- Email: [email protected]
Sustained Viral Response in Patients with Recurrent Hepatitis C after Liver Transplant Treated with Direct Acting Antivirals (DAA). A Real World Experience
respectively FIB-4 scores (r=0.40, p<0.0001) at 12 weeks after the end of therapy. Independent baseline predictors for LS decrease at SVR12 were the following factors: lower weight (OR=2.65, p=0.008), lower viral load (OR=1.97, p=0.04) and GGT value <2xUNV (OR= 2.07, p=0.03). Conclusions: Patients with SVR after 3D therapy showed significant regression of TE values. Decrease in TE was in concordance with regression of validated fibrosis scores APRI and FIB-4. Initial grade of inflammation did not influence the regression of LS. A better regression of LS is expected in patients with HCV liver cirrhosis and no associated comorbidities as obesity or alcohol consumption.
Tu1547
Background: Liver disease in pregnancy can cause significant morbidity and mortality in both pregnant women and their infants. Asymptomatic elevations in transaminases are often discovered in pregnant women incidentally. Histopathologic diagnosis is rarely indicated given the risk to the mother and fetus. This transient elevation has been described as a physiological change in pregnancy that may be secondary to decrease in relative cardiac output during pregnancy; however no study has shown equivocally if there are modifiable pre-determinants that cause elevated transaminases in pregnancy in patients without a known history of liver disease or viral hepatitis. Our aim was to investigate if there are any patient specific factors leading to elevation in liver enzymes during pregnancy, in order to suggest modifiable changes to prevent it. Methods: A retrospective chart review of patients' medical information and laboratory reports from 2004-2014 was conducted using Mount Sinai St Luke's and Mount Sinai West's electronic medical record. All pregnant women between the ages of 18-50 years who had baseline liver function tests checked at any week during pregnancy were included in the study. Patients were excluded if they have had a history of liver disease or any type of viral hepatitis. Preliminary data analysis consisted of Independent t-test, ANOVA and simple linear regression, using an intent to treat analysis model and was performed in SAS 9.4. Results: The total number of eligible subjects for analysis was 171. The mean for pre-pregnancy AST and ALT are 32.66 ± 21.21 and 35.32 ± 26.13 respectively and peri-pregnancy AST and ALT 41.01 ± 41.67 and 40.57 ± 52.94 respectively. Data analysis is summarized in the Table. With regards to change in AST, a history of chronic hypertension and severe preeclampsia have a mean difference of 31.87 with a significant 95% confidence interval (CI) of 6.15-57.92. For change in ALT, there exists significance between chronic hypertension and severe preeclampsia with a mean difference of 29.655 and a 95% CI of 1.41 to 57.90, as well as significance between exacerbated hypertension and severe preeclampsia with a mean difference of 35.48 with a 95% CI 4.15 to 66.81. Conclusions: A history of chronic hypertension and/or severe preeclampsia in previous gestations was shown to correlate with a significant increase in the liver transaminases during pregnancy. Demographic variables were not associated with a variation in liver enzymes. Larger studies evaluating blood pressure control and preeclampsia prevention may help determine their impact on abnormal liver function tests in our pregnant patient population.
Tu1545 THE PROGNOSIS OF HCV PATIENTS WITH TREATMENT HISTORY OF INTERFERON-FREE THERAPY Yasuhiro Tsuda, Tomohiro Nishikawa, Ken Nakamura, Keisuke Yokohama, Hideko Ohama, Tetsuya Sujishi, Yusuke Tsuchimoto, Akira Asai, Shinya Fukunishi, Kazuhide Higuchi Background: Since the approval of direct-acting antiviral drugs (DAA), three years have passed in Japan. Many chronic hepatitis C (CHC) patients were relieved from chronic viral infection. However, there are not sufficient data on the prognosis of these patients. In this study, we examined the clinical course and prognosis of the patients with post DAA treatment. Methods: From October 2014 to November 2016, a total of 207 Japanese CHC patients at Osaka Medical College were enrolled in this study. For genotype 1 HCV patients, the ASV/ DCV (n=110), SOF/LDV (n=61) or VIEKIRAX® (ombitasvir/ paritaprevir/ritonavir, n=8) therapy were administrated, and genotype 2 HCV patients were treated with SOF/RIB (n= 28). The patients with prior history of treated hepatocellular carcinoma (HCC) who had no defined liver tumor at the time of DAA administration were included to this study. At baseline and during follow up periods, the change of characteristics, laboratory data, cancer development and prognoses were examined. Results: The median follow-up time was 17.2 months. Overall sustained viral responses (SVR) rate was 95.6%. After HCV clearance by DAA therapy, serum ALT levels and albumin levels were significantly improved (p<0.01), and no patients relapsed HCV. However, platelet counts and prothrombin time were not changed. Fourteen patients developed HCC (HCC recurrence 13 cases, new development 1 case). Three patients were appeared HCC in the duration of DAA dosing and the others were detected during follow up periods, and other cancers were developed in 6 patients. Four patients were died after sustained viral responses (HCC 2, other causes 2). Conclusions: After HCV clearance, liver functions were improved. However, a comparatively high rate of HCC recurrences and new cancer development were seen after the interferon-free treatment. Patients treated with DAA may need the careful follow up even if they obtained HCV clearance.
