Positive Serology For Hepatitis Research Articles

Abstract MP13: Association Between Visceral Adiposity Index and Non-Alcoholic Liver Fibrosis Among United States Adults With Prediabetes

Background: Although type 2 diabetes is a well-established risk factor for non-alcoholic fatty liver disease (NAFLD) and downstream liver fibrosis, little is known about the risk factors associated with NAFLD fibrosis in adults with prediabetes. We aimed to understand whether visceral adiposity was associated with liver fibrosis, independent of insulin resistance, among participants with prediabetes. Methods: In this nationally representative, cross-sectional study, we selected non-pregnant adults ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 with prediabetes, defined as HbA1c of 5.7-6.4%, fasting blood glucose of 100-125 mg/dl, or a self-reported diagnosis of prediabetes. We excluded those with acute transaminitis (aspartate or alanine aminotransferase >500 IU/L), excessive alcohol consumption (>1 drinks/day for females, > 2 drinks/day for males), iron overload (transferrin saturation >50%), and positive hepatitis serology. Visceral adiposity was estimated using the validated Visceral Adiposity Index (VAI) and categorized into tertiles (<1.17, 1.17-2.19, >2.19). Our primary outcome was clinically significant liver fibrosis, defined dichotomously as median Fibroscan vibration controlled transient elastography liver stiffness measurements of 7.9 kPa or greater (≥F2). We used survey design-adjusted logistic regression, adjusting for covariates determined a priori (age, sex, race/ethnicity, income, education, smoking status, physical inactivity, hypertension, hemoglobin A1c (HbA1c), total caloric intake, and Homeostatic Model Assessment for Insulin Resistance [HOMA]) to estimate odds of fibrosis. Results: Among 1,290 prediabetic adults (mean age 62y [SD, 10], 44% female, 62% non-Hispanic White, representing 37,401,474 adults across the U.S.), 121 (10%) had NAFLD fibrosis. Participants in the highest tertile of VAI were more likely to be female, older, have higher waist circumference, and have comorbid cardiac conditions. The highest tertile of VAI was associated with three times higher odds of fibrosis (highest vs. lowest tertile; OR [95% CI], 3.81 [1.65, 8.79], middle vs. lowest tertile: 4.93 [1.74, 13.34]). There was no significant multiplicative interaction between VAI and HOMA (p=0.44). The highest tertile was also associated with 170% higher odds of F1 (mild) liver fibrosis (2.70 [1.10, 6.63], middle vs. lowest tertile: 2.69 [1.26, 5.77]). Conclusion: Nearly 1 in 10 adults with prediabetes have clinically significant liver fibrosis. High visceral adiposity was associated with more than 3 times the likelihood of fibrosis, independent of insulin resistance and traditional risk factors.

Investigating Ineligibility of Potential Living Liver Donors for Transplantation: Experience from a Large Liver Transplant Center in Pakistan

BackgroundLiving Donor Liver Transplantation (LDLT) is common in Pakistan, where the deceased organ donation is lacking. However, not all potential living donors are suitable for the procedure due to various medical, technical, psychosocial, and ethical reasons. This study aims to investigate the reasons for the ineligibility of potential living liver donors in Pakistan. MethodsBetween June 2022 and March 2023, 530 potential living liver donors were assessed for liver transplant recipients at the Pakistan Kidney and Liver Institute & Research center (PKLI&RC). Potential donors were evaluated in three steps, including laboratory tests imaging, and consultations. Prospectively maintained data on all potential donors were examined and retrospectively assessed to identify the causes of donor rejection. ResultsOf the 530 potential living donors evaluated, 364 of the potential donors were considered ineligible (68.67% of donors were rejected). From these rejected donors, 193 (53%) were males, and 171 (47%) were females. The mean age of the rejected donors was 26 years old. The most common reason for disqualifying potential living liver donors was a withdrawal of consent (65 cases, 17.9%). Other factors contributing to ineligibility included fatty liver infiltration reflected by a liver attenuation index (LAI) < 0, future liver remnant (FLR) < 28%, and a graft-to-recipient weight ratio (GRWR) < 0.6. Medical issues, such as abnormal liver function tests and positive hepatitis serology, also resulted in disqualification. ConclusionThis study highlights the importance of meticulous assessment of potential living liver donors to ensure their safety and the success of the transplant. The high rate of withdrawal of consent and the prevalence of medical issues indicates the need for addressing ethical concerns and improving public education on the donation process. This study also emphasizes the importance of a deceased organ donation in developing countries like Pakistan to ensure the availability of organs for transplantation.

