Survival in HIV-infected persons following liver transplantation is influenced by viral co-infection: Poorer outcome in HCV-infected persons

46

I

135

Poster Sessions HISTOLOGICAL AFTER

COURSE

OF RECURRENT

HEPATITIS

C

LIVER TRANSPLANTATION

U. l? Neumann’, T. Berg2, M. Bahra’, .I. M. Langrehr’, l? Neuhaus’. ‘Klinik F I A&em&-, Viszeral-, Und Trans~lantationschirurgie, Berlin, Get-many; 2Medizinische Klinik Mit Schwerpunkt Hepatologie Und Gastroenterologie, Berlin, Get-many Liver transplantation (OLT) in hepatitis C (HCV) positive patients is commonly complicated by recurrence of the underlying disease. However, to date there are no clear predictors for the severity of HCV recurrence. This study was performed to analyze fibrosis progression based on serial performed biopsies and to identify risk factors for outcome in HCV positive patients after OLT. A histological follow-up > 1 year was available in 183 transplants. Median age of the 111 male and 66 female patients was 53 years. Serial liver biopsies were performed l-, 3-, 5, 7-, and lo-years after OLT and scored according to Gerber et al. Predictors for histological progress were virus related, donor variables, recipient demographics, and immunosuppression. The mean fibrosis stage was 1.2 after l-year, 1.7 after 3-years, 1.9 after 5-years, 2.1 after 7 years and 2.2 after 10 years. 30083 (16,4%) of the patients developed fibrosis stage 4 after a mean of 1045 days. Predictors for cirrhosis were multiple steroid pulse therapies and donor age >36. Patients with faster fibrosis progression within the first year had a significantly impaired survival rate (p
I

136

SURVIVAL

IN HIV-INFECTED

TRANSPLANTATION CO-INFECTION:

PERSONS

IS INFLUENCED

POORER

OUTCOME

FOLLOWING

LIVER

BY VIRAL IN HCV-INFECTED

I

137

PREDICTIVE

FACTORS OF HCV RECURRENCE

TRANSPLANTATION

AFTER

LIVER

(OLTX)

S. Pevere, S. Boninsegna,

D. Martines, U. Cillo, l? Burra, l? Boccagni, G. Zanus, D.F. D’Amico, R. Naccarato, S. Fagiuoli. Department Of Surgical And Gastroenterological Sciences, Padova, Italy Post-OLTx HCV recurrence is virtually universal but rate and severity of graft disease and the identification of the factors influencing recurrence are still controversial. Aim of this study was to evaluate features and factors predictive of recurrent HCV in patients transplanted for HCV-related cirrho&. 108 consecutive patients transplanted for HCV related ESLD were evaluated (85 M/23 F, mean age 51&9.2. Mean follow-up was 63.8&32 months. 1, 5, 7-year survival rate were 78%, 72%, 68% respectively. Clinical HCV recurrence was 91%. Median time of HCV recurrence was 15&2 months. Biochemical hepatitis (HEP, ALT > 2 nv) within 6 months after OLTx occurred in 48.7%. One, 3, 5, 7-year recurrent cirrhosis rates were 2%, 9.7%, 14% and 18.4% respectively at median time of 54&3 months. Factors influencing time of recurrence, HEP and development cirrhosis (Cirrh) were evaluated.

Factors

Chi-square test ReCUlTenCe

Logistic Regression

<12 mths P

<6 mths P

P

P

NS 0.01 0.04 0.02

NS 0.07 0.02 NS

0.05 NS 0.03 NS

NS

0.08

NS

0.02 NS NS NS 0.05 NS

Age at OLT < 50 C vs CcETOH HCC No. rejection Response to IFN Ischemia time

ReCLUTenCe

HEP Cirrh

HEP Cirrh

< 12 mths P

<6 mths P

P

P

NS 0.004 NS 0.01

NS 0.01 NS NS

NS NS 0.02 NS

NS

0.02

NS

0.02 NS NS NS 0.07 NS

Conclusions: 1) Timing of recurrence appears to be influenced by concomitant alcoholic etiology (longer) and HCC (shorter). 2) Early recurrence seems to be influenced by &hernia time. 3) Late recurrence is influenced by number of rejection episodes. The development of cirrhosis appears to be mostly related to younger age at OLTx (< 50 years).

