QS423. Outcomes With Non-Heart Beating Liver Donors: A Meta-Analysis
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patient outcomes and program quality in keeping with regulatory standards resulting in improved Scientific Registry of Transplant Recipients statistics. QS423. OUTCOMES WITH NON-HEART BEATING LIVER DONORS: A META-ANALYSIS. Thomas Johnston, Hoon- bae Jeon, Roberto Gedaly, Dinesh Ranjan; University of Kentucky, Lexington, KY Liver transplantation from non-hearts beating donors (DCD) re- mains controversial. Large-scale studies utilizing registry data have shown somewhat poorer graft survival with allografts from DCD as compared to donors with brain death (DBD). Since only a small fraction of donors in the registry are DCD, most cases in the control group are from centers that have little or no DCD experience. We assessed out- comes from centers that had published their individual experiences. We conducted an extensive hand search of published articles and reports and found five studies that permitted comparison of 2 or 3 year graft survival between DCD and DBD. In three, comparison was made to a control group within the study. In two cases, we imposed a matched control group with outcomes at the level of contemporary graft surviv- als. These were included in a meta-analysis detailed below. The Odds- Ratio of 1.8 favoring DBD indicates poorer but still clinically-acceptable DCD survival (p0.05). QS424. IN THE MELD ERA, DOES INCIDENTAL FINDING OF HEPATOCELLULAR CARCINOMA DURING LIVER TRANSPLANTATION FOR END-STAGE DIS- EASE DUE TO HEPATITIS C PREDICT POOR PA- TIENT SURVIVAL? Natasha S. Becker, Christine A. O’Mahony, Jessica M. Suarez, Joel A. Rodriguez, John A. Goss; Baylor College of Medicine, Houston, TX Introduction: Incidence of end-stage liver disease and hepatocellu- lar carcinoma (HCC) associated with Hepatitis C virus (HCV) is increasing in the United States. Malignancy in this setting is often un-resectable due to underlying liver disease and multi-focality. HCC may be undiagnosed until transplant due to accompanying cirrhotic changes. As orthotopic liver transplantation (OLT) is often the only curative option for patients with HCC, it is important to identify variables that predict post-OLT survivals. The purpose of this study is to determine if the presence of HCC, particularly if found incidentally at time of transplant, is associated with poor patient survivals after OLT in HCV patients. Methods: The United Network for Organ Sharing (UNOS) database was obtained for all OLTs performed on US adults ( 18 years of age) from 2002-2005. This time period was chosen to allow for analysis of the impact of the MELD scoring system, initiated in 2002. Multiorgan transplants, re-OLTs, OLTs for malignancies other than HCC and for fulminant liver failure were excluded. The 13,678 OLTs were divided into groups according to indication (HCC/HCV, HCC/ HCV, non-HCC/HCV, and non-HCC/HCV). Patient survivals were compared using Kaplan-Meier curves and log rank tests. Fur- ther analysis was performed on the 6,239 OLTs performed on HCV patients. The effects of 28 demographic, clinical, and liver disease variables on survivals were examined. Variables significant in uni- variate analyses were entered into multivariate analyses to deter- mine independent predictors of survivals. Results: Of the 6,239 HCV patients transplanted, 2,048 (33%) had a concomitant diag- nosis of HCC. In 163 (3%), HCC was an incidental diagnosis. An additional 4,191 OLTs were performed on non-HCC/HCV patients, and 6,000 OLTs were performed on non-HCC/HCV patients. Only non-HCC/HCV patients had superior 1- and 3-year survivals when compared with the overall survival for the other three groups: 88% and 82% vs. 86% and 76% (p0.001). One- and 3-year patient sur- vivals for patients with HCV were 86% and 75%. Patients with HCV and known HCC had higher 1- and 3- year survivals than patients with HCV and incidentally found HCC: 88% and 74% vs. 83% and 67% (p0.032). Seventeen additional clinical variables were found to have univariate association