studies

812A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Table 1
Disclosures:
James W. Ferguson - Advisory Committees or Review Panels: Astellas, Novartis
The following authors have nothing to disclose: Suman Verma, Fiona M. Hand,
Matthew J. Armstrong, Marie de Vos, Douglas Thorburn, Terry Pan, John R.
Klinck, Rachel Westbrook, Georg Auzinger, Andrew Bathgate, Steven Masson,
Andrew Holt, Diarmaid D. Houlihan
1217
Sublingual administration of tacrolimus is a feasible
route and requires a lower dose to achieve similar drug
exposition in adult liver transplant recipients.
Sandra Solari 2 , Alejandra Cancino 1 , Blanca M. Norero 1 , Rodrigo
Wolff 1 , Francisco Barrera 1 , Alejandro Soza 1 , Marco Arrese 1 , Juan
Francisco Guerra 3 , Nicolás Jarufe 3 , Jorge A. Martínez 3 , Carlos E.
Benítez 1 ; 1 Gastroenterology, Pontificia Universidad Católica de
Chile, Santiago, Chile; 2 Laboratorio Clínico, Pontificia Universidad
Católica de Chile, Santiago, Chile; 3 Digestive Surgery, Pontificia
Universidad Católica de Chile, Santiago, Chile
Introduction: Oral administration of immunosuppressive drugs
is not always feasible after liver transplantation and parenteral
administration of tacrolimus (TAC) implies a significantly higher
expense of resources. The aim of this study is to evaluate the
feasibility of sublingual (sl) administration of tacrolimus in adult
liver transplant recipients. Methods: In patients on per oral
administration (po) serum TAC levels were determined at different
time points (0, 0.5, 1, 2, 4, 6 and 12 hours), then patients
were switched to sl administration and TAC dose was tapered
(starting with a 20-30% reduction of the po dose) to obtain a
similar trough level that in po administration. Then TAC levels
were determined at the same time points. The exposition to
TAC (AUC) was estimated and compared for SL and po administration.
Results: Seventeen recipients were enrolled. The mean
time required to taper de sl dose to obtain a proper trough level
was 16.41±10.5 days (range 6-40 days). There were no differences
on trough levels on po and sl administrations (7.06±2.2
vs 7.19±2.0 ng/ml respectively, p=ns). Remarkably, when
AUC was evaluated, no differences were found in both groups
(111.4±32.23 ng/ml/h vs 111.4±35.65 ng/ml/h, p=ns).
However, the dose required to achieve a similar trough level
was significantly higher when TAC was administered on po vs
sl route (4.68±2.32 vs 2.94±1.7 mg/d, p=0.018), meaning a
38% reduction. The maximum concentration after TAC administration
(Cmax) was similar in sl and po groups (19.65±9.97
vs 15.88±6.91 ng/ml, p=ns). No severe adverse effects were
registered on sl group and was well tolerated. In one patient
very few and small blisters were transiently observed for a few
days and in 4 patients a spicy taste was transiently observed
with the meals on sl group. Conclusion: Sublingual administration
of tacrolimus is a feasible alternative to po administration
and can also be monitored employing trough levels requiring
a lower dose to achieve the same drug exposition. These findings
also suggest that parenteral TAC administration could be
replaced by sl route. These findings could imply a significantly
reduction on the cost of immunosuppression therapy.
Disclosures:
Alejandro Soza - Advisory Committees or Review Panels: Merck, Roche, Gilead;
Speaking and Teaching: Merck, BMS, Roche; Stock Shareholder: Gilead,
Achillion
The following authors have nothing to disclose: Sandra Solari, Alejandra Cancino,
Blanca M. Norero, Rodrigo Wolff, Francisco Barrera, Marco Arrese, Juan
Francisco Guerra, Nicolás Jarufe, Jorge A. Martínez, Carlos E. Benítez
1218
Pre-transplant echocardiographic parameters as a tool
to evaluate post-transplant survival and cardiac outcomes
in liver transplant recipients
Daniel W. Bushyhead 1 , James N. Kirkpatrick 2 , David S. Goldberg
3 ; 1 Internal Medicine, Hospital of the University of Pennsylvania,
Philadelphia, PA; 2 Cardiology, Hospital of the University of
Pennsylvania, Philadelphia, PA; 3 Gastroenterology, Hospital of the
University of Pennsylvania, Philadelphia, PA
Background Despite advances in liver transplantation and
pre-operative risk stratification, there remains significant
post-transplant morbidity and mortality from cardiovascular
disease. There are limited and conflicting data on the role of
pre-transplant echocardiography in risk stratifying patients with
cirrhosis. Moreover, the relationship between pre-transplant
cardiac function and post-transplant cardiovascular and renal
disease is unknown. The purpose of our study was to determine
if pre-transplant echocardiography predicts post-transplant outcomes
in liver transplant recipients. Methods We conducted a
retrospective analysis of adult liver transplant recipients at the
University of Pennsylvania from January 1, 2005 to September
30, 2014. We included only patients with pre-transplant echocardiograms
that were read by a cardiologist at our institution.
Patients with acute liver failure and those without a diagnosis
of cirrhosis were excluded. Pre-transplant echocardiographic
parameters were: ejection fraction, diastolic dysfunction, aortic
stenosis, regional wall motion abnormalities, mitral and tricuspid
regurgitation, left atrial size, right ventricular size and
function, pulmonary artery systolic pressure (PASP) and right
atrial pressure. Post-transplant outcomes were: patient survival,
major adverse cardiac events (MACE; myocardial infarction
and heart failure) and chronic kidney disease (CKD) stage 4 or
5 (estimated glomerular filtration rate