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840A AASLD ABSTRACTS HEPATOLOGY, October, 2015 The mean body mass index (BMI) at transplant was 27±4.2kg/ m 2 with mean albumin 2.96±0.8g/dL. The mean TPA was 927.1±280mm 2 , which is much lower than the expected normal mean of 1211.9±242.3mm 2 . During the study time period, 13 (54%) patients died at a mean of 1.2±2 years. Conclusion: Although LVSD is an uncommon complication post-LT, patients with high MELD and malnutrition maybe at highest risk. Sarcopenia, measured by TPA, maybe a better marker for malnutrition than traditional markers. BMI can be falsely elevated by volume overload, which can explain the normal BMI seen in our patient group. Sarcopenia should be studied further as a possible predictor for LVSD. Pre-operative nutritional optimization and close post-LT echocardiogram monitoring is advisable in this population at risk for increased mortality post-LT. Disclosures: The following authors have nothing to disclose: Arun Mathew, She-Yan Wong, Michael Cheung, Flavius Guglielmo, Cataldo Doria, David A. Sass, Dina Halegoua-De Marzio 1277 Risk Stratification for Optimal Timing of Liver Transplantation Following Repeated Locoregional Therapies in Patients With Hepatitis B-Related Hepatocellular Carcinoma Hwi Young Kim 1 , Won Kim 1 , Yong Jin Jung 1 , Hyeyoung Kim 2 , Nam-Joon Yi 2 , Kwang-Woong Lee 2 , Hae Won Lee 3 , Kyung-Suk Suh 2 ; 1 Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of); 2 Department of Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of); 3 Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of) BACKGROUND: Decision of timing for liver transplantation (LT) in patients with HCC often depends on the responses to pre-LT locoregional therapies especially in cases of organ shortage. However, prediction of favorable tumor biology before LT is difficult, and supporting data for decision of LT timing is scarce. The aims were to prognosticate HCC patients who underwent LT according to their responses to pre-LT locoregional therapies, and to shed light on the decision of optimal timing for LT. METHODS: Between January 2005 and December 2011, a total of 264 patients with hepatitis B-related HCC underwent LT. Excluding 52 patients with their tumors beyond Milan criteria, 212 patients were included. Responses to pre-LT locoregional therapies were assessed using the modified RECIST criteria. Pre-LT risk scores were generated as follows: [(No. of recurrence following radiofrequency ablation or ethanol injection + 2x(No. of progressive disease following transarterial chemoembolization(TACE)) + (No. of recurrence following previous response to TACE)]. Cox proportional hazard model was used to investigate prognostic factors for recurrence-free survival. RESULTS: Median age at the time of HCC diagnosis was 51 years, and male patients were 81.1%. Median time to LT was 6.5 months(interquartile range(IQR), 1.3-27.6). Median follow-up duration after LT was 55.3 months(IQR, 39.6-81.4). Median maximal diameter of the largest tumor was 2.0cm(range, 1.1-5). Hepatitis B viral DNA was 1875 IU/mL(median) at baseline. Baseline serum alpha-fetoprotein was 19 ng/mL(range, 1.8-23200). Baseline Child-Pugh classes were A in 101(47.6%) and B in 61(28.8%), respectively. Before LT, 68 patients received at least one session of radiofrequency ablation or ethanol injection, and 100 patients received at least one session of TACE, respectively. Overall, 127 patients(59.9%) received pre-LT locoregional therapies. Pre-LT risk scores were as follows: 0, n=126(59.4%); 1-2, n=36(17.0%); 3-5, n=30(14.2%); ≥6, n=20(9.4%). From multivariable Cox analysis, pre-LT risk scores and maximal tumor diameter were independently significant prognostic factors for recurrence-free survival: risk score 0vs.1-2, hazard ratio(HR)=1.422(95% confidence interval(CI), 0.523-3.867), P=0.490); 0vs.3-5, HR=2.424(95%CI, 0.922- 6.369; P=0.072); 0vs.