studies

822A AASLD ABSTRACTS HEPATOLOGY, October, 2015
tion and patient and graft survival. Implications for the clinical
setting are conscientiously monitoring of the GFR in the first
months after liver transplantation and taking action as early
as possible to prevent worsening of the creatinine clearance.
Disclosures:
Faouzi Saliba - Advisory Committees or Review Panels: Novartis, Roche, Genzyme,
Vital therapies; Grant/Research Support: Astellas; Speaking and Teaching:
Gambro, MSD, Gilead
Rene Adam - Grant/Research Support: Merck Serono, Roche, Sanofi aventis,
astellas, novartis, Merck Serono, Roche, Sanofi aventis, astellas, novartis, Merck
Serono, Roche, Sanofi aventis, astellas, novartis, Merck Serono, Roche, Sanofi
aventis, astellas, novartis
Didier Samuel - Consulting: Astellas, MSD, BMS, Roche, Novartis, Gilead, LFB,
Janssen-Cilag, Biotest, Abbvie
The following authors have nothing to disclose: Noémie Minczeles, Valérie Delvart,
Teresa Antonini, Rodolphe Sobesky, Philippe Ichai, Audrey Coilly, Bruno
Roche, Marc Boudon, Eric Vibert, Denis X. Castaing, Daniel Cherqui, Gilles
Pelletier, Jean-Charles Duclos-Vallee
1238
Value of Magnetic Resonance Cholangiography in
Assessment of Non-Anastomotic Biliary Strictures after
Liver Transplantation
A. Claire den Dulk 1 , Martin N.J.M. Wasser 2 , Francois Willemssen
3 , Melanie A. Monraats 2 , Marianne de Vries 3 , Rivka van den
Boom 2 , Jan Ringers 4 , Hein W. Verspaget 1 , Herold J. Metselaar 5 ,
Bart van Hoek 1 ; 1 Gastroenterology and Hepatology, Leiden University
Medical Center, Leiden, Netherlands; 2 Radiology, Leiden
University Medical Center, Leiden, Netherlands; 3 Radiology, Erasmus
Medical Center, Rotterdam, Netherlands; 4 Transplant Surgery,
Leiden University Medical Center, Leiden, Netherlands; 5 Gastroenterology
and Hepatology, Erasmus Medical Center, Rotterdam,
Netherlands
Background Non-anastomotic biliary strictures (NAS) remain
a frequent complication after orthotopic liver transplantation
(OLT). The aim of this study was to evaluate whether Magnetic
Resonance Cholangiography (MRCP) could be used to detect
or exclude NAS and grade the severity of biliary strictures.
Methods In total, 58 patients after OLT from two transplantation
centres in whom endoscopic (ERCP) or percutaneous transhepatic
cholangiography (PTC) and MRCP were performed
within less than 6 months were included in the study. Of these
patients, 41 had NAS and 17 were without NAS based on
ERCP or PTC and follow-up. Four radiologists – two in each
center – used an adapted validated classification –termed
Leiden Biliary Stricture Classification (LBSC)– to evaluate the
MRCP independently and assess NAS severity on a scale from
0 to 3 points in three hepatobiliary regions.(Fig 1) A maximum
of 15 points could be obtained. Interobserver agreement of the
severity score and intra-observer agreement between ERCP/
PTC and MRCP for each region was calculated with the kappa
(κ) statistic. Results Optimal cut-off value of the LBSC to detect
the presence of NAS with MRCP was calculated at ≥ 3 points
for all readers. Applying this cut-off, sensitivity for each reader
was >90%, with a corresponding specificity of 50-82%, positive
predictive value (PPV) of 86-91%, and negative predictive
value (NPV) of 80-100%. When the cut-off value was applied
to the radiologists’ mean scores sensitivity was 98%, specificity
65%, PPV 87% and NPV 92%. MRCP performance was better
in evaluation of the intrahepatic bile ducts than of the extrahepatic
bile ducts. The additional value of MRCP for grading
severity (κ= 0.2 – 0.7) and localizing NAS (κ= 0.2 – 0.9) was
limited. Conclusion MRCP is a reliable tool to detect or exclude
non-anastomotic biliary strictures after OLT. MRCP cannot be
used to reliably grade the severity of these strictures.
Disclosures:
Bart van Hoek - Advisory Committees or Review Panels: Janssen-Cilag, Bristol
Meyers Squib, Gilead, Merck, Abbvie
The following authors have nothing to disclose: A. Claire den Dulk, Martin N.J.M.
Wasser, Francois Willemssen, Melanie A. Monraats, Marianne de Vries, Rivka
van den Boom, Jan Ringers, Hein W. Verspaget, Herold J. Metselaar
1239
Are cirrhotic patients awaiting liver transplantation protected
against vaccine preventable diseases?
Mazzola Alessandra 1,2 , Margherita Tran Minh 1,3 , Raluca Pais 1 ,
Pascal Lebray 1 , Denis Bernard 4 , Claire Goumard 5 , Yvon Calmus 1 ,
Filomena Conti 1 ; 1 Unité Médicale de Transplantation Hépatique,
APHP, Hôpital Pitié Salpétrière, Paris, France; 2 Sezione di Gastroenterologia,
University of Palermo, Palermo, Italy; 3 Clinical
and experimental Medecine, Università del Piemonte Orientale,
Novara, Italy; 4 Service d’Anesthésie Réanimation, APHP, Hôpital
Pitié Salpétrière, Paris, France; 5 Sevice de Chirurgie Hépatobiliaire
et de Transplantation, APHP, Hôpital Pitié Salpétrière, Paris,
France
Background: Cirrhotic patients are spontaneously immunocompromised
and are at increased risk of infection with higher
morbidity and mortality. Vaccination may reduce the mortality
related to infectious complications in those patients. Only
few data regarding protection against vaccine preventable
diseases and the results of vaccination are available in cirrhotic
patients awaiting liver transplantation (LT). Aims: The aims of
this prospective non-randomized study were to prospectively
assess the prevalence of hepatitis A, B and varicella viruses
(HAV,HBV,VZV) serological markers and to the evaluate the
immunization status in a cohort of cirrhotic patient awaiting LT
to determine the need of vaccination in this cohort. Patients and
methods: All the cirrhotic patients registered on the LT waiting
list in a single center were questioned about the prevalence of
previous diseases and vaccinations by a questionnaire. The
enzyme linked immunosorbent assay (ELISA) method was used
to assess the presence of HBsAg, anti-HBc, anti-HBs, anti-HAV
and anti-VZV antibodies. The positivity of serology was defined
as: HBsAg ≥1 mUI/mL, anti-HBs ≥10 mUI/L, anti-HBc≥1 mUI/L,
anti-HAV(IgG)≥1mUI/mL and anti-VZV(IgG)≥165 mUI/mL for
HBV, HAV and VZV viruses, respectively. Results: 201 patients
(male: 74%, mean age: 54±11years) have been evaluated.
The indication for LT was HCV-related cirrhosis in 42.4%, HBV
cirrhosis in 9%, alcoholic cirrhosis in 43.1%, NASH in 6.1%,
hepatocellular carcinoma in 41.9%, and other indications in
21.2%. Forty-five percent were class A, 33.2% B and 18.9%
C according to Child-Pugh score; median MELD score was 12
(6-33). Only 2.5% of patients had a vaccination book, 50%
were anaware of having or having not a pasthistory of HBV,
HAV or VZV infection. Twenty-nine percent, 6.7% and 4.0%,
respectively, reported a vaccination against HBV, HAV and
VZV. Seroprevalence was 11.1% for HBsAg, 32.2% for anti-