Tu1020 Impact of Pre-Transplant Left Ventricular Diastolic Dysfunction on Post-Transplant Acute Graft Rejection

Tu1020 Impact of Pre-Transplant Left Ventricular Diastolic Dysfunction on Post-Transplant Acute Graft Rejection

significantly patients' survival was poor tumor differentiation-G3 (54.5% vs 28.6%, P=.03) in those with pkHCC, no factor was identified in the group ...

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significantly patients' survival was poor tumor differentiation-G3 (54.5% vs 28.6%, P=.03) in those with pkHCC, no factor was identified in the group of iHCC. Conclusion: Despite an incidental finding, patients with iHCC do not differ from pkHCC in terms of recurrencefree survival and overall survival. The occurrence of iHCC significantly influences the posttransplant prognosis similarly to the patients with pkHCC. Table 1.

post-LT. These associations with infections and CVD were also significant with denovo MetS after LT. The occurrence of NAFLD with MetS did not increase the rate of these complications compared to MetS alone. In patients without MetS, NAFLD was associated with a modestly higher risk of CVD (14%) compared to patients without NAFLD (0%), P = 0.03. Kaplan Meier survival analysis did not find a significant difference in post LT survival with the occurrence of either MetS and/or NAFLD. In conclusion, MetS is common after LT with a significant proportion of it developing de novo. The presence of MetS after LT may lead to increased early morbidity with infection and later morbidity with CVD. The association of NAFLD with MetS does not increase the rate of clinically significant CVD, infections, and malignancy related complications compared to MetS alone. Prospective studies on the aggressive management of MetS and associated conditions post-LT may demonstrate improved outcomes. Tu1020

Introduction - Acute cellular rejection is a major cause of morbidity and graft failure in liver transplant (LT) recipients. Diastolic dysfunction has been shown to reduce graft survival and increase mortality in liver transplant recipients. However, it is unclear if there is a direct effect of diastolic dysfunction on acute cellular rejection leading to increased morbidity and mortality in LT recipients. Methods - Data were collected retrospectively for consecutive LT recipients between January 2000 and December 2010. Demographic and mortality-related data were obtained from the social security index. The primary outcome was biopsy proven acute cellular rejections. Graft failure and all-cause mortality were also evaluated. Diastolic dysfunction and various echocardiographic indices were assessed as predictors of acute cellular rejection by using Cox proportional hazard model. Results - A total of 970 liver transplant recipients (mean age 53.2 ±10 years, women 34.6% and white 64.5%) were followed for 5.3 ± 3.4 years. Patients with diastolic dysfunction (n=145, 14.9%) were significantly more likely to develop acute cellular rejection (HR 10.56; 95% CI 6.78 - 16.45, p = 0.0001) and graft failure (HR 2.09; 95% CI 1.22 - 3.59, p = 0.007), and demonstrated higher all-cause mortality (HR 1.52; 95% CI 1.08 - 2.13, p = 0.01). There was an incremental increase in the risk of these outcomes with worsening diastolic dysfunction, when adjusted for various risk factors such as donor and recipient age, gender, race, framingham risk score, pre-transplant MELD, transplant etiology and cold ischemia time. Conclusion - Pre-transplant diastolic dysfunction is significantly associated with an increased risk of allograft rejection, graft failure and mortality, thus requiring consideration during the pre-transplant cardiac evaluation. Mortality Associated with Various Grades of Diastolic Dysfunction

Tu1018 Sirolimus Based Immunosuppression Is Associated With Need for Early Repeat Therapeutic ERCP in Liver Transplant Patients With Anastomotic Biliary Stricture James H. Tabibian, Mohit Girotra, Hsin-Chieh Yeh, Murat T. Gulsen, Vikesh K. Singh, Guldane Cengiz-Seval, Dorry L. Segev, Andrew M. Cameron, Ahmet Gurakar INTRODUCTION: Sirolimus has inhibitory effects on epithelial healing and cholangiocyte regeneration. In liver transplantation (LT) patients, these effects may be greatest at the biliary anastomosis. We therefore investigated whether sirolimus use is associated with need for early or emergent repeat therapeutic endoscopic retrograde cholangiography (ERC) in LT patients with anastomotic biliary stricture (ABS). METHODS: Medical records of patients who underwent LT from 1998-2009 at Johns Hopkins Hospital were reviewed, patients with ABS identified, and pertinent patient, surgical, and endoscopic data abstracted. The primary outcome was early repeat ERC, defined as need for early (i.e. unplanned) or emergent repeat therapeutic ERC accompanied by signs or symptoms suggestive of biliary obstruction and/or stent occlusion. Univariate and multivariate logistic regression analyses (adjusting for age, sex, LT to ERC time, and stent number) were performed to assess the association between sirolimus-based immunosuppression and early repeat ERC. RESULTS: 45 patients developed ABS and underwent a total of 156 ERCs. Early repeat ERC occurred (at a median of 26 days) in 14/56 (25%) and 6/100 (6%) ERCs performed with and without concomitant sirolimus-based immunosuppression, respectively (OR 1.22; 95% CI 1.02-1.45; p=0.03). In multivariate analysis, sirolimus use was associated with early repeat ERC (OR 1.24; 95% CI 1.04-1.47; p=0.015); this association remained significant when sirolimus dose was modeled as a continuous variable (OR 1.40 per mg/day; 95% CI 1.20-2.02; p=0.038). CONCLUSIONS: Sirolimus-based immunosuppression appears to be associated with a modest but significantly increased, dose-dependent risk of early repeat ERC in LT patients with ABS. Prospective studies are needed to further investigate these findings and determine if sirolimus use or dose should be reconsidered once ABS is diagnosed. Multivariate analysis of the association between sirolimus use and early repeat ERC

