Session Title: Liver Transplantation: Immunosuppression, Outcomes, and Complications
Session Type: Poster Sessions
Location: West Hall (Moscone West
Convention Center
Start time: Sat, Nov 01 - 2:00 PM
Liver
Transplantation – General
P. K. Jalal; N. S.
Becker; P. Shroff; N. L. Sussman; C. O'Mahony; J. A. Goss; R. Stribling; J. M.
Vierling.
Background:
HCV cirrhosis is the most common indication for OLT in the
Aim:
To identify variables that predict patient and graft
survivals in patients transplanted for HCV.
Methods:
We performed a retrospective observational cohort study using
the UNOS database for adult liver transplants (>18 yrs). Patients with multiorgan
transplantation or retransplantation were excluded. Predictors of patient and
graft survival in HCV patients transplanted in the MELD era (2002-2007) were
identified using univariate and multivariate analyses.
Results:
·
Overall
adult recipients 1991-2007: 59,605
·
Of
these 25,052 (42%) adult patients were HCV+, and 12,351 (50%) were transplanted
in the MELD era.
·
Univariate
analyses identified nine variables as prognostic indicators for patient and
graft survivals.
o
Donor
age > 60 years
o
Serum
Creatinine >1.5 mg/dl
o
African
American race
o
ICU
stay at transplantation
o
Recipient
age >60 years
o
Cold
ischemia >6 hours
o
Diabetes
mellitus
o
Female
gender
o
Serum
albumin <2.5 g/dl.
Conclusions:
·
Multivariate
analysis identified nine predictors of both patient and graft survivals after
OLT for HCV cirrhosis in the MELD era.
·
Only
four variables can be potentially modified before OLT: albumin <2.5 (an
indicator of malnutrition), creatinine >1.5, donor age >60 yrs and cold
ischemia time >6 h.
·
The
impact of prospective modification of these variables on patient and graft
survivals after OLT for HCV should be systematically studied.
|
Variable |
Patient Survival |
p value |
Graft Survival |
p value |
|
Donor age > 60 yrs |
1.71 (1.51 - 1.93) |
<0.001 |
1.73 (1.56 - 1.93) |
<0.001 |
|
Serum creatinine > 1.5 mg/dL |
1.41 (1.26 - 1.57) |
<0.001 |
1.26 (1.14 - 1.39) |
<0.001 |
|
AA Race |
1.36 (1.18 - 1.57) |
<0.001 |
1.39 (1.22 - 1.57) |
<0.001 |
|
ICU Stay at transplantation |
1.33 (1.13 - 1.57) |
0.001 |
1.28 (1.10 - 1.48) |
0.001 |
|
Recipient age > 60 yrs |
1.32 (1.17 - 1.50) |
<0.001 |
1.14 (1.02 - 1.27) |
0.021 |
|
Cold ischemia > 6 hrs |
1.25 (1.12 - 1.39) |
<0.001 |
1.24 (1.13 - 1.35) |
<0.001 |
|
Diabetes Mellitus |
1.19 (1.06 - 1.34) |
0.004 |
1.13 (1.02 - 1.26) |
0.021 |
|
Female gender |
1.18 (1.06 - 1.31) |
0.003 |
1.14 (1.04 - 1.25) |
0.007 |
|
Serum albumin < 2.5 g/dL |
1.17 (1.06 - 1.30) |
0.002 |
1.11 (1.02 - 1.21) |
0.02 |
Liver Transplantation – Epidemiology
545. Racial
Disparities in Patient Survivals After Pediatric
Liver Transplantation.
N. S. Becker; O. A.
Taylor; J. Anguay; N. L. Sussman; C. O'Mahony; J. A. Goss.
Introduction:
Recent studies have demonstrated that adult African-American
recipients of orthotopic liver transplantation (OLT) have poor patient
survivals when compared to Caucasian recipients. Little is known about racial
differences in pre-transplant variables and outcomes after pediatric OLT. The
purpose of this study is to examine post-OLT graft and patient survivals in
transplant recipients age 17 and under.
Methods:
The United Network for Organ Sharing (UNOS) dataset was
obtained for the years 2002-2007. Data was extracted for all pediatric (<18
years of age) primary OLT recipients (n=2,967). Racial differences in
pre-transplant variables were examined. Graft and patient survivals stratified
by racial group were calculated and compared.
Results:
Data was available for 2,700 pediatric transplant recipients.
Caucasians (CA) were the largest racial group (55%), followed by Hispanics (HA)
(22%), African-Americans (AA) (17%), and Asians (AsA) (5%). Comparing racial
groups, AA and HA were more likely to have a diagnosis of fulminant hepatic
failure then were CA or AsA. AsA were more likely to have a listing diagnosis
of biliary atresia. HA were younger at time of transplant, and HA and AA were
more likely to be female. There were no significant differences among racial
groups in % of patients transplanted at Status 1, PELD/MELD score at
transplant, or % of patients undergoing multiorgan transplant (all p-values
>0.05) (Table 1). Overall 30-day mortality was 3.7% and was similar among
racial groups (p=0.180). Three-year graft survivals were similar: CA: 76%, AA:
76%, HA: 80% and AsA: 85%; p=0.308. Likewise, patient survivals did not differ
among racial groups, with 3-year patients survivals for CA, AA, HA, and AsA of
86%, 83%, 87%, and 92%, respectively, p=0.448.