with poor survivals in patients with HCV. These were entered into multivariate analysis, and indepen- dent predictors of survival (multivariate p-values 0.05) included: BMI 22, female recipient, recipient diabetes, donor diabetes, donor HCV, recipient serum creatinine 1.8mg/dL, donor over age 60, and ventilator dependence (Table 1). Discussion: In the current era of OLT for HCV, the presence of known HCC does not affect patient survivals. While incidental HCC was found to be associated with decreased survivals, it was not an independent predictor of poor recipient outcomes. The recipient and donor variables identified as prognostic in HCV patients in this analysis should be considered at time of OLT in order to optimize outcomes in this population. QS425. LONG-TERM RESULTS AND LATE MORBIDITY AF- TER STEROID-FREE, PEDIATRIC SMALL BOWEL TRANSPLANTATION (SBTX)-A CONTEMPORARY EXPERIENCE. Rakesh Sindhi, Anjan Talukdar, Kyle Sol- tys, Geoffrey Bond, Kareem Abu-Elmagd, George Maza- reigos; University of Pittsburgh, Pittsburgh, PA Background: Historical 1-year and 3-year patient survival after pe- diatric small bowel transplantation (SBTx) approaches 80% and 60%, respectively. After steroid-free, primary pediatric SBTx, with rabbit, anti-human thymocyte globulin induction, 1-year actuarial patient and graft survival in 71 consecutive recipients has improved to 94% and 90%, respectively. Long-term results were analysed after the first year, to identify major preventable morbidities. Methods: Major morbidity (late graft loss and need for another transplant procedure) was ana- lyzed after the first year in 64 consecutive children with functioning primary SBTx/LSBTx, for the 5-year period 2002-2007. Results: Me- dian age, follow-up, M:F gender, and SBTx: LSBTx was 2.2 years (range 0.3-22), 40 months (15-63), 39: 32, and 34: 37 respectively. Actuarial 5-year patient and graft survival is 80% and 66% respectively. Fifteen children (22%) experienced graft loss due to death (n7), or due to other causes (n8). Causes of death were chronic rejection (CR-3), PTLD-1, pneumonia-1, line sepsis-1, and unknown-1). Other causes of graft loss included severe late acute rejection (n2) and high-output graft failure TABLE 1 Variable p-value Hazard 95% CI BMI 22 0.037 1.282 1.015–1.621 Female Recipient 0.001 1.315 1.133–1.527 Recipient Diabetes 0.001 1.342 1.136–1.585 Donor Diabetes 0.009 1.368 1.082–1.729 Donor HCV 0.026 1.384 1.039–1.844 Serum Creatinine 1.8 mg/dL 0.001 1.647 1.383–1.961 Donor 60 years 0.001 1.858 1.559–2.213 Ventilator Dependence 0.001 2.072 1.495–2.869 436 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
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Transcript of QS423. Outcomes With Non-Heart Beating Liver Donors: A Meta-Analysis
patient outcomes and program quality in keeping with regulatorystandards resulting in improved Scientific Registry of TransplantRecipients statistics.
QS423. OUTCOMES WITH NON-HEART BEATING LIVERDONORS: A META-ANALYSIS. Thomas Johnston, Hoon-bae Jeon, Roberto Gedaly, Dinesh Ranjan; University ofKentucky, Lexington, KY
Liver transplantation from non-hearts beating donors (DCD) re-mains controversial. Large-scale studies utilizing registry data haveshown somewhat poorer graft survival with allografts from DCD ascompared to donors with brain death (DBD). Since only a small fractionof donors in the registry are DCD, most cases in the control group arefrom centers that have little or no DCD experience. We assessed out-comes from centers that had published their individual experiences. Weconducted an extensive hand search of published articles and reportsand found five studies that permitted comparison of 2 or 3 year graftsurvival between DCD and DBD. In three, comparison was made to acontrol group within the study. In two cases, we imposed a matchedcontrol group with outcomes at the level of contemporary graft surviv-als. These were included in a meta-analysis detailed below. The Odds-Ratio of 1.8 favoring DBD indicates poorer but still clinically-acceptableDCD survival (p�0.05).