PERSONS S. Norris, J.G. O’Grady, C. Taylor, B.C. Portmann, A.S. Knisely, M. Bowles, l? Muiesan, M. Rela, N. Heaton. Institute OfLiver Studies, King’s College Hospital, London, UK

Liver transplantation (LT) in HIV-positive individuals remains an experimental therapy with limited reported worldwide experience, and little longterm survival data. Here, we report our experience in 11 HIV-positive liver allograft recipients, and compare the outcomes of those co-infected with HCV infection to the non-HCV group. Methods: 11 HIV-infected patients (9M, 2F, age range 26-59 years) underwent LT between Jan 1995 -Jan 2002. Indications for LT were HCV (n=5), HBV (n=4), ALD (n=l), and NANB (n=l); 3 patients presented with acute liver failure. All patients survived >30 days. At LT, CD4 counts ranged from 124 to 500 (mean 267), and HIV viral loads from 150 to 1197, 000 copies/ml. 6 of 11 patients were exposed to HAART prior to LT, 5 patients commenced HAART peri-LT. Results: In the non-HCV group (n=6), all patients are alive, with 5 patients surviving greater than 365 days (range 100 - 1925 days). No patient has experienced HBV recurrence, and graft function is normal in all 6 patients. In contrast, all HCV-infected patients died after LT at 95-784 days (median 161 days). Four patients died of complications due to recurrent HCV infection and sepsis, despite antiviral therapy in three, while one patient died of a ruptured cerebral AV malformation. Two patients experienced complications relating to HAART therapy. Conclusion: Long-term outcome of LT in HIV-infected patients with HBV or other causes of chronic liver disease indicates that this is an acceptable therapeutic option. However, the longterm prognosis of HCV/HIV co-infected patients must remain guarded.

I 138

IS INTRAPERITONEAL ADEQUATE FAILURE?

METHOD

HEPATOCYTE FOR TREATING

EXPERIMENTAL

TRANSPLANTATION FULMINANT

AN

LIVER

STUDY IN RATS

C. Pilichos’,

D. Perea2, M. Demonakou3, I. Donta2, A. Preza’, A. Papalois4, l? Karagiannakos2, C. Fotiadis’. ‘3rd Surgical Department, University Of Athens School Of Medicine, Hellas, Greece; 2Surgical Research Department, University OfAthens School Of Medicine, Hellas, Greece; ‘Pathology Department, Sismanoglion General Hospital, Athens, Hellas, Greece; 4Research Unit, ELPEN Pharmaceuticals, Athens, Hellas, Greece Background and Aim: Fulminant liver failure (FLF) is a medical emergency and for its treatment any potential liver support measure must provide immediate and sufficient assist to hepatic function. The aim of our study was to investigate if intraperitoneal hepatocyte transplantation (HCTx), both syngeneic and allogeneic, could adequately support the acutely failing liver, after carbon tetrachloride-induced acute liver injury. Materials and Methods: After CC14 intoxication, eighty-seven male Wistar rats (recipients) were divided in four experimental groups accordingly to their treatment: I (n=24): Fresh syngeneic HCTx, II (n=24): Fresh allogeneic HCTxIII (n=24): 24.hr-cultured allogeneic HCTx and IV (n=15): sham-operated controls. Prior to HCTx, cells were embedded on plastic microcarriers. Survival, liver function tests (LFT) and histology were studied, in all four groups, on days 2, 5 and 10 post-HCTx. Results: Survival: Ten-day and mean survival (days & SD) was respectively: I: 33.3% (5.4 & 3.4), II: 33.3% (5.3 & 3.6), III: 38.8% (5.5 & 3.7), IV: 33.3% (5.4 & 3.6) (P>O.O5). Lm A significant decrease of total bilimbin and SGFT, but not of alkaline phosphatase, was noted during the lo-day