Discussion:
Although racial disparities in outcomes after liver
transplantation exist in the adult population, this study does not demonstrate
any such inequality in the pediatric population. Examining differences between
the pediatric and adult OLT populations may help to elucidate why such
disparities are observed in adults.
Table 1
|
|
Caucasians
|
African-Americans |
Hispanics |
Asians |
p-value |
|
% Status 1 |
28% |
31% |
34% |
29% |
0.06 |
|
% Fulminant |
10% |
14% |
16% |
9% |
<0.01 |
|
% Biliary Atresia/ Cholestatic Liver Disease |
35% |
39% |
35% |
45% |
0.03 |
|
Mean PELD/MELD |
20±13 |
21±11 |
21±14 |
22±13 |
0.55 |
|
% Multiorgan |
15% |
13% |
12% |
7% |
0.07 |
|
Mean Age |
5.3±5.9 |
5.2±6.0 |
4.0±5.3 |
4.9±5.8 |
<0.01 |
|
% Ventilated |
7% |
10% |
10% |
7% |
0.11 |
|
% Female |
49% |
57% |
53% |
50% |
0.02 |
Liver Transplantation – General
547. Wide
Disparity in Substance Use Policies for Liver Transplant Candidates at
R.
S. Mangus; J. Andersen; A. L. Hall.
Introduction
Discussion at the recent Transplantation Ethics conference (
Methods
Using the database from the United Network for Organ Sharing
(UNOS), all
Results
There were 96 centers identified and all were contacted. Of
the responding centers, 20% had no formal written substance use policy. Among
those centers with a written policy, 100% require complete abstinence from
alcohol prior to transplantation. The required alcohol abstinence period ranged
from a maximum of 1-year down to an “unspecified period determined on a
case-by-case basis.” 50% of centers allow exceptions to this abstinence period
if hepatocellular carcinoma (
Discussion
A national substance use policy for liver transplantation
would be beneficial to establish expectations for recipients, transplant
centers and payers, and to remove the current disparity in this area of
transplantation.
Liver Transplantation – Epidemiology
548.
Relationship between Recipient Race and
Y. Lim; R. Pedersen;
W. K. Kremers; W. Kim.
Background:
The impact of recipient race on the outcome after liver
transplantation (LTx) has been debated. While previous studies documented
poorer survival in non-white recipients, we have demonstrated that race had no
effect on post-LTx survival in select, academic centers in the
Aim:
We examined recipient race and transplant center as
predictors of post-LTx outcome.
Methods:
Individual data on all adult single-organ primary LTx
recipients between 2003 and 2005 were obtained from the Organ Procurement and
Transplantation Network. The relationship between patients' race, pre-LTx
clinical and payer status and post-LTx survival was analyzed.
Results:
There were 11,565 recipients that met the inclusion criteria,
consisting of 8,817 Caucasian (CA), 896 African (AA), 401 Asian/Pacific
Islander (AP) and 1,451 Other (O) race. Compared to CA, AA recipients were
younger (mean age 49.3 vs. 52.9 years), more likely to have HCV (56% vs. 42%)
and Medicaid (18% vs. 11%), less likely to have alcoholic liver disease (7% vs.
18%) and private insurance (60% vs. 66%). No difference in short-term patient
and graft survival was found between CA and AA: Patient [graft] survival at 3
months was 94[91]% for CA, 95[91]% for AA, 96[92]% for
AP, and 94[91]% for O. However, signficant differences were found by 2 years
post-LTx: Patient [graft] survival was 83[79]% for CA,
80[73]% for AA, 87[80]% for AP, and 85[80]% for O (p=0.01 for patient survival,
<0.01 for graft survival). These differences were partially explained by the
center - the unadjusted hazard ratio for mortality in AA was 1.22 (p=0.01),
which decreased to 1.19 (p=0.04), compared to CA. However, the final model
(Table) which included stratification on center and adjustment for recipient
age, diagnosis, payer and pre-LTx MELD, AA still had a 1.24-fold increase in
mortality and 1.33-fold increase in graft failure compared to CA. No difference
was found for AP or O race.
