Tu1013 De novo Non-Skin Malignancy Risk After Liver Transplantation for Primary Sclerosing Cholangitis

Abstract

Introduction: Esophageal varices (EV) bleeding is a severe complication of portal hypertension and can be fatal. The standard diagnostic screening tool for EV is endoscopy, which could be used as treatment of large esophageal varices, but it is still considered an invasive procedure in pediatric patients. Aim: to evaluate clinical and laboratory parameters in predicting large EV in children with intra-hepatic portal hypertension. Methods: We studied retrospectively eighty eight children (mean age: 10.1 ±7.7) with intra-hepatic portal hypertension All patients had no bleeding history and they underwent upper GI endoscopy for EV screening. We recorded variceal size (F1, F2 and F3), according to The Japan Society for Portal Hypertension classification. Patients were classified into two groups: small (F1) and no varices and large varices (F2 and F3). We evaluate seven noninvasive markers in predicting large EV: (1) platelet count; (2) spleen z score, expressed as a standard deviation score relative to normal values for age; (3) platelets count: spleen z score ratio; (4) platelets count: spleen size (cm) ratio; (5) the Clinical Prediction Rule (CPR); (6)APRI test and (7) risk score. Results: Thirty one children had large EV in the first endoscopy. In univariate analyses, platelet count, CPR, risk score, platelet count: spleen z score ratio and Child-Pugh Classification were statistically significant. The best noninvasive predictors of large varices were: platelets (AUROC 0.67; IC 95%, 0.57-0.78), CPR (AUROC 0.65; IC 95%, 0.54-0.76) and risk score (AUROC 0.66; IC 95%: 0.56-0.76). A logistic regression model was applied with large esophageal varices as the dependent variable and corrected by albumin, Child-PughClassification, bilirubin and spleen size z score. Children with CPR under 114 were 8.59-fold more likely to have large esophageal varices compared to children with CPR.114. Risk score .1.2 increased the likelihood of large varices (odds ratio 6.09; 95% CI,1.43-25.90; p=0.014). Using Child-Pugh Classification (CPC), a negative predictive value (NPV) of 92.3% for risk score over -1.2 and NPV of 88.5% for CPR under 114 in children with CPC-A for large varices. Conclusions: Children with intra-hepatic portal hypertension with CPR below 114 and risk score greater than-1.2 have more chance to present large EV. According to these results, patients with CPC-A and risk score under -1.2 and CPR over 114 have low risk of large EV. Therefore those two tests could be helpful to select cirrhotic children to endoscopic treatment.