Pre-transplant MELD Research Articles

Risk Factors for Cytomegalovirus Infection and Its Impact on Survival after Living Donor Liver Transplantation in South Korea: A Nested Case-Control Study.

Cytomegalovirus (CMV), a common pathogen, causes infectious complications and affects long-term survival after transplantation. Studies examining living donor liver transplantation (LDLT) are limited. This study analyzed the risk factors for CMV infection and its impact on the survival of LDLT patients. A nested case-control design retrospectively analyzed data from 952 patients who underwent LDLT from 2005-2021. The incidence of CMV infection for the study cohort was 15.2% at 3 months for LDLT patients managed preemptively. Patients with CMV infections were matched with those without the infection at corresponding time points (index postoperative day) in a 1:2 ratio. Graft survival was significantly lower in the CMV infection group than in the control group. CMV infection was an independent risk factor for graft survival in the matched cohort (HR 1.93, p = 0.012). Independent risk factors for CMV infection were female sex (HR 2.4, p = 0.003), pretransplant MELD (HR 1.06, p = 0.004), pretransplant in-hospital stay (HR 1.83, p = 0.030), ABO incompatibility (HR 2.10, p = 0.009), donor macrovesicular steatosis ≥10% (HR 2.01, p = 0.030), and re-operation before index POD (HR 2.51, p = 0.035). CMV infection is an independent survival risk factor, and its risk factors should be included in the surveillance and treatment of CMV infections after LDLT.

Incidence, mortality, and risk factors associated with carbapenem-resistant Acinetobacter baumannii bacteremia within 30 days after liver transplantation.

Carbapenem-resistant Acinetobacter baumannii bacteremia (CRAB-B) is a fatal infectious complication of liver transplantation (LT). This study investigated the incidence, effects, and risk factors associated with CRAB-B during the early post-LT period. Among 1051 eligible LT recipients, 29 patients experienced CRAB-B within 30 days of LT with a cumulative incidence of 2.7%. In the patients with CRAB-B (n=29) and matched controls (n=145) by nested-case control design, the cumulative incidence of death on days 5, 10, and 30 from the index date was 58.6%, 65.5%, and 65.5%, and 2.1%, 2.8%, and 4.2%, respectively (p<.001). Pre-transplant MELD (OR 1.11, 95% confidence interval [CI] 1.04-1.19, p=.002), severe encephalopathy (OR 4.62, 95% CI 1.24-18.61, p=.025), donor body mass index (OR .57, 95% CI .41-.75, p<.001), and reoperation (OR 6.40, 95% CI 1.19-36.82, p=.032) were independent risk factors for 30-day CRAB-B. CRAB-B showed extremely high mortality within 30 days after LT, especially within 5 days after its occurrence. Therefore, assessment of risk factors and early detection of CRAB, followed by proper treatment, are necessary to control CRAB-B after LT.

Absence of influence of the Korean MELD score-based liver allocation system on pretransplant MELD score in patients undergoing living donor liver transplantation

Shin Hwang, Sang Hoon Kim, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Young-In Yoon, Sung-Gyu Lee. Korean J Transplant 2021;35:152. https://doi.org/10.4285/ATW2021.OP-1237

Excellent outcome following emergency deceased donor ABO-incompatible liver transplantation using rituximab and antigen specific immunoadsorption