Conclusion:
In the current era, recipient race has no impact on
short-term post-LTx survival. However, long-term outcome is decreased in AA,
which was not explained by the center, payer or preLTx disease severity.
|
|
Patient Survival |
Graft Survival |
||
|
|
HR |
95% CI |
HR |
95% CI |
|
AA |
1.24 |
1.03-1.50 |
1.33 |
1.14-1.56 |
|
AP |
0.81 |
0.59-1.12 |
1.05 |
0.81-1.36 |
|
O |
0.86 |
0.72-1.02 |
0.91 |
0.78-1.06 |
|
HCV |
1.34 |
1.20-1.49 |
1.24 |
1.13-1.36 |
|
Public Insurance |
1.19 |
1.05-1.35 |
1.13 |
1.01-1.27 |
|
MELD |
1.02 |
1.02-1.03 |
1.02 |
1.01-1.02 |
HR=hazard
ratio CI=confidence interval
Liver Transplantation – General
555. Outcomes
and Resource Utilization during Hospitalization for Liver Transplantation in
the
G. Arora; S.
Vadhavkar; G. Singh; G. D. Friedman; G. Triadafilopoulos.
Background and Aims:
Liver transplantation (LT) is an efficacious, yet costly
treatment for end–stage liver disease and liver cancer. We aimed to determine
secular trends and association of clinical and demographic variables with the
outcomes related to LT hospitalization –mean hospital length of stay (LOS),
mean total hospitalization charges (
Methods:
The Nationwide Inpatient Sample (
Results:
LOS–R showed a downward secular trend (p=0.03). Presence of
Conclusion:
LT hospitalization outcomes overall
remained stable and compared favorably to those of all–cause hospitalizations. The post–MELD period was associated
with less in–hospital mortality but higher likelihood of non–home discharge.
|
Outcome |
Pre–MELD |
Post–MELD |
Percentage
Change/OR |
|
LOS-LT |
23.43 |
22.94 |
-2.10% |
|
LOS-AC |
4.68 |
4.63 |
-1.17% |
|
|
$880799 |
$1041187 |
+18% |
|
|
$60979 |
$83137 |
+36% |
|
IHM-LT |
8.32% |
7.00% |
OR 0.84 |
|
IHM-AC |
2.413% |
2.174% |
OR 0.90 |
LT-Liver
Transplantation AC-All-cause Hospitalization
Liver Transplantation – General
P. Tandon; K. J.
Goodman; M. M. Ma; W. Wong; A. L. Mason; G. Meeberg; D. Bergsten; M.
Carbonneau; V. G. Bain.
Background:
Liver transplantation for alcoholic liver disease (ALD) can
be complicated by abusive or “problem” drinking (PD) post-transplant. The
disparity between the growing transplant waiting list and donation rates
underscores the importance of identifying predictors for these patients. We
hypothesized that a longer duration of pre-transplant abstinence would lead to
less PD following transplantation. Accordingly, the objectives of this study
are to analyze a North American cohort of patients with ALD with or without a secondary
diagnosis of liver disease to estimate (i) the incidence of PD and its
predictors (ii) the impact of PD on patient survival.
Methods:
We conducted a retrospective review of all patients
transplanted for alcohol induced liver disease at our center between January
1991 and May 2007 surviving > 3 months post-transplant. PD was defined as
either any drinking to intoxication or >20 grams/day in women and >40
grams/day in men on at least 2 separate occasions. We used Cox proportional
hazards regression to estimate risk ratios and Kaplan-Meier curves with log
rank analysis to compare survival.
Results:
In total, 213 patients with ALD were studied from a total of
707 patients in the liver transplant program. Of 213 eligible transplant
patients, 42 were excluded. Of the 171 remaining patients, 78% were male with a
mean (±SD) age of 52.2 ± 7.6 years. Fifty-three percent of patients had
co-existing causes of liver dysfunction. The mean follow-up time was 64.8 ±
42.6 months. The mean pre-transplant abstinence was 40.4 ± 51.6 months. A total
of 41 patients (24%) drank alcohol following transplantation and of these 22
(13% of the total) developed PD. Pre-transplant abstinence duration was the
only independent predictor of PD post-transplant with the risk of PD decreasing
by 5% for every incremental month of pre-transplant abstinence. Eighteen
percent of patients died during the course of the study but there was no
survival difference noted between PD and non-drinkers.
Conclusions:
The risk for PD decreases with increasing pre-transplant
abstinence. Our data supports pre-transplant abstinence as the most important
predictor of post-transplant recidivism, however, the optimal period of
required abstinence remains unclear. Patients with durations of abstinence <18
months may benefit from more intensive follow-up and rehabilitation
post-transplant.
Risk of recidivism increases with shorter pre-transplant abstinence duration
|
|
≤ 6 months |
7-12 months |
13-17 months |
18-35 months |
≥ 36 months |
trend |
|
RR (95% CI) of problem drinking (PD) |
8.5 |
5.9 |
4.3 |
1.3 |
1.0 (referent) |
0.013 |
|
Risk of PD |
38% |
27% |
18% |
5% |
4% |
0.001 |
Liver Transplantation – General
A. Raza; G. Ramaraju; R. Razack; A. Shareef; K. Desai; D. Wilson; A. N. de la Torre; A. Fisher; A. Samanta; B. Koneru.
Purpose:
To determine if outcomes of liver
transplantation (LT) in hepatitis C virus (HCV) recipients are further worsened
by the presence of hepatocellular carcinoma (
Methods:
Using a retrospective case-control design, cases of
Results:
Sixty-five cases of
Conclusions:
1) Graft survival in
2) Differences in
3)
Liver Transplantation – General
566. Health
related quality of life predicts survival in liver transplant candidates.
