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HDV and occult HBV infected patients
Abstracts of the 46th A.I.S.F. Annual Meeting 2013 / Digestive and Liver Disease 45S (2013), S1–S48 away from their Transplant Centers (TC). Many LTP, however, continue to depend from TC of origin for certain invasive procedures such as protocol or on-demand liver biopsy (LB). Transient elastography (TE, Fibroscan® ) is an alternative non-invasive tool useful in LTP both with recurrence of hepatitis C and with other graft diseases: we revised this role in our Unit operating away from TC. Patients and methods: A dynamic TE-kPa-value was defined clinically significant and worthy of a more detailed study when both a second and a third measurement, after six and nine-twelve months respectively, proved higher than the basal TE. LTP (n=123) were divided in two groups: G1 (n=38) with biopsy-proven recurrent chronic hepatitis C patients, a well-known possibly progressive situation, and G2 (n=85) with possibly relatively stable patients, transplanted for HCV (n=18, healed), HBV (n=50), ethanol (n=10), other diseases (n=7). Results: G1-patients had basal kPa-values distributed in all Metavir stages of fibrosis (F0–1 = 42%, F2–3 = 32%, F4 = 26%), while absent/mild fibrosis prevailed in G2-patients (respectively F0–1 = 80%, F2–3 = 12%, F4 = 8%). G1-patients showed median kPa-values statistically significantly higher than G2-patients also at months 6 and 9–12. Significantly increased kPa-values were observed in 12 G1-patients (32%), leading to endoscopy (5, esophageal varices), antiviral therapy (5), and LB (2, severe fibrosis), as well as in 9 G2-patients (10%), associated with recurrent cholangitis (3) and stimulating endoscopy (2, esophageal varices) or LB (2, chronic rejection; 2, idiopathic chronic hepatitis). Conclusions: In our real-world experience dynamic variations of TE over time, suggesting graft disease of any etiology, provide an appropriate monitoring tool of LTP both to indicate and to avoid LB as well as other diagnostic and therapeutic choices. Acknowledgment: Study supported by Progetto SATTE – Regione Campania (DGR 1389/2009)
T-50 Patients/doctors/nurses relationship after liver transplantation: a prospective study on patient’s satisfaction M. De Placido 1 , R. Clarizia 2 , P. Scialoja 1 , F.P. Picciotto 3 , M. Masarone 4 , G.G. Di Costanzo 3 , A. Ascione 4 1 Istituto Universitario Suor Orsola Benincasa, Cattedra di Psicologia delle Organizzazioni, Napoli; 2 Cattedra di Ostetricia e Ginecologia, Università “Federico II”, Napoli e Scuola Internazionale di Anatomia Chirurgica, Negrar, Verona; 3 AORN Cardarelli, UOSC di Epatologia; 4 Centro per le malattie del fegato, Ospedale Fatebenefratelli, Napoli, Italy
Background and aims: In health care systems, patient’s satisfaction is one of the most important issues. Studies measuring this particular aspect are very few and the techniques not standardized. The aims of this prospective research were 1. To prepare and test a questionnaire on patient’s satisfaction after liver transplantation, and 2. Use it to check the patients/doctors/nurses relationship and the level of acceptance from the patients. Patients and methods: 131 liver transplant patients (83.2% male) using a random sampling technique were selected, among 456 regularly followed as outpatients. An expert (MDP), external to the Unit, administered the questionnaire. Data were stratified according to the level of education of the patient. Results: 88 (67.2%) patients considered medical staff to be helpful/friendly, while 87 (66.4%) expressed this for the nurses; 38 (29%) considered medical staff “professional”, while 27 (20.6%) of them made this choice for nurses. Ninety patients (68.7%) felt that they were being properly assisted and reassured (23.6%), while 2.3% felt abandoned and 5.3% confused. As for the language used by the hospital staff, 94 (71.7%) considered it simple and understandable, but 23.6% judged it as too technical. The need for more dialogue was expressed by 18.3%, while 19.3% asked to be more involved in choices of treatment; 81.7% trusted the decisions of the doctors or felt involved in the decision-making process. Thirty-nine (29.7%) claimed the necessity to receive more comprehensible information from doctors and nurses. The confidentiality of conversations with doctors/nurses was considered to be respected by 82.4%. Thirty-six patients (27.5%) asked for more reassurance from doctors. As for the language used by the staff, 4.6% with a low level of education considered it “too technical”.
S29
Conclusion: Satisfaction of patients was quite good, with only a small percentage of complain. This kind of test is very useful to improve the level of acceptance from the patients.
