Regional Transplant Center Research Articles

Using Animation to Address Disparities in Kidney Transplantation

ABSTRACT This essay reviews an arts-based project based in Buffalo, New York, seeking to educate patients with kidney failure and their social network about the transplantation process. Through a multi-phase arts-based research project, informed by a community-based steering committee and key stakeholders, 33 educational animated videos were developed and tested for efficacy in samples of diverse patients at a regional transplant center. Animation was chosen for its potential to better explain health concepts more sensibly to patients and support knowledge dissemination to their social network, who may donate a kidney or support a recipient or donor. The videos are 2D, short in duration, and designed for easy viewing on small devices using characters, scenes, narration, and movement. Aesthetic choices reinforce learning: characters have confident posture, memorable features (e.g. hair style, clothing color) with minimal detail, and model diverse races, ethnicities, gender, and body types. Scenes feature light backgrounds, illuminate main images, and are as large as possible for small screens. Narration is slow, calm, and uses strategic pauses to introduce concepts. Movement is selective to reinforce the message (signaling). The animation was guided by self-efficacy theory and the cognitive theory of multimedia learning. Findings to date indicate promising results with respect to patient knowledge and the feasibility of using animation to address disparities in kidney transplantation. Figures illustrate the evolution of the project and provide examples of the art used to capture a given aspect of the transplantation process.

Assessing asymmetrical kidney function in living donors: a retrospective cohort study on CT metrics

BackgroundLive donor kidney transplantation is the preferred kidney replacement therapy for eligible patients but requires thorough donor evaluation to minimise risks. Contemporary guidelines recommend split kidney function measurement in living donors only when there is a significant kidney size discrepancy, yet the evidence for this is poor, and practice varies nationally. This study evaluates the efficacy of CT-derived kidney metrics in detecting significant functional asymmetry.MethodsWe conducted a retrospective cohort analysis of 123 prospective living kidney donors at a regional transplant centre from June 2011 to October 2014, utilising CT to determine kidney and cortical volumes and lengths. Asymmetric kidney function (AKF), defined by > 10% function difference on DMSA scans, was correlated with CT measurements to calculate the diagnostic accuracy of current guidelines.ResultsAmong the prospective donors, the median age was 42 years, and 59.3% were female. The median split kidney function difference was 4%, with 25 individuals exhibiting > 10% AKF. Kidney length discrepancy proved to be a poor indicator of AKF (sensitivity: 28%, specificity: 84%). While negative predictive values for cortical and kidney volumes were high (96% and 93%, respectively), sensitivity was low, and specificity and positive predictive value did not meet satisfactory thresholds.ConclusionsCT-derived metrics of kidney length, cortical, and total volume show limited sensitivity and specificity in identifying significant AKF. These findings provide evidence to support revised guideline development in the assessment of living kidney donors.

Opportunities for Improving the Transplant Assessment and Education Process in British Columbia: Patient and Health Care Provider Perspective.

There are several steps patients and their health care providers must navigate to access kidney transplantation in British Columbia (BC). We explored perceptions and experiences with the pretransplant process across BC to determine where process improvements can be made to enhance access to transplantation. Anonymous surveys were sent online and via post to health care providers (including nephrologists, registered nurses, and coordinators) and patients across BC. Kidney care clinics, transplant regional clinics, and provincial transplant centers in BC. Surveys included Likert scale questions on the current pretransplant process and transplant education available in BC. The health provider survey focused on understanding the pretransplant process, knowledge, roles, and communication while the patient survey focused on patient education and experience of the pretransplant processes. A total of 100 health care providers and 146 patients responded. Seventy-six percent of health care providers understood their role and responsibility in the pretransplant process, while only 47% understood others' roles in the process. Fifty-nine percent of health care respondents felt adequately supported by the provincial donor and transplant teams. Seventy-one percent of registered nurses and 92% of nephrologists understood transplant eligibility. About 68% and 77% of nurses and nephrologists, respectively, reported having enough knowledge to discuss living donation with patients. Fifty percent of patients had received transplant education, of which 60% had a good grasp of the pretransplant clinical processes. Sixty-three percent felt their respective kidney teams had provided enough advice and tools to support them in finding a living donor. Fifty percent of patients reported feeling up to date with their status in the evaluation process. This analysis was conducted between December 2021 and June 2022 and may need to account for practice changes that occurred during the COVID-19 pandemic. Responses are from a selection of health care providers, thus acknowledging a risk of selection bias. Furthermore, we are not able to verify patients who reported receiving formal transplant education from their health care providers. Exploring these themes suggests communication with regional clinics and transplant centers can be improved. In addition, patient and staff education can benefit from education on kidney transplantation and the pretransplant clinical processes. Our findings provide opportunities to develop strategies to actively address modifiable barriers in a patient's kidney transplantation journey.

