Carlos Romero-Marrero

Safety and efficacy of sorafenib for the treatment of recurrent hepatocellular carcinoma after liver transplantation.

Recurrent hepatocellular carcinoma (HCC) following liver transplantation (LT) carries a poor prognosis. The aim of our study was to assess the safety and efficacy of sorafenib in patients with recurrent HCC following LT.

Predictors of Successful Downstaging of Hepatocellular Carcinoma Outside Milan Criteria

Background Patients with hepatocellular carcinoma (HCC) outside Milan criteria (MC) may be candidates for liver transplantation (LT) after successful downstaging. Factors that predict successful downstaging are unclear. We aimed to identify the predictors of successful downstaging of HCC in patients outside MC. Methods We performed a retrospective cohort study on consecutive patients with HCC outside MC who received downstaging with locoregional therapy. Clinical and laboratory variables, tumor characteristics including total tumor volume (TTV) and up-to-7 criteria were recorded. We performed univariate and multivariate logistic regression analyses to identify variables associated with successful downstaging. Results Of 675 patients with HCC, 90 patients outside MC received downstaging. Fifty-three (59%) patients were successfully downstaged, 37 (41%) failed downstaging. University of California at San Francisco criteria, &agr;-fetoprotein, up-to-7 criteria, TTV, and platelet count were predictors of successful downstaging on univariate analysis. Total tumor volume was an independent predictor of successful downstaging on multivariate logistic regression (P = 0.04, area under receiver operating characteristic curve 0.89 (95% confidence interval, 0.82-0.96). Fifty-two (76%) of 68 patients with TTV less than 200 cm3 were successfully downstaged, whereas only 1 (4.5%) of 22 patients with TTV greater than 200 cm3 were successfully downstaged. Forty-five (50%) patients underwent LT. Kaplan-Meier survival rates at 1 and 5 years post-LT were 95.3% and 79.4%, respectively. Patients who were successfully downstaged had better survival than patients who failed downstaging (P < 0.01). Conclusions Total tumor volume is a good predictor of successful downstaging of HCC. Patients with TTV less than 200 cm3 may be considered good candidates for downstaging. Further studies with larger cohort of patients are needed to validate this approach in patients with HCC outside Milan.

Place of Death and Hospice Utilization Among Patients Who Die From Cirrhosis in the United States

© 2018 by the AGA Institute 1542-3565/

The EMALT Score: An Improved Model for Prediction of Early Mortality in Liver Transplant Recipients:

36.00 http://dx.doi.org/10.1016/j.cgh.2017.07.007 Cirrhosis is the 12th leading cause of death in the United States. Complications of cirrhosis, such as ascites, variceal hemorrhage, hepatic encephalopathy, and renal impairment have a negative impact on patients’ health-related quality of life, and account for most deaths in patients with cirrhosis. Palliative and hospice care programs can decrease the burden of symptoms, reduce hospitalization, and improve end-of-life care. There are limited data on the utilization of hospice in cirrhosis; a population that has received limited attention from the palliative care community. Thus, we aimed to identify trends and variations in both places of death and hospice utilization in cirrhosis.

Outpatient Telephonic Transitional Care After Hospital Discharge Improves Survival in Cirrhotic Patients

Purpose: Needs, risks, and outcomes of patients admitted to a post liver transplant intensive care unit (POLTICU) differ in important ways from those admitted to pretransplant intensive care units (ICUs). The aim of this study was to create the optimal model to risk stratify POLTICU patients. Methods: Consecutive patients who underwent first deceased donor liver transplantation (LT) at a large United States center between 2008 and 2014 were followed from admission to LT and to discharge or death. Receiver–operating characteristic analysis was performed to assess the value of various scores in predicting in-hospital mortality. A predictive model was developed using logistic regression analysis. Results: A total of 697 patients underwent LT, and 3.2% died without leaving the hospital. A model for in-hospital mortality was derived from variables available within 24 hours of admission to the POLTICU. Key variables best predicting survival were white blood cell count, 24-hour urine output, and serum glucose. A model using these variables performed with an area under the curve (AUC) of 0.88, compared to the Acute Physiology and Chronic Health Evaluation III and Model for End-Stage Liver Disease, which performed with AUCs of 0.74 and 0.60, respectively. Conclusion: An improved model, the early mortality after LT (EMALT) score, performs better than conventional models in predicting in-hospital mortality after LT.