T-51 Study of HBV (re)infection in the course of liver transplantation in HBV, HBV/HDV and occult HBV infected patients T. Pollicino 1 , L. Caccamo 2 , M.F. Donato 3 , G. Raffa 1 , G. Rossi 2 , G. Raimondo 1 1 Department
of Internal Medicine, University Hospital of Messina, Messina; of Liver Transplantation; 3 Gastroenterology, Fondazione IRCCS Maggiore Hospital Milan, Milan, Italy 2 Department
Long-term anti-HBV prophylaxis has been highly effective in reducing the rate of HBV recurrence in HBsAg-positive patients or de novo infection in HBsAg-negative liver transplant recipients of anti-HBc positive hepatic grafts. Despite prophylaxis, however, HBV reinfection may occur in a considerable number of patients. Aim: To verify the possible occurrence of liver HBV reinfection in HBsAgpositive and HBV/HDV coinfected patients as well as de novo infection in HBsAg-negative liver transplant recipients in the course of LT. Methods: Explanted and transplanted liver tissues from 21 patients (5 with HBV-related, 6 with HBV/HDV-related and 10 with HCV-related chronic liver disease) were analysed. All but one donor were HBsAg-negative, 6 were anti-HBc positive, 14 were negative for all serum markers. From transplanted livers, biopsy specimens obtained before LT, in post-perfusion period and at end of LT were available. HBV DNA was tested by nested-PCR amplifications. Total HBV DNA, HBV cccDNA and HDV RNA were quantified by real time-PCR approaches. Results: At the end of surgery, 2/5 HBsAg-positive patients (both donors were anti-HBc positive), 1/6 HBV/HDV co-infected patients (the donor was HBsAg-positive) and 2/10 HCV-infected patients (one donor was anti-HBc positive and the other anti-HBc negative) showed quantifiable amounts of HBV DNA in the liver (range: 6×10–4 –1×10–3 copies/cells). Sequencing analysis of HBV isolates showed that they were donor viral strains. HBVcccDNA could be detected and quantified (range: 2×10–5 –2×10–3 copies/cell) in all the HBV-positive patients. None of the HBV/HDV-infected patients showed HDV RNA in the transplanted liver. Conclusions: (1) HBVs infecting the transplanted liver cause the re-infection of the recipients in the course of LT; (2) HDV does not re-infect the transplanted liver at the time of LT; (3) occult HBV infection may be present in transplanted liver and may persist during LT independently of the donor anti-HBc status.
T-52 The role of immunity and gender during acute liver injury R. Di Liddo 1 , V. Amodio 1 , A. Cappon 2 , D. Arcidiacono 2 , D. Bizzaro 2 , A. Tasso 1 , M.T. Conconi 1 , P. Parnigotto 3 , G.C. Sturniolo 2 , P. Burra 2 , F.P. Russo 2 1 Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Italy; 2 Department of Surgical, Oncological and Gastroenterological Sciences, Section of Gastroenterology, University Hospital Padova; 3 T.E.S Foundation ONLUS, Padua, Italy
Background: Several lines of evidence have emerged indicating sexual dimorphism in the immune response of the acute phase of the inflammatory process. Aims: To evaluate murine response to acute liver damage a flow cytometry characterization of recruited monocytes and lymphocytes at different time points was performed. In order to define a correlation between gender and infiltrating inflammatory cells, female and male mice were treated with flutamide, an androgen receptor inhibitor, following liver damage. Methods: An injection of flutamide (i.p 50 mg/kg in olive oil) per day was performed on Balb/c mice aging 8 weeks following a single CCl4 administration (i.p 0.75 ml/kg in olive oil). Animals were sacrificed at different
T-50 Patients/doctors/nurses relationship after liver transplantation: a prospective study on patient’s satisfaction M. De Placido 1 , R. Clarizia 2 , P. Scialoja 1 , F.P. Picciotto 3 , M. Masarone 4 , G.G. Di Costanzo 3 , A. Ascione 4 1 Istituto Universitario Suor Orsola Benincasa, Cattedra di Psicologia delle Organizzazioni, Napoli; 2 Cattedra di Ostetricia e Ginecologia, Università “Federico II”, Napoli e Scuola Internazionale di Anatomia Chirurgica, Negrar, Verona; 3 AORN Cardarelli, UOSC di Epatologia; 4 Centro per le malattie del fegato, Ospedale Fatebenefratelli, Napoli, Italy
Background and aims: In health care systems, patient’s satisfaction is one of the most important issues. Studies measuring this particular aspect are very few and the techniques not standardized. The aims of this prospective research were 1. To prepare and test a questionnaire on patient’s satisfaction after liver transplantation, and 2. Use it to check the patients/doctors/nurses relationship and the level of acceptance from the patients. Patients and methods: 131 liver transplant patients (83.2% male) using a random sampling technique were selected, among 456 regularly followed as outpatients. An expert (MDP), external to the Unit, administered the questionnaire. Data were stratified according to the level of education of the patient. Results: 88 (67.2%) patients considered medical staff to be helpful/friendly, while 87 (66.4%) expressed this for the nurses; 38 (29%) considered medical staff “professional”, while 27 (20.6%) of them made this choice for nurses. Ninety patients (68.7%) felt that they were being properly assisted and reassured (23.6%), while 2.3% felt abandoned and 5.3% confused. As for the language used by the hospital staff, 94 (71.7%) considered it simple and understandable, but 23.6% judged it as too technical. The need for more dialogue was expressed by 18.3%, while 19.3% asked to be more involved in choices of treatment; 81.7% trusted the decisions of the doctors or felt involved in the decision-making process. Thirty-nine (29.7%) claimed the necessity to receive more comprehensible information from doctors and nurses. The confidentiality of conversations with doctors/nurses was considered to be respected by 82.4%. Thirty-six patients (27.5%) asked for more reassurance from doctors. As for the language used by the staff, 4.6% with a low level of education considered it “too technical”.