Adjusted for gender, race, transplant etiology, cold ischemia time, donor and recipient age, pre-transplant MELD score, and Framingham risk score Risk of Graft Gailure with Various Grades of Diastolic Dysfunction

*Adjusted for gender, race, cold ischemia time, donor and recipient age, pre-transplant MELD score, and Framingham Risk score

Tu1019 Development of the Metabolic Syndrome and Its Outcomes After Liver Transplantation Nicholas Kim, Kimberly Daniel, Adnan Said

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Metabolic syndrome (MetS) is a growing epidemic associated with NAFLD (nonalcoholic fatty liver disease), which is an increasingly common indication for liver transplantation (LT). MetS is a common complication after LT due to a variety of reasons including immunosuppressive medications. We studied the effects of MetS on outcomes after LT focusing on the NAFLD phenotype. We performed a retrospective cohort study on 158 LT recipients at a single institution from 2002-2007 with follow up until September 2012. Patients were identified as having NAFLD based on history and histopathology. Patients were classified as having MetS pre-LT and at 6 and 12 months post-LT based on modified criteria from the IDF and AHA/NHLBI 2009 joint scientific statement. Recorded outcomes included hospitalizations for cardiovascular disease (CVD), infection, malignancy, cellular rejection, and death by years 1, 3, and 5 post-LT. 38 of 158 patients in our cohort were transplanted for NALFD. Patients with or without MetS pre-LT had similar baseline demographic data and no significant difference in MELD score prior to LT. MetS was common pre-LT (25%) and increased by 6 months post-LT (51%) and by 12 months post-LT (61%). A large proportion of patients without MetS pre-LT developed de novo MetS by 6 months post-LT (31%) and by 12 months post-LT (54%). The occurrence of MetS at 6 months post-LT was associated with excess hospitalizations for infections within the first year after LT (53% vs. 31% for those without MetS, P = 0.005). The occurrence of MetS at 6 months post-LT was associated with increased hospitalizations for CVD after the first post transplant year; the rate of CVD hospitalizations was 26% vs. 13% for those without MetS (P = 0.05) by 5 years

Risk of Hepatic Resection in Renal Patients: A NSQIP Study Shirley R. Domingo, Kyle Norman, Whitney Limm, Linda L. Wong BACKGROUND: Single center, retrospective studies have shown that renal insufficiency is an independent risk factor for morbidity in patients undergoing hepatic resection. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) includes prospective, peer-controlled and validated data from over 400 U.S. hospitals. We retrospectively queried the database for hepatic resections and compared characteristics and outcomes in patients with acute renal failure or require chronic dialysis to those patients without renal dysfunction. STUDY DESIGN: We queried the ACS NSQIP database from 2005-2011 for patients who underwent hepatic resections. Patients were grouped by presence of acute renal failure or require chronic dialysis (end stage renal disease, ESRD) versus patients without ESRD. Cirrhotic patients were excluded. We reviewed demographics, operative trends, and short-term outcomes. RESULTS: 8326 patients were analyzed; 29 with ESRD (0.3%) and 8297 (99.7%) without ESRD. ESRD patients were younger (56.4 & 59.4, p,0.22), less obese (mean BMI 27.8 & 29.1, p ,0.30), and had higher American Society of Anesthesiologists scores than non-ESRD patients (3.4 & 2.7, p ,0.0001). ESRD patients were 4.03 times as likely to have diabetes compared to non-ESRD patients (95% confidence interval [CI] 1.93-8.39). ESRD patients had lower albumin (3.41 & 3.98, p ,0.0001), lower hematocrit (35.45 & 39.06, p,0.0001), and higher alkaline phosphatase (132.48 & 119,

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AASLD Abstracts

AASLD Abstracts

Impact of Pre-Transplant Left Ventricular Diastolic Dysfunction on PostTransplant Acute Graft Rejection Chetan Mittal, Sumit Singla, Waqas Qureshi, Syed Hassan, Umair Ahmad, Mary Ann Y. Huang