M. B. Fallon; R.
Tanikella; G. Philips; S. M. Kawut; M. J. Krowka; R. S. Brown; J. F. Trotter;
S. Zacks; K. E. Roberts; V. Shah; N. Kaplowitz; L. Forman; K. M. Wille; M.
Mohd.
Introduction:
Health related quality of life(HRQOL)
is an important measure of the impact of chronic illness and can help guide
interventions to improve well-being. However, whether HRQOL predicts mortality
in patients evaluated for liver transplantation (LT) is unknown. We assessed
whether HRQOL predicts mortality in patients evaluated for LT.
Methods:
We administered the Liver Disease Quality of Life questionnaire(LDQOL 1.0) that includes the SF-36 (Version
2.0) to patients in the Pulmonary Vascular Complications of Liver
Disease(PVCLD) study, a multi-center prospective cohort study of patients
evaluated for LT in seven
Results:
There were 258 patients in the cohort (mean age 54 ± 9.7, 36%
female, 93% white). There were 434 person-years of follow-up. 49 of the 258
patients (19%) died. Three patients were lost to follow-up. 153 patients(59%) were listed for LT and 78(30%) underwent LT.
Among the SF-36 summary scores, cirrhotics in the lowest tertile of physical
component summary score (
Conclusions:
Self reported HRQOL significantly predicts all-cause
mortality independent of disease severity. Hence interventions directed towards
improving HRQOL of cirrhotic patients may be helpful in improving outcomes in
end stage liver disease.
Liver Transplantation – Epidemiology
586. Liver
Transplantation Trends and Survival in the Asian Population.
N. Kemmer; V. C.
Zacharias; T. E. Kaiser; G. W. Neff.
Studies to address ethnic minorities in Liver Transplantation
(LT) have traditionally focused on African Americans and Hispanics. Although,
the Asian population accounts for 4.4% of the
Aim:
The Aim of this study is to evaluate the transplantation
trends and determine survival patterns of Asian LT recipients.
Method:
Using the UNOS database, we identified all adult LT
recipients (age > 18 yrs) between 1998 and 2007. The data collected included
demographics, diagnosis, survival data and UNOS region. Statistical analysis
was done using Kaplan-Meier (KM) and log-Rank tests for survival analysis.
Results:
During the study period, 1953 patients received LT,
accounting for 4.1% of all adult LT. Of these, there were 1286 (65.8%) males
with a median age of 55 (range 18 – 75). The underlying liver disease was
hepatitis B (28.1%), Hepatitis C (18.4%),
Conclusion:
(1) Regional variation and differences in liver disease
pattern was seen among Asian population with HBV-
(2) Overall LT recipients of Asian ethnicity have a
significant survival advantage especially at (5yr) in comparison to non-Asian groups.
|
YEAR |
ASIAN |
AA |
HISPANIC |
CAUCASIAN |
|
PATIENT |
|
|
|
|
|
1 |
89% |
84% |
88% |
87% |
|
3 |
81% |
72% |
80% |
79% |
|
5 |
76% |
65% |
74% |
73% |
|
GRAFT |
|
|
|
|
|
1 |
84% |
79% |
83% |
83% |
|
3 |
76% |
65% |
75% |
74% |
|
5 |
71% |
57% |
68% |
67% |
Session Title: Liver Transplantation: Donor and Allocation Issues
Session Type: Poster Sessions
Location: West Hall (Moscone West
Convention Center
Start time: Sat, Nov 01 - 2:00 PM
Liver
Transplantation – General
P.
G. Northup; M. A. McBride; T. M. Schmitt; C. K. Argo; T. L. Pruett.
Background:
Organ donors are screened for the hepatitis C antibody
(anti-HCV) and if positive the organs are often discarded. Sometimes these
organs are transplanted under extended criteria donation. It was the aim of
this study to assess the outcomes of anti-HCV positive liver grafts.
Methods:
The United Network for Organ Sharing / Organ Procurement and
Transplantation Network dataset was used to find all adult liver
transplantations with donors who were anti-HCV positive from
Results:
70,071 liver transplantations were analyzed. 23,972 (34.2%)
involved anti-HCV positive recipients and 1, 313 (1.87%) had anti-HCV positive
donors. 77% of anti-HCV positive grafts were transplanted into anti-HCV
positive recipients while the remainder (33%) went to HCV negative recipients.
Overall donor risk between groups, as measured by the
Conclusions:
After adjusting for other pre- and post- transplant facto4rs,
there does not appear to be an increased risk of post-transplant mortality in
HCV + recipients when using well selected donors with the antibody to HCV at
the time of donation.
Discussion:
The aim of this study was to assess the outcome of HCV+ liver
grafts using the largest dataset with the longest follow-up available in the
Liver Transplantation – Epidemiology
526. The
Impact of MELD Allocation Policy on Racial Disparities in Access to Liver
Transplantation.