Critical elements of pediatric liver cancer surgery

The appropriate management of pediatric liver malignancies, primarily hepatoblastoma and hepatocellular carcinoma, requires an in depth understanding of contemporary preoperative risk stratification, experience with advanced hepatobiliary surgery, and a good relationship with one’s local or regional liver transplant center. While chemotherapy regimens have become more effective, operative indications more well-defined, and overall survival improved, the complexity of liver surgery in small children provides ample opportunity for protocol violation, inadequate resection, and iatrogenic morbidity. These guidelines represent the distillation of contemporary literature and expert opinion as a means to provide a framework for preoperative planning and intraoperative decision-making for the pediatric surgeon.

Impact of laparoscopic liver resection for access to the waiting list of a single regional liver transplant center in southern Italy: entry and dropout flows’ analysis

Impact of laparoscopic liver resection for access to the waiting list of a single regional liver transplant center in southern Italy: entry and dropout flows’ analysis

CT-448 Academic Center Outreach to Community Practices Increases Transplant Referrals and Possibly Reduces Racial Disparities

Racial disparities are evident in transplant utilization rates. Outcomes improve for multiple myeloma (MM) with an autologous stem cell transplant (autoSCT) but despite the guidelines, African Americans (AA) receive fewer autoSCT when compared to whites (W). Multiple single-institution studies have confirmed that rates of autoSCT for MM in AA are similar to W when patients are referred for evaluation. Lower referral to a transplant center may contribute to these disparities. Emphasis on physician communication to facilitate an improved referral network represents an intervention to overcome this disparity. We reviewed our center data to assess the impact of outreach on transplant referrals and impact on race. We reviewed transplants (both autoSCT and alloSCT) performed at Augusta University between fiscal years 2015 to 2021. Patients were divided into two cohorts (cohort A: FY2014-17 and cohort B: FY2019-21) based on initiation of physician outreach by our program. FY2018 was used in our analysis for a year of outreach which included visiting practices within catchment area. In addition, two outreach clinics were established in collaboration with large community practice sites. Statistics are descriptive. 389 transplants analyzed included patients age >18 years with 52% males and 45% age ≥ 61 years. Cohort B had a significant increase with 266 vs 123 in cohort A, a 116% increase. There was increased median distance travelled to our center from 15.2 to 52.3 miles. Considering 15 miles as our urban area, >60% of transplants in cohort B were from outside our area. The increase in median distance travelled was found in both autoSCT and alloSCT (15.2 vs 40.3 and 15.2 vs 79.3, respectively). More significantly, cohort B had a 147% increase in AA compared to 96% in W. The distance travelled to our center was higher for W but also increased for AA at 15.4 vs 69.3 and 15.2 vs 34.8 miles, respectively. Of note, review of regional transplant center data suggests the increased volume at our center is not related to redistribution between programs across GA and SC. Our model confirms that academic outreach increases transplant referrals. The increase includes patients of minority thus may be an effective model to reduce healthcare disparities.