Background The acceptance of ABO-incompatible (ABOi) liver grafts will expand the donor pool for a patient in urgent need for a liver transplantation (LT). Here we report our results with emergency ABOi DD (deceased donor) LT using rituximab and antigen specific immunoadsorption. Patients and Methods 2009 to 2019 we performed 20 ABOi DD LTs (adults n = 17, children n = 3) for patients in urgent need for a LT. Immunosuppression consisted of rituximab (n = 20) and basiliximab (n = 15) or anti-thymocyte globuline (n = 4), intravenous immunoglobulin (IVIG; n = 6), tacrolimus, prednisolone and mycophenolate mofetil. Fifteen patients were treated with IA (n = 14) or both IA and plasmapheresis (PP; n = 1) pre-transplant and 18 patients were treated with IA (n = 15) or both IA and PP (n = 3) post-transplant. The median pre-transplant MELD- score was 40 (range 18–40). Patient and graft survival and complications were compared to a 1:4 case matched control group of ABO-identical or compatible (ABOid/c) DDLT. Results The 1-, 3- and 5-year patient and graft survival rates were 85, 85 and 78% for the ABOi recipients and not significantly different compared to ABOid/c controls. Only one ABOi patient developed antibody-mediated rejection. Conclusion Patient and graft survival after emergency ABOi DDLT using rituximab and immunoadorption was equal to ABOid/DDLT. ABOi DD LT was a successful approach to expand the donor pool for patients in urgent need for a liver graft.

Absence of influence of the Korean MELD score-based liver allocation system on pretransplant MELD score in patients undergoing living donor liver transplantation

Absence of influence of the Korean MELD score-based liver allocation system on pretransplant MELD score in patients undergoing living donor liver transplantation

Absence of influence of the Korean MELD score-based liver allocation system on pretransplant MELD score in patients undergoing living donor liver transplantation

Sang Hoon Kim, Shin Hwang, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Ki-Hun Kim, Young-In Yoon, Woo-Hyoung Kang, Hwui-Dong Cho, Minjae Kim, Byeong-Gon Na, Sung-Min Kim, Geunhyeok Yang, Sung-Gyu Lee. Ann Liver Transplant 2021;1:10-7. https://doi.org/10.52604/alt.21.0003

Pre-Liver Transplant ROTEM™ Clot Lysis Index Is Associated with 30-Day Mortality, But Is Not a Measure for Fibrinolysis.

Complex alterations of the coagulation system in end stage liver disease lead to an increased risk of bleeding and mortality. In the present study, we investigated; 1. the association of pre-liver transplant rotational thrombelastometry (ROTEM™) variables with bleeding as well as 30-day-mortality and 2. the underlying pathophysiology. After approval from the local ethics committee, rotational thrombelastometry variables, conventional laboratory coagulation values, MELD score (model of end-stage liver disease), red blood cell loss, blood product use, coagulation factors, underlying disease, and demographic data were retrospectively analysed. Pre-transplant thrombelastometry clot lysis index (CLI) and MELD were the only variables associated with mortality, bleeding and blood product use, respectively. Mortality was 4.2%, when CLI was <85%, and increased to 25.7% when the CLI was >95%. Multivariate analysis including CLI and MELD score identified the CLI as an independent and the best predictor of 30-day-mortality. Interestingly, the inhibition of fibrinolysis did neither affect CLI nor the association of the variable with mortality. Thus, fibrinolysis can be excluded as the reason for low CLI values. In conclusion, low CLI values measured before the beginning of liver transplantation are associated with reduced bleeding and mortality, but do not indicate fibrinolysis.

25 Pre-emptive therapy for cmv viremia in living donor liver transplant recipients: a single centre experience

Background CMV infection is among the most common complication after liver transplantation which may result in graft loss, survival and increased cost. There are two major strategies for CMV disease prevention after transplantation: preemptive therapy and universal prophylaxis. We present our cohort of recipients of Living Donor Liver Transplant (LDLT) with non-detectable CMV DNA pre-transplant, with moderate risk of CMV viremia (D+/R+, d-/R+), who were preemptively treated. Aim To determine whether preemptive strategy may be feasible approach in patients with moderate risk for CMV viremia in LDLT and its appropriateness for Acute Cellular Rejection(ACR), length of hospital stay and risk of developing other infection and all-cause mortality. Method In this retrospective cohort, 225 adults with moderate risk for CMV viremia who underwent LDLT at Shifa International Hospital from 29/4/2011 to 26/4/2016 were included. All recipients were checked for CMV viremia at day 7, patients with significant viremia (DNA >137 IU/ml) were treated for CMV preemptively. Non-viremic patients on day 7 were only re-checked if had deranged LFT on follow up. Results Out of 225 patients, 83 (36.8%) patients had detectable CMV DNA at day 7. Patients with higher pre-transplant MELD >18 had more chances of developing CMV viremia n=42 (50.6) than those with MELD Conclusions Pre-emptive CMV strategy may be an acceptable approach in patients with moderate risk of CMV viremia in resource constraint setting; however, this needs prospective randomised trials for validation.

Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population.

Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days. 164 recipients were examined: 41 (25.0%) experienced PRF and 74 (45.1%) prolonged ICU LOS. Significant predictors of PRF with univariate analysis: BMI > 30, pretransplant MELD, preoperative respiratory failure, LVEF < 50%, FVC < 80%, intraoperative transfusion > 6 units, warm ischemic time > 4 minutes, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted PRF (OR 1.14, p = 0.01). Significant predictors of prolonged ICU LOS with univariate analysis are as follows: pretransplant MELD, FVC < 80%, FEV1 < 80%, deceased donor, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted prolonged ICU LOS (OR 1.28, p < 0.001). One-year survival among cohorts with PRF and increased ICU LOS was similar to subjects without. Pretransplant MELD is a robust predictor of PRF and ICU LOS. Higher MELDs at LT are expected to increase need for ICU utilization and modify expectations for recovery in the immediate postoperative period.

Su1016 Risk Factors for Post-Operative Respiratory Failure in Liver Transplant Recipients

Rationale: Post-operative respiratory failure (PRF) is a common complication after liver transplant (LT). PRF leads to increased length of intensive care unit (ICU) and hospital stay and predisposes to increased morbidity in the post-operative period. Further investigation is needed to identify risk factors for PRF in LT recipients. Aim: To evaluate pre-operative cardiopulmonary testing, recipient, donor, and surgical variables and their utility in prediction of PRF after LT. Methods: Retrospective case-control study performed on LT recipients from 2010-2012. Post-operative course was reviewed to evaluate for cases of PRF, defined as failure to extubate before or unplanned re-intubation within 48 hours from completion of LT surgery. Pre transplant recipient demographic characteristics were recorded. Donor and surgical characteristics including: simultaneous kidney transplant, cytomegalovirus (CMV) status, gender, donor source (deceased or living), age, warm and cold ischemic times were assessed. Pre-transplant cardiopulmonary testing examined included: the presence or absence of heart failure, diastolic dysfunction, left ventricular ejection fraction, right ventricular systolic pressure, forced expiratory volume in one second to forced vital capacity ratio (FEV1/ FVC), forced vital capacity (FVC), total lung capacity (TLC), forced expiratory volume in one second ( FEV1), and diffusion limit of carbon monoxide (DLCO). Variables of interest were analyzed using univariate logistic regression with an end point of PRF. Factors deemed most significant (p < 0.25) in predicting PRF were included in a multivariate regression analysis to estimate adjusted odds ratios (OR) for each variable. Variables with p < 0.05 were considered significant predictors of PRF in the final model. Results: A total of 170 patients were identified. Of those, 23.7% experienced PRF. Significant predictors including pre-transplant MELD, pre-operative respiratory failure, FVC <80%, FEV1 <80%, TLC <80%, and deceased donor source from univariate logistic regression [Table 1] were entered into multivariate logistic regression. In the final model, pre-operative respiratory failure (OR= 161.48, p = 0.002) was found to be predictive of PRF, in a model that explained 26.3 to 41.7% of variance [Table 2].Conclusions: Pre-operative respiratory failure from any etiology was identified as a significant predictor of PRF after LT. Pre-LT echocardiogram and pulmonary function testing had no predictive value for PRF. These findings support the development of protocols to aggressively wean ventilatory support immediately prior to LT. Univariate Analysis: Post-Operative Respiratory Failure

