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1056A AASLD ABSTRACTS HEPATOLOGY, October, 2015 1738 Immunization Practices Amongst Pediatric Transplant Hepatologists at SPLIT Centers Amy G. Feldman 1,4 , Shikha Sundaram 1,4 , Brenda Beaty 3 , Allison Kempe 2 ; 1 Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital Colorado, Aurora, CO; 2 General Pediatrics, Children’s Hospital Colorado, Aurora, CO; 3 Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO; 4 University of Colorado School of Medicine, Aurora, CO Objectives: To assess amongst US and Canadian pediatric transplant hepatologists: (1) current immunization practices before and after liver transplantation and (2) beliefs about the safety of different vaccines before and after liver transplantation. Study Design: An 80 item email survey of US and Canadian pediatric transplant hepatologists at centers participating in the Studies of Pediatric Liver Transplantation (SPLIT) consortium from December 2014 to March 2015. Results: The overall response rate was 80%, representing 97% of SPLIT centers. Thirty-four percent of programs did not have written protocols to guide immunizations before and after transplant and 50% of programs always involved an infectious disease physician as part of the formal liver transplant evaluation. Administration of Palivizumab was considered by 45% of hepatologists pre-transplant and by 64% post-transplant. Only 25% of hepatologists ever recommended live vaccines after transplant. Timing of inactive vaccines after transplant ranged from 1 month to greater than 6 months post-transplant. Only 6% of programs were able to provide all vaccines to patients in hepatology/ transplant clinic pre and post-transplant. Similarly, 6% of programs were always able to provide influenza vaccine to family members/household contacts. Conclusions: There is wide variation in immunization practices before and after liver transplant amongst pediatric transplant hepatologists. Specific evidence based protocols are needed to guide immunization practices before and after transplant and ensure appropriate vaccination of pediatric liver transplant recipients. Disclosures: The following authors have nothing to disclose: Amy G. Feldman, Shikha Sundaram, Brenda Beaty, Allison Kempe 1739 Detectable HBVDNA in liver allograft tissues has no clinical significance on long term follow up in liver transplant recipients under HBIg plus Antiviral prophylaxis Deniz Mut 1 , Ilker Turan 1 , Deniz Nart 2 , Funda Yilmaz 2 , Selda Erensoy 1 , Ulus S. Akarca 1 , Galip Ersoz 1 , Fulya Gunsar 1 , Zeki Karasu 1 ; 1 Department of Gastroenterology, Ege University, Izmir, Turkey; 2 Pathology, Ege University, Izmir, Turkey Combination prophylaxis with hepatitis B immune globulin (HBIG) plus an oral anti-viral (OAV) is widely accepted regimen for the prevention of recurrent hepatitis B virus (HBV) infection after liver transplantation, although there is no consensus on dose of HBIg. Persistency of HBV infection in allograft tissue in spite of prophylaxis is speculative. We examined the presence of HBVDNA using real-time polymerase chain reaction (PCR) in liver allografts in liver transplant recipients who undergone liver transplantation because of HBV related liver disease. Patients who had HBIg+Lam prophylaxis and who have no detectable serum virologic markers (HBsAg and/or HBV DNA) for recurrent disease during follow up of at least 3-years were included study. Histologic examination is also performed. We investigated if there is any correlation between tissue HBVDNA and presence of pretransplant HCC, Delta co-infection, the type of graft donor (living/cadaveric), the type of post transplant immunosuppressive medication. Results: One-hundred and fifty (116 male, 34 female) patients with a mean age of 47-years (18-64 years) were included into the study. Median duration of follow up was 5 (3-9) years after transplantation. Sixty-four patient had delta co-infection and 44 patients had HCC before transplantation. Of the patients, 108 (72%) had their grafts from living donors. HBVDNA was detectable by PCR in liver tissue of 18 (12%) patients. Immunostaining for HBVwas negative on liver