S29
Conclusion: Satisfaction of patients was quite good, with only a small percentage of complain. This kind of test is very useful to improve the level of acceptance from the patients.
T-51 Study of HBV (re)infection in the course of liver transplantation in HBV, HBV/HDV and occult HBV infected patients T. Pollicino 1 , L. Caccamo 2 , M.F. Donato 3 , G. Raffa 1 , G. Rossi 2 , G. Raimondo 1 1 Department
of Internal Medicine, University Hospital of Messina, Messina; of Liver Transplantation; 3 Gastroenterology, Fondazione IRCCS Maggiore Hospital Milan, Milan, Italy 2 Department
Long-term anti-HBV prophylaxis has been highly effective in reducing the rate of HBV recurrence in HBsAg-positive patients or de novo infection in HBsAg-negative liver transplant recipients of anti-HBc positive hepatic grafts. Despite prophylaxis, however, HBV reinfection may occur in a considerable number of patients. Aim: To verify the possible occurrence of liver HBV reinfection in HBsAgpositive and HBV/HDV coinfected patients as well as de novo infection in HBsAg-negative liver transplant recipients in the course of LT. Methods: Explanted and transplanted liver tissues from 21 patients (5 with HBV-related, 6 with HBV/HDV-related and 10 with HCV-related chronic liver disease) were analysed. All but one donor were HBsAg-negative, 6 were anti-HBc positive, 14 were negative for all serum markers. From transplanted livers, biopsy specimens obtained before LT, in post-perfusion period and at end of LT were available. HBV DNA was tested by nested-PCR amplifications. Total HBV DNA, HBV cccDNA and HDV RNA were quantified by real time-PCR approaches. Results: At the end of surgery, 2/5 HBsAg-positive patients (both donors were anti-HBc positive), 1/6 HBV/HDV co-infected patients (the donor was HBsAg-positive) and 2/10 HCV-infected patients (one donor was anti-HBc positive and the other anti-HBc negative) showed quantifiable amounts of HBV DNA in the liver (range: 6×10–4 –1×10–3 copies/cells). Sequencing analysis of HBV isolates showed that they were donor viral strains. HBVcccDNA could be detected and quantified (range: 2×10–5 –2×10–3 copies/cell) in all the HBV-positive patients. None of the HBV/HDV-infected patients showed HDV RNA in the transplanted liver. Conclusions: (1) HBVs infecting the transplanted liver cause the re-infection of the recipients in the course of LT; (2) HDV does not re-infect the transplanted liver at the time of LT; (3) occult HBV infection may be present in transplanted liver and may persist during LT independently of the donor anti-HBc status.
T-52 The role of immunity and gender during acute liver injury R. Di Liddo 1 , V. Amodio 1 , A. Cappon 2 , D. Arcidiacono 2 , D. Bizzaro 2 , A. Tasso 1 , M.T. Conconi 1 , P. Parnigotto 3 , G.C. Sturniolo 2 , P. Burra 2 , F.P. Russo 2 1 Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Italy; 2 Department of Surgical, Oncological and Gastroenterological Sciences, Section of Gastroenterology, University Hospital Padova; 3 T.E.S Foundation ONLUS, Padua, Italy
Background: Several lines of evidence have emerged indicating sexual dimorphism in the immune response of the acute phase of the inflammatory process. Aims: To evaluate murine response to acute liver damage a flow cytometry characterization of recruited monocytes and lymphocytes at different time points was performed. In order to define a correlation between gender and infiltrating inflammatory cells, female and male mice were treated with flutamide, an androgen receptor inhibitor, following liver damage. Methods: An injection of flutamide (i.p 50 mg/kg in olive oil) per day was performed on Balb/c mice aging 8 weeks following a single CCl4 administration (i.p 0.75 ml/kg in olive oil). Animals were sacrificed at different