLT between January 2008 and February 2013 were included. Information was obtained from electronic patient record, radiology, endoscopy and pathology reports. We assessed if renal impairment both during the immediate post operative period and at 3 months and 1 year had any impact on the development of strictures. Statistical analysis was done using PRISM 6. Fisher Exact test and chi-squared test were used as appropriate. Results: 812 patient episodes were reviewed of which 304 patients were repatriated to other centers so, they were excluded.508 patients were included in the analysis. The mean age at which they had OLT was 49.71± 12.56 (Male: female-328: 180). The mean blood loss during surgery was 7.5± 6.5 l. 14.2% (71) had biopsy proven rejection. 39(7.6%) patients developed biliary strictures. The odds ratio for developing BS in DCD is 9.02 (95% CI 4.4-18.4, P <0.0001). Patients who had haemofiltration were at increased risk of developing BS (RR 2.33,95% CI 1.28-4.5). Patients whose glomerular filtration rate (GFR) decreased below 60 in the first 14 days were at increased risk of developing biliary stricture (P=0.01). The above trend was not maintained at 3 months and 1 year. The rest of the comparators are shown in the table. Conclusion: Our study shows that there was a modest but significant increase in risk of developing biliary strictures if they had haemofiltration or if their GFR decreased below 60 in the first 14 days following liver transplant. The risk of developing BS is increased by 9 fold if the graft is DCD.
Su1031 High Liver Stiffness Measurement by Transient Elastography Predicts High Grade Post-Hepatectomy Liver Failure in Patients With Hepatocellular Carcinoma: A Prospective Cohort Study Charing Chong, Grace Wong, Vincent W. Wong, Philip Ip, KWONG WAI Anthony Fong, Sunny Cheung, John Wong, Kit-fai Lee, Paul B. Lai, Henry L. Chan Aim To evaluate the efficacy of pre-operative liver stiffness measurement (LSM) by transient elastography in predicting post-hepatectomy liver failure in patients underwent hepatectomy for hepatocellular carcinoma. Background Liver fibrosis and cirrhosis are well-known risk factors for post-hepatectomy liver failure (PHLF) after hepatectomy. Unfortunately, these cannot be accurately measured before hepatectomy. Liver stiffness measurement (LSM) using transient elastography appears to be an excellent tool for detection of hepatic fibrosis and cirrhosis with high accuracy. Studies on LSM in predicting PHLF according to International Study Group of Liver Surgery (ISGLS) definition in patients with hepatocellular carcinoma are scarce. Methods This was a prospective cohort study including consecutive patients underwent hepatectomy for hepatocelluar carcinoma from February 2010 to August 2014. All patients received detailed pre-operative assessments including LSM and indocyanine green (ICG) clearance test. The primary outcome was PHLF according to ISGLS definition. Results Two hundred and fifty-five patients with mean age of 58.6 years were included. Majority (81.6%) of them had viral hepatitis B infection. Ninety-two (36.1%) patients received major hepatectomy. The mean ICG retention rate at 15 minutes was 5.4 ± 5.1% and the mean LSM was 13.1 ± 11.4 kPa. For post-hepatectomy outcomes, 82 patients developed PHLF and 46 of them were grade B or C. Only LSM but not ICG showed significant correlation with grade B or C PHLF on receiver operating characteristic curves with area under curve 0.647, P=0.003. Using the cutoff at 12kPa, LSM had the sensitivity of 52.4% and specificity of 73.3% in predication of high grade (grade B or C) PHLF. LSM was also an independent prognostic factor for both high grade PHLF and major post-operative complications by multivariate analysis. Conclusion High LSM predicted the development of high grade PHLF according to ISGLS. It was a useful pre-operative investigation for risk stratification before hepatectomy.
