studies

1066A AASLD ABSTRACTS HEPATOLOGY, October, 2015
1758
Arcuate artery resistive index predicts Acute-on-Chronic
Liver Failure
Pablo Solis-Munoz 2,1 , Christopher Willars 2 , Julia Wendon 2 ,
Georg Auzinger 2 , Michael A. Heneghan 2 , María De la Flor-Robledo
3 , José A. Solís-Herruzo 1 ; 1 Research Center, Hospital “12 de
Octubre”, Madrid, Spain; 2 Institute of Liver Studies, King’s College
Hospital, London, United Kingdom; 3 University Hospital Severo
Ochoa,, Madrid, Spain
Patients with acutely decompensated (AD) liver cirrhosis are
at risk for developing acute-on-chronic liver failure (ACLF) syndrome.
This syndrome is associated with a high sort-term mortality
rate. The aim of our study was to identify reliable and
early predictors of developing ACLF in cirrhotic patients with
AD. Methods: We assessed 84 cirrhotic patients admitted for
AD without ACLF on admission. We performed routine blood
testing and detailed ultrasound Doppler studies of systemic
arteries and mayor abdominal veins and arteries. We also
calculated liver and ICU predictive scores. The area under
the ROC curve (AUROC) was calculated for all variables that
were significantly different between patients who developed
ACLF and those who did not. Sensitivity, specificity, positive
and negative predictive values, and diagnostic accuracy for
the prediction of the short-term ACLF development were determined.
Results: Of the 84 patients, 23 developed ACLF and 61
did not develop this complication. In the univariate analysis,
serum levels of urea, creatinine, and bilirubin, prothrombin
time, MELD score, portal vein, femoral and poplitea artery flow
velocity, and renal and arcuate artery resistive indices (RI) had
predictive value for short-term development of ACLF. However,
only arcuate artery RI had independent predictive value in the
multivariate analysis. The AUROC value for RI of the arcuate
arteries was 0.9971. Conclusions: On the first day of admission,
ultrasound measurement of the RI of the arcuate arteries
recognizes with a high degree of certainty cirrhotic patients
admitted because of AD who will develop ACLF.
Disclosures:
Julia Wendon - Consulting: Pulsion, Excalenz
The following authors have nothing to disclose: Pablo Solis-Munoz, Christopher
Willars, Georg Auzinger, Michael A. Heneghan, María De la Flor-Robledo, José
A. Solís-Herruzo
1759
Fulminant Hepatitis B Acute Liver Failure due to immunosuppressant
or chemo-therapy: A multicenter retrospective
cohort analysis
Filipe S. Cardoso 1 , Michelle Gottfried 3 , K. Rajender Reddy 2 , A.
James Hanje 4 , Daniel Ganger 5 , William M. Lee 6 , Constantine J.
Karvellas 1 ; 1 Hepatology/Critical Care Medicine, University of
Alberta, Edmonton, AB, Canada; 2 University of Pennsylvania, Philadelphia,
PA; 3 Medical University of South Carolina, Charlston,
SC; 4 The Ohio State University, Columbus, OH; 5 Northwestern
University, Chicago, IL; 6 University of Texas Southwestern, Dallas,
TX
Background/aims: Acute Liver Failure (ALF) due to reactivation
of latent hepatitis B (HBVr) due to chemotherapy or immunosuppression
(CTI) can be fatal and yet is preventable in many
cases. Aims: To determine the frequency of HBV-ALF due to
reactivation from CTI within the US Acute Liver Failure Study
Group (ALFSG) registry and compare patient survival and complication
rates to non-CTI HBV-ALF controls. Methods: Of a total
of 149 patients with HBV induced ALF enrolled in the US ALFSG
registry between 01/1998 and 04/2015, 26 (17%) developed
HBV-ALF due to CTI and 123 (83%) did not (controls).