Abstract W P318: Ischemic Stroke in the Post-Operative Phase of 2,035 Consecutive Orthotopic Liver Transplantations

Background: Cardiovascular morbidity has been cited as a prominent cause of post-operative orthotopic liver transplantation (post-OLT) complications, yet the role of ischemic stroke during this period remains poorly defined. We examined the incidence of post-OLT ischemic stroke, associated risk factors, etiology and neuroimaging features in an extensive single center database. Methods: All consecutive adult patients undergoing OLT from January 1, 2002 to December 15, 2013 at a single center were analyzed for neurological complications, characterizing post-operative stroke by neurology consultation and CT/MRI. Neurological history, examination, features of atrial fibrillation, concomitant infection, relevant laboratory parameters, and infarct patterns were reviewed in detail. Results: Of the 2,035 OLT cases analyzed, including 190 cases where neurology consultation was triggered, post-OLT ischemic stroke was identified in 20 patients (0.98%). Patients with ischemic stroke were significantly more likely to be older (64.4 vs. 53.6 years, p&lt;0.001), have pre-existing coronary artery disease (21.4% vs. 5.6%, p=0.011), higher pre-transplant MELD scores (34 vs 27.7, p=0.018), and greater post-transplant infectious complications both within (45% vs 22.6%, p=0.017) and beyond (65% vs. 24.4%, p&lt;0.001) 30 days post-OLT, and longer post-OLT length of hospitalization (53.2 vs 32.5 days, p=0.033). Comparing patients with and without post-OLT ischemic stroke, there were no significant differences in the incidence of preoperative (4.1% vs 5.0%, p=0.846) or postoperative (6.5% vs 10%, p=0.530) atrial fibrillation. Ischemic stroke was characterized with MRI in 19/20 (95%) and only CT in 1/20 (5%). Scattered, cortical lesions of probable embolic etiology were noted in 12/20 (60%) with only 3/20 (15%) proximal arterial territory lesions. Conclusions: Post-OLT ischemic stroke was relatively uncommon in this largest single center series of 2035 consecutive OLTs. Further insight on etiology of these complications may help to further reduce morbidity.

Correction: Predicting Survival after Liver Transplantation Based on Pre-Transplant MELD Score: a Systematic Review of the Literature

Correction: Predicting Survival after Liver Transplantation Based on Pre-Transplant MELD Score: a Systematic Review of the Literature

Pre-transplant Left Ventricular Diastolic Dysfunction Is Associated with Post Transplant Acute Graft Rejection and Graft Failure

Acute cellular rejection (ACR) is a significant cause of morbidity and graft failure in liver transplant recipients (LTR). Diastolic dysfunction (DD) is frequently present in patients with cirrhosis undergoing liver transplantation. However, it is unclear if DD leads to ACR. Data was collected retrospectively for consecutive LTR between January 2000 and December 2010. Demographic data and mortality related data was obtained from social security index. Primary outcome was biopsy proven ACR. Graft failure and all-cause mortality were also evaluated. DD was evaluated as a predictor of these outcomes. Other echocardiographic indices were also assessed as predictors of ACR by using Cox proportional hazard modeling adjusted for covariates. A total of 970 LTR (mean age 53.2 ± 10 years, women 34.6 % and white 64.5 %) were followed for 5.3 ± 3.4 years. Patients with DD (n = 145, 14.9 %) were significantly more likely to develop ACRs (HR 10.56; 95 % CI 6.78-16.45, p value = 0.0001) as well as graft failure (HR 2.09; 95 % CI 1.22-3.59, p value = 0.007) and all-cause mortality (HR 1.52; 95 % CI 1.08-2.13, p = 0.01). There was an increase in the risk of these outcomes with worsening of DD, when adjusted for various risk factors such as donor and recipient age, gender, race, Framingham risk score, pre-transplant MELD, transplant etiology and cold ischemia time. Pre-transplant DD is significantly associated with increased risk of allograft rejection, graft failure and mortality. This signifies the importance of cardiac evaluation during the pre-transplant period.

