Program Abstracts i~,-51

202 LIVER TRANSPLANTATION FOR CIRRHOSIS DUE TO CHRONIC VIRAL HEPATITIS. J.Brahm , G.Silva. SAlegria, S.Ceresa, E.Buckel, M.Uribe, S.Alvarez, C.Herzog. MT. Santander. Liver Transplant Unit, Clinica l.as Condes, Santiago-Chile

Chronic viral hepatitis is one of the main causes of liver transplantation(LT) in adults. Because of the universal reinfection after LT, pre and post- transplant antiviral treatments have been attempted. AIM: To communicate our experience in LT for chronic viral hepatitis. PATIENTS/RESULTS: From November 1993 to November 1999. we have performed 93 LT. Among these, 13/42 (31%) adults (I I male, mean age 43 yo, range 34-55 yo, 2 retransplants) and 1/51 (I,9%) children (female, 10 yo) had a viral etiology: HCV in 12 (9 genotype lb. I gnnotype la and 2 genotype 2), HBV in 1 and concomitant HCV and HBV in 1 case. Pre- transplant antiviral treatment with Interferon was used m 0 HCV cases and Lamivudine m I of HBV patients. After LT, 5/13 HCV patients received combined antiviral treatment with Interferon and gibavinn. In two adults cases, treatment had to be discontinued due to serious side effects (mielosupression and hemolysis) and in the single pediatric case because no biochemical, virological or histological improvement occured. The others 2 recipients remain under prolonged treatment (18 to 23 months), with only partial response Three of the untreated patienLs died: hepatic artery thrombosis 40 days after LT. severe fibrosing cholestatic hepatitis 12 months after surgery and sudden death of'unknown origin 60 days after LT The others 5 untreated patients are in stable condition I to 59 months after surgery The 2 HBV patients received Lamivudine and HBIG (2000 to 10.000 I U/monthly), with no evidence of HBV reinfection and with AntiHBs titars over 100 IU/ml. CONCLUSIONS: In our experience, chronic HCV infection has been the main cause of LT in adults, with only partial response to antiviral drugs and with one case offibrosthg hepatitis. This results could probably be related to the high prevalence of Ib genotype in our population, known as a negative prognostic factor The very agressive pediatric case, with early developing of end stage cirrhosis and no response to antiwral treatment, has not been frequently reported Finally. in this experience, H B V was less comon than HCV. but much easier to control

204 AUTOIMMUNE HEPATITIS TYPE I IN CHILDREN: PRESENTATION AS ACUTE LIVER FAILURE ? S L'opez, M Cualterolo, A Roy, M Zelazko, M T G de Ddvila, C Mondiglio. M Ciocca Hospital de Pediatria Juan P. Garrahan. Buenos Aires Argentina

Acute liver failure (ALF) was reported as an unusual form of presentation of autoimmune hepatitis (AIH) The purpose of the study was: u) to assess the presence and titers o f smooth muscle (SMA) and entinuclcar antibodies (ANA) in patients with ALF due to hepatitis A (HA) and crTptogenic hepatitis (CH) and b) to correlate them with the otiology, serum gammaglobulin (SGG) and liver histology Methods: The reports o f 50 patients with ALF were retrospectively reviewed Mean age: 5.4 (I.2 - 15) yes, 23 female, Etiology, autoantibodies titers. SGG and histology were considered. Results:

Diagnosis Hepatitis A (n) (27)

Age (yrs) 47 _+ 3 Sex (f/m) 17/10

SMA _> 1/80 17/27 (63%) SMA titers 206 _+ 100 SGG (g/dl) 2,4 + 087

SGG _> 2 g/dl 20•27 (74%) Only I patient (CH) presented ANA > 1/80

Cryptogenic P (23)

5.6 -+ 4 ns I 1/12 ns

1~23 (52%) ns 172 _+ I I0 ns 1.6±0.7 ns

7•23 (30%) <0.005

Liver histology was obtained fTom 30 transplanted patients All o f them presented massive parenchymal necrosis, with regenerative nodules of different size in 10 cases (5 HA and 5 CH, ns) No relationship with autoantibodies titers or SGG levels was found. Conclusions: I ) High titers o f SMA were found in more than 50% of ALl: by HA and CH 2) Hypergammaglobulinemia was more frequent in HA. 3) There were no predominantly lymphoplasmocytic infiltrate in any patient 4) None of'the characteristic features habitually considered in AIH allowed us to confirm such diagnosis in the patients studied

203 RISK FA(. 'I 'UI~ FUR RECURRENCE OF HEPAI'UCELLULAI{ CARCINOMA AFTER LIVER TRANSPLANTATION ERR Figueir~. RMC Leit~o. EO Setani. PL Bittencoml. MP Lallee. EH Quintela. PCB Masserollo, S Rata. S Mies

Liver Unit - Faculdade de Medieina da Universidade de SEo Paulo - Brazil

Introduction: Liver transplantation (OLT) has been proposed as an effective therapy to treat hepatocellular carcinoma (HCC) complicating cirrhosis. The initial results o f OLT for HCC were poor due to a high rate of'tumor recurrence. However, recurrence-free survival has improved recently after better patient selection.