244.10: Health System Barriers and Facilitators to Living Donor Kidney Transplantation: A Tale of Two States With the Highest and Lowest Rates

Purpose: Current efforts to increase living donor kidney transplantation (LDKT) entails identifying patient-level barriers and little is known about barriers that exist at the level of the health systems. The provision of transplantation in Canada is at the provincial level and there is wide variability in LDKT performance across different provinces. We aimed to learn and compare health systems with the best and the worst performance in LDKT, and to identify health system-level barriers to LDKT. Methods: This study took the form of a comparative case study analysis. Case study research is an in-depth and non-interventional examination of a single case over time using retrospective and contemporary data. Data collection entailed semi-structured interviews, document review, and participant observation. Data were analyzed thematically to generate themes surrounding the attributes and processes of a health system that facilitate the delivery of LDKT to patients, and those that create barriers. Results: In the best-performing province of Canada, five themes emerged as facilitators to the delivery of LDKT to patients. The relationship between two provincial organizations (a regional transplant and a regional nephrology order) was identified as key to enabling the mandate and processes for LDKT. On the other hand, in the worst-performing province, similar themes emerged as barriers to LDKT. Barriers were identified at the levels of organizational coordination, professional knowledge, resources, geography, and governance. Particularly, inconsistent coordination between regional clinics and transplant centers and poor role definition was seen to hinder and delay care processes. Conclusion: By comparing two health systems with variable rates of LDKT, we have identified several real-world health system-level barriers to the delivery of LDKT to patients. Many of these barriers are modifiable and have implications for practitioners, policymakers, administrators, and patients. This work is supported by a Gift of Life Institute Clinical Faculty Development Research Grant from the American Society of Transplantation and a Health Research Grant, Kidney Foundation of Canada.

310. Cryptococcal Infection Following COVID-19 infection in Solid Organ Transplant Recipients: A Case Series

BackgroundFungal infections have been identified with or following SARS-CoV-2 infection, most commonly COVID associated pulmonary aspergillosis. Cryptococcus species are ubiquitous in the environment and the third most common invasive fungal infection following Solid Organ Transplant (SOT). We describe four cases of concurrent or subsequent cryptococcal infection within 90 days following COVID-19 infection.MethodsWe conducted a retrospective study of patients presenting with proven cryptococcosis either concurrently or within 90 days following COVID-19 diagnosis. Cases were identified March 2020 through May 2021. All were seen at the University of Alabama in Birmingham, a regional referral and comprehensive transplant center. Exemption for this review was approved by our IRB.ResultsFour cases were identified, all were SOT recipients. Case details are provided in Table 1. No patients required ICU level care at any point. COVID-19 treatment included 10 days of increased steroids for 3 patients, remdesivir for 2, and 1 received no treatment for COVID-19. In contrast to the typical time-course for cryptococcal infection post-SOT (median time approx. 500 days post-transplant), three patients were greater than 2 years post-transplant and were without rejection or recent changes in immunosuppression. Patient 1 was less than 6 months post liver-kidney transplant and was diagnosed at time of admission with concurrent COVID-19 and cryptococcal pneumonia. Infection was disseminated in the other 3 cases including positive blood cultures in 2 patients and cryptococcal meningitis (CM) in 2 patients. CM cases presented later following COVID-19 and had the longest delay between symptom onset (headache, neurologic symptoms) and CM diagnosis. One patient had CM 8 years prior, but had done extremely well off fluconazole for over 6 years prior to this recurrence. All patients are doing well at most recent follow-up evaluations.Table 1. Summary of Cases ConclusionWe describe the first case series with a temporal association between SARS-CoV-2 infection and cryptococcosis. All cases were immunocompromised due to SOT. Some symptoms were attributed to post-COVID syndrome leading to significant delays in diagnosis for those patietns, highlighting the importance of considering this association for at-risk patients.Disclosures Todd P. McCarty, MD, Cidara (Grant/Research Support)GenMark (Grant/Research Support, Other Financial or Material Support, Honoraria for Research Presentation)T2 Biosystems (Consultant)

Using group concept mapping software to develop a conceptual framework of left ventricular assist device recipients' experiences