Pregnancy Outcome in Acute Viral Hepatitis E

Background: Hepatitis E is associated with poor feto-maternal outcome. Patients with acute hepatitis E who are pregnant usually require hospital admission and monitoring with liver function tests and clotting profile. Objective: To evaluate maternal and fetal outcome among pregnant women who have positive serology for hepatitis E IgM. Methods: Data of women with clinical presentation of jaundice during pregnancy and who were diagnosed as acute hepatitis E was collected on pre-structured questionnaire after obtaining consent. Data were entered in Statistical Package for Social Sciences for analysis. Results: Three hundred and thirty three women had positive serology for hepatitis E IgM. Out of these three hundred were in last trimester of their pregnancy. The gestational age of two hundred and thirty two (77%) women was less than 37 weeks at presentation. Six (2%) pregnancies ended up in miscarriage, fifty four (16 %) had fetal demise in maternal womb while two hundred and seventy three (82%) were viable fetus. One third of live born babies were kept in NICU. Indications of neonatal admission were respiratory distress in 57(72%), jaundice neonatorum in 12(15%), asphyxia neonatorum in 9(12%), while one (1%) had transient tachypnea. Neonates who died in first week of their life were 18(23%).The cause of neonatal death was respiratory distress in 12 (67%) and anoxia in remaining 6 (33%) neonates. Most of the women were discharged home however maternal mortality was recorded in 80(24%) patients, mainly in postpartum period 73(91%). Conclusion: Pregnant women with acute hepatitis E have more complicated course of this viral infection with adverse fetal and maternal implications.

HEPATITIS E: A RARE CAUSE OF IMMUNE THROMBOCYTOPENIC PURPURA

Acute viral hepatitis in children usually is a self-limiting mild disease which does not require any specific treatment. It is most commonly caused by hepatotropic viruses, hepatitis A and hepatitis E virus spread by the feco-oral route. Hepatitis E infection mostly follows an asymptomatic and anicteric course in the younger age group than icteric hepatitis. Rarely, they cause cholestatic hepatitis and fulminant hepatitis. It may rarely be associated with various extra-hepatic autoimmune manifestations. We herein report an extremely rare case of immune thrombocytopenia in a young girl associated with acute hepatitis E infection, who had an uneventful course on conservative management. She presented to us with nausea, vomiting, lethargy, jaundice, and petechial spots. On examination and investigating further, the patient had features of immune thrombocytopenic purpura and positive serology for IgM hepatitis E, whereas, a workup for other causes was normal.

Factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis in Lima, Peru

The objective of the study is to analyze the factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis. The methodology used is based on a cross-sectional study in patients receiving hemodialysis at the Centro Nacional de Salud Renal. Severe pruritus was defined as a score on the visual analogue scale greater than or equal to 7, and the strength of association with the possible risk factors was assessed by calculating prevalence ratios. Regarding the results, 264 patients were included, 59.9% were male, with a mean time on hemodialysis of 10.26 ± 7.14 years. 75% experienced pruritus, of this group, 1 in 3 presented severe pruritus. Hyperphosphatemia and the use of antihistamines were associated with a higher prevalence of severe pruritus (RP 1.71, 95% CI 1.09-267 and RP 2.39, 95% CI 1.51-3.75, respectively). The positive serology for Hepatitis C Virus was described as a protective factor for presenting severe pruritus (RP 0.55, 95% CI 0.33 - 0.89). In conclusion, severe uremic pruritus is a frequent problem in patients with chronic terminal kidney disease who have hyperphosphatemia and treatment with antihistamines independently of the time they have been on hemodialysis.

