A.-M. Roque-Afonso

Could post-liver transplantation course be helpful for the diagnosis of so called cryptogenic cirrhosis?

Abstract:  Cryptogenic cirrhosis (CC) is diagnosed in 5–30% of cirrhotic patients overall and 7% of patients who undergo liver transplantation for cirrhosis. In our series of patients transplanted for CC, pre‐transplant clinical and histological data and the post‐transplant course were reexamined in an attempt to identify the aetiology. Among the 881 patients transplanted in our centre between 1987 and 2000, 28 patients with a median age of 46 yr (range: 18–69) at transplantation were initially classified as having CC. Two patients were excluded because of intense ischaemic lesions caused by chemoembolization prevented histological analysis of the native liver (n = 1) and because of cryptic HBV infection (n = 1). Among the remaining 26 patients, four groups were individualized: (i) patients with chronic inflammatory liver disease with autoimmune features (n = 14, 54%); (ii) patients with features suggestive of non‐alcoholic fatty liver disease (n = 3, 11.5%); (iii); patients with incomplete septal cirrhosis (ISC) and vascular liver disease (n = 3), and (iv) patients with unresolved CC (n = 6, 23%). In the autoimmune liver disease group, the median International Autoimmune Hepatitis score was 12.5 (range: 11–19) after reevaluation and review of the post‐transplantation course was helpful to confirm the diagnosis with the occurrence of active graft hepatitis in nine patients, with autoantibodies in five patients. The vascular group was characterized by lesions of obliterative portal venopathy and ISC in all native livers. Diagnosis of NAFLD was based on the clinical background of obesity and/or type 2 diabetes and the presence of steatosis or steatohepatitis in native livers and graft biopsies. A definite aetiological diagnosis can be achieved in the majority of patients initially diagnosed with CC. Autoimmune liver disease emerged as the main aetiology (14 of 26 patients, 54%) and frequently recurred on the grafted liver (nine cases). In all cases a precise diagnosis is obviously of practical interest for better management of post‐transplant survey and treatment.

219 PROSPECTIVE ASSESSMENT OF LIVER FIBROSIS AFTER LIVER TRANSPLANTATION IN HIV/HCV COINFECTED PATIENTS: A USEFUL TOOL ASSESSING SEVERE FIBROSIS ON THE LIVER GRAFT

219 PROSPECTIVE ASSESSMENT OF LIVER FIBROSIS AFTER LIVER TRANSPLANTATION IN HIV/HCV COINFECTED PATIENTS: A USEFUL TOOL ASSESSING SEVERE FIBROSIS ON THE LIVER GRAFT B. Roche, M. Belnard, P. Pham, L. Allain, A.-M. Roque-Afonso, A. Coilly, T.M. Antonini, R. Sobesky, D. Samuel, J.-C. Duclos-Vallee. Centre Hepato-Biliaire, AP-HP – Hopital Paul Brousse, Unit 785, INSERM, Villejuif, Faculte de Medecine, Univ Paris-Sud, Le Kremlin-Bicetre, Laboratoire de Biochimie, AP-HP – Hopital Paul Brousse, Laboratoire Roche, Laboratoire de Virologie, AP-HP – Hopital Paul Brousse, Villejuif, France E-mail: bruno.roche@pbr.aphp.fr

823 INDETERMINATE CAUSES OF ACUTE LIVER FAILURE: INCIDENCE AND PREDICTIVE FACTORS OF SPONTANEOUS SURVIVAL AND AFTER LIVER TRANSPLANTATION (LT)

Methods: A retrospective study of patients with ALF admitted to a tertiary liver centre from 2001 to 2009 was done. We looked at the demographic data, clinical features, prognostic markers – King’s College Hospital (KCH) criteria and Model for End-Stage Liver Disease (MELD) score, and the outcome of these patients. Data was analysed using SPSS. Results: A total of 155 cases were reviewed. 63.9% were females and the mean age was 36.7±15.9 years. The causes of ALF include hepatitis B-related (23.2%), indeterminate (20.0%), nonparacetamol drug-induced liver injury (DILI) (18.7%), autoimmune liver disease (7.7%), acute paracetamol toxicity (7.1%), acute fatty liver of pregnancy (6.5%), dengue-related (5.2%), Wilson’s disease (4.7%), acute hepatitis A (1.3%), hepatitis C (1.9%) and acute Budd Chiari (1.9%). The overall survival rate was 27.1%. Even though 57.2% of the patients satisfied the KCH criteria, only 2 patients were transplanted with one survived. The spontaneous survival rate in patients who satisfied the KCH was 8.3% while in the group who did not satisfy the KCH, the survival rate was 52.9%. In the group where KCH was not applicable, the survival rate was 53.3%. The mean MELD score for patients who died was 30±7, while for patients who survived the score was 22±7. Multivariable logistic regression showed for any one point increase in MELD score, ORadj1.22 (CI 95%: 1.12, 1.32) for mortality. Conclusion: ALF patients with poor prognostic criteria had a high mortality in the absence of liver transplant. The three main causes of ALF in Malaysia were viral hepatitis B, indeterminate and nonparacetamol DILI.

493 RESULTS OF LIVER RETRANSPLANTATION IN A MONOCENTRIC COHORT OF HCV INFECTED PATIENTS

quartile of LDLR mRNA expression in the PI biopsy survived with a significantly (Log-Rank test P < 0.05) better survival than those in the three lowest quartiles. Surviving graft (n = 34, median followup 44.8 months, range 8.6–72.3) had significantly higher LDLR (P < 0.01) and NPC1L1 (P < 0.05) mRNA expression in the PI biopsy and HMGCR (P < 0.05) mRNA expression in the PR biopsy than lost grafts (n = 13, median follow-up 6.0 months, range 0.03–43.7). Conclusions: In the settings of human liver transplantation: 1. hepatic LDLR mRNA is overexpressed immediately after graft reperfusion, suggesting an increased hepatocyte cholesterol uptake from blood; 2. hepatic upregulation of genes involved in cholesterol recruitment and synthesis is inversely related to the severity of IRI and is associated with better graft survival.