Aims: To evaluate the outcome of OLT for HCC and to analyze risk factors associated with tumor recurrence

Patients and methods: Forty-seven patients (37 males, 52-+10 years) with HCC (TI-4NOM0) submitted to OLT between September 1085 end Septembel 1999 were retrospectively evaluated. The mean follow-up was 2q-L?.2 months Twenty-two patients underwent preoperative chemoembolizarJon (n=]O), percutaneous ethanol injection (n= I1 and resection (n=2). The pathological gross exammaBon showed either one nodule with less than 5cm or no more than 3 nodules with less than 3cm in 33 explants (70%). Sevmtenn patients (36%) presented incidental turnoutS. The rate of tumor recurrence was compared tc number, s=ze and location of' nodules, the presence of vascular invasion and the histological grade of HCC (classification of" Edmondson-Stether).

Results: Six o f the 47 patients (13%) presented HCC recurrence aRer a mean follow-up of 2S+_21 months. Five patients died wKh HCC recurrence and 9 due tc other causes Survival free of recurrence was observed in 36 (77%) patients. Fore patients died due to HCC recurrence. The mean number o f nodul~ (3.5_+1 0vsl 3_+O 7, p=O.004), the finding of" microscopic vascular invasion (83%vs15%, p=0.002) and the presence of histological grades III or IV ( 100%vs42%, p=0 009) were associated with HCC recurrence Two patients with gross vascular invasion at laparotomy presented recurRnce None of the incidental tumors were associated with recurrence The presence of either one nodule larger than 5cm or mukiple nodules larger than 3cm (2q%vs6%, p=0.06) was associated with tumor recurrence, but the difference was not statisticall) significant

Conclusions: The recurrence of HCC after OLT is associated with the presence of" multiple nodules, tumor microscopic vascular invasion and advanced histological grades.

205 SUBFULMINANT HEPATIC FAILURE IN AUTOIMMUNE HEPATITIS TYPE 2 IN PEDIATRIC PATIENTS ~1 Cuanerolo, S.L0pez, M T de Davda. C Mondlglio, A Ro). M Zelazko. M Cenleno. D Bes. O hnveutarza, M Ciocca Hospital de Pedmtrm Juan P Garrahan Buenos A*res Argentina

There are few cases reported of" autom~mune hepat(tis (AIH) thee 2 presenting as fidmmant and subfulmmant hepatsc Padure (SHF) m cinldren The purpose of this study was to report three girls with AIH type 2 that presented SHF =Methods: over a period of I I years. 123 panenrs with AIH were diagnosed based on international cntena. 0 (7°,0) were type 2~ 3 of them presented SHF Other etmlogles (viral. u*etabohc and toxic) were ruled out There was no personal or famdy history of" other autolmmuoe diseases Results:

i C ~ A g n T Bihrubm I Prctrombm ! Albumin ",globulin aLKM I vrs/m ] mg/dl ' Tune g/dl g/dl mers I ' I

I t 15,5 40 : I.~ ~ 2 2 t 4 ! 1/1000 ~[ ~ ! [ . [ ~ _ 3 , 36 LJ/:ooo i 3 ! 2/I ~ 23 8 1 10 I J [ 3 7 I 112000___

Histology showed macro-n,cronodular cirrhosis in cases I and 2. and nlaseive necrosis m case 3 The treatment was started with prednisone 12 mg/kg/day) and acathloprzn¢ (l.5 mg/kg/day) Evolution Patients I and 3 died while waRmg for liver transplant (LT) at 72 and 48 hours after initiating nledical treatment Patient 2 underwent LT 3 days after starling treamleot with excellent evolution at 2 years and 7 months of follow-up Conclusions: I) AIH type 2 was very. infrequent m our group. 2) 33% of cases presented SHF 3) The course of" the disease was aggresswe, not responding to mlmuuosupresslve therapy and the evolution was unfavorable m all patients 4) LT is an ahematlve treatment for this severe disease