M.
L. Volk; G. Warren; J. A. Marrero; M. Heisler.
Prior to implementation of the Model for End-stage Liver
Disease (MELD) allocation policy, racial disparities in access to liver
transplantation were documented at several stages of the process including
referral, listing, and transplant.
Aim:
The aim of this study was to determine whether implementation
of the MELD policy eliminated disparities in access to transplantation once
patients are placed on the waiting list.
Methods:
Data from the United Network for Organ Sharing (UNOS) was
analyzed for all adults on the waiting list for transplantation between 1997-2007 (n=110,042). The two largest minority
groups, African-Americans and Hispanics, were compared to Caucasians. Endpoints
included 1) probability of receiving a transplant, and 2) probability of
removal from the waiting list for death or being too sick. Regression models
were fitted for each endpoint during the pre-MELD and post-MELD eras.
Results:
During the pre-MELD era (1997-2001), African-Americans were
less likely to receive a transplant (OR 0.8, 95% CI 0.74-0.86) and more likely
to be removed from the waiting list (OR 1.32, 95% CI 1.22-1.42) than
Caucasians. In the post-MELD era (2002-2007), African-Americans are now more
likely to receive a transplant, but still more likely to be removed from the
waiting list than Caucasians. These differences can be largely attributed to
the higher MELD scores among African-Americans, as demonstrated by the
multivariate analysis in Table 1. Hispanics were less likely to receive a
transplant (OR 0.87, 95% CI 0.82-0.93) and more likely to be removed from the
waiting list (OR 1.24, 95% CI 1.16-1.33) than Caucasians during the pre-MELD
era. These differences persisted during the post-MELD era despite adjustment
for severity of liver disease, as shown in Table 1.
Conclusion:
The MELD allocation policy has improved disparities in access
to liver transplantation for African-Americans, but not for Hispanics. Further
research is needed to explain this discrepancy.
Table 1: Multivariate analysis of waiting list endpoints for African-Americans and Hispanics (relative to Caucasians) during the post-MELD era.
|
|
Odds of Transplantation |
Odds of Removal |
||
|
OR |
95% CI |
OR |
95% CI |
|
|
African-American |
1.06 |
1.00-1.12 |
0.85 |
0.79-0.92 |
|
Hispanic |
0.75 |
0.72-0.79 |
1.15 |
1.08-1.21 |
|
MELD |
1.04 |
1.04-1.04 |
1.07 |
1.07-1.07 |
Liver Transplantation – Epidemiology
C. J. Sonnenday; M. J.
Englesbe; J. Kubus; A. K. Mathur; R. M. Merion.
Background:
Marked disparities have been reported in rates of liver
transplantation (LT) by race/ethnicity and geographic region in the
Methods:
Results:
Overall, African-Americans were underrepresented as
transplant candidates (7%) compared to their proportion in the
Conclusions:
MELD-based liver allocation has not eliminated disparities by
race/ethnicity in WL death rates and access to LT. These disparities are
especially large across
WL DEATH RATES (multivariable model)
|
|
|
POST-MELD |
||
|
|
HR |
95% CI |
HR |
95% CI |
|
WHITE |
1.0 |
REFERENCE |
0.97 |
0.93-1.01 |
|
AFRICAN-AMERICAN |
1.18* |
1.09-1.28 |
1.21† |
1.11-1.33 |
|
HISPANIC |
1.03 |
0.97-1.10 |
1.01 |
0.94-1.07 |
|
ASIAN |
0.97 |
0.93-1.01 |
0.83# |
0.73-0.95 |
P<0.001
vs. white (pre-MELD); †P<0.001 vs. white (post-MELD); # P=0.006 vs. white
(post-MELD)
Session Title: Cell Death, Oxidant Stress, and Drug Toxicity
Session Type: Poster Sessions
Location: West Hall (Moscone West
Convention Center
Start time: Sat, Nov 01 - 2:00 PM
Disease Progression
– General
358.
Fulminant hepatic failure associated with chewing khat.
M. H. Chapman; J.
O'Beirne; D. W. Patch; A. P. Dhillon; G. Borges; A. Crozier; M. Y. Morgan.
Background
Chewing leaves of the khat plant (Catha edulis) is a
widespread cultural habit in
Methods & Results
Details of five Somali patients with unexplained FHF were
reviewed. All regularly chewed khat and presented with jaundice, lethargy and
abdominal discomfort. Three had had previous admissions for unexplained
hepatitis and resumed their khat habit after discharge. Apart from jaundice,
there were few distinguishing clinical features. Laboratory data indicated
severe liver dysfunction (Table). Histology showed acute severe hepatitis with
confluent panlobular necrosis, architectural collapse, mixed inflammatory
response including eosinophils with no elastic fibre deposition; some showed
venulitis. The patients who died had autopsy evidence of hypertrophic
cardiomyopathy consistent with previously described cardiac effects of khat1.
