S72 POSTERS

CKD and 2% had kidney failure by 5 years. The mean rate of decline was 4.5*2.7ml/min/l .73m2/yr. Therefore, the predicted prevalence of kidney failure at 10 and I5 years post transplantation is 5% and 18% respectively. Conclusions: Chronic renal dysfunction is an important complication after liver transplantation. Further research is required to identify modifiable risk factors for both prevalence and rate of decline.

11651 COVALENTLY CLOSED CIRCULAR DNA (cccDNA) IN POST-TRANSPLANT LIVER BIOPSIES: A NEW TOOL TO ASSESS THE NEED OF CONTINUOUS PROPHYLAXIS AGAINST HBV RECURRENCE

I. Lenci’, D. Di Paolol, G. Tisonel, F, Marcuccilli2, M. Ciotti2, T. Guenci2, C.F. Perno2, M. Angelical . ’Hepatology and Liver Transplant Center; ’Luhorutory of Molecular firology, Tor krgatu lJniwrsity, Ronze, Ituly E-mail: ilarialenci@hotmail.com

Background and Aims: According to current guidelines liver transplant recipients due to HBV-related disease require life-long prophylaxis with hepatitis B immune globulins (HBIG) with or without nucleos(t)ide analogs. This approach is extremely costly and there are no current criteria to assess whether prophylactic treatment can be withdrawn. The risk of HBV reactivation is known to be due to persistence ofthe viral genome as covalently closed circular (ccc) DNA in the nuclei of infected hepatocytes. Yet, whether cccDNA persists after years in the liver of HBsAg negative transplant recipients is currently unknown. Methods: cccDNA was detected using a sensitive quantitative real-time PCR assay with improved analytic specificity and significantly reduced false positives. An housekeeping gene (beta-actine) was used as positive extraction from liver tissue samples. A plasmid DNA construct containing a monomer of the HBV genome was used as positive control for quan- tification. The test was performed in percutaneous liver biopsies obtained from I3 liver transplanted patients ( 1 112 M/F; mean age 54.6+9.3 years) due to HBV-related cirrhosis, 5 of whom coinfected with HCV and I with HDV The mean follow-up after transplant was 79 months (range 60- 150). Liver tissue from HBsAg negative patients were used as negative control. All patients received i.v. HBIG after transplant to maintain anti- HBs titers above 70 IU/L with l00mg/day of lamivudine. In addition, 3 patients with pre-transplant lamivudine resistance received 10 mgiday of adefovir dipivoxil. Maintenance immunosuppression was cyclosporin A monotherapy in 7 patients, tacrolimus in 4 and mycophenolate mofetyl in

Results: None of the patients had HBV recurrence after transplant. All were yearly tested for HBsAg and serum HBV-DNA both ofwhich resulted undetectable at any time. In all liver biopsies obtained at the end of the follow-up cccDNA was undetectable. Conclusions: Transplanted patients receiving for a minimum of 5 years the recommended prophylaxis against HBV recurrence and who did not exhibit viral breakthrough after transplant have no evidence of cccDNA in their livers. These patients are unlikely to undergo HBV recurrence and, if data will be confirmed in more extensive settings, should be considered for prophylaxis withdrawal.

11661 RIGHT PORTAL VEIN LIGATION IS AS EFFECTIVE AS PORTAL VEIN EMBOLIZATION TO INDUCE HYPERTROPHY OF THE LEFT LIVER REMNANT

B. Aussilhoul , M. Lesurtel’, S. Dokmak’, R. Kianmanesh’, 0. Farges’, A. Sauvanet’, A. Sibert2, V Vilgrain2, J. Belghiti’ . ’Departnzent of’ Digestive Surgery; ’Department of‘ Radiology, Beuujon Hospital, Clichy, Frunce E-mail: mickael.lesurtel@bjn.aphp.fr