≥6, HR=4.805(95%CI, 1.782-12.957; P=0.002); maximal diameter, HR=1.514(95%CI, 1.097- 2.090; P=0.012). CONCLUSION: Increasing pre-LT risk score may represent a warning signal toward prompt LT rather than repeated locoregional therapies, especially in case of score≥6. Pre-LT risk score could be used as a surrogate marker of tumor biology for the decision of LT timing. Disclosures: Kwang-Woong Lee - Grant/Research Support: ChongGeunDang, Astellas, GreenCross The following authors have nothing to disclose: Hwi Young Kim, Won Kim, Yong Jin Jung, Hyeyoung Kim, Nam-Joon Yi, Hae Won Lee, Kyung-Suk Suh 1278 Synergistic anticancer effect of metformin in combination with immunosuppressant on hepatocellular carcinoma cell lines Suk-Won Suh 1 , Kwang-Woong Lee 2 , Yoo-Shin Choi 1 ; 1 Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea (the Republic of); 2 Seoul National University College of Medicine, Seoul, Korea (the Republic of) After liver transplantation (LT), immunosuppression is needed to avoid rejection and graft loss, however, it can stimulate hepatocellular carcinoma (HCC) recurrence and progression. Previous <strong>studies</strong> have shown that metformin had an anticancer effect on several cancers, including HCC. The aim of this study was to evaluate the interactions between metformin and immunosuppressive agents including sirolimus, tacrolimus and mycophenolate mofetil (MMF) for antitumor activity. Three cell lines (Huh7, HepG2 and Hep3b) were tested. Cell viability was determined using a MTT assay and Western blot analysis for mammalian target of rapamycin (mTOR) pathway related proteins were performed to reveal their mechanism. Metformin and sirolimus had synergistic antiproliferative effect and sirolimus plus metformin supplemented with MMF also showed synergistic antiproliferative effect in specific HCC cells. Synergistic effect of metformin and sirolimus through the inhibition of mTOR and its down-stream, p70S6K, and p-4EBP1 were demonstrated. Metformin and sirolimus also showed synergistic effect for the down-regulation of Livin and Survivin expressions in HepG2 and Hep3b cells. In conclusion, metformin had synergistic interactions with sirolimus in terms of anticancer effects for HCC cells and the mechanism explaining this synergistic inhibition might be related with mTOR pathway. These results may provide a foundation for further <strong>studies</strong> for patients with HCC who underwent LT in clinical era. Disclosures: Kwang-Woong Lee - Grant/Research Support: ChongGeunDang, Astellas, GreenCross The following authors have nothing to disclose: Suk-Won Suh, Yoo-Shin Choi
HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 841A 1279 Evaluation of risk indices to determine 1 year graft survival after liver transplantation using the UNOS database Shahzad Ahmed, Vinay Sundaram; Cedars-Sinai Medical Center, Los Angeles, CA Aim: Given the shortage of viable organs available for liver transplantation (LT), relative to the supply, it is critical to ensure optimal post-transplant graft survival in recipients of LT. The Model for End-Stage Liver Disease (MELD) scoring systems was developed to determine 3-month survival prior to LT. Additional scoring systems have been developed to determine post-transplant outcomes including Donor Risk Index (DRI), Organ Patient Index (OPI) and Balance of Risk (BAR) score. The aim of this study was to evaluate the accuracy of these risk indices in evaluating post-transplant graft survival at 1 year. Methods: We analyzed the UNOS database from 2006-2009. We excluded patients under age 18 or who underwent multi-organ transplantation Results. A total of 24,388 patients were studied. Among these patients, 35% had hepatitis C virus, 15% had alcoholic liver disease and 12% had cholestatic liver disease (primary biliary cirrhosis and primary sclerosing cholangitis). Regarding 1 year graft surivival, our findings indicated that all indices performed with modest accuracy as follows: MELD (>30/=16/
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1312A AUTHOR INDEX HEPATOLOGY, Octo
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