Aspirin use and risk of cholangiocarcinoma: External validation with big data

BACKGROUND Intervention to improve outcomes in cirrhotic patients (CP) after hospital discharge often focus on 30 d readmission rate (RR). However, recent studies suggest dissociation between RR and survival. At our center, CP are now offered outpatient telephonic transitional care (OTTC) by a care coordinator for 30 d after hospital discharge. AIM To determine the effect of OTTC on survival in CP. METHODS In this cohort study from a tertiary center, CP who received OTTC formed the intervention group. They were compared with a control group discharged during the same period. Mortality and RR were compared between the groups. RESULTS After OTTC introduction, 194 CP were discharged. After applying exclusion criteria, 169 CP (51% male, mean age 58 years ± 12 years) were included. OTTC group comprised 76 patients and was compared with 93 controls. Baseline disease and index admission related characteristics were not significantly different between the groups. The intervention group showed significantly higher 6 mo survival compared to controls (84.2% vs 68.8%; P = 0.03), while RR at 1, 3, and 6 mo were comparable. On multivariable analysis, the intervention group showed lower odds for mortality compared to the controls (hazard ratio: 0.4; 95% confidence interval: 0.2-0.82; P = 0.012), while higher model for endstage liver disease scores were associated with higher mortality (hazard ratio: 1.05; 95% confidence interval: 1.01-1.1; P = 0.024).

718 Predictors of Successful Down-Staging of Hepatocellular Carcinoma Outside Milan Criteria

Astrid Marot, M.D. H elène Vandenbulcke, M.D. Jean-François Knebel, M.D. Christopher Doerig, M.D. Christophe Moreno, M.D., Ph.D. Pierre Deltenre, M.D., Ph.D. Division of Gastroenterology and Hepatology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne, Switzerland Departement of Gastroenterology and Hepatology Hôpital de Jolimont Haine-Saint-Paul, Belgium Laboratory for Investigative Neurophysiology (The LINE) Department of Radiology and Department of Clinical Neurosciences University Hospital Center and University of Lausanne Lausanne, Switzerland EEG Brain Mapping Core Centre for Biomedical Imaging (CIBM) Lausanne, Switzerland Department of Gastroenterology, Hepatopancreatology and Digestive Oncology CUB Hôpital Erasme Universit e Libre de Bruxelles Brussels, Belgium

461 Outcome of Patients With Hepatocellular Carcinoma Beyond Milan Criteria

BACKGROUND Patients with hepatocellular carcinoma (HCC) outside Milan criteria (MC) may be candidates for liver transplantation (LT) after successful downstaging. Factors that predict successful downstaging are unclear. We aimed to identify the predictors of successful downstaging of HCC in patients outside MC. METHODS We performed a retrospective cohort study on consecutive patients with HCC outside MC who received downstaging with locoregional therapy. Clinical and laboratory variables, tumor characteristics including total tumor volume (TTV) and up-to-7 criteria were recorded. We performed univariate and multivariate logistic regression analyses to identify variables associated with successful downstaging. RESULTS Of 675 patients with HCC, 90 patients outside MC received downstaging. Fifty-three (59%) patients were successfully downstaged, 37 (41%) failed downstaging. University of California at San Francisco criteria, α-fetoprotein, up-to-7 criteria, TTV, and platelet count were predictors of successful downstaging on univariate analysis. Total tumor volume was an independent predictor of successful downstaging on multivariate logistic regression (P = 0.04, area under receiver operating characteristic curve 0.89 (95% confidence interval, 0.82-0.96). Fifty-two (76%) of 68 patients with TTV less than 200 cm were successfully downstaged, whereas only 1 (4.5%) of 22 patients with TTV greater than 200 cm were successfully downstaged. Forty-five (50%) patients underwent LT. Kaplan-Meier survival rates at 1 and 5 years post-LT were 95.3% and 79.4%, respectively. Patients who were successfully downstaged had better survival than patients who failed downstaging (P < 0.01). CONCLUSIONS Total tumor volume is a good predictor of successful downstaging of HCC. Patients with TTV less than 200 cm may be considered good candidates for downstaging. Further studies with larger cohort of patients are needed to validate this approach in patients with HCC outside Milan.

Tu1456 - Post Discharge Shared Medical Appointments: A Novel Approach in Transitions of Care for Patients with Cirrhosis

Child-Turcotte-Pugh score was significantly higher in the non-Asian cohort: 7 (5-13) vs. 6 (5-12), p<0.0001. Baseline evaluation showed no significant differences in tumor characteristic using the Tumor, Node and Metastasis (TNM) and Barcelona Clinic Liver Cancer (BCLC) staging criteria. Patients in the Asian cohort were more likely to undergo partial hepatic resection (17% vs. 9%, p=0.012). The two cohorts also had similar proportion of patients eligible for liver transplantation based on both Milan criteria (47-49%) and UCSF criteria (62-67%); however, a significantly higher proportion of non-Asian patients actually underwent liver transplantation compared to Asian patients (28% vs. 12%, p<0.0001). Conclusion: Compared to non-Asian patients, HCV-related HCC Asian patients were more likely female, older, and less likely to have decompensated liver disease. Tumor staging and transplant eligibility by tumor criteria were similar in both groups, but Asians were more likely to undergo partial hepatic resection while non-Asians were more likely to undergo liver transplantation. Additional studies are needed to evaluate treatment outcomes and longterm survival in Asian Americans with HCV-related HCC.