Abstract Background Advanced Heart failure (AHF) carries a high mortality rate. Heart transplantation is one therapeutic option, but low donation rates limits its availability. A left ventricular assist device (LVAD) is an alternative therapy which helps relieve symptoms, while improving prognosis and quality of life. However, lack of donors also means that the LVAD becomes a destination therapy by default.(1) Living with an LVAD requires significant psychological, social and physical adaptation for the recipients' and their families.(2) Patient reported outcome measures (PROMs) are one way of capturing these concerns and ongoing problems. Discussions with a patient and public involvement group found a range of issues not currently captured by available PROMS. Aim To develop a conceptual framework which reflects the experiences of LVAD recipients' and evaluate their importance for inclusion in PROMs using a research web platform. Method Participants were recruited from a regional transplant centre which covers a wide geographical area in the UK. Ethical approval was obtained and participants were recruited through routine LVAD clinics. Group concept mapping (GCM) is a semi-quantitative mixed methods approach that can be used to capture and quantify recipients' experiences.(3) Groupwisdom concept mapping software was used as the electronic data collection platform.(4) GCM consists of 3 stages: statement generation, thematic statement sorting, and rating statements for importance, relevance and frequency of impact. Multidimensional scaling and hierarchical cluster analysis produces visual representations of recipients' experiences as a points and cluster map, and scoring of statements produces relative importance of items across the clusters. Results 18 LVAD recipients consented to take part. 101 items and 9 clusters were generated. Clusters represented: Activities; Partner/family dependency; Travel; Mental well-being; LVAD challenges; Equipment and clothing; Physical and cognitive limitations; Restrictions, and LVAD positives. LVAD Positives and LVAD restrictions were rated high for frequency, relevance and importance. Physical and cognitive limitations was rated high for importance and frequency. Equipment was rated high for relevance and frequency, and Challenges was rated high for relevance. Conclusion GCM and the online software is a useful tool for developing a conceptual framework and mapping key areas of importance for LVAD recipients, especially, when prioritising important patient reported outcome domains for use in clinical practice, future research and design evolution. Using an electronic platform allowed us to reach participants dispersed over a wide geographical area. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): British Heart FoundationNational Institute for Health Research Cluster Rating Map for Importance

Guidelines on improving health care quality in transplantation services in the federal subjects of Russia

Objective: to provide guidelines on how to improve the quality of health care in transplantation services for Russian regions; the recommendations were prepared by the Shumakov National Medical Research Center of Transplantology and Artificial Organs (Shumakov Center) based on field trips made by Shumakov Center from 2018 to 2019 in order to assess the status and development prospects of organ donation and organ transplantation in various regions of the Russian Federation. Materials and methods. Based on the over 40 field trips made by the Center, analytical reports, as well as recommendations were prepared by the Ministry of Health of Russia for regional health authorities and transplant centers. Guidelines were selected from these recommendations to address the most significant and common gaps and errors inherent in organ donation and organ transplantation in the regions. On the basis of the analytical reports, guidelines for the roadmap (plan) for organ donation and transplantation in the region were prepared. Results. A methodological framework for solving a wide range of managerial challenges on organ donation and organ transplantation is proposed for heads and experts at healthcare institutions and medical organizations. Conclusion. Organ donation and organ transplantation should be developed for the regions using the roadmap (plan) prepared and approved by the regional health authority. This approach brings stability and consistency to the development process, creates a resource base for development, and provides coordination and oversight.

Features of the organization of outpatient monitoring of patients undergoing organ transplantation

The article presents an algorithm for outpatient monitoring of patients in the waiting lists of donor organs, preoperative examination of a recipient of the liver, kidney and pancreas, subsequent life-long monitoring of patients after organ transplantation. The main aspects of the organization of outpatient monitoring and treatment of this complex category of patients in the conditions of a regional organ transplant center are highlighted.

