studies

634A AASLD ABSTRACTS HEPATOLOGY, October, 2015
scores 6-19 or 30-40 did not vary with BMI (47% and 77%
post-LT mortality reduction, respectively, regardless of BMI).
Conclusion: Low BMI is associated with decreased LT survival
benefit in patients with moderate MELD scores. If validated,
these results support the consideration of BMI during LT listing.
significantly increased as LT survival benefit decreased. ROC
analysis showed excellent accuracy of LT futility prediction in
both cohorts. Conclusion: We describe a scoring system that
predicts LT futility based on LT survival benefit decrement. This
has the potential to improve organ allocation.
Association of BMI with LT survival benefit by MELD scores
Disclosures:
The following authors have nothing to disclose: Mohannad Dugum, Nizar N.
Zein, Alex Dugum, Rocio Lopez, Bijan Eghtesad, Ibrahim A. Hanouneh
856
Predicting Futility of Liver Transplantation (LT): A Scoring
System Based on LT Survival Benefit
Mohannad Dugum 1,2 , Nizar N. Zein 3 , Alex Dugum 4 , Rocio
Lopez 5 , Bijan Eghtesad 6 , Ibrahim A. Hanouneh 3 ; 1 Internal Medicine,
Cleveland Clinic, Cleveland, OH; 2 Gastroenterology,
Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA;
3 Gastroenterology and Hepatology, Cleveland Clinic, Cleveland,
OH; 4 University of California, San Diego, San Diego, CA; 5 Quantitative
Health Sciences, Cleveland Clinic, Cleveland, OH; 6 Transplantation
Center, Cleveland Clinic, Cleveland, OH
Background and aim: Assessment of LT futility is essential to
improve organ allocation. We aimed to devise a scoring system
to predict LT futility based on factors affecting LT survival benefit.
Methods: We defined LT survival benefit as the difference
between life expectancy if transplanted and life expectancy if
the patient remains on the waiting list (WL). LT was considered
futile if the LT survival benefit was negative. Adult patients listed
for LT in the US 1987-2012 were identified from the UNOS
database. After excluding malignant diagnoses and status 1,
patients were randomly divided to 2 cohorts: 2/3 training
(for model building) and 1/3 validation. Pre-LT survival was
modeled using competing risks analysis and post-LT survival
was assessed using Cox regression. Using these models, life
expectancy on WL and post-LT was estimated for each patient
by calculating the area under survival curve up to 5 years using
the trapezoidal rule. Using the training cohort, multivariable
logistic regression analysis was performed to build a model
for prediction of LT futility. Multiple factors were considered
for inclusion in the model and backward elimination was used
to remove factors with p>0.05. The model was then applied
in the validation cohort, and ROC analysis was performed to
assess the accuracy of LT futility prediction. Results: 33,376
patients were included in the training cohort. Average age
at listing was 53±10 years and 44% underwent LT. Median
LT survival benefit was 6.5 months [0.2, 19.1]. Older age
at listing, higher BMI, lower serum sodium, and higher MELD
predicted survival. Similar results were observed in the LT population.
The proposed score consists of age, BMI, serum sodium
and MELD. When applied in the validation cohort, the score
Disclosures:
The following authors have nothing to disclose: Mohannad Dugum, Nizar N.
Zein, Alex Dugum, Rocio Lopez, Bijan Eghtesad, Ibrahim A. Hanouneh
857
Remnant Liver Ischemia Is Associated With Early Recurrence
and Poorer Survival after Liver Resection
Jai Young Cho, Ho Seong Han, YoungRok Choi, Yoo-Seok Yoon,
Jae Yool Jang, Hanlim Choi, Jae Seong Jang, Seong Uk Kwon;
Seoul National University Bundang Hospital, Seongnam, Korea
(the Republic of)
Background: Non-anatomical hepatectomy or compromised
blood supply to the remnant liver may result in remnant liver
ischemia (RLI) of various extension and severity. There are a
few reports showing association between ischemia-reperfusion
injury and tumor recurrence in animal liver transplantation
model. However, there is no report to evaluate the impact of
RLI after hepatectomy for hepatocellular carcinoma (HCC) on
patient survival. Method: Remnant liver ischemia was graded
on postoperative CT scan in 328 patients who underwent
hepatectomy for HCC between January 2004 and December
2013. We defined RLI as reduced or absent contrast enhancement
during the venous phase and classified to minimal (none
or marginal) or significant (partial, segmental, and necrosis).
Results: We observed radiologic signs of significant RLI in 98
patients (29.9%): 63 partial, 16 segmental, and 19 necrosis,
and these patients showed more complications (P < 0.001)
and longer hospital stays (P = 0.002). Preoperative history of
transarterial embolization (P = 0.040), use of Pringle maneuver
(P = 0.028), and longer operation time (P < 0.001) were independent
risk factors for developing RLI. Patients with significant
RLI showed higher rates of early recurrence within 6 or 12
months after hepatectomy compared those without (P < 0.001).
Moreover, RLI was independent risk factors for both overall
patient (P < 0.001; RR = 6.984; 95% CI, 4.268-11.426) and
disease-free survival (P < 0.001; RR = 5.153; 95% CI, 3.615-
7.345). Conclusion: Partial hepatectomy without RLI and medical
treatment for RLI are highly recommended in patients with
HCC.
Disclosures:
The following authors have nothing to disclose: Jai Young Cho, Ho Seong Han,
YoungRok Choi, Yoo-Seok Yoon, Jae Yool Jang, Hanlim Choi, Jae Seong Jang,
Seong Uk Kwon