MON-597 Non-Alcoholic Fatty Liver Disease Determined by MRI and Its Association with Metabolic Variables in Non-Diabetic Subjects

Non-alcoholic fatty liver disease determined by MRI and its association with metabolic variables in non-diabetic subjectsBackground: Non-alcoholic fatty liver disease (NAFLD) is defined as the presence of hepatic steatosis (liver fat accumulation higher than 5% of liver weight) in the absence of other causes. Liver biopsy is recognized as a gold standard for diagnosis, but it is limited by the risks of serious complications. Besides that, the increasing prevalence of NASH led to improved imaging methods, such as Magnetic Resonance Imaging (MRI), that enable quantitative assessment of steatosis by quantifying the hepatic fat fraction (HFF), even with steatosis levels as low as 5.56%.Objective: The aim of this study was to evaluate the metabolic profile of patients without T2DM according to hepatic steatosis measured by MRI.Methods: This was cross-sectional study conducted in an Endocrinology Unity in Minas Gerais, Brazil. The study complied with the WMA Declaration of Helsinki and was approved by the Ethical Committee on Human Subject Research from the Faculty Patos de Minas. We recruited non-diabetic subjects aged above 20 years with hepatic steatosis detected by liver sonography. Exclusion criteria were alcohol consumption of more than 20 grams/day for female and 30 grams/day for male, ferritin serum levels above 1000 mg/dL, positive serology for hepatitis B or C and intake of medications known to produce hepatic steatosis. Included subjects underwent HFF quantification by MRI, and the degree of liver fatty infiltration was estimated by using chemical shift imaging. The following biochemical variables were assessed: fasting glucose and HbA1c, HOMA-IR, lipids, AST, ALT and GGT. Analysis: we grouped individuals according to the quartile of HFF and compared clinical and biochemical variables between the groups.Results: A total of 30 subjects (18 male and 12 females) were included. All subjects were overweight (10% overweight and 90% obese); 7 (23.3%) had 3 criteria and 16 (53.3%) had two criteria for MS. The only variable assessed herein that was different between males and females was HDL-c (40.5 vs 50.5 mg/dL, respectively, p=0.0255). ALT serum levels were significantly higher in subjects in the fourth quartile of HFF, when compared to those in the third quartile (76 vs 47 UI/L, respectively, p=0.037). The other clinical of biochemical variables assessed did not differ between the quartiles of HFF.Conclusion: our preliminary findings indicate that the biochemical variables related to metabolic homeostasis are poor predictors of the degree of liver fat in overweight non-diabetic subjects. Although screening for NAFLD is still a matter of debate, our results suggest that future discussions about this should take into account that excess body weight per se, independently from biochemical abnormalities, should be considered in the recommendations for screening non-diabetic subjects.

Screening of cadaver cornea donor for infections in the eye bank of the Fyodorov Eye Microsurgery Federal State Institution

Objective : to analyze negative laboratory results of cadaver cornea donor screening during preparation of corneas for transplantation according to data from the internal registry of donors of the eye bank (EB) of the Fyodorov Eye Microsurgery Federal State Institution and the European Eye Bank Association (EEBA) from 2011 through 2015. Materials and methods . Data analysis was carried out using the internal registry of EB donors and the EEBA annual directories. The analyzed data included the number of eyeballs obtained, the frequency of incomplete tests (hemolysis for EB) and positive serological results for human immunodeficiency virus (HIV-1 and HIV-2), viral hepatitis B, viral hepatitis C and syphilis. Results . In just 5 years, the EB received 3,479 eyeballs. After hemolysis of donor blood samples, 13.9% (n = 486) of corneas were excluded from the EB. EEBA recorded fewer inconclusive tests during the same period. After hemolysis and positive serological tests, 19.4% (n = 676) of corneas were excluded from the EB. Overall, the number of positive serological tests in EBs was far higher than in the EEBA data. Frequency of positive HIV tests (HIV-1 and HIV-2) and syphilis in EB showed low variability annually, while incidence of hepatitis B increased in 2015. For the analyzed period, positive serology for hepatitis C was found to be prevalent among EB donors. Mixed infections were quite often recorded in blood samples. Conclusion . Based on analysis conducted, positive serology and hemolysis were the main contraindications and led to exclusion of 33.3% (n = 1162) of cadaver donor corneas received in EB. Frequency of positive serological tests for indicated infections in EB was higher than in the EEBA data, with significant predomination of hepatitis C.

Clinical outcomes of incident peritoneal dialysis patients coming from kidney transplantation program: Acase-control study.