Su1029 Plasma Cell Hepatitis Following Liver Transplantation in Patients With Chronic Hepatitis C Virus Infection Jung Hyun Kwon, Ibrahim A. Hanouneh, Daniela Allende, Lisa Yerian, teresa diago, Bijan Eghtesad, Nizar N. Zein Backgrounds/aims Plasma cell hepatitis (PCH) - characterized by the infiltration of plasma cells around the portal triads - is an increasingly recognized entity following liver transplantation (LT), particularly in patients with chronic hepatitis C virus (HCV) infection. However, the long-term outcome of PCH is poorly understood. Herein we investigated the clinical characteristics, significance and long-term outcome of PCH following LT in patients with HCV infection. Methods Using liver transplant liver biopsy database, we identified all patients with recurrent HCV following LT at our institution between 2008 and 2013; and those that were diagnosed as PCH. The diagnosis of PCH was made based on the following
S-1043
AASLD Abstracts
AASLD Abstracts
Stem Cell Surface Markers CD133 Expression in Hepatocellular Carcinoma and As Single Prognostic Factor for Liver Transplantation Nan Jiang, Guo-Ying Wang, Yang Li
histologic features from liver biopsies (H&E stained sections and histochemical stains): 1) portal tracts are expanded by a mononuclear infiltrate in which plasma cells comprise at least 30%, 2) interface hepatitis, and 3) centrilobular hepatocytic injury accompanied by predominantly plasma cell infiltrates. Results Eleven (4%) PCH patients were identified, from a total of 321 patients with recurrent HCV after LT. From those, 46% were female and the average age was 62 year. The interval period from LT to development of PCH was 13.9 (2.5-245.5) months. Their mean international autoimmune hepatitis score was 7.0. Patients were followed over 4.2 (2-25.8) year-period post-LT, during which 6 (54.5%) patients were treated with increasing immunosuppressant and interferon-based therapy (n= 5) and sofosbuvir+ribavirin (n=1). Among patients treated with anti-HCV therapy, 3/6 patients achieved sustained virological response (SVR) and showed biochemical and histologic response, one remained with PCH even with SVR, and two subjects remained with PCH in the absence of SVR and progressed to liver cirrhosis. Five patients without anti-HCV therapy showed biochemical response to increasing immunosuppressant but 2 (40%) patients progressed to liver cirrhosis. Conclusions The present study suggests that PCH represents one of causes of graft loss post LT, in patients with recurrent hepatitis C after LT. Modulation between anti HCV therapy and increasing immunosuppressant should be carefully considered in patients who develop PCH in the setting of recurrent HCV post-liver transplant. Su1030
OLT: Orthotopic Liver Transplantation, CLD: Chronic Liver Disease, NASH: Non-alcoholic SteatoHepatitis, ALD: Alcoholic Liver disease, HCC: Hepatocellular carcinoma, HCV: Hepatitis C Virus, DM: Diabetes Mellitus, GVHD: Graft versus Liver disease, WBC: white blood cells.
Background:Recent evidences indicate that CD133, a primitive haematopoietic and neuronal stem cell marker, is known to be present in cancer stem cells (CSCs) in hepatocellular carcinoma. However , the biological significance of CD133 in hepatocellular carcinoma is controversial. This study was undertaken to explore the expression and significance of stem cell marker CD133 in prognosis of liver transplantation after hepatocellular carcinoma. Methods: Real-time PCR and western blot analysis were performed to examine CD133 expression in human hepatoma cell lines, HCC tissue and normal hepatic tissue. Immunohistochemistry (IHC) assays assessed CD133 protein expression in paraffin-embedded clinical samples taken from 109 HCC patients. The correlation of CD133 expression with the clinicopathological parameters was evaluated along with the prognostic impact of CD133 expression in these HCC patients. Results:Our study showed that CD133 is expressed in human hepatoma cell lines and HCC tissue. CD133 positive HCC cells showed higher clonogenicity in vitro and tumorigenicity in vivo. Immunohistochemical analysis of 109 HCC tissue specimens revealed that CD133 positive immunostaining was found in 44 specimens (40.4%), but was not found in normal liver tissue. CD133 positive expression levels were correlated with tumour grade(P<0.05) and tumor diameter(P<0.05). KaplanMeier analysis indicated that patients with CD133 positive levels had shorter 1,3,5-year overall survival(OS) in compared with patients with CD133 negative expression(1,3,5-year OS of 92.6% ,71.5% and 36.7% vs. 100% , 82.6% and 76.3%, respectively, P<0.001). Multivariate analyses revealed that CD133 positive expression was an independent prognostic factor for survival and tumour recurrence in patients with liver transplantation after HCC. Conclusion:Our findings suggest that CD133 positive cells are frequently present in HCC. Additionally, CD133 positive expression indicate a poor prognosis for patients.