Multivariable logistic regression was performed to determine
predictors of 21-day spontaneous survival in HBV ALF, specifically
examining the impact of HBVr ALF due to CTI. Results:
Of the 26 CTI patients, 9 received corticosteroids, 15 cytotoxic
chemotherapy (breast, lymphoma, testicular, leukemia,
myeloma), 2 received rituximab and 1 received gemtuzumab.
There were no differences between these groups in proportions
of patients with coma grade 3 or 4 (67% vs. 63%, p=0.77),
requirement for mechanical ventilation (32% vs. 46%, p=0.19)
or renal replacement therapy (18% vs. 15%, p=0.70). Of CTI
HBV-ALF patients, 10 (38%) were listed for liver transplant (LT)
(vs. 46% controls, p=0.70) and 6 (26%) received LT (vs. 34%
controls, p=0.37). Of these 6 LT patients, 2 died post-LT (survival
post-LT 67% vs. 81% in controls, p=0.59). Overall unadjusted
21-day survival was significantly lower (39% vs. 61%,
p=0.015) in CTI HBVr- ALF patients but spontaneous survival
was similar (25% vs. 35%, p=0.24) when compared with controls.
Using multivariable logistic regression to examine clinical
factors associated with 21-day spontaneous survival in HBV
ALF patients, MELD (Odds Ratio 0.87 per increment; 95% CI
0.80-0.95, p=0.0013) and maximum hepatic coma grade
> 2 (OR 0.13, 95% CI 0.04-0.41, p=0.0005) were significant.
There was a non-significant trend towards worse 21-day
adjusted spontaneous survival in CTI HBV ALF patients (OR
0.16, 0.02-1.54, p=0.11). The model performed well (c-statistic
0.87). Summary/Conclusions: HBV ALF due to CTI has
poor spontaneous survival (25%) and overall poorer outcomes,
even after adjusting for MELD and Hepatic coma grade (>2).
Guidelines from specialties that prescribe chemotherapy/immunosuppressant
therapies need to more explicitly detail testing in
who, how testing for those at risk should be performed, timing
and duration of therapy, and surveillance for those at risk not
on therapy. In this population of HBV-ALF patients where liver
transplant may not be offered, prevention of reactivation is
critical given the significant mortality observed.
Disclosures:
K. Rajender Reddy - Advisory Committees or Review Panels: Merck, Janssen,
Vertex, Gilead, BMS, Abbvie; Grant/Research Support: Merck, BMS, Ikaria,
Gilead, Janssen, AbbVie
A. James Hanje - Consulting: Salix pharmaceutical
Daniel Ganger - Advisory Committees or Review Panels: Bristol Myers, Abbvie;
Grant/Research Support: Merck, Ocera; Speaking and Teaching: Gilead
William M. Lee - Consulting: Eli Lilly, Sanofi; Grant/Research Support: Gilead,
BMS, Vertex, Merck
Constantine J. Karvellas - Grant/Research Support: Merck; Speaking and Teaching:
Gambro
The following authors have nothing to disclose: Filipe S. Cardoso, Michelle
Gottfried
1760
Mesenchymal stem cell using scaffold treatment
increased survival on acute liver failure model
Yong Kyun Cho 1 , Dae Won Jun 2 , Eun Chul Jang 3 , Seung Min
Lee 3 , Joo Hee Kwak 2 ; 1 Department of Internal Medicine, Kangbuk
Samsung Hospital, Sungkyunkwan University, School of Medicine,
Seoul, Korea (the Republic of); 2 Department of Internal Medicine,
Hanyang University College of Medicine, Seoul, Korea (the Republic
of); 3 Department of Occupational and Environmental Medicine,
Soonchunhyang University Cheonan Hospital, Cheonan, Korea
(the Republic of)
Background: Recently, the effects of mesenchymal stem cells
(MSCs) have been extensively evaluated in acute liver failure
model. However, the most commonly used methods are used
injecting MSCs through a vessel, which has a major drawback
of homing cells in other organs. The aim of current study was
to evaluate the efficacy and degree of cell homing of scaffold
loaded with MSCs on acute liver failure model. Methods: Acute