IntroductionBrazil ranks second in the absolute number of transplantations in the world. Despite improvements in graft survival, many patients will progress to graft loss and return to dialysis. Concerns exist regarding adverse clinical outcomes in this population when undergone peritoneal dialysis (PD).ObjectiveTo compare the occurrence of mortality, technique failure, and peritonitis among incident patients in PD coming from either Tx or pre-dialysis treatment.MethodologyA retrospective study in which 47 adult patients with Tx failure (Tx group) were matched for age, gender, diabetes mellitus (DM), modality and start year of PD, with 1:1 predialysis patient (nTx group). The Fine-Gray competing risk model was used to analyze mortality and technique failure.ResultsCompared to nTx, the Tx group had a lower body mass index, serum potassium, and albumin concentrations. A higher ferritin level, transferrin saturation and the number of patients with positive serology for viral hepatitis were also observed in the Tx group. In the multivariate analysis, patients of the Tx group had 4.4-times higher risk of death (p = 0.007), with infection as the main cause. Technique failure and peritonitis were similar in both groups.ConclusionPrevious Tx is a risk factor for mortality but not for technique failure or peritonitis in incident patients on a PD program.

Did Osteoblastic Cell Therapy Improve the Prognosis of Pre-fracture Osteonecrosis of the Femoral Head? A Randomized, Controlled Trial.

In patients with nontraumatic osteonecrosis of the femoral head (ONFH), implantation of bone marrow aspirate concentrate (BMAC) could delay the progression of osteonecrosis and improve symptoms in pre-fracture ONFH. However, the BMAC content, especially in osteoblastic stem cells, could have an important individual variability. An autologous osteoblastic cell product could improve the effect of such cell-based therapy. (1) Does autologous osteoblastic cell therapy decrease the likelihood of progression to subchondral fracture with or without early collapse corresponding to Association Research Circulation Osseous (ARCO) classification Stage III or higher, and provide a clinically important pain improvement compared with BMAC treatment alone? (2) Were patients treated with osteoblastic cell therapy less likely to undergo subsequent THA? (3) What proportion of patients in the treatment and control groups experienced adverse events after surgery? Between 2004 and 2011, we treated 279 patients for Stage I to II hip osteonecrosis (ON) with surgery. During that time, our general indications for surgery in this setting included non-fracture ON lesions. To be eligible for this randomized, single-blind trial, patients needed to have an ONFH Stage I or II; we excluded those with traumatic ONFH, hemoglobinopathies and positive serology for hepatitis B, C or HIV. Of those treated surgically for this diagnosis during the study period, 24% (67) agreed to participate in this randomized trial. Hips with pre-fracture ONFH were randomly treated with a core decompression procedure associated with either implantation of a BMAC (BMAC group; n = 26) or osteoblastic cell (osteoblastic cell group; n = 30). The groups were not different in terms of clinical and imaging characteristics. The primary study outcome was treatment response, defined as the absence of progression to subchondral fracture stage (ARCO stage III or higher) plus a clinically important pain improvement defined as 1 cm on a 10-cm VAS. The secondary endpoint of interest was the frequency in each group of subsequent THA and the frequency of adverse events. The follow-up duration was 36 months. We used an as-treated analysis (rather than intention-to-treat) for our efficacy endpoint, and an intention-to-treat analysis for adverse events. Overall, 26 of 26 patients in the BMAC group and 27 of 30 in the osteoblastic cell group completed the trial. At 36 months, no clinically important differences were found in any study endpoint. There was no difference in the proportion of patients who had progressed to fracture (ARCO stage III or higher; 46% of the BMAC hips [12 of 26] versus 22% in the hips with osteoblastic cells [six of 27], hazard ratio, 0.47 [95% CI 0.17 to 1.31]; p = 0.15). There was no clinically important difference in VAS pain scores. No differences were found for either the WOMAC or the Lequesne indexes. With the numbers available, there was no difference in the proportion of patients in the groups who underwent THA at 36 months 15% (four of 27) with osteoblastic cells versus 35% (nine of 26) with BMAC; p = 0.09 With the numbers available, we found no differences between the treatment and control groups in terms of the frequencies of major adverse events. We found no benefit to osteoblastic cells over BMAC in patients with pre-collapse ONFH; side effects were uncommon and generally mild in both groups. This study could be used as pilot data to help determine sample sizes for larger (presumably multicenter) randomized controlled trials. However, this novel treatment cannot be recommended in routine practice until future, larger studies demonstrate efficacy. Level II, therapeutic study.

