studies

836A AASLD ABSTRACTS HEPATOLOGY, October, 2015
significant CMV infection seen mostly within 1 st month in seropositive
population. Post-Tx CMV infection does not correlate
with pre-Tx CMV immunity.
Disclosures:
The following authors have nothing to disclose: Ekta Gupta, Viniyendra Pamecha,
Nadeem Hasnain, Yogita Verma, Ajeet S. Bhadoria, Niteen Kumar, Shiv
K. Sarin
1269
Good results of liver transplantation for decompensated
cirrhosis with multi-organ failure in ICU: a retrospective
study in two French centers
Florent Artru 1 , Alexandre Louvet 1 , Isaac Ruiz 2 , Julien Labreuche 3 ,
Eric Levesque 2 , Philippe Ichai 2 , Sebastien Dharancy 1 , Guillaume
Lassailly 1 , Emmanuel Boleslawski 4 , Gilles Lebuffe 5 , Audrey Coilly 2 ,
Eric Vibert 6 , Philippe Mathurin 1 , Didier Samuel 2 , Faouzi Saliba 2 ;
1 Hepatology, CHRU Lille, Lille, France; 2 Hepatology, Hopital Paul
Brousse, Villejuif, France; 3 Biostatistics Unit, CHRU Lille, Lille,
France; 4 Surgery Transplant Unit, CHRU Lille, Lille, France; 5 Anaesthesiology
Department, CHRU Lille, Lille, France; 6 Surgery Transplant
Unit, Hopital Paul Brousse, Villejuif, France
Resuscitation and transfer in intensive care unit (ICU) is often
debated in patients with end-stage liver disease (ESLD), a condition
associated with a very poor outcome. Few data are
available on the results of liver transplantation (LT) in cirrhotic
patients with multiorgan failure (MOF) and ESLD, admitted to
the ICU. Aims: 1) to describe outcome of patients with ESLD
and MOF transplanted while in ICU 2) to compare the outcome
of these patients to those who were not hospitalized in
ICU at time of LT and to those admitted to ICU but who did not
benefit from LT. Methods: Patients were retrospectively selected
from two French centers if they underwent LT for ESLD while in
ICU with at least 2 non-hematological organ failures defined
by SOFA score or if they had only liver failure but required
mechanical ventilation at time of LT. We excluded combined
liver-kidney transplantation. In order to evaluate the impact
of MOF at time of LT, we performed a case-control study in
which each patient with MOF was matched A) to 4 control
patients transplanted outside ICU (matching on age and gender)
B) to 1 (or 2 when possible) patients hospitalized in ICU
with MOF, not transplanted (matching on age, gender, SOFA
score). Results: From 2008 to 2014, 41 transplant recipients
with a median age of 53.4 years (19.5% female) met the
inclusion criteria. At time of LT, MELD score was 40 (95%CI:
33-40), SAPS 2 score was 51 (49-63) and SOFA score was
14 (13-15). Median duration of ICU stay before LT was 9
days (5-12). Prior to LT, 39% had vasopressive therapy, 51%
had mechanical ventilation and 51% had renal replacement
therapy. Duration of stay after LT was 12 days in ICU and 43
days in total. No PNF was observed. 6 patients underwent a
surgical procedure during the first month. 32 patients (78%)
developed bacterial infection post-LT, 12 (29%) CMV reactivation
and 7(17%) fungal infection. The 1-year patient survival
of the cohort was 85.04±5.6%. Based on the case-control
study, this good survival at 1 year was not different from that
of matched controls transplanted outside ICU (n=164): 85.04%
vs. 87.04%, p=0.8. As expected, patients transplanted with
MOF had a higher MELD score at time of LT as compared
to patients transplanted outside ICU: 40 vs. 16 (p