studies

640A AASLD ABSTRACTS HEPATOLOGY, October, 2015
be explained by the decreased uptake of contrast agent via
Oatp1a1 protein.
Disclosures:
The following authors have nothing to disclose: Akira Shimizu, Akira Kobayashi,
Takahide Yokoyama, Hiroaki Motoyama, Hiroshi Sakai, Noriyuki Kitagawa,
Tsuyoshi Notake, Tomoki Shirota, Kentaro Fukushima, Shinichi Miyagawa
Disclosures:
Thomas D. Schiano - Advisory Committees or Review Panels: salix, merck, gilead,
pfizer; Grant/Research Support: galectin, massbiologics, biotest
The following authors have nothing to disclose: Amy Tan, M. Isabel Fiel, Stephen
C. Ward, Marcelo Facciuto, Swan N. Thung, Myron E. Schwartz, Sander S.
Florman
870
Lack of Radiologic-Pathologic Correlation and Associated
Clinical Features of Patients with Hepatocellular
Carcinoma Undergoing Liver Transplantation
Amy Tan 1 , M. Isabel Fiel 3 , Stephen C. Ward 3 , Marcelo Facciuto 4 ,
Swan N. Thung 3 , Myron E. Schwartz 4 , Sander S. Florman 4 ,
Thomas D. Schiano 2 ; 1 Internal Medicine, Icahn School of Medicine
at Mount Sinai, New York, NY; 2 Liver Diseases, Icahn School
of Medicine at Mount Sinai, New York, NY; 3 Pathology, Icahn
School of Medicine at Mount Sinai, New York, NY; 4 Surgery,
Recanati/Miller Transplantation Institute; Icahn School of Medicine
at Mount Sinai, New York, NY
Background: The Milan criteria are widely applied in selecting
and listing patients with hepatocellular carcinoma (HCC) for
liver transplantation (LT). They fundamentally depend on the
sensitivity of radiologic imaging in detecting lesions. We aimed
to compare radiologic detection with pathologic assessment of
HCC in explanted livers as well as to identify clinical features
that might impact this correlation. Design: At our institution, LT
candidates undergo CT scan or MRI every 3-6 months depending
on if they have HCC and if it is being actively treated.
Per protocol, all explanted livers are weighed, sectioned at
0.5cm intervals, and reviewed by the pathologist. For the current
study, retrospective clinical data were gathered, including
demographics, MELD score, # of lesions seen on imaging, and
history of locoregional therapy (LRT). Retrospective histopathological
review of liver explant sections was performed by a
liver pathologist (MIF) blinded to patient identities. The degree
of cirrhosis based on the Laennec sub-classification (4A=incomplete
cirrhosis, 4B=nodules with thin fibrous septa, 4C=nodules
surrounded by thick fibrous septa) was assessed. Correlation of
the number of tumors found on radiologic imaging and pathologic
examination was performed. Results: 148 patients with
HCC who underwent LT over a 36-month period were studied.
There were 114M & 34F, 60.2±7.2 years of age. 105 had
LT for HCV, 17 for NASH, 19 for HBV, and the rest for other
etiologies. 66 patients (45%, Group A) showed concordance
between imaging and pathologic findings of HCC whereas 82
(55%, Group B) did not. Laennec staging was performed on
patients over the first 21-month period. 32/34 in Group A and
26/27 in Group B had cirrhosis. More Group B than Group
A patients had class 4C cirrhosis (p=0.028). Patients with a
lack of concordance also had a higher creatinine (p=0.019)
and MELD score (p=0.021). There was a trend towards smaller
liver volumes in this group as well. No significant difference
was found in age, sex, time between LT and last imaging
study, and LRT. 39 (48%) in Group B had tumors ≥1cm not
detected by pre-LT imaging. Conclusion: There was a high rate
of non-correlation between radiologic and pathologic findings
in our cohort of patients with known HCC. We found that
HCC is detected less well on imaging in patients having more
advanced fibrosis, as well as in patients with renal dysfunction
and higher MELD scores. Current radiologic modalities may
not be sensitive enough to identify HCC lesions in this population
and thus underestimate tumor burden at time of LT. This
may be due to less optimal penetration of radiologic contrast
into their liver parenchyma.
871
Using Biomarkers to Predict Progression to End-stage
Renal Disease within 6 Months of Liver Transplant
Joseph Bahng, Peter L. Abt, Deirdre Sawinski, Anirban Ganguli,
Debra McCorriston, Mary Ann Lim, Kimberly A. Forde; Perelman
School of Medicine at the University of Pennsylvania, Philadelphia,
PA
Background Liver transplant (LT) recipients are at increased
risk for chronic kidney disease and end-stage renal disease
(ESRD). Creatinine, the standard for assessment of renal function,
provides limited prognostic information about the likelihood
of recovery from acute kidney injury (AKI). Our aim was
to create a predictive model for progression to ESRD within 6
months of LT that incorporates clinical data and biomarkers.
Methods We enrolled 202 patients listed for LT at our center
from 2012-2014. Serum and urine samples were collected at
enrollment, at LT, and 1 year thereafter. Clinical and demographic
data were also collected. Patients were followed until
they developed the primary outcome, ESRD, defined as glomerular
filtration rate