studies

824A AASLD ABSTRACTS HEPATOLOGY, October, 2015
1242
The Association of Pre-Transplant Sarcopenia and Cirrhotic
Cardiomyopathy with Postoperative Complications
after Liver Transplant.
Tripti Gupta 1,2 , Ryan M. Durel 1 , Qingyang Luo 1 , Daniel Devun 1 ,
John Seal 1 , Emily Ahmed 1 , David S. Bruce 1 , Trevor W. Reichman 1 ,
Shobha Joshi 1 , Natalie H. Bzowej 1 , Nigel Girgrah 1 , Humberto E.
Bohorquez 1 , Ari J. Cohen 1 , Ian C. Carmody 1 , George E. Loss 1 ,
George Therapondos 1 ; 1 Ochsner Clinic Foundation, New Orleans,
LA; 2 University of Queensland, Brisbane, QLD, Australia
Background: Sarcopenia in patients listed for liver transplantation
(LT) is associated with increased death on the wait list
and may affect post-operative recovery. These patients also
have cirrhotic cardiomyopathy but its effect on post-operative
outcomes remains unclear. Aims: To describe the prevalence of
sarcopenia and cirrhotic cardiomyopathy in a cohort of adult
patients with cirrhosis who are waitlisted for LT. To explore a
correlation between these two conditions. To investigate their
effect on post-operative outcomes. Methods: This is a retrospective
study of 327 cirrhotic patients who underwent LT at
Ochsner Medical Center between Jan 2012-Dec 2013. Pre-LT
data such as demographics, clinical characteristics, etiology
of liver disease, MELD score, 2D echocardiographic data (Left
ventricular volume index- LAVI), E/A ratio, QTc interval were
collected. CT abdomen/pelvis was used to calculate psoas
muscle cross-sectional area (at L4 level). Post-LT data were also
collected- no of days in hospital (first admission), no of ICU
admissions, no of infections and creatinine level. Results: The
M:F ratio was 68/32 and the mean age was 55 yrs. The mean
MELD score was 23.5. Data for the first postoperative year
were collected. The MELD scores and other demographics as
well as 1-yr patient and graft survivals in the sarcopenia vs
non-sarcopenia groups were similar. Cardiac assessment: 36%
of our cohort had an abnormal LAVI. Sarcopenia: 19.5% of
patients were sarcopenic. There was no correlation between
the presence of sarcopenia and any of the abnormal cardiac
measurements. 12.5% of patients with sarcopenia were discharged
to a rehab facility vs only 6.8% of patients without
sarcopenia. See Table for other post-LT outcomes. Summary:
There was no correlation between the presence of sarcopenia
and cirrhotic cardiomyopathy. Sarcopenia was shown to
be associated with prolonged hospital stay, more episodes of
infection and was more likely to lead to a discharge to a rehabilitation
facility rather than home. The presence of cirrhotic
cardiomyopathy pre-LT was associated with worse renal function
at 1 year post LT. Conclusions: Sarcopenia is associated
with increased post-LT morbidity and increased health care
utilization while cirrhotic cardiomyopathy is associated with
post-LT renal impairment. Although both conditions are seen
in patients with cirrhosis, they do not appear to be associated
with each other.
Post-LT outocmes
Disclosures:
Shobha Joshi - Grant/Research Support: Salix, Eisai; Speaking and Teaching:
Merck, Gilead, Bristol-Myers Squibb
Natalie H. Bzowej - Grant/Research Support: Gilead Sciences, Ocera Therapeutics
Nigel Girgrah - Speaking and Teaching: Merck, Bayer, Vertex, Gilead, Merck,
Bayer, Vertex, Gilead, Merck, Bayer, Vertex, Gilead, Merck, Bayer, Vertex,
Gilead
The following authors have nothing to disclose: Tripti Gupta, Ryan M. Durel,
Qingyang Luo, Daniel Devun, John Seal, Emily Ahmed, David S. Bruce, Trevor
W. Reichman, Humberto E. Bohorquez, Ari J. Cohen, Ian C. Carmody, George
E. Loss, George Therapondos
1243
Outcomes Post-Liver Transplant for Primary Sclerosing
Cholangitis: Colitis Activity and Malignancy
Astrid-Jane Greenup 1 , Gokulan Pavendranathan 1,2 , Mathew J.