Prevalence of Hepatitis B, Hepatitis C, and HIV in Multiply Transfused Sickle Cell Disease Patients from Oman.

BackgroundIn Oman, the prevalence of hepatitis B (HBV) infection is 5.8%, with 2.8–7.1% HBV carriers. Hepatitis C (HCV) prevalence among Omanis is 0.41%. A total of 2917 human immunodeficiency virus (HIV) infections were notified among Omanis by 2017. This study was performed as there was no data on the prevalence of HIV, HBV and HCV in sickle cell disease (SCD) patients from Oman.Study Design and MethodsIn this retrospective, cross-sectional study, medical records of all SCD patients who attended our hospital between 2011 to 2017 were retrieved from the hospital information system. Following approval by the local medical research and ethics committee, data on HIV, HBV, and HCV exposure were recorded to estimate the prevalence.ResultsAmong a total of 1000 SCD patients (491 males and 509 females), twenty-three (2.3%) patients showed positive serology for hepatitis B surface antigen (HbsAg), of whom sixteen (1.6%) were HBV DNA positive. 126 (12.6%) had anti-HCV antibodies (anti-HCV), of whom fifty-two (5.2%) were HCV RNA positive. None of the patients had positive serology for HIV. A normal liver was observed on abdominal ultrasound in 788 (78.8%) patients, whereas 208 (20.8%) had hepatomegaly, and 4 (0.4%) had liver cirrhosis. Thirty-six (3.6%) patients died, but in only two patients, the mortality was due to cirrhosis of liver.ConclusionsThis study provides the first comprehensive data on the prevalence of HBV and HCV infections among Omani SCD patients exposed to blood transfusions. Reassuringly, no case with HIV was observed.

The impact of individual extended donor criteria on short- and long-term outcome after liver transplant in the MELD-score era

Background: Not all extended donor criteria (EDC) have an equal impact on graft survival after liver transplant (LT). We designed this study to identify a combination of EDC that predicts graft failure in the MELD-score era. Methods: We analyzed 465 consecutive LTs (no-EDC, n=112; EDC ≥1, n=353) and examined the EDC (donor age >65 years, mechanical ventilation >7 days, aminotransferases >3x normal, bilirubin >3mg/dL, serum-Na+ >165mmol/L, positive hepatitis serology, macrosteatosis >40%, BMI >30, cold ischemia time (CIT) >14h, malignancy-, and drug abuse history). We aimed to identify the most relevant EDC and a combination thereof predictive of primary non-function (PNF), delayed non-function (DNF), short- (90 days), and long-term (5 year) graft failure. Results: Graft survival did not differ significantly between the LT-cases of no-EDC and EDC ≥1. The multivariate analysis identified macrosteatosis (HR 5.5 95%CI 1.9-16.0, p=0.002), donor age (HR 1.9 95%CI 1.1-3.5, p=0.034), and CIT (HR 2.0 95%CI 1.0-3.9, p=0.052) to be predictive of graft failure. Their combination affected both short- and long-term graft survival (p=0.041 and 0.002), which was also observed after controlling for labMELD with a cut-off value of 20 (p=0.023 and 0.001). Conclusion: Our analysis identified three parameters that clearly outweighed the rest of the EDC. The combination of fatty liver, older donors and long ischemia time worsens short- and long-term graft survival and also puts the graft at risk irrespective of recipient’s labMELD-score.

Brazilian chronic dialysis survey 2017.

Introduction:Having national data on chronic dialysis is essential in treatment planning.Objective:To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017.Methods:Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units.Results:Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%).Conclusion:The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.