QS424. IN THE MELD ERA, DOES INCIDENTAL FINDINGOF HEPATOCELLULAR CARCINOMA DURINGLIVER TRANSPLANTATION FOR END-STAGE DIS-EASE DUE TO HEPATITIS C PREDICT POOR PA-TIENT SURVIVAL? Natasha S. Becker, Christine A.O’Mahony, Jessica M. Suarez, Joel A. Rodriguez, John A.Goss; Baylor College of Medicine, Houston, TX
Introduction: Incidence of end-stage liver disease and hepatocellu-lar carcinoma (HCC) associated with Hepatitis C virus (HCV) isincreasing in the United States. Malignancy in this setting is oftenun-resectable due to underlying liver disease and multi-focality.HCC may be undiagnosed until transplant due to accompanyingcirrhotic changes. As orthotopic liver transplantation (OLT) is oftenthe only curative option for patients with HCC, it is important toidentify variables that predict post-OLT survivals. The purpose ofthis study is to determine if the presence of HCC, particularly iffound incidentally at time of transplant, is associated with poorpatient survivals after OLT in HCV� patients. Methods: TheUnited Network for Organ Sharing (UNOS) database was obtainedfor all OLTs performed on US adults (� 18 years of age) from2002-2005. This time period was chosen to allow for analysis of theimpact of the MELD scoring system, initiated in 2002. Multiorgantransplants, re-OLTs, OLTs for malignancies other than HCC andfor fulminant liver failure were excluded. The 13,678 OLTs weredivided into groups according to indication (HCC/HCV�, HCC/HCV�, non-HCC/HCV�, and non-HCC/HCV�). Patient survivalswere compared using Kaplan-Meier curves and log rank tests. Fur-ther analysis was performed on the 6,239 OLTs performed on HCV �
patients. The effects of 28 demographic, clinical, and liver diseasevariables on survivals were examined. Variables significant in uni-variate analyses were entered into multivariate analyses to deter-mine independent predictors of survivals. Results: Of the 6,239HCV� patients transplanted, 2,048 (33%) had a concomitant diag-nosis of HCC. In 163 (3%), HCC was an incidental diagnosis. Anadditional 4,191 OLTs were performed on non-HCC/HCV� patients,and 6,000 OLTs were performed on non-HCC/HCV� patients. Onlynon-HCC/HCV� patients had superior 1- and 3-year survivals whencompared with the overall survival for the other three groups: 88%and 82% vs. 86% and 76% (p�0.001). One- and 3-year patient sur-vivals for patients with HCV were 86% and 75%. Patients with HCVand known HCC had higher 1- and 3- year survivals than patientswith HCV and incidentally found HCC: 88% and 74% vs. 83% and67% (p�0.032). Seventeen additional clinical variables were found tohave univariate association with poor survivals in patients withHCV. These were entered into multivariate analysis, and indepen-dent predictors of survival (multivariate p-values � 0.05) included:BMI � 22, female recipient, recipient diabetes, donor diabetes, donorHCV�, recipient serum creatinine � 1.8mg/dL, donor over age 60,and ventilator dependence (Table 1). Discussion: In the current eraof OLT for HCV, the presence of known HCC does not affect patientsurvivals. While incidental HCC was found to be associated withdecreased survivals, it was not an independent predictor of poorrecipient outcomes. The recipient and donor variables identified asprognostic in HCV� patients in this analysis should be considered attime of OLT in order to optimize outcomes in this population.
QS425. LONG-TERM RESULTS AND LATE MORBIDITY AF-TER STEROID-FREE, PEDIATRIC SMALL BOWELTRANSPLANTATION (SBTX)-A CONTEMPORARYEXPERIENCE. Rakesh Sindhi, Anjan Talukdar, Kyle Sol-tys, Geoffrey Bond, Kareem Abu-Elmagd, George Maza-reigos; University of Pittsburgh, Pittsburgh, PA
Background: Historical 1-year and 3-year patient survival after pe-diatric small bowel transplantation (SBTx) approaches 80% and 60%,respectively. After steroid-free, primary pediatric SBTx, with rabbit,anti-human thymocyte globulin induction, 1-year actuarial patient andgraft survival in 71 consecutive recipients has improved to 94% and90%, respectively. Long-term results were analysed after the first year,to identify major preventable morbidities. Methods: Major morbidity(late graft loss and need for another transplant procedure) was ana-lyzed after the first year in 64 consecutive children with functioningprimary SBTx/LSBTx, for the 5-year period 2002-2007. Results: Me-dian age, follow-up, M:F gender, and SBTx: LSBTx was 2.2 years (range0.3-22), 40 months (15-63), 39: 32, and 34: 37 respectively. Actuarial5-year patient and graft survival is 80% and 66% respectively. Fifteenchildren (22%) experienced graft loss due to death (n�7), or due to othercauses (n�8). Causes of death were chronic rejection (CR-3), PTLD-1,pneumonia-1, line sepsis-1, and unknown-1). Other causes of graft lossincluded severe late acute rejection (n�2) and high-output graft failure
TABLE 1
Variable p-value Hazard95%CI
BMI � 22 0.037 1.282 1.015–1.621Female Recipient �0.001 1.315 1.133–1.527Recipient Diabetes 0.001 1.342 1.136–1.585Donor Diabetes 0.009 1.368 1.082–1.729Donor HCV� 0.026 1.384 1.039–1.844Serum Creatinine � 1.8
mg/dL�0.001 1.647 1.383–1.961
Donor � 60 years �0.001 1.858 1.559–2.213Ventilator Dependence �0.001 2.072 1.495–2.869
436 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
