studies

1078A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Hypothermia (HT) has been shown to prevent cerebral edema
and intracranial hypertension associated HE. In this study, we
report the outcomes of ALF patients treated with hypothermia
with and without transplantation. Methods This is a single
center retrospective study from 2002 to 2014. We reviewed
all ALF patients treated with HT for HE with and without liver
transplantation (Oltx). Demographic data was collected. Primary
and secondary outcomes include survival and complications
respectively. Survival was calculated using Kaplan-Meier
method. Bootstrap analysis was used to perform an additional
internal validation. Results 44 patients were treated for ALF
during the study period. The cohort was stratified as follows:
Group 1 (HT/Oltx), Group 2 (HT/No Oltx), Group 3 (Medical
Management/Oltx). The indication for HT was grade III/IV
HE and instituted at 32°-34°. Twenty patients (46.5%) were
bridged to transplantation. Group 2 patients were evaluated
for Oltx except for one and 3 were listed. Survival was poor
with mean 20 days. One died while waiting and 2 were
removed. Four patients (17%) improved. Overall survival was
50% (mean 362 days). One year-survival was 75% in Group
1 versus 58% for Group 3 when patients received transplant.
At the 2.5 years post Oltx, 50% (6 out of 12) in Group and
62.5% (5 out of 8) in Group 1 were alive. Mean survival was
584 days (SD 106) for Group 1, 294 (SD 49) for Group 3, 20
(SD 3.4) for Group 2. Bootstrapping showed a difference in
survival between Group 1 and Group 3 (Wilcoxon, Log-Rank,
Likelihood Ratio p-Value 6 months,
n=75); and G3, past HCV infection (ie, positive anti-HCV and
negative HCV RNA PCR, n=15). RESULTS. In G1without HCV
infection, 20 of 20 (100%) urine specimens tested negative for
HCV-Ags using our EIA assay. Similarly, in G3 with past or
resolved HCV infection, all 15 of 15 (100%) urine specimens
tested negative for HCV-Ags, confirming 100% specificity of
our HCV-Ags EIA when used for testing urine samples. Patients
in G2 had chronic HCV genotype 1-6 infections, serum HCV
RNA levels ranged from 62,000 to 9,960,000 IU/mL quantified
using PCR, and serum creatinine level ranging from 0.5
to 1.7 mg/dL. In 75 of 75 of G2 patients, all urine specimens
tested positive for HCV-Ags, indicating our HCV-Ags assay had
a sensitivity of 100% for testing urine specimens. The mean
coefficient of variation (CVs) was 9.8% and 6.4%, respectively,
for intra-assay precision and inter-assay reproducibility.
Using a group of urine specimens from patients with very low
serum HCV RNA PCR ranging from 26 to 148 IU/mL, the
lowest detection limit of our HCV-Ags EIA for urine specimens
was equivalent to serum HCV RNA level of 26 IU/mL. Optical
density measurements for HCV-Ags from the urine specimens
with chronic HCV infection correlated significantly with the
corresponding serum HCV RNA level quantified using PCR (y
= 0.0702 x + 0.141, R 2 = 0.8212, p