Frozen samples of khat leaves and liver from one patient were
analysed using an HPLC-
Summary
There is strong presumptive evidence that the liver injury in
these patients was Khat-related viz:
1) Absence of other identifiable cause
of liver injury,
2) Positive re-challenge in three cases
3) Histopathological features
reminiscent of ecstasy-related hepatotoxicity with which Khat shares
biochemical similarities
4) Identification of khat in the liver
sample
5) Khat induces hepatotoxicity in
animals2
The mechanism of the liver injury remains unclear, but is
likely to be idiosyncratic.
In conclusion, khat should be considered as a cause of
unexplained liver injury particular in immigrants from
References
1. Al-Habori et al, J Ethnopharm 2002(83);209
2. Saha & Dollery, J R Soc Med 2006(99);316
|
Case |
Sex |
Age |
Khat use |
Bilirubin |
|
AST |
ALP |
Albumin |
INR |
Outcome |
|
1 |
M |
36 |
Daily for 10 years |
9.6 |
1589 |
1543 |
231 |
38 |
1.5 |
Died |
|
2 |
F |
36 |
3/week for 10 years |
14.9 |
X |
2346 |
230 |
29 |
1.9 |
OLT |
|
3 |
F |
32 |
2/week for 4 years |
16.9 |
796 |
X |
193 |
35 |
2.2 |
OLT |
|
4 |
M |
28 |
3/week for 8 years |
14.6 |
2314 |
3250 |
213 |
34 |
1.2 |
OLT |
|
5 |
M |
34 |
2/week for 9 years |
11.58 |
76 |
246 |
244 |
21 |
2.7 |
OLT |
Disease Progression – General
H. Han; A. S. Boxer;
M. Adler; J. L. Matloff; D. C. Carriero; M. Vachon; D. T. Dieterich.
Purpose:
Patients over the age of 40 with Hepatitis C (HCV) have a
three-fold higher prevalence of Type 2 diabetes (T2DM) than those without HCV.
In addition, glucose abnormalities are associated with a poorer virologic
response in chronic HCV patients. Attempts to improve insulin sensitivity prior
to or during combination pegylated interferon and ribavirin therapy may result
in a higher rate of viral response to HCV treatment.
Aim:
The aim of the study is to assess hepatic safety of insulin
sensitizers such as TZDs and metformin, and/or cholesterol lowering agents like
statins when used in patients with chronic HCV, prior to HCV treatment.
Methods:
IRB-approved, retrospective chart review from 2002 to 2007 of
patients at a liver clinic in our center with chronic HCV treated with at least
one of the study medications. We examined variations in
Results:
Fifty-two patients (73% males, ages 36-68), of which 32 were
on TZDs, 14 on metformin, and 6 on statins, were included for analysis.
Compared to the pre-treatment, the post-treatment group evidenced a decreased
trend in all biochemical parameters except for TG and
Conclusions:
The decreasing trends in
Session Title: IASL Posters
Session Type: Poster Sessions
Location: Default
Start time: Sat, Nov 01 - 2:00 PM
Diagnostic
Tools – Biochemical/Imaging
457.
Fibrotest Fibromax: International Standardization Of Biochemical
Markers Measurements For Results Concordance Between Laboratories.
D. Messous; R. Morra;
M. Munteanu ; T. Poynard; B. Hainque; F.
Imbert-Bismut.
Background:
World-wide utility of fibrosis blood markers is limited by
the variability of results depending on analytical systems used to perform the
assays. Analytical standardized methods should now be adapted to the different
analyzers in order to improve harmonization of FibroTest- Fibro-Max score
results between different laboratories.Objective:
Aim:
The aim was to assess the impact of the international
analytical standardization on result transferability between various analyzers
of FibroTest-FibroMax components [alpha2-macroglobulin (A2M), haptoglobin (
Methods:
GGT activities were measured according to standardized
methods, as
Results:
Conclusion:
Standardized conditions have to be used to perform the assays
of blood markers especially for combination components. P5P have to be used for
the correct measurement of
HCV Disease Progression – General
470. The Impact
Of Alcohol Abuse, HCV
Infection And Liver Dysfunction On Neuropsychological And
Neurophysiological Profile Of Patients With Liver Cirrhosis.
F. Campagna; S.
Schiff; M. Ruzzoli; A. Biancardi; D. Mapelli; P. Pujatti; D. Pavanello; P.
Angeli; A. Gatta; P. Amodio.
Background and aim.
Neuropsychological and EEG alterations are ascribed to
minimal hepatic encephalopathy (MHE) in cirrhotic patients. Chronic alcohol
abuse and HCV infection can act as confounders since they may impair brain
functioning. Aim of the study was to identify the influence of these
confounders in the evaluation of patients with liver cirrhosis.
Material and methods.
Neuropsychological profile and EEG spectral parameters were
studied in 6 groups of subjects to allow a two ways ANOVA design:
a) 30 healthy subjects,
b) 30 non-cirrhotic subjects with
HCV-hepatitis,
c) 30non-cirrhotic chronic alcohol
abusers,
d) 30 subjects with HCV-related
cirrhosis,
e) 30subjects with alcohol-related
cirrhosis,
f) 30 subjects with no alcohol, no viral
related cirrhosis.
