studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 639A
centre. Operative details, post-operative course and current
status of these patients were reviewed. Results: Over a 5 year
period (2010-2015), 13 patients underwent APOLT in our centre.
Of these, 8 patients (5 males) underwent APOLT for MLD.
The indications were Propionic acidemia (PA) (n=4), Citrullinemia
(n=1) and Crigler-Najjar syndrome (CNS) (n=3). The
median age at transplantation for PA and citrullinemia was 38
months (9-52 months) while the median age for patients with
CNS was 14 years (6-23 years). Five patients received living
related donor grafts, two (1 Citrullinemia and 1 CNS) received
deceased donor grafts, and one child with CNS received a
partial left lobe graft recovered from the child with PA who
underwent a left lobe APOLT (Domino graft). Graded portal
vein banding (to prevent portal steal to the graft) was done
in all cases. One child had hepatic artery thrombosis on day
4 which was successfully managed by thrombectomy. One
child developed two episodes of acute rejection diagnosed by
biopsy and managed with steroid pulse therapy. All patients
are well (median follow up 9 months) (range 14 days-55
months) with normal liver function tests and unrestricted protein
intake and activity. Conclusion: The outcome of APOLT in our
series is comparable to the reported outcomes for OLT in MLD.
APOLT is an acceptable treatment for non-cirrhotic MLD. The
major advantages are the safety of the remnant native liver in
case of technical complications which can translate into better
patient survival and the lack of an anhepatic phase, which
ensures a smooth intra-operative period. In addition the patient
will have the option of future corrective therapies in the native
liver.
Disclosures:
The following authors have nothing to disclose: Mohamed Rela, Priya Ramachandran,
Mohamed Safwan, Naresh P. Shanmugam, Sanjay Govil, Mettu S. Reddy
868
Graft Survival following Domino Liver Transplantation:
The U.S. Experience
Ian W. Folkert 1 , David S. Goldberg 2 , Matthew H. Levine 1 , Kim M.
Olthoff 1 , Abraham Shaked 1 , Peter L. Abt 1 ; 1 Surgery, Hospital of
the University of Pennsylvania, Philadelphia, PA; 2 Gastroenterology,
Hospital of the University of Pennsylvania, Philadelphia, PA
Introduction: Domino liver transplantation, in which the
explanted liver from a patient with a hepatic metabolic disorder
(domino donor - DD) is subsequently transplanted into
a second patient (domino recipient - DR), has been utilized
as a method to increase the donor organ supply. Outcomes
of domino transplantation in the U.S. have not yet been fully
evaluated, nor compared to recipients of deceased donor and
living donor grafts. Methods: We performed a retrospective
review of all domino liver transplants performed in the United
States utilizing the UNOS liver transplant database. Graft survival
of DD and DR were compared to recipients of deceased
donor and living donor liver grafts respectively. Results: From
2000-2014, there were 144 domino transplants performed at
38 different centers. Mean DD age was 47; 66% were male.
Mean DD waitlist time was 276 days. The most common diagnosis
leading to transplant in the domino donor was familial
amyloidosis (80%). 26 (18%) DD received multiple organs at
the time of transplant, with 22 receiving a simultaneous heart
transplant. Mean age of the DR was 57 years; 67% were male.
Mean waitlist time for the DR was 543 days. The most common
diagnosis leading to transplant in the domino recipient was
hepatitis C (26%). Mean MELD score at time of transplant for
domino donors vs. deceased donor controls was 8 vs. 21.
Mean MELD score at time of transplant for domino recipients
vs. living donor controls was 15 vs. 15. Kaplan-Meier survival
analysis demonstrated no statistical difference in graft
survival between domino donors and a control group receiving
deceased donor grafts at 1 (88% vs. 85%, p=.34) and 5 years
(71% vs. 69%, p=.56). There was also no difference in graft
survival between domino recipients and living donor controls at
1 (85% vs. 83%, p=.57) and 5 years (68% vs. 71%, p=.66).
Conclusions: Domino transplantation is an effective strategy to
increase liver transplantation, with post-transplant graft survival
that is not different when compared to transplantation using
deceased donor or living donor grafts.
Disclosures:
The following authors have nothing to disclose: Ian W. Folkert, David S. Goldberg,
Matthew H. Levine, Kim M. Olthoff, Abraham Shaked, Peter L. Abt
869
Application of Gadoxetate Disodium-Enhanced MR
Imaging in a Rat Model of Acute Partial Liver Congestion
Akira Shimizu, Akira Kobayashi, Takahide Yokoyama, Hiroaki
Motoyama, Hiroshi Sakai, Noriyuki Kitagawa, Tsuyoshi Notake,
Tomoki Shirota, Kentaro Fukushima, Shinichi Miyagawa; Surgery,
Shinshu University, School of medicine, Matsumoto, Japan
Purpose: To evaluate the features of hepatic congestion on
gadoxetate disodium (Gd-EOB-DTPA)-enhanced magnetic resonance
imaging (MRI) and the mechanisms responsible for
the radiological findings in a rat model of acute partial liver
congestion. Materials and Methods: We used male Wistar rats
weighing 250–320 g. A conventional T1-weighted spin-echo
sequence of the liver was performed using a 1.5T magnetic
resonance imager with an 80-mm magnetic aperture for animal
studies. We induced regional liver congestion using partial left
lateral hepatic vein ligation (n = 5) and evaluated the following
in both congestive liver (CL) and non-congestive liver (non-CL):
1) chronological changes in the relative enhancement (RE) up
to 60 minutes after Gd-EOB-DTPA administration and other
parameters including the maximum RE value (C max
), time to
maximum RE (T max
), elimination half-life of RE (T 1/2
), and the
hepatocellular uptake index per unit volume (HUI/V), 2) the
amount of bile secretion and ATP concentration, and 3) mRNA
and protein expression of rat organic anion transporting protein
1a1 (Oatp1a1) using real-time PCR and immunohistological
examination. Results: 1) The RE in the CL reached a small
peak (18%) at 5 minutes, corresponding to approximately half
of the value observed in the non-CL, then slowly decreased in
a linear manner thereafter. The degree of RE in the CL was
significantly lower than that in the non-CL for up to 30 minutes
(P < 0.05). 2) The amount of bile secretion was significantly
decreased in the CL (3.6 ± 4.1 μL/h/g of liver) compared with
those in the non-CL (90.2 ± 32.2 μL/h/g of liver, P < 0.001).
Similarly, the ATP concentration was significantly reduced in
the CL (0.5 ± 0.2 μmol/h/g wet liver) compared with those in
the non-CL (3.3 ± 1.3μmol /g wet liver, P < 0.001). There were
significant correlations between the ATP concentration and the
HUI/V (r 2 = 0.593, 95% CI 0.587-0.599, P = 0.004), C max
(0.546, 0.538-0.555, P = 0.008) and T max
(0.458, 0.487-
0.500, P = 0.012); the closest correlation was observed with
the HUI/V. 3) An immunohistological examination showed that
Oatp1a1 protein expression was downregulated in the CL.
The mRNA level of Oatp1a1 in the CL was significantly upregulated,
compared with that in control rat liver (P = 0.046),
whereas no significant difference was observed between the
CL and the non-CL (P = 0.698). Conclusion: Gd-EOB-DTPA-enhanced
MRI is useful for detection of the congestive liver area
clearly depicted as hypointense. Reduced signal intensity in
the congestive area on Gd-EOB-DTPA-enhanced MRI could