studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 589A
majority of patients were treated for splanchnic vein thrombosis
(12/20) whereas in the TAC group the majority of patients
were treated for non-splanchnic venous thrombosis (12/19).
The TAC group had been treated for a mean of 478 days of
therapy compared to 253 days in the DOAC group (p=0.2).
In the DOAC group, 9/20 (45%) were exposed to traditional
anticoagulation prior to initiation of DOAC. There were 3 documented
bleeding events in the TAC and 4 bleeding events
in DOAC (p=0.9). There were 2 major bleeding events in the
TAC group and 1 major bleeding event in the DOAC group.
There was 1 moderate bleeding event in each group and 2
mild bleeding events in the DOAC group. On univariate regression
and Cox proportional hazard modeling there were no significant
predictors of bleeding, including concurrent antiplatelet
therapy. Conclusions: DOAC display similar safety characteristics
compared to TAC in cirrhosis patients. We did not identify
any characteristic that predicted a bleeding event while on
anticoagulation. Larger, prospective studies with anticoagulant
agents are needed to further define safety, pharmacokinetics
and efficacy in patients with cirrhosis.
Bleeding events
ICH- intracranial hemorrhage
Disclosures:
Curtis K. Argo - Independent Contractor: Salix Pharmaceuticals
Patrick Northup - Consulting: Janssen
Stephen H. Caldwell - Advisory Committees or Review Panels: Vital Therapy;
Grant/Research Support: Genfit, Gilead Sciences, Immuron, Hyperion, Immuron,
NGM
The following authors have nothing to disclose: Nicolas Intagliata, Zachary
Henry, Hillary Maitland, Neeral L. Shah
762
Transient elastography evaluation of hepatic and spleen
stiffness in patients with hepatosplenic schistosomiasis
Zulane D. Veiga 1 , Cristiane A. Villela Nogueira 2 , Renata D.
Perez 2 , Homero S. Fogacas 2 , Flavia F. Fernandes 1 , Gustavo
Pereira 1 , João Luiz Pereira 1 , Carlos Eduardo C. Marques 2 , Marta
Cavalcanti 2 ; 1 Gastroenterologia e Hepatologia, Hospital Federal
de Bonsucesso, Rio de Janeiro, Brazil; 2 Hepatologia, Hospital Universitário
Clementino Fraga Filho, Rio de Janeiro, Brazil
Hepatosplenic schistosomiasis (HES) is characterized by portal
hypertension and periportal fibrosis. Transient elastography
(TE) has been used to evaluate liver and spleen stiffness in
many liver diseases. To our knowledge, schistosomiasis has not
been evaluated by TE so far, and its correlation with ultrassonographic
(US) findings related to portal hypertension remains
to be defined. Objective: To assess liver and spleen stiffness by
TE in patients with HES in comparison to compensated cirrhotic
patients and its relation to US findings. Methods: Sixty nine
patients were prospectively included in the study: 29 had HES,
23 had HCV-related liver cirrhosis with esophageal varices
and 17 were healthy controls. Liver and spleen stiffness values
were assessed using the FibroScan® 502 equipment (Echosens,
Paris, France) by an experienced operator. Ten successful
measurements were carried out for each patient. Liver and
spleen stiffness values were considered adequate if the success
rate were at least 60% and the interquartile range (IQR) were
< 30% of the median value. TE range values are 3.5 to 75 kPa.
Patients with liver stiffness (LS) values > 9.5 Kpa were classified
as having significant liver stiffness and spleen stiffness (SS) =
75 kPa as high spleen stiffness. Patients with HES were submitted
to ultrasound with dopplerfluxometry (Doppler Hitachi
EUB 5500 3,5 MHz probe) by a well-trained examinator in
World Health Organization (WHO) protocol for US assessment
of schistosomiasis. Values are expressed as percentage
and mean±SD. Results: Patients with HES had LS significantly
higher than controls and lower than cirrhotic patients: 16.3 ±
19,9 vs 3,7 ± 0,7 vs 29.7±15,4 kPa (p= 0,001). SS values
were comparable between HES and cirrhotic patients: 57.5
±18,5 vs 54 ± 21,6 kPa (p=0,4) and were significantly higher
than controls (p= 0,001). Significant LS was observed in 52%
of HES patients and was associated with higher values of aminotransferases:
AST 45,7 ± 21 vs 32 ± 9,6 ALT 48 ± 22 vs
31,7±10,8 (P< 0,05). SS values were = 75 kPa in 43% of
HES patients while 24% of cirrhotic and no controls presented
this value (p=0,06). In HES patients, high SS was associated
to higher values of splenic artery resistance index (p=0,003),
portal vein diameter( p=0,09), portal vein congestion index
(p= 0,05) and splenic diameter (p= 0,09). Conclusion: HES
patients present a distinct pattern of liver and spleen elastography
in comparison to cirrhotic patients, with lower frequency
of significant LS and higher frequency of high SS. In HES population,
elevated spleen elastography may be a surrogate of
splenic artery resistance and portal vein congestion.
Disclosures:
The following authors have nothing to disclose: Zulane D. Veiga, Cristiane A. Villela
Nogueira, Renata D. Perez, Homero S. Fogacas, Flavia F. Fernandes, Gustavo
Pereira, João Luiz Pereira, Carlos Eduardo C. Marques, Marta Cavalcanti
763
Shunt or meso-portal bypass for portal hypertension in
children
Neslihan Celik, Geoffrey Bond, Kyle A. Soltys, Rakesh Sindhi,
George V. Mazariegos; Hillman Center for Pediatric Transplantation,
Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Purpose To review surgical porto-systemic or meso-portal
bypass techniques and post-surgical short and long term outcomes
for the children with portal hypertension (PH). Methods
Children who underwent porto-systemic or meso-portal bypass
surgery for PH were reviewed retrospectively in terms of underlying
or concomitant pathology, patient characteristics, surgical
techniques, radiologic patency and clinical outcomes. Results
Between 2002 and 2014, 40 patients underwent 46 bypass
surgeries consisting 26 spleno-renal shunt (SRS), 9 meso-caval
shunt (MCS), 8 meso-Rex bypass (MRB), 1 MRB-SRS and
1 spleno-adrenal shunt. 34 patients with long term follow up
(median 2.85 year, range 0.49-13.28 years) were analyzed.
Extra-hepatic portal vein obstruction (EHPVO) and variceal
bleeding were the indications for surgery. Porto-systemic shunts
were done when MRB was not technically feasible. There was
underlying liver disease in 17 patients (Group-A) and normal
liver parenchyma with EHPVO in 17 patients (Group-B). The
liver pathologies in Group-A were post-liver transplantation
portal vein thrombosis (n=6), idiopathic liver fibrosis (n=5),
total parenteral nutrition induced liver fibrosis (n=3), biliary
atresia (n=2) and primary sclerosing cholangitis (n=1). Thrombophilia
(n=6) and umbilical vein catheterization (n=5) were
the concomitant pathologies in Group-B with idiopathic subgroup
(n=6) presenting no other abnormal finding. Median
patient age was 6.65 years (range 0.65-18.55 years). Three
patients had re-shunt surgery due to shunt thrombosis. Three
patients underwent liver transplantation because of end stage
liver disease (n=2) and porto-pulmonary hypertension (n=1) in
Group-A. One syndromic patient with thrombophilia died 5