Prevalence of Hepatitis B, Hepatitis C and HIV in Sickle Cell Disease Patients from Oman

Background and Purpose: Oman is a country with an intermediate prevalence of Hepatitis B (HBV) carriers (2.8-7.1%, 20101), while the prevalence of HBV infection was 5.8% (20142). Hepatitis C (HCV) prevalence reported from Oman was 0.41% (20163). Further, a total of 2394 Human Immunodeficiency (HIV) infections were identified among Omanis (20134). Unfortunately, there are no studies on the prevalence of HIV, HBV and HCV in sickle cell disease (SCD) patients from Oman.Objectives: This study was therefore performed to estimate the prevalence of HBV, HCV and HIV among SCD patients from Oman.Methods: In a retrospective cross-sectional cohort study, medical records of all patients with SCD and sickle cell trait (SCT) patients who received blood transfusions between 2006 to 2017 were retrieved from the hospital information system. Specifically, data on HIV, HBV and HCV exposure were recorded to study the prevalence, following approval for the study from the hospital medical research and ethics committee.Results: Amongst a total of 1000 patient (491 males and 509 females), 126 (12.6%) had anti-HCV antibodies (anti-HCV) based on serology and amongst these 52(5.2%) were PCR positive. Genotype 1 was the most predominant (n=36), followed by genotype 3& 4(n=7 each) followed by genotype 2(n=2). 23 (2.3%) SCD patients showed positive serology for hepatitis B surface antigen (HbsAg) and amongst these 16 (1.6%) were PCR positive. None of the SCD patients showed positive serology for HIV. Liver Ultrasound was normal in 788 patients (78.8%), whereas, 208(20.8%) had hepatomegaly and 4(0.4%)had liver cirrhosis. Further, only 2 patients amongst the 36 patients who had died had a hepatic cause.Conclusion: This study provides comprehensive data on the prevalence of HBV and HCV infection among SCD patients and raises concerns regarding the HCV prevalence in these patients with its impact on chronic liver disease. Reassuringly, no case with HIV was observed. DisclosuresNo relevant conflicts of interest to declare.

Hepatitis B Reactivation Rate Is Higher Undergoing Some Cytotoxic Chemotherapy in Patients with Solid Tumors: A Large Retrospective Study

Objective: The reactivation rate of chronic hepatitis B virus infection in cancer patients and chemotherapy regimens thought to be associated with hepatitis reactivation were investigated. Patients and Methods: In all, 3,890 cancer patients were included in this study. Mortality rates, chemotherapy regimens, cancer types, number of positive hepatitis serology and reactivation rates were obtained. Results: Only 354 patients had positive hepatitis serology results (HBsAg+). Twenty-four patients (6.7%) with HBsAg positive serology had reactivation. In patients with hepatitis reactivation, the rates of usage of 5-fluorouracil (5-FU), cisplatin, cyclophosphamide, doxorubicin, steroid, rituximab, and vincristine were found to be significantly higher than corresponding rates in patients with positive hepatitis serology results but without hepatitis reactivation (p < 0.05 for all). Conclusion: Increased reactivation rates were detected with usage of 5-FU, cisplatin, cyclophosphamide, doxorubicin, steroid, rituximab, and vincristine.

Assessment of the quality of life in patients on haemodialysis in Iraq.

Chronic kidney disease requires life-long renal replacement therapy, which can greatly impair the quality of life (QOL) of patients. This cross-sectional study aimed to assess the QOL of patients on haemodialysis, and the factors affecting it, at the dialysis unit of Basra General Hospital. A total of 104 patients with end-stage renal disease on haemodialysis were included. Data were collected using the World Health Organization QOL questionnaire. Sociodemographic and clinical data were also collected. Of the 104 patients, 57% were male, 73% were older than 45 years, 87% were of middle and low socioeconomic status, 70% had been on dialysis for more than 1 year, 74% had arteriovenous fistula vascular access, 34% had diabetes and 48% were positive for hepatitis virus. All domains of QOL (physical health, psychological, social relationships and environment) were affected; the physical domain was the most severely affected. Older age, lower socioeconomic status, longer duration of dialysis, central line vascular access, having diabetes and positive hepatitis serology were significantly associated with lower QOL (P < 0.05).