All groups were matched for age; the cirrhotic patients were
matched for the liver insufficiency. All groups underwent extensive
neuropsychological investigation and quantified EEG analysis.
Results.
·
Alcohol
misuse alone had a detrimental effect on Phoemic Verbal Fluency (PVF) and
Interference Tasks
·
Cirrhosis
had detrimental effect on the TMT(B-A) and Phoemic Verbal Fluency
o
Alcohol
increased the detrimental effect of cirrhosis on the TMT-A and TMT-B
·
HCV
infection per se showed a trend for reduced performance in the Interference
Tasks
·
Cirrhosis
had a detri8mental effect on the
o
HCV
infection did not have additive detrimental effect on the neuropsychological
profile of patients with liver cirrhosis.
Neurophysiological Evaluation
·
Cirrhosis
influenced every EEG spectral measures (MDF, Absolute Spectral Power, Delta,
Theta, Alfha, and Beta relative power)
·
Alcohol
misuse alone did not show any significant influence, but it showed a trend for
an additive detrimental effect on the MDF, Absolute Sprectral Power, Delta and
Beta relative power of patients with liver cirrhosis.
·
HCV
infection per see influenced the Absolute Spectural Power and an interaction
cirrhosis-HCV infection was found (p<0.05)
Conclusions.
1.
The consequences of chronic alcohol misuse are highly evident on memory
interference tasks;
2.
Alcohol abuse had a synergic effect with cirrhsois in damaging executive
functions;
3.
The influence of HCV infection, if any, was negligible;
4.
The EEG changes were found to be mainly related to the factor
‘cirrhosis.’
Diagnostic Tools – General
R. Loomba; R.
Bettencourt; E. Barrett-Connor.
Background:
It is unclear if men and women have a differential effect of
alcohol (ETOH) dose &
Aim:
To examine the sex-specific
association of ETOH dose &
Methods:
A cross-sectional study of 2466
individuals (mean age 70 yr,
Results:
In multiply-adjusted analyses, the only statistically
significant independent association of ETOH dose with raised
Conclusions:
In these community based sample older in older adults, there
was a threshold association of raised serum
Given the current obesity epidemic, these results may have
important public health implications.
Diagnostic Tools – Biochemical/Imaging
477. Non-invasive
Prediction of Liver Fibrosis in Nonalcoholic Fatty Liver Disease.
L. A. Adams; J.
George; E. Rossi; D. van der Poorten; J. G. Kench; B. DeBoer; G. C. MacQuillan;
G. P. Jeffrey.
Nonalcoholic fatty liver disease (NAFLD) is the commonest
liver disorder worldwide, however only a small proportion of individuals
develop significant liver damage. Staging is thus vital for prognosis and
management however, currently requires liver biopsy. We examined the accuracy
of three non-invasive models, namely Hepascore (HS), Fibrotest (FT) and the AST
to Platelet Ratio Index (APRI) in predicting different levels of fibrosis in
patients with NAFLD.
Methods:
Serum was taken from NAFLD patients at the time of liver
biopsy and analysed for the components of the non-invasive models. Liver
biopsies were staged according to the Kleiner classification. Fibrosis was
classified as significant (F2-4), advanced (F3-4) and cirrhosis (F4). Accuracy
was determined by area under the receiver operator characteristic (AUROC)curve analysis. Cutoffs were determined according to the
highest Youden Index (sensitivity + specificity -1).
Results:
119 patients (54% male) with a mean (SD) age of 48.7 (13.0)
years were assessed. 44 (37%) were overweight (
Conclusion:
·
Hepascore
and fibrotest have equivalent accuracy in determining liver fibrosis in NAFLD.
·
Diagnostic characteristics of noninvasive markers for significant fibrosis
|
|
Youden
Index |
Sens |
Spec |
PPV |
NPV |
|
Hepascore |
0.50 |
56% |
94% |
88% |
75% |
|
Fibrotest |
0.33 |
73% |
60% |
57% |
75% |
|
APRI |
0.42 |
72% |
70% |
64% |
78% |
HCV Diagnostic Tools – General
Y. Maor; P. Halfon; D.
Bashari; G. Penaranda; G. Morali ; R. Klar; S. Bar-Meir; U. Martinowitz; R.
Oren.
Introduction:
The use of non-invasive markers of fibrosis is particularly
desirable in hepatitis C (HCV)-infected hemophilia patients. Significant
fibrosis was estimated by both by Fibrotest (FT) and Fibroscan (FS) in a high
proportion of hemophiliacs. Direct comparison between these tests has not been
performed.
Aim:
To estimate liver fibrosis by FT and
FS in HCV-infected hemophilia patients.
