studies

810A AASLD ABSTRACTS HEPATOLOGY, October, 2015
1213
Prediction of Posthepatectomy Liver Failure based on
Preoperative Liver Fibrosis Assessment: Comparison of
Mac-2 Binding Protein Glycosylation Isomer and Liver
Stiffness Measurement
Takahiro Nishio, Kojiro Taura, Kazutaka Tanabe, Gen Yamamoto,
Yukihiro Okuda, Yoshinobu Ikeno, Satoru Seo, Kentaro Yasuchika,
Etsuro Hatano, Hideaki Okajima, Toshimi Kaido, Shinji Uemoto;
Department of Surgery, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
Posthepatectomy liver failure (PHLF) is one of the major
causes of hepatectomy-related mortality, and accurate prediction
of PHLF based on preoperative liver function test is
essential. Recently, Mac-2 binding protein glycosylation isomer
(M2BPGi) has been proposed as a useful liver fibrosis
marker, while liver stiffness (LS) measurement was also well
accepted as a noninvasive assessment tool for liver fibrosis.
We evaluated the usefulness of these novel liver fibrosis markers,
M2BPGi and LS, for predicting PHLF. One hundred and
thirty-eight patients with hepatocellular carcinoma undergoing
hepatectomy between August 2011 and October 2014 were
analyzed. Preoperative serum M2BPGi level was measured
in addition to a routine blood test, and LS was measured by
acoustic radiation force impulse-based Virtual Touch Tissue
Quantification (VTTQ) technology. Remnant liver volume rate
(REM) was calculated by computed tomography volumetry.
PHLF was diagnosed according to the definition of the International
Study Group of Liver Surgery and was graded as A,
B, or C. The accuracy of predictors was assessed by the area
under the receiver operating characteristic curve (AUROC). The
mean serum M2BPGi level (cut off index) was 1.0±0.5 in F0-1,
1.7±1.1 in F2-3, and 4.5±3.6 in F4; and the mean VTTQ value
(m/s) was 1.4±0.3, 1.7±0.6, and 2.7±0.9, respectively; both
of which significantly increased according to the progression
of liver fibrosis stage (p < .01). M2BPGi had AUROCs of 0.80
for the diagnosis of F≥2, 0.82 for F≥3, and 0.83 for F4, which
were better than any other fibrosis markers including the VTTQ
value. PHLF occurred in 34 patients (24.6%): grade A, 15
patients (10.9%); grade B, 14 patients (10.1%); grade C, 5
patients (3.6%). The AUROCs of M2BPGi were 0.61 for the
prediction of PHLF grade ≥A, 0.70 for grade ≥B, and 0.64
for grade C; while those of VTTQ value were 0.66, 0.77, and
0.72, respectively. Multivariate stepwise selection identified 3
best fit significant factors for the prediction of PHLF: M2BPGi
(odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4,
p = .013), platelet count (OR, 0.42; 95% CI, 0.23-0.72, p <
.01), and REM (OR, 0.37; 95% CI, 0.23-0.59, p < .01). The
predictive model including these 3 variables had AUROCs
of 0.77 for predicting PHLF grade ≥A, 0.81 for grade ≥B,
and 0.80 for grade C; and this model enabled the estimation
of safe resection liver volume according to the risk of PHLF
by the preoperative M2BPGi and platelet count. Conclusions.
M2BPGi and LS were useful markers for predicting PHLF as
well as liver fibrosis progression.
Disclosures:
Etsuro Hatano - Speaking and Teaching: Bayer
The following authors have nothing to disclose: Takahiro Nishio, Kojiro Taura,
Kazutaka Tanabe, Gen Yamamoto, Yukihiro Okuda, Yoshinobu Ikeno, Satoru
Seo, Kentaro Yasuchika, Hideaki Okajima, Toshimi Kaido, Shinji Uemoto
1214
Two-Year Results of a Pilot Program in Early Liver Transplantation
for Severe Alcoholic Hepatitis
Brian P. Lee 1 , Po-Hung Chen 1 , Ruben Hernaez 1 , Ahmet Gurakar 1 ,
Benjamin Philosophe 2 , Zhiping Li 1 ; 1 Medicine, Johns Hopkins University
School of Medicine, Baltimore, MD; 2 Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD
OBJECTIVE: Six months of alcohol abstinence is typically
required before a patient is considered for liver transplant (LT).
In October 2012, our LT center initiated a pilot program to
transplant selected patients with acute alcoholic hepatitis. The
purpose of this study was to assess the results of this pilot program
and the effects on organ allocation. METHODS: Data
was collected from all patients with alcohol-related liver disease
(ALD) since initiation of our pilot program in October
2012. These patients were stratified into three groups based
on indication for LT: severe alcoholic hepatitis as first liver
decompensation (Group 1), alcoholic cirrhosis with ≤6 months
abstinence (Group 2), alcoholic cirrhosis with ≥6 months
abstinence (Group 3). Follow-up period was defined as time
between date of transplant and date of last follow-up or death.
Recidivism was any evidence of alcohol consumption following
LT. The number of organs allocated for ALD within 2 years of
the pilot program was compared to the 2-year period immediately
prior to implementation. RESULTS: 36 patients underwent
LT. All patients in Group 1 had Maddrey’s Discriminant
Function greater than 32. Table 1 has patient characteristics
and outcomes. 18 of 36 (50%) LTs performed for ALD had
less than 6 months of abstinence prior to listing. Compared
to the 2-year period prior to the pilot program, there was an
increase in the proportion of organs indicated for ALD (20%
vs. 12%; p=0.13). 6-month survival was 100%, 100%, 83%
in Group 1, 2, 3, respectively (p=0.16). CONCLUSIONS: For
carefully selected patients presenting with alcoholic hepatitis,
early LT resulted in similar 6-month survival and alcohol relapse
rates compared to patients undergoing LT after 6 months of
abstinence. Patients transplanted for acute alcoholic hepatitis
(Group 1) had significantly higher MELD score and shorter
length of time on the transplant list compared to both other
groups. The implementation of a policy allowing early LT for
ALD resulted in an increase in proportion of organs allocated
for alcohol-related indications, but did not reach statistical significance.
Table 1: Patient Characteristics and Outcomes
*Excluding two patients who died during the post-operative
period
Disclosures:
Ahmet Gurakar - Advisory Committees or Review Panels: Gilead; Grant/
Research Support: BMS
The following authors have nothing to disclose: Brian P. Lee, Po-Hung Chen,
Ruben Hernaez, Benjamin Philosophe, Zhiping Li