708P - Epidemiological study of histologically proven advanced hepatocholangiocarcinoma: An AGEO multicenter retrospective study

Background: Hepatocholangiocarcinoma (cHCC-ICC) is a rare primary hepatic tumor combining the features of cholangiocarcinoma and hepatocellular carcinoma. Few data about the epidemiology of cHCC-ICC have been reported, mainly from surgical series in Asian and American populations. The aim of this study was to evaluate epidemiological features and overall survival (OS) of histologically proven advanced cHCC-ICC patients. Methods: Data from patients treated for histologically proven cHCC-ICC in six French university hospitals between 2008 and February 2017, were retrospectively collected. The main clinical, biological, treatment and follow up data were reported. Statistical analysis was performed using Graph Pad Prism 6. Results: Thirty patients were included (76.6% of men, median age 64 years [extreme 37-88]). Cirrhosis was associated in 33.3% of cases (Child-Pugh score A: 70%). Positive serology for hepatitis B virus and C was found in respectively, 5 (16.6%) and 2 (6.6%) patients; with 1 co-infection. Chronic alcoholism was noted in 33.3%, diabetes and obesity were both present in 26.6% of cases. Alpha-fetoprotein, carbohydrate antigen 19-9 and carcinoembryonnic antigen serum levels were above normal in respectively 39% (median = 5.3 μg/L [2 – 21 479]), 50% (median = 21.8 IU/mL [4.5-20 000]) and 14% (median = 2.4 µg/L [2-88]) of cases. Six patients (20%) were initially treated by surgical resection. At the diagnosis of advanced disease, 66.6% of patients had multifocal hepatic lesions, 50% distant metastases (bone (23.3%), lung (20%), peritoneal metastases (13.3%)). Twenty-seven patients (90%) received first line of systemic treatment. Twenty-four patients were treated by chemotherapy: Gemcitabine (Gem) alone (n = 1), Gem+oxaliplatin (Gemox) (n = 12), Gemox + bevacizumab (n = 9), Gem+cisplatin (n = 2). Two patients received chemoembolization, 1 patient received sorafenib. Twenty-one (70%) and 4 (13.3%) patients had a second and third line of treatment, respectively. Median OS was 14.5 months. Conclusions: Advanced cHCC-ICC appear to be aggressive tumors with a poor prognosis. Cirrhosis was associated in one third of cases. Systemic treatments are not standardized and must be evaluated in a dedicated study. Legal entity responsible for the study: Dr. Yann Touchefeu Funding: None Disclosure: All authors have declared no conflicts of interest.

The Yield of Abdominal Ultrasound in the Evaluation of Elevated Liver Enzymes during the Second and the Third Trimester of Pregnancy

Aims: To determine the clinical yield of abdominal ultrasound in the evaluation of elevated liver enzymes (ELEs) in the second and the third trimester of pregnancy. Methods: A retrospective cohort study including all pregnant women admitted to a single tertiary care center was conducted between April 2011 and January 2015 with ELE. Inclusion criteria included gestational age above 24 weeks and ELEs, abdominal ultrasound report, and live fetus. Exclusion criteria included known maternal liver disease, structural or chromosomal fetal anomalies, and positive serology for viral hepatitis. All patients underwent abdominal ultrasound. A significant finding of this study led to a change in treatment. Results: One hundred and twenty patients (41.8%) met inclusion criteria: 93 (77.5%) had a normal scan and 27 (22.5%) had abnormal findings. Significant ultrasound findings were found only in 2 (1.6%) patients: gallstones in the common bile duct and suspected autoimmune hepatitis. There were no significant differences between patients with and without ultrasound findings in the rate of cholestasis of pregnancy, preeclampsia, chronic hypertension, and gestation diabetes. Conclusion: Abdominal ultrasound examination in this population has a low clinical yield. The decision to perform an abdominal ultrasound must be individualized based on the obstetric history, clinical findings, and the level of liver enzymes.

Brazilian Chronic Dialysis Survey 2016.

National chronic dialysis data are important for the treatment planning. To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2016. A survey based on data of dialysis centers from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis centers. 309 (41%) of the dialysis units in the country answered the questionnaire. In July 2016, the total estimated number of patients on dialysis was 122,825. The estimated prevalence and incidence rates of chronic maintenance dialysis were 596 (range: 344 in the North region and 700 in the Southeast) and 193 patients per million of population (pmp), respectively. The annual incidence rate of patients with diabetic nephropathy was 79 pmp. The annual gross mortality rate was 18.2%. For prevalent patients, 92% were on hemodialysis and 8% on peritoneal dialysis, and 29,268 (24%) were on a waiting list of renal transplant. A venous catheter was the vascular access for 20.5% of the hemodialysis patients. The prevalence rates of positive serology for hepatitis B and C showed a tendency to reduce from 2013 (1.4% and 4.2%, respectively) to 2016 (0.7% and 3.7%, respectively). The absolute number and the prevalence and incidence rates of patients on dialysis continue to rise steadily; the gross mortality rate remained stable. Regional inequities are evident in these rates.