Results of Kidney Transplants From Deceased Donors Discarded From Transplantation by a Regional Transplant Center but Accepted and Transplanted by Another Center

BackgroundKidney allocation policy in Poland is strictly patient oriented. Kidneys are transplanted by the same center that made procurement. Sometimes kidneys are transferred for transplantation to another center due to medical or logistic reasons or according to allocation rules. AimThe aim of the study was to compare early graft and recipient survival rates in cases of kidneys exported for transplantation to another center and in cases of kidneys transplanted typically. MethodsData came from national transplant registry. Kidney transplants from the years 2008 to 2017 were divided into several groups. One-year graft and patient survival rates were calculated for each group, and statistical differences were cross-calculated between groups. ResultsGroups were compared by using the χ2 test. Statistical analysis showed significantly lower graft and recipient survival rates: in the group of kidney transplantations performed in another transplant centers vs group of kidneys not transferred, where kidney transplantations were performed in a regional transplant center (P = .005 and = .02); and in the group of kidneys transferred due to logistic reason and allocation rules vs group of kidneys not transferred, where kidney transplantations were performed in regional transplant center (P = .01 and = .04). ConclusionEarly results of kidneys procured and transplanted by the same regional transplant center are significantly better than kidneys that have been transferred for transplantation to another center, but this result concerns only the subgroup of kidneys shifted due to logistic or allocation reasons. Early results of kidneys discarded by a regional team due to medical reasons and transplanted by another team are not different from results of transplantations performed by the same center that made the procurement.

A56 THE USE OF HIGH VOLUME PLASMAPHARESIS IN ACUTE LIVER FAILURE

Abstract Background Acute liver failure (ALF) can result in irreversible shock, cerebral herniation or development of multiple organ failure (MOF). One randomized study and a separate case series have demonstrated the safety and potential improvement in transplant-free survival with the use of high volume plasmapheresis (HVP). HVP is defined as an exchange of 8-12L or 15% of ideal body weight with fresh frozen plasma. In ALF, cytokines are responsible for the progression of MOF and HVP removes these cytokines from the systemic circulation. We report a case of implementing HVP in an adult with ALF in the intensive care unit (ICU) at a tertiary care center. Aims This case and the associated literature review highlight the value of HVP in ALF. Methods Case report and literature review. Results We report a case of a 34-year-old male who presented in ALF secondary to unknown ingestion. He was admitted to the ICU for worsening transaminitis, coagulopathy, hepatic encephalopathy, renal failure and hemodynamic instability which required vasopressor and ventilatory support. A discussion was made with hepatologists at a regional transplant center for potential consideration of either transplant or Molecular Adsorbent Recirculating System (MARS) therapy. However, the patient was too hemodynamically unstable for transport and also began to develop signs of cerebral edema. As a result, they recommended a trial of high volume plasmapheresis. Shortly after initiation, the patient’s hemodynamic, respiratory, and biochemical parameters began to improve, resulting in less vasopressor and ventilator support (Table 1). Despite improvements in these parameters, the patient’s cerebral edema continued to worsen and an electroencephalogram showed signs of a very low likelihood of functional neurological recovery. Given the overall picture, the patient’s spouse decided to withdraw care. Conclusions Presently, liver transplantation remains the only definitive management strategy for ALF patients, but many do not survive to liver transplant or are not candidates for medical or psychosocial reasons such as with this case. As a result, this case demonstrates the potential benefits of conducting HVP in centers without access to MARS or transplantation. However, although HVP did improve certain parameters for this patient, it did not improve overall prognosis. This suggests that prognosis may not improve once a certain threshold of MOF develops. Therefore, in this case and the associated literature review the optimal timing of initiating HVP remains unclear. Funding Agencies None

Validation of the International Classification of Disease 10th Revision Codes for Kidney Transplant Rejection and Failure.