Su1028 Renal Impairment During the Immediate Postoperative Period Is Associated With Increased Risk of Biliary Stricture (BS)- Retrospective Study Suresh Vasan Venkatachalapathy, Naina K. Shah, John Devlin, Nigel Heaton, Andreas Prachalias, Srinivasan Parthi, Wayel Jassem, Hector Melendez, Krishna Menon Introduction: Biliary stricture is a common complication following orthoptic Liver transplantation. The reported incidence of biliary stricture is 5-15% following deceased donor liver transplantation (1). There is no published data to suggest renal impairment following OLT either increases or decrease the incidence of strictures. We conducted retrospective review to assess the above. Methods: A retrospective review of all adult patients who had OLT between January 2008 and February 2013 were included. Information was obtained from electronic patient record, radiology, endoscopy and pathology reports. We assessed if renal impairment both during the immediate post operative period and at 3 months and 1 year had any impact on the development of strictures. Statistical analysis was done using PRISM 6. Fisher Exact test and chi-squared test were used as appropriate. Results: 812 patient episodes were reviewed of which 304 patients were repatriated to other centers so, they were excluded.508 patients were included in the analysis. The mean age at which they had OLT was 49.71± 12.56 (Male: female-328: 180). The mean blood loss during surgery was 7.5± 6.5 l. 14.2% (71) had biopsy proven rejection. 39(7.6%) patients developed biliary strictures. The odds ratio for developing BS in DCD is 9.02 (95% CI 4.4-18.4, P <0.0001). Patients who had haemofiltration were at increased risk of developing BS (RR 2.33,95% CI 1.28-4.5). Patients whose glomerular filtration rate (GFR) decreased below 60 in the first 14 days were at increased risk of developing biliary stricture (P=0.01). The above trend was not maintained at 3 months and 1 year. The rest of the comparators are shown in the table. Conclusion: Our study shows that there was a modest but significant increase in risk of developing biliary strictures if they had haemofiltration or if their GFR decreased below 60 in the first 14 days following liver transplant. The risk of developing BS is increased by 9 fold if the graft is DCD.
Su1031 High Liver Stiffness Measurement by Transient Elastography Predicts High Grade Post-Hepatectomy Liver Failure in Patients With Hepatocellular Carcinoma: A Prospective Cohort Study Charing Chong, Grace Wong, Vincent W. Wong, Philip Ip, KWONG WAI Anthony Fong, Sunny Cheung, John Wong, Kit-fai Lee, Paul B. Lai, Henry L. Chan Aim To evaluate the efficacy of pre-operative liver stiffness measurement (LSM) by transient elastography in predicting post-hepatectomy liver failure in patients underwent hepatectomy for hepatocellular carcinoma. Background Liver fibrosis and cirrhosis are well-known risk factors for post-hepatectomy liver failure (PHLF) after hepatectomy. Unfortunately, these cannot be accurately measured before hepatectomy. Liver stiffness measurement (LSM) using transient elastography appears to be an excellent tool for detection of hepatic fibrosis and cirrhosis with high accuracy. Studies on LSM in predicting PHLF according to International Study Group of Liver Surgery (ISGLS) definition in patients with hepatocellular carcinoma are scarce. Methods This was a prospective cohort study including consecutive patients underwent hepatectomy for hepatocelluar carcinoma from February 2010 to August 2014. All patients received detailed pre-operative assessments including LSM and indocyanine green (ICG) clearance test. The primary outcome was PHLF according to ISGLS definition. Results Two hundred and fifty-five patients with mean age of 58.6 years were included. Majority (81.6%) of them had viral hepatitis B infection. Ninety-two (36.1%) patients received major hepatectomy. The mean ICG retention rate at 15 minutes was 5.4 ± 5.1% and the mean LSM was 13.1 ± 11.4 kPa. For post-hepatectomy outcomes, 82 patients developed PHLF and 46 of them were grade B or C. Only LSM but not ICG showed significant correlation with grade B or C PHLF on receiver operating characteristic curves with area under curve 0.647, P=0.003. Using the cutoff at 12kPa, LSM had the sensitivity of 52.4% and specificity of 73.3% in predication of high grade (grade B or C) PHLF. LSM was also an independent prognostic factor for both high grade PHLF and major post-operative complications by multivariate analysis. Conclusion High LSM predicted the development of high grade PHLF according to ISGLS. It was a useful pre-operative investigation for risk stratification before hepatectomy.
Su1029 Plasma Cell Hepatitis Following Liver Transplantation in Patients With Chronic Hepatitis C Virus Infection Jung Hyun Kwon, Ibrahim A. Hanouneh, Daniela Allende, Lisa Yerian, teresa diago, Bijan Eghtesad, Nizar N. Zein Backgrounds/aims Plasma cell hepatitis (PCH) - characterized by the infiltration of plasma cells around the portal triads - is an increasingly recognized entity following liver transplantation (LT), particularly in patients with chronic hepatitis C virus (HCV) infection. However, the long-term outcome of PCH is poorly understood. Herein we investigated the clinical characteristics, significance and long-term outcome of PCH following LT in patients with HCV infection. Methods Using liver transplant liver biopsy database, we identified all patients with recurrent HCV following LT at our institution between 2008 and 2013; and those that were diagnosed as PCH. The diagnosis of PCH was made based on the following
S-1043
AASLD Abstracts
AASLD Abstracts
Stem Cell Surface Markers CD133 Expression in Hepatocellular Carcinoma and As Single Prognostic Factor for Liver Transplantation Nan Jiang, Guo-Ying Wang, Yang Li