studies

818A AASLD ABSTRACTS HEPATOLOGY, October, 2015
the rest was a mixed pattern. Radiologic cholangiopathy was
seen in 9 (36%) of patients. Of 17 patients who had liver biopsies,
chronic rejection was seen in 6 and nonspecific hepatitis
in 4; stage 3-4 fibrosis was present in 7 patients. A total of
76% of patients had either liver test, radiographic, or histologic
abnormalities of the graft. There were 4 graft failures, leading
to death in 2 patients and a repeat OLT in 1, while one is
awaiting repeat OLT. Another patient died from sepsis related
to hepatic abscesses. Conclusions: Liver grafts in children continue
to function >15 years later in adulthood, but abnormal
liver tests, radiographic or histologic findings are present in
majority of these grafts. Chronic rejection was common, and
graft failure that required repeat OLT or led to death occurred
in a few patients. The presence of donor-specific antibodies in
the patients with graft abnormalities will be investigated further.
Disclosures:
J. Michael Millis - Advisory Committees or Review Panels: Vital Therapies; Board
Membership: Vital Therapies
Helen S. Te - Advisory Committees or Review Panels: BMS; Grant/Research
Support: Abbvie, Conatus, BMS
The following authors have nothing to disclose: Shewit Giovanni, Andrew I.
Aronsohn, John F. Renz, Ruba K. Azzam, Pamela Boone, Kathleen Dasgupta
1230
Lack of effect of CMV reactivation in the outcome of
HCV-infected liver transplant(LT)patients
Victoria Aguilera 1,2 , Tommaso Di Maira 1 , Isabel Conde 3 , Angel
Rubin 1,2 , Carmen Vinaixa 1,2 , Salvador Benlloch 1,2 , Martin Prieto
1,2 , Marina Berenguer 4,2 ; 1 Hepatology Section, Hospital Universitari
La Fe, Valencia, Spain; 2 CIBERehd, Instituto de Salud Carlos
III, Grant PI13/01770, Valencia, Spain; 3 Hepatologia, Instituto
de Investigación Sanitaria Hospital Universitari La Fe, Valencia,
Spain; 4 Facultad de Medicina, Universidad de Valencia, Valencia,
Spain
Background: The role of CMV reactivation in recurrent hepatitis
C after LT is controversial. Other aspects such as development of
infections, diabetes mellitus (DM), rejection and cardio-vascular
events (CVE) have also been associated with CMV reactivation
post-LT. Aims: To evaluate if CMV reactivation is associated
with (1) aggressive recurrent hepatitis C and (2) post-LT infections,
rejection, DM and CVE. Patients and methods: Patients LT
from Jan 2011 to Dec 2013 due to HCV-cirrhosis with HCV-positive
viremia. CMV Reactivation was defined as CMV viral
load(VL) >400c/ml. CMV VL was determined in a clinical basis
during the first 12 months after LT. Outcome variables were:
(i) aggressive recurrent hepatitis C (defined as F>1, F=0 with
moderate inflammatory activity or cholestatic hepatitis), acute
rejection (Banff criteria), infections, de novo DM post-LT and
CVE. Demographics, donor, immunosuppression(IS), surgical,
hematological, biochemical and virological related variables
were also recorded. Results: 77 patients (mean age:56yr (25-
68), 67% men, 46% HCC) were included. Donor and recipient
CMV serologies were as follows: D+/R+:n=61,79%; D -/
R+:n=6,8%; D+/R-:4, 5%; D-/R-:n=6, 8%. CMV prophylaxis
(during 90 days) was administered in 7(9%) patients. Reasons
for prophylaxis were: CMV-D +/R - n=3, Methylprednisolone
boluses or basiliximab use, n=4. CMV reactivation occurred in
26 patients(33%), 24(34%) without prophylaxis and 2(28%)
with prophylaxis (p=ns). Time to reactivation was 138 vs 45
days in those with and without prophylaxis (P=.026). Reactivation
led to anti-CMV treatment in 16(61%) pts. Severe recurrent
hepatitis C occurred in 55 pts (71%), 9 (12%) pts developed
rejection, 39 pts (51%) infections, 15(20%) de novo DM and
6 (8%) a CVE. Nor CMV reactivation nor CMV treatment were
associated with aggressive recurrent hepatitis C, rejections,
infections, de novo DM or CVE. Graft and patient survival were
not related either with CMV reactivation. There was a trend
towards a potential protection effect of sirulimus-SRL- based IS
and CMV reactivation (20% in SRL group vs 39% in non SRL
group, p=0.1) but triple therapy or basiliximab use were not
associated with reactivation. Conclusions: CMV reactivation
occurs frequently after LT. About half of cases require therapy.
In patients with prophylaxis, CMV reactivation tends to occur
at later time points. Given the lack of association between
CMV reactivation and post-transplant outcome, we believe it
is unnecessary to prolong CMV prophylaxis for more than 3
months, as suggested by some authors. mTor inhibitors seem to
protect against CMV reactivation; larger studies are needed to
confirm this finding..
Disclosures:
The following authors have nothing to disclose: Victoria Aguilera, Tommaso Di
Maira, Isabel Conde, Angel Rubin, Carmen Vinaixa, Salvador Benlloch, Martin
Prieto, Marina Berenguer
1231
Blood Phosphatidyl ethanol identifies alcohol use
among liver transplant recipients
Michael F. Fleming 2 , Jenny Vue 1 , Michael R. Lucey 1 ; 1 Medicine,
Univ. of Wisconsin School of Medicine and Public Health, Madison,
WI; 2 Family Medicine, Northwestern University, Chicago, IL
All patients with liver failure due to alcohol use disorder (AUD)
who undergo liver transplantation (LT) are advised to abstain
from alcohol. Monitoring alcohol use in AUD -LT recipients is
hampered by lack of easily usable methods to identify alcohol
relapses. Phosphatydylethanol (PEth), a red cell-membrane
phospholipid that is released into circulation after alcohol use,
accurately identifies recent alcohol use (i.e. in the prior 30
days) in healthy subjects and AUD patients. The whole blood
concentration of PEth varies in a dose-response fashion with
consumption, with >8ng/ml being considered a positive test
for recent exposure. There are no known false positive tests
and PEth is considered 100% specific. PEth can detect daily
drinking of > 2 drinks or intermittent binge drinking. We report
a prospective study of blood PEth as a marker of alcohol use
among 213 LT recipients at 2 US liver transplant centers. All
subjects gave informed consent. The protocol was approved by
the IRBs at each institution. Methods: The sample included 147
men and 66 women with a mean age of 59 years. 131 had
a history of alcohol dependence prior to LT and 82 served as
non-alcohol dependent controls. Subjects participated in a face
to face interview to assess recent alcohol use using a 30-day
timeline follow-back calendar procedure and dried blood spot
collection at study entry, and at 6 and 12 months thereafter.
PEth was determined using an Agilent Zorbax chromatography-tandem
mass spectrometry procedure and was performed
by the United States Drug Testing Laboratories in Chicago.
Results: among the available data, 49 subjects (23% of the
total sample), including 39 AUD subjects (30% of the AUD
group) and 10 controls (12% of the control group), had a positive
test of >8 ng/ml, either at baseline or during the follow-up
period. 149 patients reported no alcohol use and had a negative
PEth assays. 32 subjects (15% of the total sample) reported
no alcohol use and had a positive test indicating recent alcohol
use. Of the 25 subjects who reported recent alcohol use, 11