621 Treatment of HCV Recurrence After Liver Transplant: A Review of Early Virologic Responses Using Telaprevir, A Single Center Experience of 24 Patients

two groups were compared using independent-samples t-test. Survival analysis and the distributions were calculated using Kaplan-Meier method and Mantel-Cox log-rank test. Results: Out of total 43 combined liver-kidney transplants, 30 SLK cases (24 post-MELD and 6 pre-MELD) were included. Proportions of age, gender, ethnicity, pre-transplant MELD score; pre-transplant renal replacement therapy requirement, hypertension, diabetes mellitus and follow-up period were similar in two groups. Median follow up period was 30 months. Both overall and kidney-graft survival in pre-MELD era were 50%, but improved to 91.7% in post-MELD era (p=0.02). When compared according to HCV diagnosis, there was no statistical significance in overall and kidney-graft survival between 9 HCV and 15 non-HCV groups in post-MELD era (p=0.67 and p=0.4, respectively). Conclusion: Literature suggests lower risk of liver graft loss in SLK compared to LTA, but not much information is available regarding the specific diagnosis of the underlying liver disease, HCV vs non-HCV.Our study demonstrated that overall and kidney graft survival has significantly improved post-MELD as compared to pre-MELD era. Additionally, our study showed that there was no statistical difference in overall and kidney-graft survival between HCV and non-HCV groups. This observation needs to be further studied and verified in larger cohort to fully identify the impact of Hepatitis C infection on liver and kidney grafts, post transplantation.

A Validated Model for Predicting Outcome after Liver Transplantation: Implications on Transplanting the Extremely Sick

Introduction: The transplantation community is facing an ongoing crisis of organ shortage. In a “sickest first” allocation system, some patients are transplanted at the extreme of their disease. Few of them achieve very poor results. We sought to identify risk factors associated with inferior results and develop a model for predicting such outcome, in an intention to minimize sub-optimal outcome and loss of scarce organs. Methods: The study is a retrospective cohort analysis, based on a single institution prospectively maintained database. Hospital length of stay (LOS) was the main outcome measure. Secondary outcome measures were patient and graft survival, post-operative liver graft and kidney function, and transplant cost (reported in relative units [RU]). The patient population consisted of 1,060 consecutive recipients who underwent primary LT at our institution. The first cohort included 643 patients transplanted between September 2002 and March 2006 (“Study Cohort”- SC). This cohort was used to identify risk factors for poor outcome and construct a mathematical model to identify patients with expected inferior results. Mean patient follow-up was 40.5 ± 0.8 months. The second cohort consisted of 417 patients transplanted from April 2006 to December 2009. This cohort was used for validation of the model (“Validation Cohort”- VC). Validation was done by calculating the probability of adverse outcome (LOS>60) and comparing the actual hospital stay, patient and graft survival and transplant cost of the patients with the highest score (53 patients; 12.7%) to those of the rest of the VC. Mean patient follow-up was 54.8 ± 1.3 months. Results: In the SC of 643 patients, post-operative LOS ranged from 1 to 209 days with a mean and median of 27.7 and 16 days, respectively. Sixty five patients (10.1%) had LOS > 60 days. One- and three-year patient/graft survival rates were 81.9%/76.1% and 73.4%/67.4%, respectively. Patient and graft survival of those with LOS >60 days were significantly inferior (p < 0.0001) while the cost of transplantation was significantly greater (3.42 RU vs. 1 RU, p < 0.0001), when compared to those with hospital LOS ≤ 60 days. In a multivariable analysis, recipient pre-transplant dialysis (p< 0.001), mechanical ventilation (p< 0.015), MELD score (p< 0.003) and age (p< 0.009) were independent predictors of LOS > 60 days. The ROC curve of the model prognosticating hospital LOS > 60 days was 0.75 (95% CI [0.70, 0.81]). In the validation phase of the study, 53 patients (12.7%) were expected to have adverse outcome by the model. These patients had significantly longer LOS (48.5±4.5 vs. 25.6±1.3 days; p < 0.0001), higher cost (1.53 RU vs. 1; p < 0.0001) and inferior patient and graft survival (1 and 3 years survival of 71.7% and 64.2% vs. 87.6% and 79.2%; p< 0.007). Conclusions: Older patients with the combination of advanced MELD score, in need of mechanical ventilation and renal replacement therapy, are prone to prolonged and expensive hospital stay and significantly inferior patient and graft survival. Using the proposed model, allows for identification of candidates with high probability of poor outcome.

