studies

638A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Patient survival by location at time of 3rd transplant
Disclosures:
The following authors have nothing to disclose: Vandana Khungar, David S.
Goldberg, Peter L. Abt
865
Mechanisms of Gender Disparities in Liver Transplantation:
An Examination of Organ Offers
Lauren D. Nephew, James D. Lewis, David S. Goldberg, Kimberly
A. Forde; Gastroenterology, Hospital of the University of Pennsylvania,
Philadelphia, PA
Background: In the MELD era, women are more likely than men
to become too sick or die on the liver transplant list and less
likely than men to receive liver transplantation.Gender differences
in creatinine, a component of the MELD score, is a potential
contributing factor. However corrected MELD scores that
account for these differences have not been shown to improve
estimates of 3-month mortality or rates of transplantation in
women. However, receiving a liver transplant is a complex
process that involves first receiving an organ offer. The role of
organ offers in gender disparities in liver transplant have yet to
be explored. We hypothesize that female waitlist candidates
will have lower MELD scores compared to male waitlist candidates
and as a result will receive fewer organ offers. Methods:
A retrospective cohort study of patients listed for liver transplantation
in the United States was conducted. We included adult
match runs from May 10, 2007 through June 17, 2013. Given
different criteria for wait listing and organ allocation for multiorgan
transplantation, retransplantation, bypasses, and status
1, these patients were excluded from the analysis. The primary
outcome was receipt of an organ offer defined as appearing
in the first position on any match run. Multilevel mixed effects
logistic regression modeling was used to account for clustering
of the data by donor service area. Univariable analysis was
performed to evaluate unadjusted gender differences in the
odds of receiving an organ offer. Multivariable analysis then
evaluated region, blood type, race, exception point status,
etiology of liver disease, and listing MELD as potential confounding
variables. Results: There were 64,995 candidates
who appeared on a match run during our study period. Organ
offers were made to 10,714 candidates (65.1% male, 35%
female). On univariable analysis, there was no association
between gender and organ offer (OR=0.98, CI 0.94-1.02).
When blood type, ethnicity/race, exception point status, etiology
of liver disease, and region were added to the model,
their remained no association between gender and organ offer
(OR=.98, CI 0.94-1.03). Conclusions: We hypothesized that
lower creatinine values could result in lower MELD scores and
hence fewer organ offers for female transplant candidates.
However, female waitlist candidates are just as likely as men
to receive an organ offer. These analyses suggest that gender
disparities in liver transplantation do not occur at the level of
the organ offer. Future work will explore gender disparities in
organ refusals.
Disclosures:
James D. Lewis - Grant/Research Support: Bayer
The following authors have nothing to disclose: Lauren D. Nephew, David S.
Goldberg, Kimberly A. Forde
866
Significance of functional hepatic resection rate using
3D fusion image of CT and 99m Tc-galactosyl human
serum albumin scintigraphy
Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo
Shimada, Kenji Wakayama, Tatsuya Orimo, Hideki Yokoo, Akinobu
Taketomi; Gastroenterological Surgery I, Hokkaido University
Graduate School of Medicine, Sapporo, Japan
Background: Preoperative estimation of hepatic functional
reserve is important for major hepatectomy. Though future
remnant hepatic “volume” is calculated by CT images as volumetry,
it was difficult to estimate the “function” of future liver
remnant. Hepatic receptor imaging with 99m Tc-galactosyl-human
serum albumin ( 99m Tc-GSA) scintigraphy is frequently
used for evaluating hepatic functional reserve. In this study,
we evaluated the usefulness of calculation of functional hepatic
resection rate (FHRR) using 3D fusion image of CT and 99m Tc-
GSA single-photon emission computed tomography (SPECT)
scintigraphy. Methods: 57 patients who underwent more than
one sectionectomy at our institution between October 2013
and March 2015 were enrolled in this study. Of these, 26
patients presented with hepatocellular carcinoma, 12 with hilar
cholangiocarcinoma, 6 with intrahepatic cholangiocarcinoma,
4 with liver metastasis, and 9 with other diseases. 50 patients
underwent bisectionectomy, and 7 trisectionectomy. We compared
the volume hepatic resection rate (VHRR) with FHRR.
FHRR was defined as the resection volume counts per total liver
volume counts of 99m Tc-GSA SPECT from 3D fusion image with
CT. Results: FHRR and VHRR were 38.6 ± 19.9 and 44.5 ±
16.0 (mean ± standard deviation) respectively. The regression
coefficient of FHRR on VHRR was 1.16 and the coefficient of
determination was 0.87 (p 5.0mg/dl) was
observed in 6 of 57 patients. There was no operation-related
death. Conclusion: Calculation of FHRR was important for
major hepatectomy because there was a discrepancy between
FHRR and VHRR in some cases due to hepatic insufficient inflow
and congestion.
Disclosures:
The following authors have nothing to disclose: Yosuke Tsuruga, Toshiya Kamiyama,
Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo,
Hideki Yokoo, Akinobu Taketomi
867
Auxiliary partial orthotopic liver transplantation (APOLT)
for metabolic liver disease- is it still relevant?
Mohamed Rela 2 , Priya Ramachandran 1 , Mohamed Safwan 2 ,
Naresh P. Shanmugam 2 , Sanjay Govil 2 , Mettu S. Reddy 2 ; 1 Pediatric
Surgery, CHILDS Trust Hospital, Chennai, India; 2 Institute of
Liver Disease and Transplantation, Global Hospital & Health City,
Chennai, India
Purpose: The role of auxillary partial orthotopic liver transplantation
(APOLT) for non-cirrhotic metabolic liver disease
(MLD) is controversial because of greater technical challenges
and higher rejection rates when compared to orthotopic liver
transplantation (OLT). The aim of our study was to examine
the outcome of APOLT in our series of patients with selected
non-cirrhotic MLD. Methods: We retrospectively reviewed the
case notes of all patients who underwent APOLT for MLD in our