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Kaplan-Meier Survival Analysis post-Liver Transplantation based on mRECIST Response(CR/PR) or Non-response (SD/PD).

Mo1942

The Feasability and Reliability of Transient Elastography by FibroScan: APractice Audit of 3,000 ExaminationsChristopher P. Schneider, Faruq Pradhan, Robert P. Myers, Pam Crotty, Jenna E. Tracey

Background: Liver stiffness measurement (LSM) using transient elastography has emergedas an important tool in the management of patients with chronic liver disease. Our objectiveswere to examine the feasibility and reliability of LSM and to identify patient and operatorcharacteristics predictive of unreliable results. Methods: We retrospectively investigated thefrequency and determinants of LSM failure and unreliable results using the FibroScan(Echosens; Paris, France) over a 3-year period. All LSMs were performed by two experiencedoperators (>50 prior exams). LSM failure was defined as no valid measurements, andunreliable LSM had <10 valid measurements, a success rate <60%, and/or an interquartilerange (IQR)/LSM (IQR/M) >30%. Potential predictors of unreliable LSM were examined inmultivariate logistic regression analyses including patient age, gender, the operator, operatorexperience (first 499 scans, 500-999th scans, ≥1000 scans), FibroScan probe (M vs. XL),and presumed cirrhosis (LSM ≥13 kPa). In a subset of patients, medical records werereviewed to identify additional predictors including liver disease etiology (HCV, HBV,NAFLD, vs. other/unknown), obesity (body mass index [BMI] ≥30 kg/m2), and diabetesmellitus. Results: Between June 2008 and June 2011, we performed 2,966 LSMs (87% usingthe M probe and 13% using the XL probe) in 2,437 patients. LSM failure occurred in 4.8%(n=141) of all examinations and 4.8% (n=118) at the first examination. LSM failure did notdiffer between the M and XL probes (4.8% vs. 5.3%; P=0.71). Excluding patients with LSMfailure, unreliable LSMs were observed in 14% (n=335) of patients at their first examinationand were more common using the XL probe (22% vs. 14%; P=0.01). In the primary analysis,independent predictors of unreliable LSM included older age (odds ratio [OR] per year:1.03; 95% confidence interval [CI] 1.02-1.04), female sex (OR 1.39; 95% CI 1.09-1.77),presumed cirrhosis (OR 1.75; 95% CI 1.43-2.32), and use of the XL probe (OR 1.98; 95%CI 1.29-3.03). Although reliability varied by operator (OR 0.50; 95% CI 0.40-0.64), operatorexperience did not influence the risk of unreliable LSM. In a sub-analysis including patientswith complete clinical data (n=429), the only independent predictors of unreliable resultswere older age (OR per year, 1.03; 95% CI 1.00-1.05), the operator (OR 0.37; 95% CI0.17-0.78), and obesity (OR 3.01; 95% CI 1.68-5.41). Gender, diabetes, the underlyingliver disease, cirrhosis, operator experience, and the FibroScan probe were not significantin this analysis. Conclusions: Although FibroScan failure is uncommon (5%), unreliableresults are obtained in approximately one in seven patients. The most important determinantsof unreliable results are obesity and the operator, emphasizing the need for adequate oper-ator training.

Mo1943

Peripheral Blood Platelet Count Predicts Post-Tips Mortality in Patients WithCirrhosisWissam Bleibel, Wael Saad, Daniel Sheeran, Curtis L. Anderson, Patrick G. Northup,Abdullah M. Al-Osaimi

Introduction: There is laboratory and autopsy data suggesting that platelet activation maybe a contributing factor in the development and progression of cirrhosis and portal hyperten-sion. In addition, there is increasing evidence that thrombocytopenia of liver disease is notonly a marker of portal hypertension and hypersplenism but also an indicator of loss ofhepatocellular mass and function. It was the aim of this study to determine if peripheralblood platelet count predicts mortality in cirrhosis patients after a TIPS procedure. Methods:In this retrospective study, 148 consecutive patients who underwent TIPS at a single trans-plant center were evaluated with laboratory tests prior to the procedure. We evaluated thehospital EMR and social security death index databases to determine patients' survival.Results: The patients were predominantly male (61.5%), suffered from alcoholic hepatitis(33.8%), had a mean age of 54.7 years (SD 11.9), a mean MELD score of 13.6 (SD 6.5),and a mean platelet count of 135,700 (SD 93,900) at the time of TIPS. The post-proceduralmortality rate was 18.9, 26.4, 33.1, and 53.4 percent at 3 months, 6 months, 1 year and2.5 years respectively. There was a direct correlation between length of survival and plateletcount. In a multivariate regression model, platelet count of less than 100,000 (HR 1.58,95% CI 1.03-2.41, p 0.036) was a strong predictor of mortality. Among MELD componentscreatinine (HR 1.25, p 0.015) and bilirubin (HR 1.09, p 0.006) were predictive yet INR

S-1006AASLD Abstracts

was not (HR 1.61, p 0.3). Conclusions: Low platelet count is a sensitive predictor of post-TIPS mortality and is a sign of more advanced liver disease. Patients with platelet count ofless than 100,000 had higher short and long term post-TIPS mortality rates than those withhigher platelet counts. Larger scale studies are needed to confirm this finding.Comparison Table: patients with platelet count of less than 100,00 vs those with higherplatelet count

This survival curve shows the difference in survival between patients with platelet countless than 100,000 and those with higher platelet counts.

Mo1944

Ultrasound Shear Wave Elastography: A Non-Invasive Tool to Predict LiverFibrosisVilas Patwardhan, Manish Dhyani, Kathleen E. Corey, Atul K. Bhan, Qian Li, Raymond T.Chung, Anthony Samir

Background: Patients with chronic liver disease and hepatic fibrosis are routinely evaluatedwith abdominal ultrasound. Liver biopsy, which is commonly performed under ultrasoundguidance, is the current gold standard for staging liver fibrosis, but is invasive and may beassociated with sampling error and inadequate tissue acquisition. Ultrasound shear waveelastography (SWE) is a new technology that may represent a non-invasive alternative toliver biopsy to measure hepatic fibrosis. Methods: From May 2010 through April 2011,patients were prospectively enrolled to undergo ultrasound-guided liver biopsy and concur-rent hepatic ultrasound SWE. Liver biopsies were obtained to evaluate fibrosis stage inpatients with known chronic liver disease or for evaluation of abnormal liver chemistries ofunknown etiology. SWE measurements were obtained by a single technician at the left lobe,right lobe superficially, right lobe deep, and at the approximate biopsy site. SWE data wasinterpreted by a single radiologist who was blinded to biopsy results and was not involvedwith SWE image acquisition. Biopsy specimens underwent blinded pathologist review andwere assigned METAVIR and Ishak fibrosis, steatosis, and inflammation scores. Receiveroperator curves (ROC) of the ability of SWE to predict varying stages of liver fibrosis werethen constructed. Results: Seventy-six patients underwent liver biopsy and SWE for stagingof fibrosis (n=36) or evaluation of abnormal liver chemistries (n=40). Etiologies of liverdisease based on biopsy pathology included hepatitis C (HCV; n=24), hepatitis B (HBV; n=4), steatohepatitis (nonalcoholic and alcoholic; n=21), sarcoidosis (n=2), cholestatic liverdisease (n=10), drugs (n=1), and autoimmune hepatitis (n=5). The cause of liver disease