MELD-based graft allocation system fails to improve liver transplantation efficacy in a single-center intent-to-treat analysis

Since March 2007, priority access to liver transplantation in France has been given to patients with the highest MELD scores. To undertake an intent-to-treat comparison of center-based vs. MELD-based liver graft allocation. Retrospective cohort analysis (patients listed 6th March 2007 to 5th March 2009; MELD period) with a matched historical cohort (patients listed 6th March 2005 to 5th March 2007; pre-MELD period) in a single high-volume center. Analysis was on an intent-to-treat basis, i.e. starting on the day of wait listing. Compared to pre-MELD, fewer patients with a MELD score less or equal to 14 (P=0.002), and more patients with a MELD greater or equal to 24 (P<0.05) were transplanted during the MELD period. For HCC candidates, median waiting time increased (121 vs. 54 days, P=0.01), transplantation rate halved (35% vs. 73.5%, P<0.001) and dropouts due to tumor progression increased (16% vs. 0%, P<0.001). Moreover, postoperative course did not change significantly except for infectious complications (35% vs. 24%, P=0.02); overall patient survival was 69.8 ± 3.1% vs. 76 ± 2.9% (P=0.29) and overall graft survival was 77.6 ± 3.4% vs. 82.8 ± 2.9% (P=0.29). Transplant failures were mainly due to deaths on the waiting list in the previous system, but to dropouts related to disease progression in the new system. Cirrhotic patient survival rate did not change (78.1 ± 4.4% vs. 73.5 ± 4.5%, P=0.42), while that of HCC patients decreased (65.3 ± 5.3% vs. 86.8 ± 4.4%, P=0.01). Post-transplant survival worsened significantly according to pre-transplant MELD score (P=0.009). The MELD-based graft allocation system introduced discrimination against HCC patients, whose incidence has increased dramatically, and should be reevaluated.

Outcome of HCV/HIV-Coinfected Liver Transplant Recipients: A Prospective and Multicenter Cohort Study

Eighty-four HCV/HIV-coinfected and 252-matched HCV-monoinfected liver transplant recipients were included in a prospective multicenter study. Thirty-six (43%) HCV/HIV-coinfected and 75 (30%) HCV-monoinfected patients died, with a survival rate at 5 years of 54% (95% CI, 42-64) and 71% (95% CI, 66 to 77; p = 0.008), respectively. When both groups were considered together, HIV infection was an independent predictor of mortality (HR, 2.202; 95% CI, 1.420-3.413 [p < 0.001]). Multivariate analysis of only the HCV/HIV-coinfected recipients, revealed HCV genotype 1 (HR, 2.98; 95% CI, 1.32-6.76), donor risk index (HR, 9.48; 95% CI, 2.75-32.73) and negative plasma HCV RNA (HR, 0.14; 95% CI, 0.03-0.62) to be associated with mortality. When this analysis was restricted to pretransplant variables, we identified three independent factors (HCV genotype 1, pretransplant MELD score and centers with <1 liver transplantation/year in HIV-infected patients) that allowed us to identify a subset of 60 (71%) patients with a similar 5-year prognosis (69%[95% CI, 54-80]) to that of HCV-monoinfected recipients. In conclusion, 5-year survival in HCV/HIV-coinfected liver recipients was lower than in HCV-monoinfected recipients, although an important subset with a favorable prognosis was identified in the former.