histology of all patients. Of the 18 patients with detectable HBVDNA by PCR, the liver graft showed no hepatitis on histologic examination. Detectable tissue HBVDNA had no correlation with age, sex, delta co-infection, HCC, type of donor and type of immunosuppressive medication. Conclusion: in spite of combination prophylaxis with HBIg+OAV, and of there is no detectable serologic markers in their serum, some (12%) cases may have detectable HBVDNA in their liver tissue. However presence of HBVDNA in grafts has no clinical impact. But in patients with detectable HBVDNA, the risk of reactivation may persist indefinitely. Disclosures: Ulus S. Akarca - Advisory Committees or Review Panels: GILEAD, BMS, MSD, AbbVie The following authors have nothing to disclose: Deniz Mut, Ilker Turan, Deniz Nart, Funda Yilmaz, Selda Erensoy, Galip Ersoz, Fulya Gunsar, Zeki Karasu 1740 HBV cccDNA evaluation in HBV-core antibody (HBcAb)-positive liver transplant donors Gian Paolo Caviglia 1 , Francesco Tandoi 2,3 , Maria Lorena Abate 1 , Alessia Ciancio 1,4 , Renato Romagnoli 2,3 , Antonina Smedile 1,4 ; 1 Medical Sciences, University of Turin, Turin, Italy; 2 Surgical Sciences, University of Turin, Turin, Italy; 3 Liver Transplant Center, Città della Salute e della Scienza, Molinette Hospital, Turin, Italy; 4 Gastroenterology, Città della Salute e della Scienza, Molinette Hospital, Turin, Italy Introduction Occult hepatitis B virus infection (OBI) is defined as the presence of Hepatitis B Virus (HBV) DNA in the liver of subjects negative for hepatitis B surface antigen (HBsAg). A high OBI prevalence has been reported in the anti-HBV core antibody (HBcAb)-positive population as residue of a past infection. OBI-positivity may be responsible for recurrent or de novo hepatitis B in immunosuppressed subjects. In the setting of liver transplant, prophylaxis for hepatitis B recurrence is routinely performed in all HBcAb-positive liver graft recipients. However, the risk of HBV reactivation is linked to the presence of intrahepatic covalently-closed-circular DNA (cccDNA) being the replication-competent form. Aim To evaluate the presence of intrahepatic HBV cccDNA and its correlation with OBI status in a cohort of HBcAb-positive liver donors. Methods Liver biopsies from 78 consecutive HBsAg-negative/HBcAb-positive deceased donors (mean age 66 [31-91] years; M/F=50/28) were tested for OBI by 4 parallel nested-PCRs to detect HBV S, Core, Polymerase and X sequences. According to Taormina expert meeting statements, samples turned positive for at least 2 targets were scored as OBI-positive. cccDNA presence was assessed by a specific nested-PCR after enzymatic digestion with S1 nuclease. Results Among HBcAb-positive liver donors, OBI prevalence was 56.4% (44/78). In detail, 28 liver biopsies were 4/4 targets positive, 7 were 3/4, 9 were 2/4, 11 were 1/4 while 23 biopsies were completely negative. cccDNA prevalence was 32.1% (25/78) in the whole cohort and 45.5% (25/55) in the OBI-positive group (including those positive for only 1 target). A significant direct correlation was found between OBI and cccDNA-positivity (r=0.594; p
HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1057A ed-PCRs was significantly associated with cccDNA detection (OR=2.295, 95%CI 1.7574-4.5556; p10 ng/mL, 83% were male, and 88% were non-Asian. Comorbidities included diabetes (29%), smoking (63%), HBV (2%), and HIV (12%). Median HCC size was 2.8 cm (range, 0.8-18.2), 83% had a single lesion on imaging and 51% had histologic vascular invasion. Median lab values at the time of HCC diagnosis indicated that liver function was generally well-preserved: albumin 4.2 g/dL (2.1- 5.0), platelets 148 x 10 3 cells/μL (48-446), and total bilirubin 1.3 mg/dL (0.2-8.8). HCC was diagnosed via surveillance (imaging and/or AFP) in 27 patients, and in response to symptoms in 13. In the surveillance group, 85% were within Milan criteria vs 23% in the symptomatic group (p
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1312A AUTHOR INDEX HEPATOLOGY, Octo
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1366A CATEGORY INDEX HEPATOLOGY, Oc
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