Background:Clinical research requires that diagnostic codes captured from routinely collected health administrative data accurately identify individuals with a disease.Objective:In this study, we validated the International Classification of Disease 10th Revision (ICD-10) definition for kidney transplant rejection (T86.100) and for kidney transplant failure (T86.101).Design:Retrospective cohort study.Setting:A large, regional transplantation center in Ontario, Canada.Patients:All adult kidney transplant recipients from 2002 to 2018.Measurements:Chart review was undertaken to identify the first occurrence of biopsy-confirmed rejection and graft loss for all participants. For each observation, we determined the first date a single ICD-10 code T86.100 or T86.101 was recorded as a hospital encounter discharge diagnosis.Methods:Using chart review as the gold standard, we determined the sensitivity, specificity, and positive predictive value (PPV) for the ICD-10 codes T86.100 and T86.101.Results:Our study population comprised of 1,258 kidney transplant recipients. The prevalence of rejection and death-censored graft loss were 15.6 and 9.1%, respectively. For the ICD-10 rejection code (T86.100), sensitivity was 72.9% (95% confidence interval [CI], 66.6-79.2), specificity 97.5% (96.5-98.4), and PPV 83.8% (78.3-89.4). For the ICD-10 graft loss code (T86.101), sensitivity was 21.2% (95% CI, 13.2-29.3), specificity 86.3% (84.3-88.3), and PPV 11.7% (7.0-16.4).Limitations:Single-center study which may limit generalizability of our findings.Conclusions:A single ICD-10 code for kidney transplant rejection (T86.100) was present in 84% of true kidney transplant rejections and is an accurate way of identifying kidney transplant recipients with rejection using administrative health data. The ICD-10 code for graft failure (T86.101) performed poorly and should not be used for administrative health research.

Economic and social problems of providing medical care to kidney and liver recipients on an outpatient basis (on the example of a regional outpatient transplantation center)

The article is devoted to the problems of providing medical care in outpatient settings to patients who have undergone organ transplantation. The authors analyzed the economic efficiency of the outpatient transplantation center and concluded that a new payment mechanism for this type of medical services is needed. In addition, the article describes the system of social measures necessary for recipients of organs that are performed in a medical organization due to the lack of a rehabilitation program for such patients.

The Analysis of Economic Efficiency of Medical Services for Kidney and Liver Transplantation from Live Donors in a Transplantation Center (Through the Example of Volga District Medical Center, FMBA of Russia)

The relevance of the article is connected with the need for competent financial planning of the activities of medical organizations, which is especially significant in the provision of high-tech medical care. The organ transplantation is performed in addition to the capital of Russia only in a few regional medical centers, therefore the analysis of the adequacy of the financial quota for such an operation with its real cost price has not been carried out yet. Aim: to determine the adequacy of the financing of transplantation of human organs at the expense of the federal budget quotas for high-tech medical care to the real cost of this type of medical care. Research methods. The calculation of the cost of kidney and liver transplantation in case of intravital and posthumous donation was carried out by direct costs in the Volga district medical Center. It was found that the size of the quota for these operations is lower than their cost in the context of a regional organ transplantation center. Conclusion: the results indicate that it is mandatory for managers to assess the cost of organ transplants in the implementation of financial planning to improve the economic efficiency of medical organizations.

P.117: The results of kidney transplants form deceased donors discarded from transplantation by a regional transplant center due to medical risk factors and accepted and transplanted by another center.

P.117: The results of kidney transplants form deceased donors discarded from transplantation by a regional transplant center due to medical risk factors and accepted and transplanted by another center.

Evaluation on the Use of Italian High-Speed Rail to Support Transportation Network for Transplantation Activities