Keegan 1 , Sean Griffin 1 , David Bowen 1,4 , Warwick Selby 1,3 , Nicholas
A. Shackel 1,4 , Simone I. Strasser 1,3 , Geoff McCaughan 1,4 ,
David J. Koorey 1,3 ; 1 A W Morrow GI and Liver Centre, Royal
Prince Alfred Hospital, Sydney, NSW, Australia; 2 University of
New South Wales, Sydney, NSW, Australia; 3 University of Sydney,
Sydney, NSW, Australia; 4 Centenary Institute of Cancer Medicine
& Cell Biology, Sydney, NSW, Australia
Background The reported risk of colorectal cancer(CRC) in
patients transplanted for primary sclerosing cholangitis(PSC)
is higher than in other transplant indications and non-transplanted
patients with PSC.Yearly endoscopic surveillance is
recommended.Furthermore, inflammatory bowel disease(IBD)
activity varies despite immunosuppressive therapy. Aims The
aims of this retrospective observational study were to examine
IBD colitis activity and rates of colonic dysplasia and cancer
in patients post-liver transplantation for PSC. Methods Data
for patients undergoing liver transplantation for PSC at Royal
Prince Alfred Hospital from January 1986 to December 2014
was collected and analysed. Results One hundred and fourteen
patients were transplanted for PSC during this 29-year period.
Thirty-one patients were excluded for less than 2 years of follow
up post-transplant (deceased(n=20;19 prior to 2008) or transplantation
since January 2013(n=11)).Of the remaining 83
patients,14 patients had a pre-transplant colectomy,care of 4
patients was transferred to another interstate transplant centre
and 3 had limited available medical records.Eighteen of 62
patients did not have IBD pre-transplant,of whom 1 required
a colectomy(for sporadic CRC) and 4 subsequently developed
IBD.Accordingly,post-transplant IBD outcomes were available
for 48 patients with mean age 58 years,male to female ratio
2:1 and diagnosis of ulcerative colitis in 28 and Crohn’s
disease in 20.Mean follow-up was 11 years.Forty-seven of
48 had had at least one colonoscopy;median interval 1.74
years.Colitis was histologically active in 68%(n=32) post-transplant,including
22 patients with quiescent disease preceding
transplant.Three patients received tumour necrosis factor
antagonist therapy,inducing remission in two whilst the other
required colectomy.A further four patients needed colectomy
for refractory colitis.In the remaining 15,colitis was quiescent
post-transplant.Six patients had a total or hemi colectomy for
the indications of CRC(3),invisible dysplasia(1),endoscopically
unresectable polypoid dysplasia(1) and caecal volvulus(1).An
additional 4 patients had a history of invisible dysplasia and
4 endoscopically resectable polypoid dysplasia. Conclusions
Colitis has been active in 68% of patients post-transplant for
PSC.Dysplasia and/or CRC have been detected in 14 patients.
Colectomy has been necessary in 11 patients overall.These
findings emphasise the need for aggressive surveillance and
colitis management post-transplantation, including vigilance
for de novo IBD development.Median colonoscopic interval
of 1.74 years remains longer than recommended and is an
opportunity for quality improvement.
Disclosures:
Simone I. Strasser - Advisory Committees or Review Panels: Janssen, AbbVie,
Roche Products Australia, MSD, Bristol-Myers Squibb, Gilead, Norgine, Bayer
Healthcare; Speaking and Teaching: Bayer Healthcare, Bristol-Myers Squibb,
MSD, Roche Products Australia, Gilead, Janssen, Abbvie