Tu1546 SUSTAINED VIRAL RESPONSE IN PATIENTS WITH RECURRENT HEPATITIS C AFTER LIVER TRANSPLANT TREATED WITH DIRECT ACTING ANTIVIRALS (DAA). A REAL WORLD EXPERIENCE Saurabh Kapur, Hrishikesh V. Samant, Jiten Kothadia, Robyn Rudloff, Rinjal Brahmbhatt, Timothy McCashland, Marco Olivera-Martinez Background: New oral combinations of DAA are well-tolerated with high sustained viral response (SVR) in patients with post liver transplant (LT) recurrent hepatitis C in clinical trials, but "real world" experiences are scarce. The aim of this study is the evaluation of safety and efficacy of various DAA regimens in recurrent hepatitis C after LT. Methods: 107 LT patients with recurrent HC treated at our Institution between December 2013 and February 2016 were reviewed. The main analyzed outcome was SVR 12 weeks after the end of treatment. Results: Amongst the study cohort (71, Male), 93.4% (100/107) achieved SVR including 65% who were INF non-responder. SVR rates for different genotypes and treatment protocols are shown in table. Forty patients had mild side effects: Headache, fatigue, rash and irritability. Eight patients reduced the tacrolimus/cyclosporine dose during antiviral treatment. In 18/68 RBV treated patients; RBV dose was reduced and was discontinued in one due to severe anemia. Three patients died due to complex medical issues while on antiviral therapy; these events were most likely not directly related to DAA. Aside these, no severe side effects of the antiviral regimen were observed and all patients completed the treatment course successfully. Conclusion: Short course regimens of all-oral DAAs are highly effective, safe and well tolerated in LT recipients. Outcome post transplant Hepatitis C treatment per genotype
†Change in AST = Peri-Pregnancy AST - Pre-Pregnancy AST ‡Change in ALT = Peri-Pregnancy ALT - Pre-Pregnancy ALT §Significance exists between Chronic Hypertension and Severe Preeclampsia with a mean difference of 31.87 with a 95% CI of 6.15-57.92. §§Significance exists between Chronic Hypertension and Severe Preeclampsia with a mean difference of 29.655 with a 95% CI of 1.41 to 57.90 and significance exists between Exacerbated Hypertension and Severe Preeclampsia with a mean difference of 35.48 with a 95% CI 4.15 to 66.81. *Significance between HELLP Syndrome and all other categories, but given only one
S-905
AGA Abstracts
AGA Abstracts
ARE THERE PRE-DETERMINANTS FOR ELEVATED LIVER ENZYMES IN PREGNANT WOMEN? Michael E. Herman, Daniel Castaneda, Rupa L. Iyengar, Praneet Wander, Bharat Monga, Ritu Singh, Zainab Al-Ibraheemi, Graham Ashmead, Olanma Okoji
Tu1547
Background: Liver disease in pregnancy can cause significant morbidity and mortality in both pregnant women and their infants. Asymptomatic elevations in transaminases are often discovered in pregnant women incidentally. Histopathologic diagnosis is rarely indicated given the risk to the mother and fetus. This transient elevation has been described as a physiological change in pregnancy that may be secondary to decrease in relative cardiac output during pregnancy; however no study has shown equivocally if there are modifiable pre-determinants that cause elevated transaminases in pregnancy in patients without a known history of liver disease or viral hepatitis. Our aim was to investigate if there are any patient specific factors leading to elevation in liver enzymes during pregnancy, in order to suggest modifiable changes to prevent it. Methods: A retrospective chart review of patients' medical information and laboratory reports from 2004-2014 was conducted using Mount Sinai St Luke's and Mount Sinai West's electronic medical record. All pregnant women between the ages of 18-50 years who had baseline liver function tests checked at any week during pregnancy were included in the study. Patients were excluded if they have had a history of liver disease or any type of viral hepatitis. Preliminary data analysis consisted of Independent t-test, ANOVA and simple linear regression, using an intent to treat analysis model and was performed in SAS 9.4. Results: The total number of eligible subjects for analysis was 171. The mean for pre-pregnancy AST and ALT are 32.66 ± 21.21 and 35.32 ± 26.13 respectively and peri-pregnancy AST and ALT 41.01 ± 41.67 and 40.57 ± 52.94 respectively. Data analysis is summarized in the Table. With regards to change in AST, a history of chronic hypertension and severe preeclampsia have a mean difference of 31.87 with a significant 95% confidence interval (CI) of 6.15-57.92. For change in ALT, there exists significance between chronic hypertension and severe preeclampsia with a mean difference of 29.655 and a 95% CI of 1.41 to 57.90, as well as significance between exacerbated hypertension and severe preeclampsia with a mean difference of 35.48 with a 95% CI 4.15 to 66.81. Conclusions: A history of chronic hypertension and/or severe preeclampsia in previous gestations was shown to correlate with a significant increase in the liver transaminases during pregnancy. Demographic variables were not associated with a variation in liver enzymes. Larger studies evaluating blood pressure control and preeclampsia prevention may help determine their impact on abnormal liver function tests in our pregnant patient population.