BackgroundOne of the main activities connected with transplantation is the rapid and timely transportation of patients, medical teams, and human organs from donation to transplantation centers under the compliance of national guidelines and principles of quality, performance, and safety. High-speed transportation on a railway network is becoming relevant both in terms of performance and extensiveness of the service. Methods and ObjectivesOur study explores the feasibility of adopting a high-speed rail network for the transportation of those organs with large cold ischemia time and those less influenced by transportation-related perturbations (ie, temperature, speed, vibrations), assessing savings and relative performance improvement. In this study, only kidneys have been considered; the transplantation database has been integrated with the national high-speed railway network and timetables. A function is implemented that allocates to air transportations those records with 1 of the 2 ends situated on islands, remote regions, and abroad, while rail transportation is preferred where constraints on capacity and compliance with cold ischemia time are met. Road transportation is still feasible for those records involving 2 adjacent regions and for intraregional transportation. ResultsThe opportunity of integrated road-rail transportation in place of air or all-road transportation allows users to lower generalized costs and reduce driven distance for personnel and vehicles allocated to a regional transplantation center’s fleet and staff. Savings in fleet and staff usage can serve to improve the performances at the local level. ConclusionsThe knowledge and analysis of transportation alternatives for human organs with less stringent safety and preservation criteria allow a more efficient allocation of resources both at the local and national level—without compromising quality and reliability of the system.

A Mixed-Methods Study of Stem Cell Transplantation Utilization for Newly Diagnosed Multiple Myeloma

BackgroundCurrent guidelines recommend that autologous hematopoietic stem cell transplantation (AHSCT) be considered for all eligible patients with multiple myeloma during first-line treatment. However, less than one-third of patients in the United States undergo the procedure. The reasons for this are unclear. Patients and MethodsWe performed a mixed-methods study including qualitative interviews of patients who declined AHSCT at a high-volume regional transplantation center. ResultsOver a 12-month period, 63% (129/206) of patients underwent AHSCT during first-line therapy. The consulting physician deemed 26% (47) ineligible. An additional 11% (23) were eligible but declined. In the qualitative interviews, 3 themes emerged regarding AHSCT refusal: (1) possible toxicity and disruption in quality of life; (2) unclear gains of AHSCT versus standard chemotherapy; and (3) the sense that transplantation was not suggested for them specifically, rather it was “the routine”; we coined this theme “impersonalized medicine.” ConclusionOn the basis of our findings, we stress the importance of providers helping patients weigh the respective benefits and outcomes of AHSCT and non-AHSCT treatment approaches during the clinical encounter, a key tenet of shared decision-making.

Abstract No. 587 Endovascular management of vascular complications after liver transplant

To characterize the incidence of vascular complications in patients receiving orthotopic liver transplants (OLT) at a single regional liver transplant center between 2005 and 2017, and review the frequency of endovascular techniques as primary treatment. All OLTs performed at our institution between 2005 and 2017 on patients aged 18-89 were reviewed. Cases with vascular complications were included in the study. From 2005 to 2017, 523 OLTs were performed at our institution. During this period, there were 45 (8.6%) vascular complications after transplant. These involved the hepatic artery (HA) in 37 (82.2%) patients, portal vein (PV) in 11 (24.4%) patients, and inferior vena cava (IVC) in 3 (6.7%) patients; 9 patients had multiple vascular complications. HA stenosis (HAS) was the most common, occurring in 28 patients. Of these, the initial intervention was endovascular in 20 patients: successful by balloon angioplasty alone (2/20, 10%) or angioplasty and stent (10/20, 50%). 25% (5/20) of patients needed surgical intervention after a failure or complication of primary endovascular treatment. The rest of the patients were primarily treated with either surgical intervention (5) or no treatment (3). HA thrombosis occurred in 9 patients. 4 patients were treated initially by endovascular approach: subsequently successful in (1), re-transplanted (1), surgically revised (1), and failed with conservative management (1). The remaining 5 patients required primary surgical intervention by either re-transplant (3) or revision (2). PV thrombosis occurred in 8 patients. No endovascular interventions were performed. 2 patients were managed primarily with surgical thrombectomy, and the remaining 6 treated conservatively. PV stenosis occurred in 3 patients: treated primarily with a stent via trans-ileocolic venous access (1), surgically revised (1), and required no intervention (1). Lastly, IVC stenosis occurred in 3 patients: 1 patient was treated successfully with stent and the remaining 2 patients required no intervention. Endovascular techniques provide effective minimally invasive options for the management of vascular complications after orthotopic liver transplant.