Evaluation of the Risk of Hepatitis B Reactivation Among Patients with Chronic Myeloid Leukemia Treated with Tyrosine Kinase Inhibitors

▪Background: Immunosuppressive therapy is a known risk factor for hepatits B reactivation. The highest risk is reported in hematologic patients treated with anti-CD20 monoclonal antibodies, glucocorticoids and hematopoietic stem cell transplantation. Currently, treatment with tyrosine kinase inhibitors (TKIs) in the vast majority of chronic myeloid leukemia (CML) patients is life-long. Recently healthcare professionals were advised to test for hepatitis B infection before initializing therapy with TKIs and closely monitor HBV carriers. The risk is considered class effect with all TKIs and recommendations are based on case reports.Aim: The aim of the current study was to evaluate the risk of hepatitis B reactivation in patients with CML treated with TKIs.Methods: The records of patients with CML treated with TKIs from a single center were systematically reviewed for hepatitis B serology and serum biochemistry.Results: One hundred eighty one patients diagnosed with CML between the years 1983 and 2016 were evaluated. The median age at diagnosis was 49.7 years (range 18-89), 117/181 (65%) males, with median duration of follow up with TKI therapy of 5.3 years (range 0.4 to 33 years). Over a total of 1195 years of therapy with TKIs no cases of HBV reactivation were identified. Among 114 patients with hepatitis serology, 11 patients (10%) had evidence of prior resolved HBV infection (HBsAg negative/anti-HBc positive). Two of them had anti-HBs positive serology, one had negative PCR for HBV DNA and other two patients received lamivudine prophylaxis. Only one patient had HBsAg positive serology. None of the patients with positive hepatitis serology had clinical or biochemistry evidence of hepatitis B reactivation. The 67 patients without available hepatitis serology had normal liver transaminases at 6 months of TKI therapy and at last day of follow up, confirming that no overt hepatitis B reactivation occurred.Conclusions: We evaluated hepatitis B reactivation in a rather large cohort of CML patients, treated with TKIs. Although there were no cases of HBV reactivation during long term follow up, it should be emphasized that even a low incidence may exert a significant risk due to the long duration of treatment in a chronic disease with lifelong therapy. Our study infers that patients with serology of prior resolved HBV infection are at low risk for hepatitis B reactivation. Larger cohorts of patients with positive hepatitis B serology in a multicenter long term evaluation should be performed in order to address current recommendations for patients' safety and concerns. DisclosuresNo relevant conflicts of interest to declare.

Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy?

The partial liver's ability to regenerate both as a graft and remnant justifies right lobe (RL) living donor liver transplantation. We studied (using biochemical and radiological parameters) the rate, extent of, and predictors of functional and volumetric recovery of the remnant left liver (RLL) during the first year in 91 consecutive RL donors. Recovery of normal liver function (prothrombin time [PT] ≥70% of normal and total bilirubin [TB] ≤20 µmol/L), liver volumetric recovery, and percentage RLL growth were analyzed. Normal liver function was regained by postoperative day's 7, 30, and 365 in 52%, 86%, and 96% donors, respectively. Similarly, mean liver volumetric recovery was 64%, 71%, and 85%; whereas the percentage liver growth was 85%, 105%, and 146%, respectively. Preoperative PT value (p = 0.01), RLL/total liver volume (TLV) ratio (p = 0.03), middle hepatic vein harvesting (p = 0.02), and postoperative peak TB (p < 0.01) were predictors of early functional recovery, whereas donor age (p = 0.03), RLL/TLV ratio (p = 0.004), and TLV/ body weight ratio (p = 0.02) predicted early volumetric recuperation. One-year post-RL donor hepatectomy, though functional recovery occurs in almost all (96%), donors had incomplete restoration (85%) of preoperative total liver volume. Modifiable predictors of regeneration could help in better and safer donor selection, while continuing to ensure successful recipient outcomes.