Methods:
FT and FS were performed up to three month apart in different
laboratories that were unaware of the results of the alternative test. Liver
Stiffness Measurements (LSM) was performed at three points on the right lobe of
the liver. Two validated algorithms were used to improve evaluation of fibrosis
by these non-invasive markers (1, 2).
Results:
Fifty-seven hemophilia patients with HCV were evaluated by FT
and FS. LSM could not be obtained in two patients: obesity- 1, surgical scars-
1.
See Table
Using the two algorithms additional fourteen patients could
be reliably estimated for fibrosis stage ≥2 by combining FT and FS
scores.
Conclusions:
·
A high proportion HCV-infected hemophilia patients were estimated with significant or
advanced stages of liver fibrosis using both FT and FS.
·
Nevertheless,
the individual agreement between modalities was only fair, and improved in more
advanced stages of fibrosis.
·
Practical
indicators of the accuracy of FT and FS may improve estimation of fibrosis in
this population.
References:
1.
Bourliere M, et al. J Viral Hepat 2006;13:659-70.
2.
Lucidarme D, et al. Hepatol 2007:318A.
Comparison between FT and FS for evaluation of liver fibrosis in hemophiliacs with HCV
|
Fibrosis
Stage |
>
2 |
>
3 |
= 4 |
|
FibroTest(%) |
27 (49) |
20 (36) |
11 (20) |
|
FibroScan(%) |
30 (54) |
18 (33) |
8 (15) |
|
Kappa |
0.24 |
0.32 |
0.44 |
|
Concordance (%) |
34 (62) |
38 (69) |
47 (85) |
HCV
Disease Progression – General
504. The Illness Intrusiveness of a Hepatitis C
Diagnosis.
M.
B. Murphy.
Aim:
The aim of this pilot study was to describe the Illness
Intrusiveness of a diagnosis of Hepatitis C virus (HCV) in adults. Infection
with HCV affects an estimated 4 million Americans and 170 million worldwide.
The disease becomes chronic in up to 85% of those who are infected. Care for
the patient with HCV is typically delivered in specialty clinics and the focus
of care is usually on treatment. Less attention is given to the experience of
adjusting to the diagnosis.
Illness intrusiveness refers to the degree to which an
illness or its treatment interferes with important elements of a patient’s
life, especially the ability of the individual to continue participation in
valued activities or interests. Illness intrusiveness compromises psychological
well being in chronic diseases. The Illness Intrusiveness Rating Scale (IIRS)
measures the extent of the interference of a chronic disease in important life
domains.
Thirty patients diagnosed with HCV who presented to a
Hepatology clinic for evaluation of their disease participated in the study.
Internal consistency of the IIRS for this sample was determined using
Cronbach’s alpha (r = 0.94). Mean total IIRS score was 35.46, SD = 20.38. The
total possible range of scores was from 13 to 91; the range of scores for the
study sample was 13-91. Subscale scores for the IIRS were obtained by
calculating item means. For the Instrumental subscale, the mean was 3.05
(SD=1.95). For the Intimacy subscale the sample mean was 1.3 (SD=1.01). The
Relationships and Personal Development subscale mean was 2.47 (SD=1.5). The
mean IIRS score for this population was slightly lower than the mean IIRS
scores of subjects with more symptomatic chronic conditions such as
hyperhidrosis and bipolar disorder, and higher than patients with insomnia. In
addition to the IIRS, study subjects were asked to describe their HCV illness
experience. Responses included ‘shock’, ‘concern’, ‘depressed’,’increased
stress’,‘devastated’, ‘anxiety’, ‘scared’ , and ‘worry about the future’, which
suggest a strong negative emotional response to receiving a diagnosis.
Conclusion
Results of this study indicate that future research with this
population is warranted in order to identify the true nature of the impact of
the diagnosis of HCV. QOL , uncertainty of illness ,
and anxiety and depression indices may provide additional insight .
HCV Treatment – Pegasys
K. Takaguchi; T.
Nagano; M. Wato; N. Baba; T. Seno; T. Inaba; S. Watanabe; K. Kawai.
Background and Aims
Peginterferon (
Methods
We analyzed the data from 64 naïve patients with chronic
hepatitis C who were treated with peginterferon alfa-2a monotherapy for HCV
genotype 2 infection at our hospital between January
2004 and September 2005. 33 patients were male and 31 patients were female
(mean age 55.9 ± 12.2 years, mean body weight 59.8 ± 11.0kg);38 patients had
low baseline viral load(LVL:<500KIU/mL) and 26 patients had high baseline
viral load(HVL: ≥500KIU/mL). Distribution of HCV subtypes were 2a (n=47),
2b(n=15) and 2ab(n=2). Liver biopsy was performed in
53 patients.(F1: 15 patients ,F2: 26 patients,F3:11
patients,,F4: 1 patient). Patients received peginterferon alfa-2a 90 or
180μg subcutaneously once a week, 48 weeks. Doses were modified according
to the hematological test results. 23 patients were treated shorter duration
due to the adverse events.
Results
A sustained virologic response (
Conclusions
Peginterferon alfa-2a monotherapy produced a high rate of