Impact of Human T Cell Leukemia Virus Type 1 in Living Donor Liver Transplantation

Human T cell leukemia virus type 1 (HTLV-1) is an endemic retrovirus in southwestern Japan, which causes adult T cell leukemia (ATL) or HTLV-1 associated myelopathy in a minority of carriers. Here, we investigated the impact of HTLV-1 status in living donor liver transplantation (LDLT). Twenty-six of 329 (7.9%) HTLV-1 carriers underwent primary LDLT. One recipient negative for HTLV-1 before LDLT received a graft from an HTLV-1 positive donor. Eight donors were HTLV-1 positive. Twenty-seven recipients (13 male and 14 female; mean age 52.5 years) were reviewed retrospectively. ATL developed in four recipients who ultimately died. The intervals between LDLT and ATL development ranged from 181 to 1315 days. Of the four ATL recipients, two received grafts from HTLV-1 positive donors and two from negative donors. The 1-, 3- and 5-year HTLV-1 carrier survival rates were 91.3%, 78.3% and 66.3%, respectively. Fulminant hepatic failure as a pretransplant diagnosis and a pretransplant MELD score ≥ 15 was identified as risk factors for ATL development in this study (p = 0.001 and p = 0.041, respectively). In conclusion, LDLT can be performed for HTLV-1 positive recipients. However, when fulminant hepatic failure is diagnosed, LDLT should not be performed until further studies have revealed the mechanisms of ATL development.

OC-063 The severity of hepatic ischaemia-reperfusion injury is associated with acute kidney injury following donation after brain death liver transplantation

IntroductionDonation after Cardiac Death liver transplant recipients have an increased frequency of acute kidney injury (AKI) during the immediate post-operative period and in these patients peak peri-operative aspartate amino-transferase (AST),...

Regression of Cardiac Cirrhosis and Survival After Heart Transplantation

Introduction: There is limited literature whether patients with end-stage heart failure and cardiac cirrhosis should undergo heart transplantation. Many patients are excluded from heart transplantation due to underlying cardiac cirrhosis. Regression of cirrhosis has been shown in a few case studies, however, outcomes of patients with cardiac cirrhosis who underwent heart transplantation is unknown. Aims: To determine short and long-term survival and examine the possibility for regression of cardiac cirrhosis after heart transplantation. Methods: We identified all adult patients with clinical diagnosis of cardiac cirrhosis who underwent heart transplantation (n=43) at our institution between April 1991 and January 2009. Cirrhosis was defined on the basis of histological confirmation or evidence of portal hypertension and nodularity on imaging. Patients with any form of primary liver pathology were excluded (n=5). Multivariate logistic regression analysis was used to identify factors independently associated with mortality after cardiac transplantation. Outcomes were analyzed using Kaplan-Meier method. Mortality data was collected from our electronic health records and confirmed using the social security death index. Results: In our study cohort of 38 patients (median age, 59.0 ±15.7 years; males, 84.2%; Caucasian, 76.3%, pre-transplant median MELD, 12.50 ± 5.47; median follow up, 40 months), 9 patients had clinical diagnosis substantiated by biopsy or imaging. Three patients with pre-transplant biopsy also underwent post-transplant biopsy. One patient with biopsy proven stage 4 fibrosis regressed to stage 2 after cardiac transplantation. Survival at 30 days, 1 year, and 5 years in our patient cohort were 92.11%, 81.49% and 69.27% respectively (Figure 1). Multivariate Cox regression analysis revealed that pre-transplant MELD, biopsy or image proven cirrhosis, did not predict all-cause mortality. Conclusion: Liver cirrhosis due to end stage heart failure is not a contraindication for heart transplantation as survival is comparable to nationwide estimates of patients without cirrhosis undergoing heart transplantation.