Tu1545 THE PROGNOSIS OF HCV PATIENTS WITH TREATMENT HISTORY OF INTERFERON-FREE THERAPY Yasuhiro Tsuda, Tomohiro Nishikawa, Ken Nakamura, Keisuke Yokohama, Hideko Ohama, Tetsuya Sujishi, Yusuke Tsuchimoto, Akira Asai, Shinya Fukunishi, Kazuhide Higuchi Background: Since the approval of direct-acting antiviral drugs (DAA), three years have passed in Japan. Many chronic hepatitis C (CHC) patients were relieved from chronic viral infection. However, there are not sufficient data on the prognosis of these patients. In this study, we examined the clinical course and prognosis of the patients with post DAA treatment. Methods: From October 2014 to November 2016, a total of 207 Japanese CHC patients at Osaka Medical College were enrolled in this study. For genotype 1 HCV patients, the ASV/ DCV (n=110), SOF/LDV (n=61) or VIEKIRAX® (ombitasvir/ paritaprevir/ritonavir, n=8) therapy were administrated, and genotype 2 HCV patients were treated with SOF/RIB (n= 28). The patients with prior history of treated hepatocellular carcinoma (HCC) who had no defined liver tumor at the time of DAA administration were included to this study. At baseline and during follow up periods, the change of characteristics, laboratory data, cancer development and prognoses were examined. Results: The median follow-up time was 17.2 months. Overall sustained viral responses (SVR) rate was 95.6%. After HCV clearance by DAA therapy, serum ALT levels and albumin levels were significantly improved (p<0.01), and no patients relapsed HCV. However, platelet counts and prothrombin time were not changed. Fourteen patients developed HCC (HCC recurrence 13 cases, new development 1 case). Three patients were appeared HCC in the duration of DAA dosing and the others were detected during follow up periods, and other cancers were developed in 6 patients. Four patients were died after sustained viral responses (HCC 2, other causes 2). Conclusions: After HCV clearance, liver functions were improved. However, a comparatively high rate of HCC recurrences and new cancer development were seen after the interferon-free treatment. Patients treated with DAA may need the careful follow up even if they obtained HCV clearance.
Tu1546 SUSTAINED VIRAL RESPONSE IN PATIENTS WITH RECURRENT HEPATITIS C AFTER LIVER TRANSPLANT TREATED WITH DIRECT ACTING ANTIVIRALS (DAA). A REAL WORLD EXPERIENCE Saurabh Kapur, Hrishikesh V. Samant, Jiten Kothadia, Robyn Rudloff, Rinjal Brahmbhatt, Timothy McCashland, Marco Olivera-Martinez Background: New oral combinations of DAA are well-tolerated with high sustained viral response (SVR) in patients with post liver transplant (LT) recurrent hepatitis C in clinical trials, but "real world" experiences are scarce. The aim of this study is the evaluation of safety and efficacy of various DAA regimens in recurrent hepatitis C after LT. Methods: 107 LT patients with recurrent HC treated at our Institution between December 2013 and February 2016 were reviewed. The main analyzed outcome was SVR 12 weeks after the end of treatment. Results: Amongst the study cohort (71, Male), 93.4% (100/107) achieved SVR including 65% who were INF non-responder. SVR rates for different genotypes and treatment protocols are shown in table. Forty patients had mild side effects: Headache, fatigue, rash and irritability. Eight patients reduced the tacrolimus/cyclosporine dose during antiviral treatment. In 18/68 RBV treated patients; RBV dose was reduced and was discontinued in one due to severe anemia. Three patients died due to complex medical issues while on antiviral therapy; these events were most likely not directly related to DAA. Aside these, no severe side effects of the antiviral regimen were observed and all patients completed the treatment course successfully. Conclusion: Short course regimens of all-oral DAAs are highly effective, safe and well tolerated in LT recipients. Outcome post transplant Hepatitis C treatment per genotype
†Change in AST = Peri-Pregnancy AST - Pre-Pregnancy AST ‡Change in ALT = Peri-Pregnancy ALT - Pre-Pregnancy ALT §Significance exists between Chronic Hypertension and Severe Preeclampsia with a mean difference of 31.87 with a 95% CI of 6.15-57.92. §§Significance exists between Chronic Hypertension and Severe Preeclampsia with a mean difference of 29.655 with a 95% CI of 1.41 to 57.90 and significance exists between Exacerbated Hypertension and Severe Preeclampsia with a mean difference of 35.48 with a 95% CI 4.15 to 66.81. *Significance between HELLP Syndrome and all other categories, but given only one
S-905
AGA Abstracts
AGA Abstracts
ARE THERE PRE-DETERMINANTS FOR ELEVATED LIVER ENZYMES IN PREGNANT WOMEN? Michael E. Herman, Daniel Castaneda, Rupa L. Iyengar, Praneet Wander, Bharat Monga, Ritu Singh, Zainab Al-Ibraheemi, Graham Ashmead, Olanma Okoji