Background and Aims: Right Portal Vein (PV) obstruction induces hypertrophy of the future left liver remnant. The aim of this study was to

compare Portal Vein Ligation (PVL) and Portal Vein Embolination (PVE) before right hepatectomy in terms of efficacy for induction of left liver hypertrophy. Methods: Between 1998 and 2003, 35 patients with liver metastases underwent a right portal branch obstruction before “high r i s k ” right hepatectomy because of a future remnant liver volume less than 30% of the total liver volume or because of a postchemotherapy liver parenchyma. PVE was performed percutaneously in 18 patients, while 17 patients underwent a PVL during a first stage laparotomy for resection of the primary tumor (n= 10) and/or resection of left liver metastases (n= 16). Results: There was no complication following PVE and postoperative hospital stay was 2 f l days. In group PVL, 6 patients had postoperative complications which were related to primary tumor resection and postop- erative hospital stay was 1 3 f 6 days. The left liver volume increased from 509&222 ml to 641f220 ml after PVE (p <0.001), and from 477f179 ml to 6 3 8 f 192 ml after PVL (p i 0.001). After PV occlusion, the increase of the left liver volume was not significantly different between the two groups (35f38‘X after PVE vs. 38&26% after PVL, p =0.7). After PVE, 6 patients were not eligible for right hepatectomy because of insufficient hypertrophy of the left liver (n=2) or tumor progression (n=4). After PVL, 3 patients were not eligible for resection because oftumor progression (n = 2) or death (n = I ) . Prior to resection, CT-scan showed a portal cavernoma in 3 patients of each group. Technical difficulties during surgical procedure were similar in both groups according to duration of procedure (6 .4f l hours vs. 6 . 7 f l hours, p = 0.7) and transfusion rates (33% vs. 28%, p = 0.7) after PVE and PVL, respectively. Conclusion: Right PVL and PVE result in a comparable hypertrophy of the left liver. During the first laparotomy of a two-step liver resection, PVL can be efficiently and safely performed.

11671 LONG TERM EFFICACY OF ENDOSCOPIC TREATMENT OF BlLlARY COMPLICATIONS (BC) AFTER ORTHOTOPIC LIVER TRANSPLANTATION (OLT)

S. Meidoubi’, F. Chermak2, J.L.. Payen3, P. Bauret2, C. Bregeon’, N. Railhac’, F. Muscari4, B. Suc4, N. Kamar4, L, Rostaing4, L. Alric’, J.P. Vinell , G.P. Pageaux2, K. Barangel. ‘Hfipitul Purpan, Ti)zilouse; 2H(7pitul St Eloi, Montpellier: “Hfipital de Montuuhun, Montauhun:

Hfipital Rangueil, Toulouse, Frunce E-mail: mejdoubi.s@chu-toulouse.fr

Background: BC after OLT are the most frequent complications. They still a cause of morbidity with a high risk of graft failure. Most of trans- plantation centers use endoscopic retrograde cholangiography (ERCP) for diagnostic and treatment of those complications (Vallera, Liver Transplant Surg 1995). Aims: To evaluate long term efficacy and safety of the endoscopic therapy in the management of BC after OLT. Endoscopic efficacy criteria was non surgical treatment with bilio-digestive anastomosis. Patients and Methods: Two hundred four patients were retrospectively screened for the presence of biliary complications. All of them had a choledochocholedochostomy as end-to-end without T tube. Exclusion criteria was ischemic biliary complications. BC were first detected by MRI in most of cases. ERCP procedures were performed by experienced endoscopists. Maximal number of treatment sessions per patient was 2 to 3 (prothesis insertion and/or balloon dilatation). Follow-up after the last ERCP was one year (range 1-6). Results: ERCP showed biliary complication in 66 patients (43 male, median age 52 years). The liver disease was alcoholic cirrhosis (n=37), chronic hepatitis C (n= 23) and other (n=6) . 74% of BC occurred after the first month of OLT. ERCP was successfully performed in 61 patients (92%) and detected 53 anastomotic strictures. A total of I84 procedures was performed, (median per patient = 3). The median time interval between the procedures was 3 months.